The undersigned hereby applies for consideration as a homeowner desiring to perform construction on his/her own real property pursuant to O.C.G.A. § 43-41-17(h) as follows:

In making this request for a "homeowner" permit, the undersigned states the following to be true:
1. Applicant does or intends to reside in property, which will not be offered for sale or lease and will not be used by the general public.
2. Property described in the permit application is currently owned by applicant.
3. Applicant will perform the work or act as the general contractor, PERSONALLY providing management and direct supervision of the work, and accepts inherent responsibilities for the work authorized by the approved permit.
4. Applicant agrees to hire Georgia-licensed contractors for work that is further sub-contracted. All plumbing, electrical, HVAC, and low-voltage work will require separate permits. The applicant may not delegate the responsibility to directly supervise and manage all or any part of the work relating thereto to any other person unless that person is licensed by the State of Georgia and the work being performed is within the scope of that person's license.
5. Applicant agrees to perform all work in accordance with all applicable codes and strictly adhere to the inspection requirements. The undersigned acknowledges that all required inspections must be performed in an established sequence prior to coverage of the work and that any work done in violation of the codes must be corrected or may be ordered to be removed.
6. Applicant acknowledges that he/she is aware that a permit issued under the provisions of applicable statutes, ordinances, and codes may be revoked for false statements or misrepresentation as to the material fact in the application on which the permit was based.
7. Applicant further acknowledges that he/she is aware that any knowingly false statements made in the permit application will subject said applicant to possible prosecution. Georgia Criminal Code, Section 16-10-71 (False Swearing).