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E - c R. q w LU Z A O ti 0 LL O b CL Q z Cc O WReq0 Wmw Lu y4'LU CC ❑J❑❑q0 4❑.q❑ ❑C: H of ^� M as ry 1 L1 :Z!q © C l C p T ? ICE w s U z U q 4 a 4 u u 6 Ili b U018-=5 386 Lf)cl Ate CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive j P.O. Box 1768 ( Newport Beach, CA 92658.8915 www newoortbeachca oov t (949) 644-3200 Your name as the 01 we *ilk not Isstr, pnfvisfon, signed; owner cannot exec' permitting authority. NOTICE TO EROPS&a QNER mit has been submitted In your name listing yourself as the builder of P.A'gf ier-Builder. a bufidhtg permit untif you hava read, tnittaied your understanding of serh rid rattt reed this dorm110 us at our ofHolel addrass' indicafad. An agent of the e this notice unless.you, the property owner, obtain the prior approval of the dWN98'S AC_KNOWL900-MENT AND vE,BIEl AMIN QF rNEO&J !BON DiREC7IONS: Read and initial each statement below to signify youutiderstand or verify this Information, - a.T,1. 1 understand a frequent practice of unlicensed parsons is to have the property owner obtain an *Owsu�rr Sunder Wilding permit that eesaneausty impi"tas;that the property owner is providing his or bar own labor and material personalty. 1, as an Owner -Builder, maybe held liable and subject to serious :e may not I of the limits M I understand building permits are not required to be signed by property owners unless they are rible for the construction and are not hiring a licenced Contractor to assume this responsibility. F understarnd' as an "fivdner-Guiltier^ t am the responsible, party of record on the permit. f and that I may protect myself from potential financial risk by hiring a licensed Contractor and Etre 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 arse numbers on permits and contracts. I understand if t employ or otherwise engage any persons, other than California licensed tors, and the total value of my construction is at least five hundred dollars ($500), including labor I understand if I am considered an "employer" under state and federal taw, I must register with the Ind federal government, withhold payroll taxes, provide workers' compensation disability insurance, nttibuta to unemployment compensation for each "employee.' I also understand my failure to abide e laws may subject me to serious financial risk, I understand under California Contractors' State License Law, an Owner -Builder who builds amity residential structures cannot legally build them with the intent to offer them for sale, unless k is performed by licensed subcontractors and the number of structures does not exceed four my calendar year, or all of the wodz is, performed, under contract with a;licensed general building, aor, I understand as an Owner: Bt lid r iT (sail i" pl perty foirLw{ii6i this permit is issued, I may he Me for any financial or personal jnjurf�i{ sustpjila&ty' any 1aybsegden1 owners) that result from any Fbm&o%iw_bulder vcairdoc 08/1116 c r v 00 00o v v vv ecV cca ut licensed contractors. of and consent to an Owner-SUIlder building permit applied for In my name, and the party legally and financially responsible, for proposed construction activity at the I address; I agree that, as the party legally and financially responsible for this proposed construction I will abide by all applicable laws and requirements that govern towner-Suliders as well as Tit. I agree to polity the Jaguar of this form immediately of any additions, deletions, or changes to to Informatidn I have orovided on this form- fMQxtfemme df'iraperly, owrw. ,yv z aN , . Property Ownses Signature: Datw Note, The following Authorization Form is regttlrad to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Oullder. pp p�?yyp M .A ! PR k f Excludino ilio Notice to Property Owner, the execution of which 1 understand1s my personal resoonslbtlity. I harebv authorize the following person(s) to act as my agent4ej to apply for, sign, and file la Property Ownses Signature: Note: A copy or the ownses driver's ocans permit is issued to verify the property yawn c normv+P"cr 5wrder vat'fdm a&1 35 oU )party owner for the address listed above and I Its accuracy, Nota: A copy of the owner's driver's ile to the age cy is required to be presented when iVgate: ` I arfzation is required to be presented when the Project Location orAddross: Name of Authorized Agent; S'?'75r- V ' 494=510 510 Tat No 2- la Property Ownses Signature: Note: A copy or the ownses driver's ocans permit is issued to verify the property yawn c normv+P"cr 5wrder vat'fdm a&1 35 oU )party owner for the address listed above and I Its accuracy, Nota: A copy of the owner's driver's ile to the age cy is required to be presented when iVgate: ` I arfzation is required to be presented when the