HomeMy WebLinkAboutP2023-0228 - MiscCITY 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 name listingyourself as the builde of
the property improvements specified at 00�7nrji�(7cf \_i+l Ih EaL%� 5�N+
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
DI ECTIONS: 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
ner-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 y property.
2. 1 understand building permits are not required to be signed by property owners unless they are
re risible for the construction and are not hiring a licensed Contractor to assume this responsibility.
. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I
risible
that I may protect myself from potential financial risk by hiring a licensed Contractor and
hg 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
r license numbers on permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed
ractors, 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.
A6. 1 understand if I am considered an "employer' under state and federal law, I must register with the
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 ese laws may subject me to serious financial risk.
,\A7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds
e-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
Co tractor.
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
I
for any financial or personal injuries sustained by any subsequent owner(s) that result from any
late construction defects in the workmanship or materials.
Forms\owner builder verifdoe 08/12/16 1 of
Zdo Z 91/Zl/So aop'}!ian iappq is—o\—oa
-ainjeu6ls s jauMo Aliadad ay; AjuaA of panssl si jlwjad
ayj ue4M pa;uesaid aq of pannbei s1 uogezuejou woo} Jo 9su8011 s,Janup s jauMo ay; jo Adoo V :ajoN
:Ole(]
:ajnjeu6lS s jauMo Rjjadad
-ain}euBts s jeumo Apedad ay} AjuaA of panssl si f jiwaad ayj
uegm pajuasaud aq of pa gnbaa s; AouaBe ay; of ajgejdeooe uogeoguaA isgjo jo 'uggezuejou waoj 'asuaoif
s,jeApp s,iaumo ay; jo Moo y :ejoN 'Aminme sp fq!ljoo PUB uoljeuuojul anoge eqj jno pall9 Llleuosiad
I pue anoge pa;sll ssaippe ay; jo; jauMo Alisdad ay; we 1 ;eyj Ainfied jo Alleued japun aieloap I
ON
:;uebV pazuoyjnV jo ssaippV
:ju96V pazuoyjnV;o aweN
:ssaJppV Jo u06e30-1 1001oud
:(XioM jo uopdposaa ao) joofad uol;onujsuoo jo sdooS
-pafad Aw Jo; jlwUad jappq-jaumo ue ule;qo of Ajess000u sjuawnoop ay;
op pue 'u61s 'joj Aidde of (s)jua6e Aui se joe of (s)uosied 6ujiA011o; ay; azuoy;ne Agejay 1 'Aj!I!q!suodsaj
leumed Aw si puejsiapun 1 yo14M jo uo6noaxe aqj 7aumo Aliedad o; 9011oN aqj bulpnlox3
JIVH39 SAGNMO A1N3dOZld NO 13V 011N39V j0 NOIIVZRIOH1f1V
-jappg-jaumo
aqj joj pwied ugi;onajsuoo a joj Aidde of jeumo Apadoud aqj jo jue5e ue BuijeuB.Isep uagm
Aluo jeumo Apedold aqj dq pajajdwoo aq of pannbei si wioj uoijezuogjny Bu1mopoj aqj :ajoN
1)
s jaumo Al} odad
:aaumo Apedad;o oweu juud
ainjeuBis s,jeumo Apodoid ayj AjpaA of ponssi si jgwied ayj uoym pajuasaud
aq o; paambei si uopezpejou uuoj jo asueajj saanup s,uaumo dpedoid ayj jo Adoo V :ojoN
•jluuod ay; 6uinssl uoj'u01slAl4 6uippng 'goeog jiodmaN;o AID ay; of pouinjau pue jeumo
Alisdad ay; Aq pouBIs pue pajoidwo0 eq jsnw wjo; siy;'panssl aq ueo jluliad 6ulpllnq a ejo;ag
'06MA00 oomnsw uoijesuadwoo
sjo�joM jieq; ;o snjejs ay; pue pasueop /pedoud cue sio;oel;uoo esoq; ;ou jo JayjayM 6u1AjpgA ao;
olglsuodsei eq 111m noA 'sio;oei;uoo any of ysim pue jaPpg-jaumo se jlwied a ulejgo nog( ji sGbewep
jo; algell play aq Am nog( 'fqjadad jnoR uo bw1 joM apyM painful si wig jo lenP!AlPul;eyj jo aaAoldwo jo
Joj0ej;uo0 pasuaogun ue;l jeyj pue;siepun of nog( jo; juepodw1 osle si 11 'jinoo pA10 ul aq Aew sio;oeu;uoo
pasuaollun ;suie6e Apowei Aluo inoA 'juleldwoo a ;o jlnsai a se ulejsns Xew, noA ssol lapueug
Aue yjIm noA jsisse o; olgeun aq Aew pjeoe asueolq a;e;S siolompoo ay; 'asua0p a aney jou saop oqM
auoawos 1411M joei;uoo nog( 11 -ollgnd ay;;oajad of pau6lsap smel Aq pa;eln6au aue siopei;uoo pasuaoli
•w10; s141 uo Papinad aney I uol;ewJoJu1 ayj e
o; se6uego jo 'suogalop 'suoijlppe Aue;o Alajelpawwl wjo; slyj;o panssl aqj R}l;ou of a9i6e I Z.
-siaA ldwo
se paM se siaPpg-jauMo w9no6 1e41 s;uawannbei pue smel algeoildde lie Aq appe 111M I 'L • _; e
uol;onu;suoo pasodad siy; jo; alglsuodsai Allepueug pue /lle6al Aped ay; se 'jeq; asibe i 'I Ir
�7b y Ni7C (��z0 :ssajppe 6"0110
1
ay;;e (jlny0e uogoru;suoo pasodad jo; alglsuodsa� (p pueulj pue (pe a1 Aped ay; we 11e43 puejs
pue 'eweu Aw ui jo; palldde;lwjad bulppnq jappng-jauMo ue of juasuoo pue;o ajeme we I "0l,
•siojoei;uoo pasueoll;noge uol;emo;ul 2o'w
Jo; Ao6 eo-glso•MMM jo (Z4LZ) SISo-4ZE-008-L Is (glSo) PJeog 8sua011 a;ejS s1oj08Auo0 elwopleo
ay; joe;uoo Aew 1 puejsiapun osle I -sjuappoV leli;snpul;o uolslAl4 epopleo aqj pue 's;uawled jgauag
jo juawliedap elwo;peo ay; 'uo6ejjsluiwpV sseulsne pews sa;ejs pajlun ay; 'aowaS anuanay IBR54yi
ay; wa; ,roAojdwa„ us se suolje6pgo Aw 6uipue6ei uopew1ojul ajow ulejgo Aew 1 pue;sjapun 1