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Home My WebLink About07-7378 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7378 Permit Number: 7378 Permit Type: MECHANICAL Class of Work: A/C CHANGEOUT Proposed Use: NOT APPLICABLE Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: Name: BEDARD, PAUUJULlA Address: 38720 6TH AVE ZEPHYRHILLS, FL. 33542 2,000.00 1/10/2008 60.00 60.00 1/10/2008 A/C CHANGE OUT - 2 TON Address: 38720 6TH AVE ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 11-26-21-0010-14800-0000 Phone: ~ ~5/off 1/L DUCTS INSTALLED DUCTS INSULATED FINAL REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing, consult with your lender or an attorney before reco . g your notice of commencement." --~C::;~ CONTRACTOR SIGNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Building Department b 1:\... IJ V E Fax-813-780-0021 '1'i)lq, ./ Owner's Name Date Received / c~PJ.f4 gUI LI , . JOB ADDRESS Fee Simple Titleholder Address I 13'37;:;"0 I ~ WORK PROPOSED B D D I A-(<!. NEW CONSTR INSTALL SFR BLOCK Co -t1'\ Au e- I PARCEL ID#I B D D 0\CU\,~o~ I SQ FOOTAGE I LOT # SUBDIVISION PROPOSED USE TYPE OF CONSTRUCTION ADD/ALT REPAIR COMM FRAME D D D 'Z~ (OBTAINED FROM PROPERTY TAX NOTICE) SIGN 0 MOVE D DEMOLISH OTHER STEEL I o OTHER I deSCRIPTION OF WORK I . 'r I I I . . . . . I . . . I , I I . . . I . . . . . I . . I I . . . . I I I . . . I I I I . . . . I . . . I I I , . . I I I . . I I I . . . . . . . . . . . I I I . . . I I I . . I I . I . . . I I II . . . . . . . . I . I I I I I . . . . . . . . I I I I . . I . I I I I I . I I I I I I I I BUILDING SIZE HEIGHT 1$ I 1$ I 1$ I ~ MECHANICAL 1$ Z Fv-... I i OC) o. l..AJ D GAS D ROOFING D SPECIALTY D OTHER FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO """""""""""'1""""1""'1"""11""'"',.."".."..,..",..'."1....".""....,"'..'1'.'."1""""""""""""""""'" D BUILDING VALUATION OF TOTAL CONSTRUCTION ELECTRICAL AMP SERVICE D PROGRESS ENERGY D W.R.E.C. D D PLUMBING VALUATION OF MECHANICAL INSTALLATION BUILDER SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT Y/N License # COMPANY REGISTERED Y / N FEE CURRENT Y/N License # COMPANY REGISTERED Y / N FEE CURRENT Y/N License # COMPANY REGISTERED \-\-CJ")~~ I Y / N FEE CURRENT Y/N License # COMPANY REGISTERED Y / N FEE CURRENT Y/N License # ""1,""1,1",,111,,,11,,1,1',,1111,11,1111,,,111111111111111111111111111111111111111111111111111111111111111II111111111111111111111111111111111 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. II " I1111 " " 11111 " III " I111II1111111 " 11111111111111 " I1111111111 " 11111 " I1111 " 11111 " 111111 " I11111111 " " II " 111111 " 11II " I1111 " 1111111111 Directions: Fill out application completely. Owner & Contractor sign back of application, notarized '-1 p.)1)YY'\ - CCJ'r ~~. If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000) Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades NC Fences (Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone "V" unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to. violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Officia~ for a period not t~ exceed nin~ty \90) da~s and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the,Job IS conSidered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER AN ATTORNEY BEFORE RECORDING YOUR CE OF COM ME EMENT. FLORIDA JURAT (F.S. 3 ~ W ~ OWNER OR AGENT. ""- ~ 7- ~ L - ~ CONTRACTO """-- . SUQSc7'bed and s to (or affirm d) before m this Su~cril,>ed and sw~to (or af!!rmed) before me th)l>, r i 19 O<b by \ Jot Lo~ by~ nr<1~. ~O~{'JJ/.l ~O Who