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Box 1708 9 Nevricort Beach, CA 82058-8g15 wuwvnewcortcescihca.uov 1(948) 044-3200 NOTICE TO PROPERTY OWNER Dear Property Owner: An application fora building permit has been submitted in your name fistng yourseifas the builder of the property improvements specified at 5 ; � 1<g�y4 ;0A'. lgl,,inea-f 'Z. C We ars providing you. with an Owner -Builder AcknoWledgment, and'Imormafffori Verification Form to make you aware of your responsihl0t®s and possible risk you may incur by having this permit Issued In your name as the OwnerBuilder. We wit not, issue a building permit until you have read, Initiated your understanding of each provision, signed, and returned this forin to us at our official address indicated. An agent of the owner cannot execute'thie notice unless you, the propertyowner, obtain the pdor.approval"of fie permitting authority. `OWNERI-0 ACKNO iVj 9011IiENTAND VERIFICATION OF INFORMATION DISECTIONS. Read'and lnittafeach siatemenf belowto signify yod undersfohd or verily ffiis inionrerrorr. c 1, I understand a frequent practice of unlicensed persons Is to have the property owner• obtain an "Owner-Bulder" building permit that erroneously Implies that the property owner is providing his or her. even labor and material personally, I, as an Owner -Bulkier, maybe held gable 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 homaawner's Insurance may not provide coverage for those injuries. I am Wilfully acting as an Owner Builder and am awareof the limits of my insurance coverage for ir7juuies to workers an rnyproperty, 2, I understand building perhnifs are not required fo he signed by property owners unless thay'are r3spapslble for the construotlon and are not hiring a licensed Contractor to assume this rasponsibllity. - I understand as an "Ow or-Sulldee' I am the responsible party of record on lire permit I understand that i may protect myself fi•orn potential financial risk by hiring a licensed Contractor and h�tQng the permit fifed in hispr her name instead of my own, =( 4. I understand Contactors are required by law to be licensed and bonded in Callfornia and to list theiirnr license numbers on permits and contracts. Lam* 5. I understand if I employ br otherwise engage any •persons, other than Gallft. nla goense.d Contractors, and file total value of ury construction Is at least five hundred dollars ($500), including labor and materials, I maybe considered an,"empl'oyer' understate and federal law. c3 0• I understand if I am oonsidered an "employer" understate and federal few, I must register wigr the state and federal government, withhold payroll taxes, provide workers' compensation disabilitylnsbrance, and contribute to unemployment compensation far each "employee." i also understand myfaliur•eto abide bythess laws may subject me to sedous•financlal risk. j_7. I understand'under'Cat(omia Contractors' State License Law, an Owner-Bultder who builds single-family residential structures cannot loyally build them with the Intent to offer them for sale, unless aN work is performed by licensed cubconh•aofors and the number of, structures does not exceed four within any calendar year, or all of the werk is performed under contract with a licensed general building Contractor. i understand as an Owner Builder if t sell the property for which this permit Is issued, I may be held gable for anyfinancial or personal injuries sustained by any subsequent owners) that resultfrom any Intent oindsh•uotiori defects In Ilia workmanship or materials. _ Feuasrotvner t,dtder cmrifaee a9/2srr3 - 102 E D. I understand I may obtain more information regarding my obligations as an "employer" from ilia Internal Revenue Service, the United States SIma11 Business Admintstratfon, the California Department of Benefit Payments, and the California Dtvtsion of Industrial Accidents. I also understand I may contact the California. Contrabbis' State License Board (CSLB) at 1.-SCUA321-CSLB (2762) or www.cslb.oa.gov for more information about licensed contractors.. _ Q 1 O. I amaware of and cansent to an Owner-Stillder building permit applied for In my name, and understand that I em the party legally and financially res 3onsibie for proposed co struction activity at the follr�owing address: � 1 (,Q '11. 1 agree that, as the party legally anti financially responsible for• this proposed construction activity, I Wil abide by all applicable laws and requirements that govern Owner -Builders as well' as employers. 12. 1 agree to notify the fssuer of this foam Immecriately 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. Nyou Contract with someone who does. not have a license, the Contractors' State Llcehse Board may be unable to assfsf you with any financial lose you may sustain as a result of a complaint. Your -only remedy against unlicensed Contractors maybe In civil court. I Is also Important fol• you to understand that if an unlicensed Contractor or employee of that incMdual or firm is Injured while working an your property, you maybe held liable for damages. If you obtain. a penxlit as owner-Bjrflder• 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.limperty oviner and returned to the CltyofNewport Beach, Building division, forissuing toe permit. Note. A copy of the property owner's driver's license or form notarizadon Is requlred•to be presented when the parmitis issued to ved ythe properiy owners signature. Print name of Property Owner's Signature• C,,14 1 d/ t Note: The folloWng AuthorizaffonForm Is regulred to he completed by the property ovurero* Men designating an. agent of the property otnner to apply fora construction permit for fire OvRter-Bulldar. AUTHOPIZA-RdN OF At3EN1`TO ACTON PROPERTY OWNER'S BEHALF E;dlLtdfng the Notice to Property Owner, the execution of which 1 understand is my personal responsibility, I hereby authorize the follow ng person(s) to act as my agent(s) to applyfor, sign, and file the documents nacessaryto obtain an Owner= Builder. Permit for myproject. Scope of Construction Project (or Desorlpffbn of Work): Project Location or Address: . Zs all l Qa G r✓Jr��y /;a Name ofAuthorizedAgent: Address.of Authorized I declare under penalty of perjur, personally filled out Ilia above info license, fermnoterfzetlon, or other the permUs issued to vedfythe pn PropertyOwner's Signature. No '%/// 221--4n942-- rty owner, for the address fisted'above, and accuracy. Note: A copy. of the owner's driver's to the agencyis mquned to he presented Wien Data. Note: A copy of the owner's driver's license orform notadzatfon is required to be presented when the permit is issued to verify the property owners signature. Fomelowmc 6uMer verZdw 94123/13 2 oft :3