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25 Justice Way, Dawsonville, GA 30534 [PHONE REDACTED] Dawson County Community Development Homeowners Self-Work Affidavit I understand that all of the construction codes, state and county rules and regulations will apply to me and be enforced by the county as though I am a licensed contractor. I further understand that I must either contract with a State Licensed Contractor for electrical, plumbing, mechanical, and insulation or perform this work myself. I am aware of, and consent to, an owner-builder building permit applied for in my name and that I am at least the owner of the property and I am the party legally and financially responsible for the installation or construction of : at the following address: Check each applicable trade that owner-builder will be responsible Building______ Electrical Plumbing HVAC Insulation 1. I understand that the state law requires construction to be done by a licensed contractor and under the provisions of O .C 43-41-17, I have applied for an owner-builder permit for an exemption from the the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. 2. I understand that as owner-builder I may build or improve a building or structure on real property owner by me which is intended upon completion for use or occupancy solely by me and my family, firm, or corporation and its employees, and not for use by the general public and not offered for sale or lease. 3. I understand that as owner-builder, I must provide direct, onsite supervision of the construction. I also understand that I may not delegate the responsibility for supervising work to a contractor who is not licensed to perform the work being done. 4. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws, ordinances, building codes and zoning regulations. Property Owner Signature: Printed Name: Subscribed and sworn to me before me this Notary Public Stamp: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16-10-20 of the Official Code of Georgia. The above information is true and correct, and I so depose and state before an officer authorized to administer oaths by the State of Georgia. Disclosure Statement