Owner License Exemption Form Fillable
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10 Johnston County Inspection Department Owner License Exemption Form Pursuant to NC GS 87 - 14 a 1 Address of Real Property where the building is being constructed or altered I , _____________________________ , hereby claim an exemption from licensure under GS 87 - 1 b 2 by initialing the relevant provision in paragraph 1 and initialing paragraphs 2 - 5 below and attesting to the following 1 ______ I certify that I am the owner of the property set forth above on which this building is to be constructed or altered ; or _______ I am legally authorized to act on behalf of the firm or corporation which is constructing or altering this building on the property owned by the firm or corporation as set forth above name of firm or corporation _____________________________________________________________________________________________________ ; 2 _______I will personally superintend and manage all aspects of the construction or alteration of the building and that duty will not be delegated to any person not duly licensed under the terms of Article 1 of Chapter 87 of the General Statues of NC ; 3 _______I will be personally present for all inspections required by the NC State Building Code , unless the plans for the construction or alteration of the building were drawn and sealed by an architect licensed pursuant to Chapter 83A of the General Statutes of NC ; 4 _______I will personally occupy the building for at least 12 consecutive months following completion of construction and understand that if I do not do so , it creates the presumption under law that i fraudulently secured the permit under the terms Article of 1 of Chapter 87 of the General Statutes of NC ; 5 _______I understand that a copy of the AFFIDAVIT will be transmitted to the NC Licensing Board for General Contractors for verification that I am validly entitled to claim an exemption under GS 87 - 1 b 2 for the building construction or alteration specified herein I further understand that , if the NC Licensing Board for General Contractors determined that I was not entitled to claim this exemption , the building permit issued for the building construction or alteration specified herein shall be revoked pursuant to GS 153A - 362 or GS 160A - 422 Signature of Affiant ________________________________________________________________ Date _______________________ Sworn to or affirmed and subscribed before me this _______ day of __________ , 20_____ ________________________________________ Signature of Notary Notary Stamp Seal ________________________________________ Printed Signature of Notary My Commission expires _____________________ , 20_____ NOTE It is a Class F felony to willfully commit perjury in any affidavit taken pursuant to law GS 14 - 209 Page