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_ DISCI.OSIIR$ STATS6'�L3T FOR O�PidSR ` �, � CITY OF ZSP8YI�HILL6 BIIILDINt3 DBPART�N'P _. have read and fn11y understand and agree to the provision.s of this iastrnmeat_ - � The undersigned states and affirme that he or she is deairous of coastructing, , reaovatiag, addirig to or resoofiag lsis or her owa domicile, that he or she ' actnally occupies; or �avill occupy by saa.d domicile, and same is not for rent, lease or sal.e_ That he or ahe shal.l comply with the followiag canda.tions: 1. That the owaer and he or she alone sSaZl act as the bnilder for all phases of construction.. - 2_ Tha,t the owaes �vill comply with aI.Z provisions of the City of Zephyrhills ordi.n.aaces aad codes pertineat to the bnildiag. 3. That ia the eveat various phases of coastruction ase subcontracted; .he ovill engage only properly licensed snbcoatractors aad mi7.I. personalZy, supervise such work: ' 4. That ia the event the Building Inspector shall require corsectioas to be made, the owner will assume full reapoasibility �o insnre they. are made, and upon completion will calZ foz� a reiaspection before prcceediag with the buildiag. 5. That the owner •shall assume full responsibility for the constructa.on and will aot expect supervision of his �vork from the City of �ephyrhills Bnilding Departmeat_ 6_ Tha.� prior to final inspection aay additional fees, including reinspection , feea, must be paid s.a, fiall_ A v�rittea reqnest from this office shall. constitute aa official aotice to pay addi.tional fees. 7. That the o�vaer sha].1 comply wi.th all C3.ty, State aad Federal lav�a ia regard to social. aecurity, wor3zmaa's compeasation, liea laais, eto., where applicable. S. That the owaer shall comp�y with all the safety codes iasued by the Florida Iadnstrial Commissioa. � 9. 3tate law requa.res construction to be done by licensed contractors. You have appl.ied for a permit under aa exemptioa to t,hat law. The exemptivn allows you, as the aatner of your propesty, to act as yonr owa contsactor wi.th certai.n restricti.ons evea. thongh yau do aot have .a license. You must psovide direct oasite supervisioa of the construction yourselE. Yon may bui.ld or improve a one-family or t�ro-fam:i.ly resideaae or a farm outbuildiag. You may also bwi.ld or improve a commercial buildiag,� provided your costs do not exceed $25,000. The buildiag or resa.dence mnst be for your owa use or occupaacy. It may not be built or substantially improved for eale or lease_ Sf you sell or leaee a � _buildiag you have bsai.lt os substaatially impsoved yourself -within I year after the constructioa is complete, the law will preat�e tlzat you built or snbstautially improved if £or sale or lease, which is a violatioa of this _ E'Semp�-a.oa. You may not hire aa �saliceased persoa to act as yonr coatractor or to supervise peaple morkiag on your bu�.ldi.ag_ It is your respoasibility �o make snre that peaple emiployed by you have licenses sequired by atate law and by county or muaicipal licensing O=dinanng8. You may-not delegate t]ie respansibility £or B�ervising v�ork to a licensed contractor who is aot licensed to perform the �vosk beiag done. Aay persoa working on your builc3ing _ - who is nct licensed must work under your direct s�ervision and must be employed by you, which means that yon must dednct F.I.C.A. aad v�ithholdi.ag tax and proqide workers' co�pensatioa far that employee, alI as preacribed. by lav�_ I Yaur construction must compl wi.th a].Z applicable laws, ordi_a.ances, bniZdi.ng codes, aad zoniag regnla ' . ' OWNSR•S SIG1�TiJRS DBTS �—/�p—f.� ADDRBSS �3'fD Mal��hif� 7�►"., � v�hNrl��'1/� 335�[7� PEtoNS n?0?- ,?_ 5l8 � WITNSSS• p�T # ` �O S Z I ' -