HomeMy WebLinkAboutChange of Contractor a
PLANNING & DEVELOPMENT SERVICE RECEIVGD
BUILDING & ZONING DIVISION
.2300 VIRGINIA AVE JUL 0 8 2020
FORT PIERCE, FL 34982 ST. Lucie County, Permitting
(712) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEAS ELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work.There is a$50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: l0 ,. oZ0C)0 Permit Number: ���D—
Site Address: l L'�3! �:� s o c>e�l'7 1� . 509
� D" QL�Cin State License SLC License
Original GC,subcontractor or owner/builder
yki) Nu 15 State License � SLC License
New GC,subcontractor® v
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arisMlratRany and all claims of action for any reason,which may arise as a result of this change of
contractor cc r can t ation of permit.A permit cannot be cancelled if work has been performed.
,eSIGNA RE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
&NT NAME --+7J�1 PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The ollowing i stcument was acknowledged before me this The following instrument was acknowledged before me this
day of 20 day of 20_ by
by-
who is nen-onallv known to me who is personally known to
or o has duced as me or who has produced as ID.
Signature of Notary Date Signature of Notary Date
KA R E N
S. NIELSEN
Revised 04/15/16 �_° =State of Florida-Notary Public.
Commission #o� GG 207484
My Commission Expires
June 12, 2022
Planning&Development Services Department
® Building&Code Regulations
0 0. 2300 Virginia Avenue b'`EC�r�E�
-- - Fort Pierce,Florida 34982
(772)462-1553 J U L 0
a ( 2020
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT
v l F.S.489.103(7)EXEMPTIONS ST. Lucie County, Permitting
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; it
is your responsibility to make sure that people employed by you have licenses required by state law and by�eppty
or municipal licensing ordinances. Initial
If you sell or lease a building you have built or improved within one year after constructio
complete, then a presumption is created that it was built or improved for sale or lease;which is a viol n o
this exemption. Initial
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 es,
and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice on howl
the minimum code. InitialI
,
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 �y
I understand that if I compensate any person or company for work performed they are required-to b
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable o e
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction pro'- t-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relate "ic I w
cost,which could include loss of wages during recovery from their injury. Initial l�
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 Departm nt to the Florida State Department of Professional Regulation.ZSigned5ad;knowle ed on this
_day of of 20 Z6
O ner/Builder Signature
STATE OF FLO I A:15,COUNTY OF -(-,2 1
_
bhp fpreu ing.iTrument�vas acknowledged before me this day of 20W
yy(( �/ r��(( `� who is personally known to me,or who has
produced as identification.
i .
Signature of Nbtary Type or Print Name of Notary (Seal)
Title:Notary Publi q,Offl umber
SLCPDSD Revised 02/ KAREN S. NIELSEN
State of Florida-Notary Public
=* *= Commission # GG 207484
y
M Commission Expires
June 12, 2022