HomeMy WebLinkAboutChange of Contractor ., �: PLANNING & DEVELOPMENT SERVICES
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BUILDING & ZONING DIVISION
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2300 VIRGINIA AVE ---- Ileg
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 0 C T 2 6
Si'. Lucie County, Permitting r.
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner,
and a 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: N C 1 I a s - Permit Number: 150� �dy 1
Site Address: . 5 i1 h�( (d, -.c (e, I f b+ 1 `i<&- -e
State License SLC License
Original GC, subcontractor or owner/builder
y"{� State License SLC License
New GC,subcbntractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmldss St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
c ntractor/sub ntract r canc 11at, of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME O(a /r I e/b GyC f,.e_A PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
aSo day ofOc* ,2039 byr—q �w a day of 20_ by
gC'6e who is personally known to me who is personally known to
or who has produced AF&_ as ID. me or who has produced as ID.
Signat, _op... DFJWNp 11},gNE GNENIS Signature of Notary Date
MY COMMISSION#GG 022023
EXPIRES,December 16,2020
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0 Planning&Development Services Department
p o,,,_•„ , o - •.._ Building&Code Regulati --
2300 Virginia Avenue RECEIVED
Fort Pierce,Florida 34982
(772)462-1553 0 C T 2 6 2020
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATkMI NT
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 county
or municipal licensing ordinances.
Initial Here.69,
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.
Initial Here.
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 codl�
zoning regulations. Initial Here.
I.understand that the building official and inspectors are not there to design or give advice on how to met the
minimum code. Initial Here.
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handle in a civil
court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial Here.
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 may be responsible and liable for the cost f t
license. Initial Here. C
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 medical cost, hi
could include loss of wages during recovery from their injury. Initial Here.
C/
To qualify for this exemption under this subsection, an owner must personally appear, 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 r orted by the Building and Zoning
Department to the Florida State Department of Professional Regulation. ed and ackn wled ed on this
day of of 20_
Owner/Builder Signature
STATE OF FLORIDA
COUNTY OF Sir .Lo c'\2
The foregoing instrument was acknowledged before me this a<, day of 2(S
by Cg t m el o E-'sc c who is personally known to me,or who has
produced�of
�,ypL as identification.
23
-taDEANNAMARIEGIVENS
Signatutary Type or Print Name of Not ;*e MY PIKES:COMMI SIgr�#CyC�oz2o0
Title:Notary Public Commission Number - p�= EXPIRES:0 2020
Bonded 7tIN Notary Public Umlerwcltars