istare Eersonally known to me or haslhave produced Who is/are personally known to me or has/h~ve p~odu?ed ~L- ::::DLL0 <2- L\C as identification. P- - 'D~ \-\. C. as Identification. ~..a~ d~ Notary Public Commission No. STOP WORK By order of the Building Official: Wi{{iam)l. (]3urgess All Building, plumbing, electrical and mechanical work shall cease at the below m~ntioned property. Address: 3 ~ 7 ~ 0 Date: /- 9- d rI /:~ ~ A-z-> t=' ~ J Code Enforcement Officer: Contact the _---- ~~...", Zephyrhills Building Depatf'ment ) 5335 - 8th Str./ ~ '"-;6 i'-7377d- 813-780-0020 \'y~l.- .~ r / 75'1 ~ * L6:5~ /-/o-D9 )(/1f/t.,1 --.. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ~940NORTH MONROE STREET TALLAHASSEE FL 32399-0783 (850) 487-1395 TATUM, VESTAL V TATUM REFRIGERATION Alc SERVICES PO BOX 7837 TAMPA FL 33673 lp 11 q S C(2cf~ C~~ \~ P 5.36/<{- -- Ceil tI 8(3- SoS-2b"'~ 81 :3- e72..- 1../ ~o1 if 3B12-0 ~ C[t: ~ . STATE OF FLORIDA AC# 32588,0 . DEPARTMENT OFaUSINESS~' .'. . PROFE-SSIONAL UGU'IiAT70N""", RM0031291 06/12/07 060769d2:! REGISTERED MECfIANJ:CALCONTRACTOJ TATUK, VESIl'AL V . .. ........ .":" TATUK. REFRZGERATIp~,A/C SERVJ:0E1 (INDIVIDUAL. Mt7S'r"iHEETAUr.LOC1i:t. LICENSING REQUIREMENTS ");>>RIOR:" TO CONTRACTING :IN ANY AREA) .; HAS REGISTERED. unde~ .the p~ovUions 6'f.'Ch..1l'! BzpfraU.... ate.AOG .~:J., 20ll~'LI)'TQ6i2po'4~5 DETACH HERE ~~C# .~.~ 5c~,~0:~~, c.....';;c ;.. ST~T~:~F FLO~IDA. . '~}~; (W 0r'li~ ~ ~~!~"s;fh'~j,~R~1"lm~~~B~ON SEQ1lvo7,06i.ild~ liii;,;::'06)'::;12,,~:tf)O'7 '0~(1'?,"69'O,25 .. itf)3Jj~92 ,.:":,'<\1,,...,,.,.. .'iii.'"'" .".':'~"'~.",,.L:iit."'T .'.".I:'...".~'ll.'i'"'t.'."", n.l:.........1'ITI'i'i':""..,;t"Ofti: .. rlR:............: .~'\'\'..""" 1;;lt"'e:""'''~UJi:UU..'~al'~'-, ~:\J.11t~~V ~--',,- \W'i::)",~anf~€i ~Itci~w/'" ~g REGi~ftm:: :~\t>".frnde~i''\t~He :'p::r~i,sions :''df Chap't,e~. 4,$'.9' ~S. ~ , Expiration date: AUG 31, 2009"';"1'( ,_.... (.:l:'ND~V'~UAL:,HllST MEET ALL LO~:U:'~~SIN ~~;~JiliaN:/:O::~7;;~ "814 W''lNDIANAAVE ' TAMPA ). II "'1\1 . 'II'~'I'>(', 11"1 'I' \ I.,itl ','jl';."I. 'i, ~::':'.~~~.;:._~,:;, ,. I. 1+'11,1 ~"I'\'" ~ , '~\;j\"'"'h, \,1 lh \11" \ '"I j I , \~, I I I 1'1 '::.~:,\i'(",",:,~, .'~I\'. ~ :1\ ltAR' '1\1' "II', I I "~ ' '. :",",I':;<:;,:~\,:,\'" C LurE ;"\.I,;:tt,;ISX ' .. " lll~~,m '1"'mL"" jf~"~W~~~~\?~;\;,',~" . "~~~1Ci~~~ ,\) \ , 1 \ \ '.~."', .. . . . '-. -. - '---. .. '. ~ -". .'[ - -'- -" . ~ - - ~ -~ - . - - .f%~pJ\~ ~f~~IREO BY LAW HOLLY BENPoN SECt{ETAax,i HIl,LSBOROUGHCO-.-Y .,. .,smES,. .-. .,;.~L..msEIU.!CTl~NS . ,... ~1W ~~..._- ~ - ... ---- .-.... -..-.----- 1. The Hillsborough County BusineSS T$ Receipt only ieptesents payment Qf .a, bl\<uuess: tax fur the privilege 6f operating a business in Hillsborough County and does not constitUte co1l1peteney~ It does nOL pertnit the: business. to violate any existing regulatory or zoning laws of the \State,,~Qun.ti :1;>1" d~, nOt' .doe$, it etetnpt the b~ nom ally other taxes, licenses or permits that may be ~uited boy laW. .. 2. Business tax receipts expire midnight,. Sep.tenlber 30th. Failure, t!) disp~y a w1id bumws~ ~ ~ip.t ~~r September 30th is a violation of H'illsbQtough C<1OOty Ot1furatt~ 954, as ~ended, by '02~S" 3. Payment ofa HiUsl1t'\'rQ. .Ua't-; r~l'1;rit'<t 'Di'Fi';.ri,ali-, ~.hV> t'-., lf~'''- :~''''dabt: ~'nl..~,:the Tf-:-. 'fnPin;t f(} be T~"r;aed. is, [a "lf1lhHeated . .,'_ ?y~ ~u. ~-.r M!-J."~~S' ~~.~QU"';\~!M,.l___.-,-J.,e- ~~-B-._ f!~l:ty,~~.. .-- - ",'!;i.!:\!.Y.-.--- .- -' Y;~M..~ '.. payment of the tax. MAKE CHECK PAYABLE to: DOUG BELDEN" TAX COLLECTOR PO BOX 172920 ....