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'LSE• fE EE m�mv�?Uz, O!5 a 7b t •�fff t O 0 U Ln � U m 0 3 0 ay M :os c c m O a o Q N U C N O> h o # a a c L C yN O a O N u L E= a 0« N a3 a > NE n m y O U �L N « � 3 � L mo 3 E_ C y Y 5= 3 oa « O nU o > O U w >�J mLDL n o N EO GN c n « m .M J m C E L O >� N N CO a C) � c N O ' €e a� W 3a O N O aO « p Z N a n c p o a > IJ Z O W u 0 O 0 n Z ui U N 0 0 0 U z E LD O a F £ w m CF o F V W a a'U Z mt a a « Z5 m O m C U a m a aw o o ,Z c m L` C o _o v U a m L f a m= m — 3 a ° N O n o >. N , w it a y N n L { 0 a J n a V L C Q m - > a t ° a m- c U .R E O FO N X2o2(�o�Vu� CITY OF NEWPORT BEACH W PAI0)Q Nv( COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915 www.newportbeachca.aov 1(949)644-3200 NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yo self as the uilder of the property improvements specified at rf ✓� 7, �p� We are providing you with an Owner -Builder Acknowledgment and Information Ve fication 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 rQIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 1. 1 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 grimy property. understand building permits are not required to be signed by property owners unless they are ons/ble for the construction and are not hiring a licensed Contractor to assume this responsibility. _ 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 ving 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 t" license numbers on permits and contracts. understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor d materials, I may be considered an "employer" under state and federal law. understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, bthese contribute to unemployment compensation for each "employee." I also understand my failure to abide laws may subject me to serious financial risk. 7. 1 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 ntractor. ° �C 8. 1s lunderstand as an Owner-Builder.if.1 sell®theopropsrty for ovh`icllrothis permit is issued, I may be held ie for any financial or personal injuries °sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 0c o00 0 • . noc 0 IIcr c mo c Fors\owner builder vecifdoc 08/12/16 ° 00 000 °° oo° 000 �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 lifornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for reinformation about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and u erstand that I am the party legally and financially responsible for proposed construction activity at the f II wing address: 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 eloyers. 1 . 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 i issued to verify the operty owner's signature. •�zc�` � � Q Print name of property owner: Y—Vl i Y�_ J Property Owner's Note: The following Authorization Form is required 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 -Builder AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the y pperhl owneies sonatupre.- . . . . . . . . . . Property Owner's Signature: •• •• Date: Note: 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 properly;owpeC s $gngtoi;e : • • :0. . . . • . . Forms\owner builder verif.doc 08/12/16 • • • • • • • • 2:og2: • • i CH's' OF NEWPORT BEACH CONRKUNM DE+ VELOPIl E' NT DEPARTMENT iY V�1L�YLi'iv �%=W y�1i.Y1Y 100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8915 www.newportbeachca.gov 1 (949) 644-3200 ACKNOWLEDGMENT OF NO CONSTRUCTION -RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS On June 11, 2019, the City Council adopted an ordinance restricting construction -related noise on Saturday in High Density Areas effective August 12, 2019. I acknowledge that any construction -related noise, (including, but not limited to operating power equipment or machinery in a manner that produces noise) is not allowed on Saturday or Sunday in High Density Areas in accordance with Newport Beach Municipal Code 10.28.040. As the owner of the property, I am responsible to ensure all persons working on the property comply with this provision of the Newport Beach Municipal Code. - Project Address: Owner's Name: Owner's Signati Ujo 0 Contractor's Signature: Date: -- - —4_� \_. ��_ GGO 4GG CCO Odie C Fl C C 9J GOC C a C c C cr, o c cG o G C G o a G c c c o c - C o c F0na5Wakn0WIed9Maal No 6atUrday__CansBua lon-JifghOene tyPreas c 0 0 o C Q G C mEi 90© P O OO, 6O Q(!O t 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.newpoftbeachca.gov 1 (949) 644-3200 SMOKE DETECTOR AND CARBON MONOXIDE SELF -CERTIFICATION (this certification is to be filled out by the permittee or homeowner) Project Address: t as�fl Permit Number: Property Owner: _ Licensed Contractor: Lic #: The State of California now requires that smoke and carbon monoxide detectors must be installed in all residential buildings California Residential Code (CRC) Section R314.1, CRC R315.2 states in part that existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors. CRC Section R314.3, CRC 8315.3 defines required locations. Both boxes be/ow must be checked. �❑ Carbon Monoxide Alarm: On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms or in each hallway outside of the rooms, and each level of the dwelling. Detectors are also required in bedrooms with gas fired appliances /G.1 LJ Smoke Alarms: Installed in each room used for sleeping purposes, outside each sleeping area, and on each level of the dwelling unit. Retrofitted detectors may be battery operated for buildings where no alterations are performed on the interior. Multiple -purpose alarms (carbon monoxide and smoke alarms) shall comply with all applicable standards and must be approved by the State Fire Marshall. The devices must be installed per manufacturer's specifications. I, the undersigned, hereby certify that I am the permittee or homeowner of the project. I further certify that smoke alarms and carbon monoxide alarms are present and tested to be functional ' all the following locations: Signature: Date: n NOTE: This self -certification i y used for projects to the exterior of the structure where a cess to the , interior of the dwelling by the ity of Newport Beach Building Inspector is not achieved during the course of construction.