as recorded by
Page and that this statement has
was constructed by the owner as an unlicensed builder on property as identified on:
County Tax Map Parcel: or Lot Number:
Plat Book: Page or as referred by Deed Book:
been recorded in the Register of Deeds Office of Orangeburg County on this date of:
Property Owner: /
Builder of Dwelling:
Date:
Please place Notary Seal Below:
Notary Public for South Carolina
My Commission Expries: ______________________
SWORN TO before me this _________________ day
of _______________________________, 20 _______
______________________________________(SEAL)
(signature)
RESIDENTIAL
DISCLOSURE
CERTIFICATION
FORM
129 Rowes Pump Dr
P.O. Box 495
Rowesville, SC 29133
803-534-2745
Department of Building Safety
4795 South Church St. Ext. - Suite 2
Roebuck, SC 29376
864-586-6111
(please print name clearly)
STATEMENT FOR INDIVIDUALS WANTING TO BUILD THEIR OWN HOMES
(THIS STATEMENT MUST BE RECORDED IN THE REGISTER OF DEEDs OFFICE OF Orangeburg COUNTY)
State Law requires residential construction to be performed by licensed residential builders and specialty 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
builder even though you do not have a license. You must supervise the construction yourself. You may build or improve a one-
family or two-family residence. The building must be used for your own use and occupancy.
It may not be built for sale or rent.
If you sell or rent a building you have built for yourself within two years after construction is complete, the law will presume that you
built it for sale or rent, which is a violation of this exemption. You may not hire an unlicensed person as your residential builder or
contractor. It is your responsibility to make sure that people employed by you have licenses as required by state law and by county or
municipal licensing ordinances. Your construction must comply with all applicable laws, ordinances, building codes and land use
regulations.
I, , do hereby acknowledge that the residential building or structure
Page 1 of 1 ResDCF42349CI(REV.8/2020)
