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<br />CNNER-nUIJ.m:R AFFInhVIT <br /> <br />STATE OF FLORIDA ) <br />COUNTY OF PASCO ) <br /> <br />'. <br /> <br />D1~FORl: me, the undersigned authority, personnlly Appeared <br /> <br />;<Pbe;?! :;:'!tfJ/UrL <br /> <br />. who being by me first duly sworn, under oath, deposes and staLes <br /> <br />tl S follow 5 : <br /> <br />I do hereby swenr/affirm: <br /> <br />ThilL I own the property descJ:ibed ns <br /> <br />Ze-JJtzvr /11 ( I~ , /:"L <br />fir' <br /> <br />~9yof <br />355:';0 <br /> <br />9~~ <br /> <br />, <br /> <br />A~,rue: <br /> <br />Disclosure Statement <br /> <br />Stllt.P. 1m.' n>r}lJi rAS confitruction to l).~ don~ by li.censed contn,ctors. YOll hnve ilPplied <br /> <br />for 0 permit under on exempt.ion to the IIJw. <br /> <br />The exemption allows you, AS the owner of <br /> <br />your property., Lo Ilct liS your own contr.actor even though you do not hnvc Il 1 iCr:\nse, YOIJ <br /> <br />mllst supp.rvisc the construction yourself. <br />(omi.ly residence or Il form outbuilding. <br />building ~L 11 cost of $25,000.00 or less. <br /> <br />You may build .or improve a one-family or two- <br /> <br />You r.IIlY also build or improve a commercial <br />Th~ building must be. for your own use and <br /> <br />occupanc.y. <br /> <br />It may not bo built for sale or lease. <br /> <br />If you sell or lease a building you <br /> <br />have built yourself ~ithin one year after the construction is complete, the law will pre- <br />sume that you built it for sale or lease. which is a violation of this exemption. You mllY <br />not hire 011 unlicensed p~rson as your contractor. It is your responsibility to mllke sure <br />that people employed by you have licenses required by Stote law and by County or municipal <br /> <br />licensing ordinances. <br /> <br />Any person working on your building who is not licensed must work <br /> <br />under Y0ur supcrvis.ion Ilnd must be employed by you, which means that you must deduct <br />F. I.C.A, Hnd withholding tllX and provide Workers' CCl1pensation for that employee, all as <br /> <br />pr~scribed by Lw, <br /> <br />Your construction must comply with all applicable lows, ordinances, <br /> <br />building c':>des. flnd ;o.cnir:g reg:JlcJtjOl~;;. <br /> <br />FURTJ~ER AFF J ANT SA YETH NOT. <br /> <br /> <br />liabilities <br /> <br />That I hnvc l'end the fore.~oi.l1g, and nm lIh'nre 0[ my r <br />[or COl1struction work on the above-described <br /> <br />lIgrec to each of the <br /> <br />aforesaid stipul nLilil1S. <br /> <br />,II <br /> <br />Ow r's Signature <br /> <br />q- C;'-fl1 ~ <br /> <br />Address <br /> <br />J ~ I? L; f h I / 1:-. r: t 33.s-Y/J <br />'-q- 'j/-C}f--C/ <br />Date <br /> <br />SWORN to and subscribed before me <br />this C dov of /V{L~-<- <br />J- J <br />2012- /"' <br /> <br />(~-1)!~ <br /> <br />Notary Public <br />Sta~\of Floridll ~t Lorge <br />/; ). " /2 <br />C J-?! () l fj }.{. (;r02 ~ "/0 AJ <br />Print, Type, or Stamp Commissioned <br />Name of Notary Public <br /> <br />My Commission Expires: <br /> <br />I1PU1Uc <br />8>>nQl1' <br />Fll:ll'lltW <br /> <br />~AULA M. PRfSTON <br />~, DD05SIU <br />~s NOV 0.5 _ <br />~:= <br /> <br />., ......;.. .,~ '.,......, <br /> <br />Personally Known <br /> <br />or Produced Identification <br />,., , <br />YJ;~I 'P<Z res J..-) C f! uSe. <br /> <br />).. <br />-. <br /> <br />'. <br /> <br />Type of Identification <br /> <br />PC93053047/A <br />