HomeMy WebLinkAboutSubcontractor agreement l i
Planning&Development 110vices Department
COLUJI TY Building&Code Regulations
• R I D A 2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553
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OWNERBUILDER 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.
You may not hire an unlicensed person to act as your contractor or to supervise people working on your building; iti
is your responsibility to make sure that people employed by you have licenses required by state law and y county
or municipal licensing ordinances. Initial
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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 vi lation of
this exemption. Initial
You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed t
perform the work being done. Your construction must comply with all applicable laws, ordinances,build' odes,
and zoning regulations.; Initial
I understand that the building official and inspectors are not there to design or give advice on how#o�mee�t
the minimum code. Initial `/I
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.
Initial
I understand that if I compensate any person or company for work performed they are req u' t be
licensed in this jurisdiction. If for some reason they do not possess a license,I may be responsible and li e or the
cost of the license. Initial
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 related ed'cal
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 owner/builder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional 7Regulat' igned and acknowledged on this
day of of 20 16)
C),
Owner/Builder Signature
STATE OF Fl, A _
COUNTY OF ICS
ThQ_fogoing in e t as acknowledged before me this day of 20Z&,
by who is personally known to me,or who has
produce as identifica nn
ZPaY'�s, KAREN S. NIELSEN
State of Florida-Notary Public
Signature of Notary Type or Print Name of Notarya co ion # GG1207484
Title:No Public Commission Number ,;;oFF�o �' M�`���`ir((mis ,2 Expires
June 12, 202Y
SLCPDSD Revised 02/7/20
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x a�
PERMIT#. ISSUE'DATE
,a O � O
'PLANNING& DEVELOPMEI'+TT SERVICES >'!
J - �- Building& Code Compliance Division
r-� r BUILDING PERMIT
SUB-CONTRA C`TOIt AGREEMENT
Jensen Beach Plumbing, Ind.,!,
�
have agreed to be
p. (Company Name/Indivit3llal'Name)
the Plumbing Subcontractor for Tlna Atha
(Type of Trade) (Primary Contractor)`
For the,:pro�ect located,at;Sand Dollar Villas 420.00EAN DR#';812Jensen"Beach;F0495;7,
(Project Street Addressor Property'Taic ID#)
It is understood that,.'if there is any change of status regarding our pafticipatton with the above mentioned
pro�edt-'Jhe Building and.Code Regulation Division of St..Lucie County will be`advised pursuant to the
filing of a Change of gub-contractor notice. .r
CONTRAPMR SIGNATURE(Qualifier) SUXCONTRACTOR SSI`GNATURE(Quame)
1- c1g Lonme`Culbertson
It!RDVT NAME "PP NAME j
246541RF11067372
p.COUNTYCERTWCATION ER COUNTY CERTIFICATION NUMBER'.
State ofFlorlda;County of State of Florida,County of
da, tY C.fC
Tde foregoing ina 'merit was signed beforeme t � day of The foregoing lostrument was signed before me this�dayiof
204'+ ;' pr,;f. 26P6 by Lonnie Culbertson
who'is persanigy lotown_or lies produced a
who IS personaily.lmown,or has produced a
as identifieabon. as 1 .
MMSHAWM
STAMP ..I b11f C01rlfiSS1091 Qum
STAMP
gnature ofNotary Public ��
Prini— Name of Nota "P�lic i, P a No
t1Jt James L.Miles
NOTARY PUBLIC y• nx J
,. _STATE OF FLORIDA Kt `
i comm#GG210264
ltevisod 11/162016 .p qE �� Expires 4/23/2022
PERMIT# ISSUE DATE
zon-3-G�
I�I� II 11 IIII� li PLANNING & DEVELOPMENT SERVICES
OBuilding & Code Compliance Division
COUNTY0 R I D A RECEIVED
BUILDING]PERMIT I
SUB-CONTRACTOR AGREEMENT MAR 2.I31070 2470
Permitting Department
St.Lucle County
{
have agreed to be
k(Company Name/Individual Name)
_
the <. I C1f, — Sub-contractor for I- c, 4
(Type of Trade) (Primary Contractor) j
For the project located at-� k4Z,6 S, 6 QCA(1 &A"'A
(Project Street Address or Property Tax ID#)
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It is understood that, if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St. Lucie County will be advised pursuant to Ithe
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNATURE(Qualifier) -S CONTRACTOR SIGNATURE(Qualifier)
71—
PRINT NAME PRM NAME
M �7/
COUNTY CERTIFICATION ER COUNTY CERTIFICATION NUMBER
State of Florida,County of l c r, State of Florida,County of t y}
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The foregoin instrument was signed before me this day of The foregoing instrument was signed before me this 'aOday of
2b Q gg , 1( �. ,20 by R r/L�
who is personally knowrils///or has produced a t..* who is personally known_or has produced a
as identification. as identification.
A } ? I
d\4�S' STAMP A ;( STAMP
Signa ure of Notary Public Si reWflSofalyFfiblic
� I
E
Print Name of Nota P Pia%, N REP4 S. t4 L.sE�1 Print Name o gig
State of Florida-Notary Public
='4 •� commission #GG 207484 State Of Florida
My Commission Expires ilsonJune 12, 2022 ion GG 275464
6!2022
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Revised 11/16/2016
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