- ---.--~.JJ6n~ -----. 2007-2008 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9-30-2008 o o 1 RENEWAL '.FOUQ NO_ 1619 FACILITIES OR MACHINES ROOMS o SEATS , EMPLOYEES OCC. CODE BUSINESS TYPE H WASTE SURCHARGE TAX BUSINESS LOCATION NAME MAILING ADDRESS 6179 SCORPIO CIR 124 TAMPA 33614 TATUM VESTAL TATUM REFRIGERATION A/C SERVICES PO BOX 7837 TAMPA FL 33673-7837 BUSINESS TAX DOUG BEl,..DEN, TAx COLLECTOR $13-63$.5200 THIS BECOMES A TAX RECEIPT WHEN VALIDATED. HAS HEREBY PAID A PRIVilEGE TAX TO ENGAGE IN BUSINESS, PROFESSION. OR OCCUPATION SPECIFIED HEREON, ......~~.]!.!.!;;... ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW ** CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 07/06/2007 EXPIRATION DATE: 07/05/2009 V PERSON: TATUM FEIN: 650547297 BUSINESS NAME AND ADDRESS: TATUM REfRIGERATION A/C SERVICES INC POBOX 7837 TAMPA fL 33673 SCOPES OF BUSINESS OR TRADE: 1- REGISTERED MECHANICAL CONTRACT VESTAL IMPORTANT: Pursuant 10 Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemplion from Ihis Chapter by liling a certilicale of eleclion under this seclion may nol recover benefils or compensalion under this chapter. Pursuant 10 Chapter 440.05(12), F.S., Certificales of eleclion to be exempl... apply only wilhin Ihe scope of Ihe business or lrade lisled on lhe nolice 01 election 10 be exempt. Pursuant 10 Chapler 440,05(13), F.S., Notices of election to be exempt and certificales of election 10 be exempt shall be subject to revocation if, at any time alter Ihe liling 01 the notice or the issuance of Ihe certilicate, the person named on Ihe notice or certificale no longer meets lhe requiremenls of Ihis seclion for issuance of a certificale, The departmenl shall revoke a certificale at any lime for lailure of the person named on Ihe certilicate to meet Ihe requiremenls of Ihis section. DWC- 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 .--.--.-.-,..-.----.----..........-'-"-". .-~..___....-'---..r:;--S'.~.:;.-..._-.__ -.__ ~_ ,.,.._..._...._.....~......__......~_~.-......... QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE: 07/06/2007 EXPIRATION DATE: 07/05/2009 PERSON: VESTAL V TATUM FEIN: 650547297 BUSINESS NAME AND ADDRESS: TATUM REFRIGERATION Alc SERVICES INC POBOX 7B37 TAMPA, Fl 33673 SCOPE OF BUSINESS OR TRADE: 1 ~ REGISTERED MECHANICAL CONTRACT F IMPORTANT Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who OL elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this D chapter. H Pursuant to Chapter 440.05(121. F.S., Certif icates of election to be exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. R E Pursuant to Chapter 440.05(131. F.S.. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC- 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 BANKERS St. Petersburg, ,Florida 337UI 4/02/07 DECLARATIONS PAGE .....RANCI! oaoup 5000 OOOOOVECT GL NEW BUSINESS Vector r-h ......~~..;. ' ... ""~..... .'...~,~.'>."'.'~ ,.' ......OQ. ..... .~7.:i~~;~ Page 1 of 2 4/02/07 .llii~~~,;i~1:.,-i'; .':.~~~..~, ,.,.,1; AM 09-0082802 (813)931-7467 :~ ~~lq-~I~~:-~..~:~~,,~~._~ Agent (813)931-7467 A F KILBRIDE INSURANCE AGY INC 4501 N NEBRASKA AVE TAMPA FL 33603 TATUM REFRIGERATION AND A/C SERVIC ES VESTAL TATUM DBA PO BOX 7837 TAMPA FL 33673-7837 In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as ~tated iD-this-p9.1i~y. , , $1,000,000 $1,000,000 $1,000,000 $100,000 $5,000 $250 ,.::l-~~~!~~~~."::~t;.:.~~?E~ti~;~:i}~.:C~<~'/ . .~. ~~:.