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12. I agree to notify Pasco County immedlately of any add(tions, deletions,or changes to any of the fnformatlon that 1 have <br /> provided on this disclosure. ' � <br /> Licensed contractors are regulated by faws de�lgned to protect the public, 19you contractwith a person who does not have a <br /> license,the Consfructlon fndus4ry Licensing•Board and the Florida Department of Business and Professional Regulation may be <br /> unable to assi�t you w�th any financia!loss that you sustain as a resuit of�a complaint. Your only remedy against an unlicensed• <br /> contractor may be in civil caurt. It Is atso important#or you to understand that if an unlicensed con�racfior or employe�of an <br /> individual or Pirm is injured while working on your�roperty,you may be hefd ifable for damage�. li you obtain an Owner Builder <br /> Permit and wish to hire a IlcensEd contractor,y'ou will b�e�e�ponsible�or ve�if`ying whether ths oontractor is properly Iicensed <br /> and the status pf the contractor's compertsation coverage. <br /> ' I certify that I hav�read the foregeing and am aware of rny responaibll(fles and IiabiRi4ies for <br /> construction work on the above-descrlbed ptoperty and do herby agree to each of the aforesaid stipulations. <br /> FURTHER AFFIANT SAYETH NOT. <br /> �� <br /> Owner's na e <br /> Owner' rinte 1Vame <br /> 9�.�y� �!���2�2� L-R,��' <br /> , Address <br /> ' �0,. /�070� 7 <br /> Date <br /> S1IVORN.to.and.subsGribed.befor.e.me.this�daypf. �!Tp��L , �D/'�. <br /> STATE OF FLORIQA • � o�{�-c�0o�0 <br /> My Commission:Expi res: .: .::.�......::.... <br /> COUNTY OF SHIRDEN K DEL COTTO <br /> ���y p�iy�� . <br /> :?o�'a �t�y P�(�-St�le ot flarf �.. . <br /> � Cp�laittbo.N fF 9l05d�t� p , <br /> . � . <br /> Seal: :�, Mr:CM�•E���lwa 28. � <br /> IIIMI� �. <br /> _ ... ... <br /> '�' �oeMO - NOTARY <br /> Personally Known or Produced Identiflaation� <br /> ��� ... .�/�. .... .. ._.......................... ............... <br /> Type of ident(fication <br /> ............................................................. . <br /> � <br />� Page 2 of 2 - <br />�I <br />