The Private Provider Compliance Affidavit is the notarized statement in which the principal of a registered Private Provider firm affirms to the City of Cape Coral that the firm's plans review and inspection work will meet the standards of F.S. 553.791. It is one of the documents tied to the Cape Coral permit process for firms that review plans or perform inspections instead of the city. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the city publishes the original at the official source link.
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What is Private Provider Compliance Affidavit – Cape Coral, FL?
The Private Provider Compliance Affidavit is a one-page City of Cape Coral form in which the Private Provider Principal of a registered Private Provider firm affirms that any building permit application or building permit on which the firm provides plans review and/or inspection services will meet or exceed four stated standards.\n\nThe form is issued under the header of the Development Services Department, 1015 Cultural Park Blvd, Cape Coral, FL 33990. In it the principal affirms that:\n\n- all Duly Authorized Representatives meet the requirements of F.S. 553.791 and, at the time of review or inspection, are licensed or certified for the specific trade or trades they perform;\n- the firm and all its representatives continuously meet the minimum insurance requirements of F.S. 553.791;\n- all plans the firm reviews comply with the applicable codes, as defined by F.S. 553.791;\n- to the best of the principal's knowledge and belief, the building components and site improvements inspected under the principal's authority will be completed in conformance with the approved plans and the applicable codes.\n\nThe page ends with a signature and date for the principal and a Florida notary block, so the document is signed and acknowledged before a notary public. It is an affirmation by a firm; it is not a permit application.
Who needs to file Private Provider Compliance Affidavit – Cape Coral, FL?
The main user is the Private Provider Principal of a Private Provider firm that is registered as a Private Provider with the City of Cape Coral. The principal signs the affidavit on behalf of the firm, and the firm name is written into the opening statement.\n\nThe form applies to firms that provide plans review and/or inspection services on a building permit application or building permit. The Duly Authorized Representatives of the firm are not signers, but the affidavit commits the firm to ensuring they meet the requirements of F.S. 553.791 and hold the license or certification for the trade or trades they perform.\n\nA notary public must complete the acknowledgment block, so the signer needs to appear before one. The form does not describe anyone signing for the principal, and it is not for property owners, contractors or applicants who are not acting as a Private Provider firm.
When to file Private Provider Compliance Affidavit – Cape Coral, FL
The form prints no due date. It is made by a firm that is a registered Private Provider with the City of Cape Coral, and its statements apply to any building permit application or building permit on which the firm provides plans review and/or inspection services. Completion is therefore tied to the firm's status as a registered Private Provider and to the work it takes on. To confirm when the city expects a new or updated affidavit, contact the Development Services Department at the address or email printed in the form's header. The form is marked Revised 2/6/23.
Documents you need
- Identification for the notary, such as an ID of the type you enter on the form, when the notary does not know you personally; the notary block asks for the type of ID.
How to fill out Private Provider Compliance Affidavit – Cape Coral, FL
Enter the principal's name
In the opening statement, write the name of the Private Provider Principal after "I,".
Enter the Private Provider firm name
Write the legal name of the Private Provider firm in the blank after "the Private Provider Principal of". The firm must be registered as a Private Provider with the City of Cape Coral.
Read the four affirmations
The form lists four commitments: representative licensure under F.S. 553.791, continuous insurance compliance, plans that meet the applicable codes, and inspected work that conforms to approved plans. There are no boxes to check; signing affirms all four.
Sign and date as principal
The Private Provider Principal signs on the signature line and enters the date beside it.
Complete the notary county and date
In the notary block, the state is printed as Florida. Enter the county, then the day, month and year on the line starting "Before me, this day of".
Identify who appeared before the notary
Enter the name of the person who appeared, their title (the "as the" blank) and the firm (the "for" blank).
Record how identity was established
Mark whether the signer is personally known to the notary or produced identification, and enter the type of ID.
Add the notary signature and seal
The notary public signs and places the seal in the space provided.
Review and download the completed PDF
Check that names match, the date is entered and the notary block is complete, then download or print the PDF from FillingPDF and deliver it as described under How to submit.
How to submit Private Provider Compliance Affidavit – Cape Coral, FL
The form names no submission channel of its own. Its header identifies the City of Cape Coral Development Services Department, 1015 Cultural Park Blvd, Cape Coral, FL 33990, with the email address [email protected]. Use those contacts to confirm where and how the city wants the signed and notarized affidavit delivered. The city hosts the PDF in its Permit Document Center, in a Private Provider folder. FillingPDF lets you fill out and download the PDF; submission follows the agency's channels.
Common mistakes to avoid
- Leaving the notary block (county, date, name, title, firm, ID type, notary signature and seal) unfinished after the principal signs.
- Having someone other than the Private Provider Principal sign the line printed for the Private Provider Principal Signature.
- Omitting the principal's name or the firm's name in the opening statement, which is where the affirmation identifies who makes it.
- Not stating whether the signer is personally known to the notary or which type of ID was produced.
- Forgetting the date next to the principal's signature.
- Treating the affidavit as a permit application; it only affirms the firm's compliance with F.S. 553.791 and the applicable codes.
Frequently asked questions
What is the Private Provider Compliance Affidavit?
It is a City of Cape Coral form in which the principal of a registered Private Provider firm affirms that the firm's plans review and inspection work will meet F.S. 553.791 and the applicable codes. It is signed by the principal and acknowledged before a notary.
Does the affidavit apply to every Cape Coral permit?
It covers any building permit application or building permit on which the firm provides plans review and/or inspection services. It is not an application for a permit, and the form does not apply to work where the firm provides neither service.
Who signs the Private Provider Compliance Affidavit?
The Private Provider Principal signs and dates it on behalf of the firm. A notary public then completes the acknowledgment, which records the county, the date, the person's title, the firm and how identity was established.
Does the affidavit need to be notarized?
The form includes a Florida notary block with the notary's signature and seal, and it records that the signer personally appeared before the notary. Complete that block before delivering the affidavit to the city.
What does the firm affirm about its representatives?
Every Duly Authorized Representative must meet F.S. 553.791 and, at the time of review or inspection, be licensed or certified for the specific trade or trades performed. The firm and its representatives must also keep the minimum insurance that statute requires.
Where do I send the Private Provider Compliance Affidavit?
The form lists no delivery channel. Its header gives the Development Services Department, 1015 Cultural Park Blvd, Cape Coral, FL 33990, and [email protected], so contact the city there to confirm how it wants the completed affidavit.
Can I fill out the affidavit online on FillingPDF?
Yes. You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not file or send the affidavit to the City of Cape Coral; you deliver it through the city's channels.
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