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PROPERTY OWNER AFFIDAVIT – GENERAL CONTRACTOR Notice: This form must be completed and submitted to the Gordon County Building Department before a permit is issued to a Property Owner to act as the General Contractor in lieu of a State of a Georgia licensed Residential/General Contractor. All information requested on this form is mandatory. Property The undersigned hereby applies for special consideration as owner of the property listed above, desiring to perform construction and serve as general contractor for the subject property. In making this request for a Property Owner building permit, the undersigned hereby states the following to be true: 1) The building or structure is located on real property owned by the undersigned and is intended for occupancy by the undersigned upon completion and will not be used by or open to the general public. 2) The undersigned has not sold a building or structure that they constructed and acted as a property owner contractor within the prior 24 months in the State of Georgia. 3) The subject property is not to be offered for sale or lease as provided in O.C.G.A. 43-41-17. 4) The undersigned shall serve as the contractor or record and accept all inherent responsibilities and liabilities for the work authorized by the approved building permit. 5) The undersigned may not hire or assign another individual or firm to hire sub-contractors without that individual or firm being duly licensed by the State of Georgia per O.C.G.A. Title 43, Chapter 41 and further securing required permits or affidavits from the Gordon County Building Department. 6) The undersigned agrees to build in strict accordance with all applicable codes and strictly adhere to the inspection requirements of Gordon County AND acknowledges that inspection must be performed in an established sequence as required by Gordon County and that work done in violation of the building codes must be corrected or shall be ordered removed. 7) The undersigned acknowledges and is aware that a permit issued under the provisions of the Gordon County codes may be revoked for false statements or misrepresentation as to the material fact in the building permit application on which the permit was issued. 8) The undersigned acknowledges that knowingly making false statements in order to obtain a building permit will subject the undersigned to possible prosecution and/or fine per Georgia Criminal Code Section 16-10-20 (False Swearing) with fines not more than $1,000.00 and imprisonment for not less than one nor more than five years or both. 9) The undersigned further agrees to indemnify, hold harmless and defend the City of Marietta, its operator, agents and contractors from any and all liabilities and action that may arise from any actions or inactions associated with the issuance of this building permit. Notary Public: State of Georgia County of Sworn and subscribed before me this Signed: Property Owner Print Name: of GORDON COUNTY BUILDING AND PLANNING