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OWNER-BUII.DER AFFIDAVIT ST~ JF FLORIDA ) COUNTY OF PASCO ) BEFORE me, the undersigned authority, personally appeared Ma.Y1t<.d 0onZa../ec:... , who being by me first duly sworn, under oath, deposes and states as follows: I do hereby swear/affirm: That r own the property described IlS 3tI-;]!i - ~/- OO'tO-oocrx;J - I4:W Gra.V'ld /ton 7-Dvl5 - p~sc- On e.... Disclosure Statement Stllt~ 1m.: rN!uires con~truction to lJ... don~ hy licensed contnictors. Yon hllvc IlpplJed 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 mus t supervise the construction yourse I [. family residence or 11 farm outbuilding. You may build or improve a one-family or two- You may also build or improve a commercial building l't I] cost of $25,000.00 or l~ss. Thf> building must be for your own use find occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself tdthin onp. year after the construction is complete, the lall1 will pre- sume that you built it for sal~ 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' CC11pensation for that employee, all as prescribed by law. Your construction must comply with all applicable lAWS, ordinances, bu i1 (Jj ng codes. llnd :>:cning ,l:egu loti <,.11:3. That I havl'! read the foregoing, and am awnr~ of my responsibilities and liabilities for construction work on the above-described property And do hereby agree to each of th~ aforesaid stipulations. FURTHER AFFIANT SAYETH NOT. ?JJ~~ Owner' Sig ture 37t/-!J/ N~m live. Address 2'o/~Th;{/~ ROo 33~cfl ~ / :l;;L/ 03 I { Date SWORN to and subscriPf-d before this ~Jd.ay of H~/A.a,.r- ~~ Ni:~b~ Stat~y~~~~ida at Large 0/1 7.1lY'l () e &tv- Print, Type, or Stamp Commissioned Name of Notary Public me "\\111,, Suzanne Bahr "~t>P!YPlJ~ /;~/:~ Com!l1ission #DD157131 :;.~. ~:..~ ExpIres: Nov 15,2006 "/~~OFf~O~" Bonded Thru '1,,,,,\,, Atlantic Bonding Co., Inc. My Commission Expires: Personally Known _____ or Produced Identification Type of Identification Y. ( ~. /" , PC93053047