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12$ UMCt.
oirapproval of the
N FtINFORMAT„ION..
ti
erstand or verify this intormation.
lave the property owner obtain an
Petty owner Is providing his or her
held liable. and :subject to serious .
is or her employees while working
ge for those injuries. I am willfully
:e coverage for injuries to workers
v. brooenv owners unless thev are
I understand as l@n "Owner Builder° rl 18M the responsible party of record on the permit. L
understandth'at) may p tect myself from potential financial risk by hiring a licensed Contractor and
`- haw the perms filed to hs or her name'.msfeatl of my own.
s _4. I understand Contractors are required by !aw io be licensed and banded in Califomia and to list
z' -iheir license numbers,op-parmds and contracts -
5. 1 understand If I ¢mploy or orherwlse lsngage any persons, other than California licensed
Contractors, and the total value pf,my construdlon !s a feast i(ve hundred dollars ($500), including labor
end� /matarials,.a maybe considered an "employer' under stalls and r'ederal laws
fib. I understand if I arrtconsidered en �employern under state ar4d federal law„ I must register with the
state and federal govemment, withhold payroll taxes, provide workers compensation disability insurance,
..and contribute to.unerrip1' ' "i t rrompemsabon for esoh employee.°_ I also understand my failure to abide
by t�hesrig laws may subject me to sedousfinanclAl risk.
Wv7 I understand under California Contractors State Llcense:Law, an Owner -Builder who builds
single-family residential structures cannot legally build them With the intent to offer them fofsale unless
all work is performed by licensed subcontradtois, amil the numggt of structures does not exceed four
within any calendar year, or all of the work is performed under pontrsct wigs aalcensed general building
Contractor. ;
r B. I understand as an Owner -Builder if r sell it 8 VOParty for which this,pennit is issued, I may be
held lre
liable for any financial or peonaldnjA4 sdst ithad by any subsequent owners) that result from any
latent construction defects in the workmanship or materials
Forms% w r buildar_vodfdm 08/I&JO
r e
I declare under penalty of pe
personally filled out the above
license, form notarization, or of
the permit is issued to verify thl
Property Ownees Signature:
owner's dril
Note: A copy Of the permit its issued to ver the prs
Formsbwncr builde,Yenrd" eB/17116
}T:k
Ink obligations as an 'employer, from the
dmintstration; the Gallfomle Department of
deritst 1 also understand I may contact the
321GSLB (2�52)` or wwvt.oslbioa.gov for
�el��� applle(! fo7 In my name, and
?, p posed coriattircllon actlYlty at the
ts3$posetl bonshuctlon
1,"Sm,rylfdes as, Well as
9t s or chan es x,��,� �. g., to
6Qr gone
�hKeny
ce s8d
3,, petot
)efpt `
`roperty
7f fo be
w�
gate7�77� z0T.-O
y the property, owner only
mstfuctlon permit for the
NER'S BEHALF
iderstand is my :personal`
1) to apply for, sign,and file
g�.9�^aHthr� i
port t3�a�h 9z6�3
ddress listed above and I
Ocy Is required to be Presented when
squired to be presented when the
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(,,OFNEWPORT BEACH
f DEVELOPMENTDEPARTMENT
)'w t$`(IILDII(GDMSION
@are I p b Box'1768 ] Newport Beach, CA'92658.8915
ogPpaaohca.gov 1(949) 644-3200
a" -
ONSTRUCTION-RELATED NOISE
!,IN HIGH DENSITY AREAS
i ,adopted an ordinance restricting
"in -High Density Areas effective
e ated noise, (including, but not limited
.,
Bryan a mannerithat produces noise)
rC H%9h Density Areas in accordance
I O 28.040. As the owner of the
allxpersons working on the properly
rt Beach Municipal Code.
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