HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
-"` BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
µ a FORT PIERCE, FL 34982 APR 2 2 1011
(772) 462-1553 FAX 462-1578 Pwrnitting Department
St. Lucie County
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERNIT
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. Anew 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: 6_14 Permit Number:
Site Address:
C? liJ Chart State License SLC License
Original GC,subcontractor or ownerlbuilder
Src-b eto 'State License SLC License
New GC,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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SIGNA'EUP,E OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME �r Yd�9y Ge,- PRINTNAME
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
�a day of q Pam,20'6•\ ,b �'Oct f" day of 20_ by
who is personally known to me who is personally known to
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Planning&Development Services Department
COUNTYBuilding&Code Regulations
• R I D A 2300 Virginia Avenue
Fort Pierce,Florida 34982
(772)462-1553 RECEIVED
OWNER/BUILDER AFFIDAVIT DISCLOSURE STATEMENT APR 2 2 2021
F.S.489.103(7)EXEMPTIONS
'¢rmitting Department
State law requires construction to be done by licensed contractors. You have applied for a permit under an011'tV
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 andy�unty
or municipal licensing ordinances. Initial
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/
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 LL (._.
I understand that the building official and inspectors are not there to design or give advice on how,tq meet
the minimum code. Initial
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 for 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 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 owneribuilder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 21
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Owner/Tu&Ter'S ignature
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this day of ,20a% ,
by �r�_bg,n x,o We:x who is personally known to me,or who has
produced as identification.
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SLCPDSD Revised 02n120