HomeMy WebLinkAboutOwner Builder Affidavit i
Planning&Development Services Department
• Building&Code Regulations
• 2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553
OWNERIBUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S.489.103(7)EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you,as the owner of your property,to act as your own contractor even
though you do not have a license. You must provide direct, on-site supervision of the construction yourself. You
may build or improve farm outbuildings, a one-family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own
use or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved for sale or lease, which is a violation of this exemption. You
may not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is
your responsibility to make sure that people employed by you have licenses required by state law and by county or
municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed
contractor who is not licensed to perform the work being done. Your construction must comply with all applicable
laws,ordinances,building codes,and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice on how to meet�,�
the minimum code. Initial/' '
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes. �� ;g.�
Initial
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license,I maybe responsible and liab or the
cost of the license. Initial
ec—
I understand that if any person that is unlicensed and uninsured gets injured on my construction project-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relate medipl
cost,which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection,an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owneribuilder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
Z-7 day of :R.4n�e of 20Z_,K.
Owner/Builder Signature
STATE OF FLORIDA
COUNTY OF 54-- L
The foreg,o{ng instrument was acknowledged before me this"day of ��t ,20�,
by oc< � I�t��C who is personally known to me,or who has
produced d as identification.
r� z,-*- �
Signature of Notary Type or Print Name of Notary (Seal)
Title:Notary Public Commission Number
SLCPDSD Revised 05/15/2014
1111111,
4F State of F o dab oRFORD
Commita,y Public
ssion M GG 783217
's, My Commission
Fsbru r s 022res
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ST.LUCIE COUNTY UTILITIES-P.O.BOX 228,
FT.PIERCE FL 34982
3t. Lucie County - PCIS e S C`
NAME ' �� � J
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)6-27-2018 10:24:31 ACCT.# f 1��q'L�- I!�^,
17842/4754 EP SERVICE ADDRESS -1 bO
)ESMORE, BRUCE
3900 PAPAYA DR
:ORT PIERCE EE
134982 SUBDIVISION LOT BLOCK t
EE
amount Tendered: 520.00 ALL BILLING ADDRESS
amount Paid: 519,00 Q
)hanse Due: 1 .00 PHONE# -1�j S q b If? I O MOVE IN/CLOSING DATE
Thank You This application hereby request and authorizes the Utility to render water and/or sewage disposal
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations,which by reference are made apart of this contract.Applicant agrees to pay
Jser ID: RODRIGUEZM the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
SOCIAED IDL SEC/ O ^ r nt
F
SPOUSE SOCIAL SEC.
O ICE USE ONLY
DATE RECEIVED 1 CASH CHK# RECEIVED BY
WATER COMM ST.LUCIE COUNTY UTILITIES-P.O.BOX
SEWER RES 28 FT.PIERCE FL 34982
D � Q G�
METER SZ. M� NAME -e S m
IRR ACCT.#
$ SECURITY DEP SERVICE ADDRESS CA,
SERVICE FEE
SAME DAY FEE
SUBDMSION �- LOT Z-
1 OVERTIME FEE BLOCK
�� �✓ METER INSTALL. BILLING ADDRESS
CFC/WATER
FPUA CFC PHONE#
CFC/SEWER MOVE IN/CLOSING DATE
GUAR.REV. This application hereby request and authorizes the Utility to render water and/or sewage disposal
LATERAL
services to the premises described above in accordance with the Utilities present or future rates,
rules and regulations,which by reference are made a part of this contract.Applica4t agrees to pay
TOTAL the Utility promptly for such services in accordance with the established rules and regulations.
CUSTOMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
CUSTOMER r
SIGNATURE a eco-,-, % SOCIAL SEC/ I e
FED ID
NAME OF SPOUSE
SPOUSE SOCIAL SEC.
O
DATE RECEIVED CASH O CE USE NLY
CHK#_ RFrPfvpn n C