HomeMy WebLinkAboutOwner - Builder Affidavit Disclosure Statement1-_�x.t� �— r ._ ,ttit+ ,� r: ti •L L-`yY :. •.,;i:�,.i{';�' �_ „1, ,a•.
Planning & Development Service
Building & Code Regina
s Department
tions
2300 Vironi*aNvenue
Fart Pierce, Florida 3498.2.
(772) 4620W-1553
OWYNEWBUILDER AFFIDaVIT DISCLOSURE STATEMENT
F.S. 489o103 (7) EXEMPTIONS
State law requires construction to be done bv licensed contractors. You have applied Tor a pemin under an
zsemption to that law. The exemption allows you, as the owner of your property, to act as your ow-n contractor even
though you do not have, a license. You,
must provide direct, 0%n-site supervision of the consmiction yourself. You
may build or improve farm outbuildings, none-family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a not exceeding S?S000.00 as ;one as it is for your own._.-ost
use or occupancy. You mav not build or improve said Structures forthe purposes of sell'ng or leasing that building.
-e
You may not hire an unlicensed person to act as
is tiour responsibiiity to make sure that people e
or mLuiicinal 1icensina- ordinances.
your contractor or to supervise peop�e w�rk�nff �n YOU17 buildi'no.: i�
;mp�oyed b%,r vou have 1'�..en�e� �equ�red bv 'ate haw and by county
iiI Here,
If vou seal or 1ease a buildincy timi have built or I'mproved wtthin one ve(i-r after constTuction is canzpiete, t
t�o� �s c�ea��c� fllr.if i� was Kiiflt ���' �mpr«v�d i�� �a�� or ���s�, �h�c� ts a v���at�ar� �f this cxi:�,Mvtlon.
%_� F -I'ty for env-1 i work "D
t ato ] `6 ib1
.. k being
FF r[}y ,
Lhe �ion n� 1zoniri-cT reauilations.
understand hat t1e
and inspe
minimtin i ode.
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ctors rre not to desiLyn or it v i.ho�v to the
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cutx�nproject-���beI understand that if any, trson that 'is anlicenscd and unilAsured �ets in�ure� on my
'�rl3d nd�� �L� ��hichentxfled to %�rorkmers c�rr���n���i��. � c�ul� �� h��d ia�l� for ail d4����, �����and
could 3 �from
���crude ��5 � w-� a�e� du��n� recov�:r�� the-ir inj`urv. InJfial Here.
y + 1,��yS—•—het 4}Fhe bul permit
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To qualifv for this � mptlo ll under thi � i i o � appear, persona
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-tppfication. and imaI -ffif---v
I ho_-rE.-xby acknowtzdae that I read and understand the above di'scloS-ittre statenient grid that f far-ther understand
that. anv �-ic� atian of the berms of the aw�.er/bui�c� r �x�:rr�pt���n shall be reported by the Buildinc, and Zonma
Deartmg��t o the Flori*da Stage �epa�tn��ni of �rofzs�iona l R,p�ula�ion. Si�n�:� - nd acKr�����rledg�c� on this
day of ' of
STATE OF FLORID
C 0 Uti T Y 0F �
The -foi 'nor instruz
by
pro, ducyd 4
Oix er/Bui1d er°,i�nature
�.U4 WaS aiaowIedaFed before nee this day of
� 10 Aft
Who 'is personall-v knowerw�a rr�Por ho has
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Sl'gnature o f N otar
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Title, Ni"ota-l-v 13ub
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