HomeMy WebLinkAboutCHANGE OF CONTRACTOR_ PLANNING & DEVELOPMENT SERVI S
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 SEP 2 5 2019
(772) 462-1553 FAX 462-1578 ST, Lucie county, permitting
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
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: I -c2 —•mil `l I I Permit Number:
Site Address: 92-:?s /I. �A /W4 ���'� #l5 2
V� �SU& D�Utp meo-i t.._ L C State License SLC License) / F�
Original GC, s ontractor or owner/builder
LO L I (a m V10.111'&ha_ r State License SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmles% 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 resultof this change of
ontrac e n ra r cancellation of permit. A permit cannot be cancelled if work has been performed.
S NA er SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
a.5 day of <s "20\q by����s4'M,
t e.N%4 4 \ who is personally known to me
who
lip]
DEANNAMARIE GMNS
MY COMMISSION 0 GO 022023
EXPIRE& Decem tf Nia I6, 2r'Aters
SotdedThnt Notary
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of 20by
is personally known to
me or who has produced as D.
Signature of Notary Date
SCANNED
BY
St. Lucie County
Planning & Development Services Department
Building & Code Regulations
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772) 462-1553
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 cable
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 meet
the minimum code. Initi
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 arWle
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible
cost of the license. In
I understand that if any person that is unlicensed and uninsured gets injured on my construction ct-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and rela a 'c I
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
Zom Depart ent t the Florida State Department of Professional Regul ion. Sipe and acknowledged on this
`L,5day of of 20 �.
Owner/Buil er Signature
STATE OF FLORIDA
COUNTY OF 6},t0cNa
The foregoing instrument was acknowledged before me this 01l5 day of S�,
by W h : a��\ a . 4 m.\.. m who is personally known to me, or who has
produced T- as idemificai
• 'r' DEANNAMARIE GIVENS
a'yM•..
IN f9*1Q_�r�.S ,$ •r NIY COMMISSIONgGG 022023
S.
Signature of NotaYy Type or Print Name of Notary 4 mbor16,2020
°' Bonded 7pabllc Undemdton
Title: NotaryPublic Commission Number Oa-�d �$: t••+'•
SLCPDSD Revised 05/15/2014