HomeMy WebLinkAboutP2014-0324 - MiscCITY OF NEWPORT BEACH
COMII"ITX DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive 1 P.O. Box 17681 Newport Beach, CA 92658-8915
www.newpo tbeachca.uov 1(949) 644-3200
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NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application fora building permit has been submitted In your name fisting yourself as the builder of
the propertyimprovementpspecifiedat S'8 Tiwror cc-- ^7 S
We are providing you wfth an Owner -Builder Acknowledgment and hformatiori 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, slyned, 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 ACKNOWLEDGMENTANO VERIFICATION OF INFORMATION
DIRECTIONS: Read'and initial each statementbelowto slgt* you understand or verify this ipfonnallon
(!L_f . I understand a frequent practice of Lin licensed persons is to have the property Omer '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, maybe hell liable and subject to serious
financial risk for anyinjuries sustained by an unlicensed person and his ocher employees while working
on my property. My homeowner's insurance may not provide coverage for those injuries. I am Wilfully
acting as an Owner -Builder and am aware of the limits of my Insurance coverage for injuries to workers
on my property.
kJ-- 2. 1 understand btilding permits are not required to be signed by property owners unless they are
tesparrsible 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 patty 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.
jL4. I understand Contractors are required by law to be licensed and bonded in Carfornia and to list
their license numbers on permits and contracts.
LP-5. I understand if I employ br otherwise engage any persons, other than California licensed
Contractors, and the total value of my construction is at least Iva hundred dollars ($500), including labor
and materials, i maybe considered an,"emplooyer" understate and federal law.
t� 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 contdbute to unemployment compensation for each "employee." I also understand myfailureto abide
bythese laws may subject meto serious financial risk.
t� 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds
single-faimily residential structures cannot legally build them with the intent to offer them for sale, unless
of 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 Noensed general building
Contractor.
1: —&. 1 understand as an Owner -Builder if i sell the property for which this permit is issued, 1 may be
held Nab Is for anylinancial or personal injuries sustained by arrysubsequent owner(s) that resut from any
latent construction defects In the workmanship or materials. _
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0-9. 1 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 die
California. Contractors' State License Board (CSLB) at 1,400-321-CS1.8 (2752) or www.csb.ca.gov for
more infonnation about licensed contractors..
c� 10. 1 am aware of and consent to an Owner-Bullder building permit applied for In my name, and
understand that I am the party legally and financially responsible for proposed constriction activityat the
following address:
14t-11. 1 agree that, as the party legally and financially responsible for this proposed conshrction
activity. I will abide by all applicable laws and requirements that govern Owner -Builders as well as
employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to
any of the information 1 have provided on this form.
Licensed contractors are regulated by laws designed to protect the public. 9 you contract with someone
who does. not have a license, the Contractors' State License Board may be unable to assistyou with any
financial loss you may sustain as a resuk 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 maybe hell 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 propedy 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 drivers license or form notarization is required. to be
presented when the pennitts issued to verify the. property owner's signature.
Print name
Property On
!Vote: The folloving Authorization Form is required to be completed by the property ovuteronly
Man designating an. agent of the property owner to apply for construction permit thr the
Ovtper-Builder.
At1THORiZATON 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-BUIlderPermit for my project.
Scope of COMIJIVPrcJ(< r Desc% :
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Project Location or Address: �� 7r r ror �e� 12 GS
Name of Authorized Agent TeINo 714411dead '
Address. of Authorized Agent: ifq-w ekx-Aoir .160 YA7, L&:, er , C,, man
t declare under penalty of perjury that I and the property owner for the address listed above and
personally filled out the above information and certify its accuracy. Note: A copy.of the owner's driver's
license, form notarization, or other verify tlon acceptable to the agency -is required to be presented when
the permit is issued to verfiythe prrpe y wnars signature.
Property Owner's Signature: I t,11 I_ Date;
Note: A copy of the owner's drivers license or form notarization is required to be presented when the
permit is issued to verify the property owner's signature.
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