HomeMy WebLinkAboutlounsbury affidavit - signedL
Plannin AL Dc-% r1oIignc111 Sin ice% Drparlnit itI
Building Sk ("ode lirgulialions
1301k % Iritinia Avertor
Fo r l Pie rct. Floridt 34931
(7 ) 462AS
VN E Rill U l I - DER AFFIDAVI F DISCLOSURE STATENUENU
State faxv requires construction to be dune by licensed contractors. You have aPPlicd for a permit under in
e+Kemti n to that is l he exemption allows yvu, as the Dover of your pr pertYo to act as your "n contractor even
though )oudo not have a ficcnsc. You must provide direct, onislte supers ision of the n truction ) uu lf Nrou
may build or aMPMVC fa t outbuildings, a one -family or mo-farnify residence for our use and occupancy. YOU
may also build or i rnpro %-c a comincfci3l building at a cost not exceeding 7 ,000. o0 as long as it is for � cpur own
UWor oCc upa.ncy- You mad. riot build of improve said structures for the purses of l I tag or lC i ng tl�at build'
You may not hire an un icenscd per -son to act as your contractor or to supervise p oplc working on your building. it
is your r0ponsibility to make sure that peopIc cm Io ed by you have licascs T-cquired by slue law and by county
or municipal licensing ordj�nanc s.
Initial Hem
If you soli or Base a bullding you hay a built or improved within one ycar after constmcfion is complete. fen a
presu mpt i on i 5 created that it was bu i I t or i rnpm- cd for sale or lease, whic h i s a violation of this eXe Mption_
Initijil 111CM Ae�
YOu maY not Mcgatc the responsibility for supervising work a I ice reed oontractor who is not ficensed to perform
the work betag done. Your construction must comply with all applicable Iaw5., ordinances, building des and
zoning rcgu 1dl i ns Initial Here.
ere.
undcrstand that the building official and inspectors arc not tahcrc to desip or give advice an how to meet the
minimum code. lniti-2t I1C . 400�
I undcrsL=d that as an owner -builder that any contract disputes with su aractors and l must bc handled in a civil
court with, the advice of an atiome . This department will not mitigate any contract disputes,
Initial Here.
y�
I undo rstand thu i f 1 comps ns ate any person or comp wi - fer %ya rk perfo rTned Oicy are requ irk to be liccnscd in this
jurisdiction. If for some rv; on they do not possess a licciiscy I may responsible and h-able for the cosl of the
liccrnse. HOW iltrci(
I understand that if any person that is un I iccns d and i rL%urcd gets injured on my construction eject -they a) be
emit led to workmen's corn pcnsatlo n. I could be 1iel d liable for all doctor, Iawycr wd related medical cost~ which
could include loss of wages during r o of from their injury. Initial l lcr ez _e�
To qualify for this exemption under this subsection, an owner Must pcTNORatl , Wear, sign the building p% it
application, and i nifial 1 he o bovc
f h rcby acknowicdge that I have rend and understand the abos. disclosure statement md t t l further undcrsiand
that any violation of t he tarns or the o ncri hui lder e,% crn phon shall be reported by tk Building and Zoning
!kpanment to tInc Florida Statc Depiuiment of Professional lacgulatton. Signcd and ackiw%%jedged on this �
day of �* _ _ _ € f 20� .
ncr Builder r C_ /N�
STATE OF ITPORIDA
UrKI-Y OF
The roreguing j nstru mc ni svis nn1d gcd bc lo rc rc his #f 1 21
b V ADD Y — — ._who is personally kno%n -- _ to me. or he has
prodvqd_4L_`'
Signature of Notary
JAIC'.
olac
Type or Print Name of a1�
t.
Commissionliun►bcr���Q
. Notary PublK , s to of Nca
y C on* Expires Ga 16. 2023
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