HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES__
BUILDING & ZONING DIVISION LRECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 EP(772) 462-1553 FAX 462-1578 e County, P¢rmittil7g
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 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
Tne
ncingCAany work. There is a $50.00 fee for the Change of Contractor.
HNGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.-w 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:
Site Address: 1 d K FCAJa! t 0
Permit Number:
State License SLC License
Original GC, subcontractor or ownerlbbuilder
�T Ak i'� 1 I� t�1 State Licenser J 36) 6 J " SLC License �!
New , subcontractor
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 arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
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SiGNAhJRE OF OWNER (or owner/builder) SIIUNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINTNAME
State of Florida, 0ent
Lucie County State of Flori*ins
Lucie County
The following inaclmo�ed ed efore me thi a fo lowinac led ed before me this
day of20�0 by I !({v(���ay o2/0�byg
who is p onally lrnown to me pis personally known to
or who has
me or who
Signdtur�of Notary Date
KAREN S. NIELSEN
°�- State of Florida Notary Public
Revised 04/15/16 =••= Commission # GG 207484
P My Commission Expires
1 +"" June '12, 2022
of Notary ' Date
^=St AREN S.
y ate of Flori N/EI-SE
Comr- da-No N
Y Cor84
r ion it GG 207 tibl
Issi
ue 72 n Expires
Planning & Development Services Depa Iment
RECEIVED.
Building & Code Regulations
2300 Virginia Avenue S F P 112018
Fort Pierce, Florida 34982
(772) 462-1553 ST, Lucie County, Permitting
OWNER/BUILDER 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
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 required to be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and liable fpr the
cost of the -license. Initial V
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, 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 Depart nt to Itieflorida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20 .
OwnerBu ei rdl Signature
STATE OF FLO A
COUNTY OF
The re oin� instru , t was acknowledged before me this day of 20 IF
,
by ij�V who is personally known I to me, or who has
Dro u —.1r L as identification.
Signature of Notary Type or Pr• e of Notary (Seal)
Title: Notary Public sL�S iu er
KAREN S Notary Public
tate of Florida N 7a84
SLCPDSD Revised 05115/ L*° ;_ Commissioo # G� 20 fires
e;= My cornmission Exp
June 12, 2022