HomeMy WebLinkAboutX2022-1749 - Misc�EWP°RT CITY OF NEWPORT BEACH
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r COMMUNITY DEVELOPMENT DEPARTMENT
� BUILDING DIVISION
U fie.. ✓ ? 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportboachca.gov 1 (949) 644-3200
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SOLAR CONTRACTOR DECLARATION
Keep with Inspection card.
This form is for the Inspector to take at time of final inspection
PART 1: To be completed BEFORE PERMIT ISSUANCE
JOBSI E ADDRESS:
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CONTRACTOR NAME:
CONTRACTOR STATE LICENSE #:
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ANEL MAKE #:
PANEL MODEL #:
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I PART 2: To be completed PRIOR TO INSPECTION REQUEST I
and placed with jobsite inspection card
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I, i.. aL declare that the PV module make and model
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number, quantity, and location are installed as per the approved plans. Module
manufacturer, make, model and number, fire classifications of modules, and
brackets 41ZB h the apprAved plans for the project located at the above
referenced add ' iin#e City of Newport Beach.
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CITY OF NEWPORT BEACH XZ`bLZ— P qq
COMMUNITY DEVELOPMENT DEPARTMENT k10 ("Sbt AV&
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.00v 1 (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 [ IZ4S7rYt_ 14r/6-
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 is- 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.
�'L 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.
YID -2. 1 understand -building -permits -are.not required to be signed by property owners unless they are
[esponsibleJorthe construction -and are not hiring a licensed Contractor to assume this responsibility.
-A3. i understand -as -an _"Owner -Builder" I am the responsible party of record on the permit.
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. 1 understand Contractors are required by law to be licensed and bonded in California and to list
their license numbers on permits and contracts.
7 5. 1 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
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.
_- ,Fe- 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
Contractor.
J�L8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
held 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.
Foms\owner builder vedfdoc 08/12/16 1 of2