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Secretary of State LLC-12NC
Statement of No Change
(Limited Liability Company)
IMPORTANT — Read instructions before completing this form. This form may
be used only If a complete Statement of Information has been filed previously
and there has been no change.
Filing Fee — $20.00
Copy Fee — $1.00;
Certification Fee - $5.00 plus copy fee
20-D35627 r
FILED
In the office of the Secretary of State
of the State of California
AUG 23, 2020
This Space For Office Use Only
1. Limited Liability Company Name (Enter the exact name of the LLC as it is recorded with the California Secretary of State. Note:
If you registered in California using an alternate name, see instructions.)
CHOP CHOP, LLC
oT.2-DigitmSecretary of State File Number
cc
201629110318
o
3. State, Foreign Country or Place of Organization (only if formed
outside of California)
CALIFORNIA
4s ° No CI1aiggo Statement (Do not alter the No Change Statement. If there has been any change, please complete a Statement of
° `informatforfFrorm LLC-12).)
Thorc` `has been no change in any of the information contained in the
° prig-vidus complete Statement of Information filed with the California
Secretary of State.
5. The information contained herein is true and correct.
08/23/2020 Kirk Huffman
One Manager
Type or Print Name of Person Completing the Form The
Return Address (Optional) (For communication from the Secretary of State related to this document, or if purchasing a copy of the
filed document, enter the name of a person or company and the mailing address. This information will become public when filed.
(SEE INSTRUCTIONS BEFORE COMPLETING.)
Name: F
Company:
Address:
City/State/Zip:
LLC-12NC (REV 01/2017) 2017 California Secretary of State
www.sos.ca.govibusinesslbe
"X,6 0k)
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.newportbeachca.gov 1 (949) 644-3200
OWNER -BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION
(HSC 19825)
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your narj�e�licsting yourself as the builder of
the property improvements specified at 43P .a ,ni y /
We are providing you with an Owner -Builder Acknowledgment and Information 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
m
d CtIONS: Read and initial each statement below to signify you understand or verify this information.
° b -Cl 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
° ovin labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious
f q no vial risk for any injuries sustained by an unlicensed person and his or her employees while working
" og `rpy property. My homeowner's insurance may not provide coverage for those injuries. I am willfully
agligg es an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
C on �y property.
<<°° !
1 t' 26 1 understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�3.. I understand as an "Owner -Builder' I am the responsible party of record on the permit. I
un erstand that I may protect myself from potential financial risk by hiring a licensed Contractor and
haying the permit filed in his or her name instead of my own.
U4. I understand Contractors are required by law to be licensed and bonded in California and to list
t eir license numbers on permits and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed
o tractors, and the total value of my construction is at least five hundred dollars ($500), including labor
qnA materials, I may be considered an "employer" under state and federal law.
�UL6. I 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,
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.
7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds
si gle-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
C tractor.
8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
he 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 buitdff vedf doc 08/12/16 1 of 2
tLg- 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.csib.ca.gov for
Tinformation about licensed contractors.
10. 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 finan sally responsible for proposed construction activity at the
Mf��t1JJqq mg address: 4SB' �r_4 _�tJ r
. 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
e Ioyers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to
an 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:he
presented when the permit is issued to van the property owner's signature.
Print name of property owner=PNA/J
1—
Property Owner's
...
Date:
�'L p_Lt�
°
a
e: The following AuthoYlzati n Form is required to be completed by the property owner only
whe esignating an agent of he property owner to apply for a construction permit , the °
Owner- er. •• /" •••°°°
....
AUTH ZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEH F
Excluding the Notice to operty Owner, the execution of which I understand is my personal
responsibility, I hereby authori he following person(s) to act as my agent(s).td'apply for, sign, and file
the documents necessary to obtain Owner -Builder Permit for my project!
Scope of Construction Project (or Desc 'on of Work): -`
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjK that I am the property owner for a address listed above and I
personally filled out the abovfiolrnformation and certify its accuracy. Note: opy of the owner's driver's
license, form notarization, other verification acceptable to the agency is req d to be presented when
the permit is issued to v ty the property owner's signature.
Property
Date:
Note: A of the owner's driver's license or form notarization is required to be presented when the
perms issued to verify the property owners signature.
Forms\owner builder verif.doc 08/12/16 2 of 2