2410 Willow Ave - OWNER BUILDER AFFIDAVITa
I
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for homeowners
from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
FSS 489.103 Disclosure Statement
State Law requires construction to be done by licensed contractors. You have applied for a permit under an exemption
to that 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. The building or residence must be for
your own use or 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 yourself within 1 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 supervision 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 direct 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.
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
i I UNDERSTAND AND AGREE TO THE EXEMPT iON PROVISIONS OF FLORIDA STATUTES 489.103
AS LISTED ABOVE.
I HAVE ACCESS TO THE ADOPTED CODES.
I AM FAMILIAR WITH THE CODE PROVISIONS.
I HAVE ADEQUATE KNOWLEDGE AND QUALIFICATIONS TO SAFELY PERFORM AND DIRECTLY
SUPERVISE THE WORK.
THIS PROPERTY IS NOT AN APARTMENT, CONDOMINIUM OR RENTAL PROPERTY.
THIS STRUCTURE IS NOT BEING BUILT WITH MY INTENTION TO SELL, RENT, OR LEASE.
I UNDERSTAND THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN
OWNER BUILDER STRUCTURE WITHOUT BEING INVESTIGATED.
I UNDERSTAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A.,
j WITHHOLDING TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE.
OProperty Address:(L kL
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performing
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do hereby state that I am qualified and capable of
requested construction involved with the permit application filed.
Form of Identification
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Must be Photo
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A violation of this exemption is a misdemeanor of fvfirsf e ree pL
exceeding 1 year and a $1,000.00 fine in additia .9 any eivil perra
jurisdiction shall withhold final approval, revoke ttf0`perm. t, o ;pigs
activity against the owner and any person performiiS`g vifork'thaVreq'
Rev. 4/20/07) `'>/JJ 1111NIN
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Date
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nis ble by a term of imprisonment not
ktiegDin addition, the local permittingactionorremedyforunlicensed
uirfW icensure under the permit issued.