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OWNER-BUIlDER AFFIDAVIT STATE OF FLORIDA ) COUNTY OF PASCO ) , . BEFORE me, the undersigned authority, personally appeared, ') () h,...~ f"{\ -€.. ~/\.\r(j f ~ . who being by me first duly sworn, under oath, deposes and states as follows: I do hereby swear/affirm: That lawn the property described as II - ;;).0.- J-.I-- 00 I 0.--0 :::. s;cx:)-oO:.:rQ Disclosure Statement State law requires construction to b8 done by licensed contractors. You have applied for a permit under an exemption to the 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 supervise the construction yourself. family residence or a farm outbuilding. building e.t a cost of $25,000.00 or less. You may build or improve 8 one-family or two- You may also build or improve 8 commercial The building must be for your own use and occupancy. It may not be built for sale or lease, If you sellar lease a building you have built yourself within one year after the construction is complete, the law will pre- sume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. 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. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F,I.C.A. and withholding tax and provide Workers' Co~pensation for that employee, all as prescribed by law, Your construction must comply with all applicable laws, ordinances, building codes, and zcning regulations, That I have read the foregoing, and am aware of my responsibilities and liabilities for construction work on the above-described property and do hereby agree to each of the aforesaid stipulations. FURTHER AFFIANT SAYETH NOT. C-flZ'J~~ 9 . Owner's Signature v / It!=- p~ 2 - ~ /~ 23f?1D Address f t.!~ ate ~ SWORN to and subscribed before me this day of 19 Notary Public State of Florida at Large My Commission Expires: Print, Type, or Stamp Commissioned Name of Notary Public Personally Known _____ or Produced Identification _____, Type of IdentificBt~,* 1rJ-d,;)&::>- '/;:;;1 ~9--3&V~ PC93053047