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PASCO COUNTY CENTRAL PERMITTING DIVISION OWNER- BUILDER AFFIDAVIT STATE OF FLORIDA) COUNTY OF PASCO) ' r BEFORE me, the undersigned authority, personally appeared R) chard De 0 ] YY) C1 who being by me first duly sworn, under oath, deposes and states, as follows: I do hereby swear /affirm: That I own the property described as ! r - ' -c ?. 3o -etcop 61 70 I • cS Disclosure Statemen State law requires construction to be 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 with certain restrictions even though you do not have a license. You must provide direct, onsite supervision of the construction yourself. You may build or improve a one- family or two - family residence or a farm outbuilding. You may also build or improve a commercial building provided your costs do not exceed $75,000.00. The building or residence must be for your own use and occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved within one year after the construction is complete, the law will presume that you built or substantially improved it 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. 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' Compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning 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. ' r - Owner's Si re 3 `i4 l ?� iri €1) RikE - d ss bat' SWORN bat' SWORN to and subscribed before me This y day of "4-44 . 20fr, pPY P , SUSAN ANN! AVALLEE oD 777369 Notary Public EXPIRES: July 22, 2012 State of Florida at Large °� oFFLO� ` eo ndedThw Budget Notary Services My Commission Expires: S u s ,r i:fl1 n 4-C C `t" t` - Print, Type, or Stamp Commissioned Name of Notary Public Personally Known V or Produced Identification Type of Identification