~. General Aggregate L1m1t Other Than Products/Completed Operations Limit Personal Advertising Injury Limit Each Occurrence Limit Fire Damage Limit (Any One Fire) Medical Payments Limit (Any One Person) Property Damage Liability Deductible Per Claim Form of Business: Q Individual 0 Joint Venture Business Description: o Partnership o Organization (Other than Partnership or Joint Venture) HEATING AND A/C INSTALLATION AND REPAIR AND REFRIGERATIONREPAIR THIS POLICY CONTAINS A DESIGNATED WORK ENDORSEMENT. DAMAGES RESULTING FROM WORK OR OPERATIONS WHICH ARE NOT SPECIFIC AND CUSTOMARY TO THE CLASSIFICATION SHOWN OR OTHERWISE LISTED IN THE ENDORSEMENT AS EXCLUDED ARE NOT COVERED ON THIS POLICY. CG 21 46 1093 1093 CG 03 00 0196 0196 CG 21 67 0402 0703 BGL 99.306 0906 CL 1750286 0286 CG 21 96 0305 0505 BXXX99.206 0305 BGL 99.335 0704 CG 21 47 1093 1093 CG 02 20 0792 0792 IL 00 21 1185 1185 BGL 09.00A 1296 CG 00 67 0305 0505 BGL 04.333 0798 BGL99.100B 1296 BGL 99.300 0906 BGL 09.331 0905 CG 00 01 0196 0196 BGL 99.301 1195 BGL 99.304 0597 BGL 09.00B 1296 IL 09 85 0103 0403 CG 21 70 1102 0403 BGL 99.337 0405 0406 BGL 99.200 0405 0406 Deborah S Brcka Countersigned by Authorized Representative 4/03/07 Date Copies Sent To: As Indicated On The Back 00828020900053317450709200008 DISCLOSURE STATEMENT FOR OWNER CITY OFZEPHYRHILLS-BUILDING DEPARTMENT I, provisions of this instrument. have read and fully understand and agree to the The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for rent, lease or sale. That he or she shall comply with the following conditions: That the owner and he or she alone shall act as the builder for all phases of construction. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes pertinent to the building. That in the event various phases of construction are subcontracted, he will engage only properly licensed subcontractors and will personally supervise such work. That in the event the Building Inspector shall require corrections to be made, the owner will assume full responsibility to insure they are made, and upon completion will call for a reinspection before proceeding with the building. That the owner shall assume full responsibility for the construction and will not expect supervision of his work from the City of Zephyrhills Building Department. That prior to final inspection any additional fees, including reinspection fees, must be paid in full. A written request from this office shall constitute an official notice to pay additional fees. That the owner shall comply with all City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc., where applicable. That the owner shall comply with all the safety codes issued by the Florida Industrial Commission. State law requires construction to be done by licensed 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 contractor with certain restrictions even though you do not have a license. You must provide direct onsite supervision of the construction yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial building, provided your costs do not exceed $75,000. The building or residence must be for your own use or occupancy. It may not be built or substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for superviSing work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A and withholding tax and provide worker's compensation for that employee, all as prescribed by law. Your construction must compiy with all applicable laws, ordinances, building codes, and zoning regulations. OWNER'S SIGNATURE ~ C /' ADDRESS 3"Btlc...... ~ Aae.... PHONE WITNESS 1. 2. 3. 4. 5. 6. 7. 8. 9. DATE PERMIT I/Masterforms/OwnersAffidavitINov07