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HomeMy WebLinkAboutX2019-0794 - Misck2ot-�,- 0-75-1 ago, wa �e rohar CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915 www.newportbeachca.gov 1 (949) 644-3200 NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit ha,,4S.�een submitted in your name lis ourself _ascthe�uilder of. the property improvements specified at'4 Ls/ diTyc/4 7- We are providing you with an Owner -Builder Ackno t and Inform t� Verlficati6n Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION IQ RECTIONS: Read and initial each statement below to signify you understand or verify this information. /_I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers Pon property. 2. 1 understand building permits are not required to be signed by property owners unless they are V sible for the construction and are not hiring a licensed Contractor to assume this responsibility. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit.tand that I may protect myself from potential financial risk by hiring a licensed Contractor and h&a'ay the permit filed in his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. t �' I understand if I employ or otherwise engage any persons, other than California licensed Contra( tors, and the total value of my construction is at least five hundred dollars ($500), including labor nnd materials, I may be considered an "employer' under state and federal law. NL-6 - understand if I am considered an "employer' under state and federal law, I must register with the stat.= and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and cortribute to unemployment compensation for each "employee." I also understand my failure to abide �by tnesA laws may subject me to serious financial risk. 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be eld liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Fa mslow er builder venfdoc 08/12/16 1 of 2 / 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. / O. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially respon ible for pro onnstr_uctio activity at the following address: ) G� Ali y r /L p�OK J14— r_ // / �L ��z (ttr� I —I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the City of Newport Beach, Building Division, for issuing the permit. Note: A copy of the property owner's driver's license or form notarization is required to be presented when the permit is issued to verify the property owner's signature. Print name of property ownernk�li//,Z;i eLa� Property Owner's Signature: V %1�/ �7 ) Date: Note: The following Authorizatiori Form is requirerd to be completed by the property owner only en designating an agent of the property owner to apply for a construction permit for Ow -Builder. A ORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S LF Excluding the Noll o Property Owner, the execution of which I erstand is my p rg^nal responsibility, I hereby a rize the following person(s) to act as my t(s) to apply for, sign, and file the documents necessary to in an Owner -Builder Permit for m oject. Scope of Construction Project (o scription of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty erjury that I am the property owner for the ess listed above a',d I personally filled out th Rove and certify its accuracy. Note: A cop a owner's driver's license, form notari ion, or other verification acceptable to the agency is required to sented when the permit is is to verify the property owner's signature. Signature: Date: a/tfs: A copy of the owner's driver's license or form notarization is required to be presented when the permit is issued to verify the property owner's signature. Forrns\owner builder verifdoe 08/12/16 2 of