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Home My WebLink AboutX2020-1373 - MiscX WO 1S73 EWPO iszc� P.�h CITY OF NEwpoxr BEACH � COMMUNITY DEVELOPMENT DEPARTMENT e 0 r z. BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768, Newp rt Beach, CA 92658-8915 4FO P www.newnortbeachca.cov 1 (94 ) 644-3200 wN... (HSC 19826) Dear Property Owner An application for a building permit has been submittggd in you are listing yourself as the builder of the property improvements specified at S2 ! (A�e We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you ay 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 caner, obtain the prior approval of the permitting authority. DIRECTIONS. Read and initial each statement below to signify you understand or verify this information. &. 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. 1, 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 mverage 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. 02. 1 understand building permits are not required to be si ned by property owners unless they are responsible for the construction and are not hiring a licensed Coritractorto assume this responsibility. "3. 1 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 he permit filed in his or her name instead of my own. I understand Contractors are required by law to be lice sed and bonded in California and to list their license numbers on permits and contracts. A5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least fie hundred dollars ($500), including labor materials, I may be considered an "employer" under state and federal law. fjV_6.1 understand if I am considered an "employer" under sta a and federal law, I must register with the state and federal government, withhold payroll taxes, provide w)rkers' 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 single-family residential structures cannot legally build them wit 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. 8. I 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. Fu=\ow cr builder verifdoc 08/12/16 1 of2 9. I understand I may obtain more information regarding mat Revenue Service, the United States Small Business P Benefit Payments, and the California Division of Industrial Acc California Contractors' State License Board (CSLB) at 1-800 more information about licensed contractors. A10. 1 am aware of and consent to an Owner -Builder bu understand that I am the pa legally and financially respo it t oing address: l _7 %, c� 4&2c Al, 11. 1 agree that, as the party legally and financially r I will abide by all applicable laws and requirement employers. -4212. 1 agree to notify the issuer of this form immediately any of the information I have provided on this form. Licensed contractors are regulated by laws designed to prote who does not have a license, the Contractors' State License E financial loss you may sustain as a result of a complair Contractors may be in civil court. It is also important for you to or employee of that individual or firm is injured while working c damages. If you obtain a permit as Owner -Builder and wish t for verifying whether or not those Contractors are properly compensation insurance coverage. my obligations as an "employer' from the iministration, the California Department of cents. I also understand I may contact the 321-CSLB (2752) or www.csib.ca.gov for permit applied for in my name, and proposed construction activity at the ponsible for this proposed construction that govem Owner -Builders as well as any additions, deletions, or changes to the public. If you contract with someone and may be unable to assist you with any Your only remedy against unlicensed iderstand that if an unlicensed Contractor your property, you may be held liable for hire Contractors, you will be responsible sensed and the status of their workers' Before a building permit can be issued, this form must bcompleted 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 drivers license r 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: 7- 1'_- 7 e 2� Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to pply for a construction permit for the Owner -Builder. Excluding the Notice to Property Owner, the execution Of which I understand is my personal responsibility, I hereby authorize the following person(s) to acl as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit f r my project. Scope q%ConstructWn Project (or gescrigtipn ofYNork): Project Location or Address: 15Z.6 Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am, the property ner for the address listed above and I personally filled out the above information and certify its acc racy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to th agency is required to be presented when the permit is issued to verify the propertoyvy ers signature. Property Owner's F, Note: A copy of the owner's driver's license or form nota permit is issued to verify the property owner'sesignature. Date: lio is required to be presented when the j Fomulow el —builder miidoc 08/12/16 2of2 . I`