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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newoortbeachca.00v ] (949) 644-3200
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified at 2 O 1 !12— OiLC-t I Si C \ /L11:lAQDIL`i, (Jz&g::
We are providing you with an Owner -Builder Acknowledgment and InfaVrnation Verification 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
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
A'` 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
on my property.
I understand building permits are not required to be signed by property owners unless they are
�s-�poonnsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
l✓"3. I understand as an "Owner-Builder"I am the responsible party of record on the permit. I
understand that I may protect myself from potential financial risk by hiring a licensed Contractor and
having the permit filed in his or her name instead of my own.
4 4. I understand Contractors are required by law to be licensed and bonded in California and to list
their license numbers on permits and contracts.
I understand if I employ or otherwise engage any persons, other than California licensed
ontractors, and the total value of my construction is at least five hundred dollars ($500), including labor
and materials, I may be considered an "employer" under state and federal law.
6. 1 understand if I am considered an "employer' under state and federal law, I must register with the
tate and federal government, withhold payroll taxes, provide workers' compensation disability insurance,
and contribute to unemployment compensation for each "employee." I also understand my failure to abide
by these laws may subject me to serious financial risk.
W___�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.
4I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
e d 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.
Forms\owner builder verifdoc 08/12/16 1 Oft
qI9. 1 understand I may obtain more information regarding my obligations as an "employer" from the
rnal 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.
a4z". I am aware of and
understand that I am the pal
following address: QQ
11. I agree that, as t
tivity, I will abide by all
employers.
consent to an Owner -Builder building permit applied for in my name, and
y legally and financialy responsible for prposed construction activity at the
he party legally and financially responsible for this proposed construction
applicable laws and requirements that govern Owner -Builders as well as
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to
n 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 owner:
Property Owner's
Date:
Note: N following Authorization Form is required to be completed by the prope y owner only
when desiOnkting an agent of the property owner to apply for a constructio permit for the
Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Prop Owner, the execution of which understand is my personal
responsibility, I hereby authorize the (lowing person(s) to act as my ent(s) to apply for, sign, and file
the documents necessary to obtain an O r-Builder Permit for my ojact.
Scope of Construction Project (or Description Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
No
I declare under penalty of perjuryat I am the property owner for the address list bove and I
personally filled out the above injefmation and certify its accuracy. Note: A copy of the owner river's
license, form notarization, or o er verification acceptable to the agency is required to be presented when
the permit is issued to verifyMe property owner's signature.
Property Owner's
Date:
Note: A copy the owner's driver's license or form notarization is required to be presented when the
per i uad to verify the property owner's signature.
Forms\ovmer builder verlf.doe 08/12/16 2 of 2
° State of California L S
Secretary of State
® Statement of Information
°a.
FE79581
(Domestic Stock and Agricultural Cooperative Corporations)
FEES (Filing and Disclosure): $25.00.
FILED
If this is an amendment, see instructions.
IMPORTANT — READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
In the office of the Secretary of State
of the State of California
1. CORPORATE NAME
AKS EQUITIES, INC.
JUL-18 2016
2. CALIFORNIA CORPORATE NUMBER
C3509951
This Space for Filing Use Only
No Change Statement (Not applicable if agent address of record is a P.O. Box address. See instructions.)
3. If there have been any changes to the information contained in the last Statement of Information filed with the California Secretary
of State, or no statement of information has been previously filed, this form must be completed in its entirety.
❑ If there has been no change in any of the information contained in the last Statement of Information filed with the California Secretary
of State, check the box and proceed to Item 17.
Complete Addresses for the Following (Do not abbreviate the name of the city. Items 4 and 5 cannot be P.O. Boxes.)
4. STREET ADDRESS OF PRINCIPAL EXECUTIVE OFFICE CITY STATE ZIP CODE
9716 WEXFORD CIR, GRANITE BAY, CA 95746
5. STREET ADDRESS OF PRINCIPAL BUSINESS OFFICE IN CALIFORNIA, IF ANY CITY STATE ZIP CODE
9716 WEXFORD CIR, GRANITE BAY, CA 95746
6. MAILING ADDRESS OF CORPORATION, IF DIFFERENT THAN ITEM 4 CITY STATE ZIP CODE
Names and Complete Addresses of the Following Officers (The corporation must list these three officers. A comparable title for the specific
officer may be added; however, the preprinted titles on this form must not be altered.)
7. CHIEF EXECUTIVE OFFICER/ ADDRESS CITY STATE ZIP CODE
GURPREET SINGH KHERA 9716 WEXFORD CIR, GRANITE BAY, CA 95746
8. SECRETARY ADDRESS CITY STATE ZIP CODE
HARINDER KAUR KHERA 9716 WEXFORD CIR, GRANITE BAY, CA 95746
9. CHIEF FINANCIAL OFFICER/ ADDRESS CITY STATE ZIP CODE
GURPREET SINGH KHERA 9716 WEXFORD CIR, GRANITE BAY, CA 95746
Names and Complete Addresses of All Directors, Including Directors Who are Also Officers (The corporation must have at least one
director. Attach additional pages, if necessary.)
10. NAME ADDRESS CITY STATE ZIP CODE
GURPREET SINGH KHERA 9716 WEXFORD CIR, GRANITE BAY, CA 95746
11. NAME ADDRESS CITY STATE ZIPCODE
12. NAME ADDRESS CITY STATE ZIP CODE
13. NUMBER OF VACANCIES ON THE BOARD OF DIRECTORS, IF ANY: 0
Agent for Service of Process If the agent is an individual, the agent must reside in California and Item 15 must be completed with a California street
address, a P.O. Box address is not acceptable. If the agent is another corporation, the agent must have on file with the California Secretary of State a
certificate pursuant to California Corporations Code section 1505 and Item 15 must be left blank.
14. NAME OF AGENT FOR SERVICE OF PROCESS
GURPREET SINGH KHERA
15. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL CITY STATE ZIP CODE
9716 WEXFORD CIR, GRANITE BAY, CA 95746
Type of Business
16. DESCRIBE THE TYPE OF BUSINESS OF THE CORPORATION
REAL ESTATE
17, BY SUBMITTING THIS STATEMENT OF INFORMATION TO THE CALIFORNIA SECRETARY OF STATE, THE CORPORATION CERTIFIES THE INFORMATION
CONTAINED HEREIN, INCLUDING ANYATTACHMENTS, IS TRUEAND CORRECT.
07/18/2016 GURPREET SINGH KHERA CEO
DATE TYPE/PRINT NAME OF PERSON COMPLETINGFORM TITLE SIGNATURE
8I-200 (REV 01/2013) Page 1 of 1 APPROVED BY SECRETARY OF STATE
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