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Frorri: 49!�8!2075 70:49 #4�4 P.041 � ` I � DISCIASETRB STATSaiBk]�P FOR 04�NER - CITX OF ZSPHYRHILLS BIIILDINC� DSPARTMBNT Y, C� ,Q,�,��CU-v y� Faaz� read and fully uadarstand aad agree to the provisiona of thia inatrumeat. The uaderaigaed atates aa8 affirme that he or ehe ie deairoua of conatructing, • renovating, addiag to or reroofiag his or her owa domicile, that he or ehe actually occupies, or will occupy by esid domiaile, aad eame ia not for reat, lease or saZe. That he or she shall coiap].y with the followiag conditione: 1. That the_owaer aad he or she aloae shall act as the builder tor all phasea of coastruction. 2. That tha ownes wi11 comply with ali provi�ions of the Ciby oP Zeghyrhilla ordiaances aud aodes gertiaeat to the buildfag. 3. That ia the eveat various phases of coastruction are aubcontracted, he wi11 engage oniy properly liceasad aubcontractors aad will peraonally superviae such work. 4, Tha� ia the event the Building Inspector ahall reguire correctioae to be ma8e, the owaer will aesume full responsibility to iaeure �hey are made, aad upon completioa will call for a reinepectioa before proceediag with the buildiag. 5. That the owuer eha11 aseume full reapoasiliility for the coaetructioa and wiil aot expect supez�visioa of hie work �rom the City og Zephyrhills Suildiag Depastsnent. 6. That psior to final inepection aay additioaal fee�, including reinapectioa feeB, muat be paid in gull: A writtea requeet from this ofgice ehall coastitute an o£tfcial aotice to pay additiional fees. 7. That the owaer ahall comply aith all City� State amd Federal laars ia regard to social security, workman's compansation, liea lawa, etc. , svhsre apgliaable. T 8. That the owaer ehall comply with all the eafaty codes issued by the Florida 2nduBrrial Cammisaion. 9. State law reguires coa�tructioa to be 8one by licenaed coatractora. You have applied for a permit uader aa exemptioa to that la�v. The exemption allows you, as the ovmer of your property, to act aa your rnva contractor with certaia restrictioas even though you do aot have a licenee. You sauat provide direct oasite aupervision ot the constzvction yourself. You may build or improve a oae-femily or two-family reaideace or a fano outbuilding. You may also build or improve a commnrcial buildiag, proviSed yaur eo�� do not �xcss8 $75,000. The building or re�idea.ce must be for your owa uee or occupaacy. It may not be built or subetaattally improved !or eale or leaae. I� you eelZ or leaee a buildiag you ha.ve built or substanbially improved yourself wi.thia 1 year after the coaetruction is complebe, the laa will preeume that you built or aubetaatially improved if fos eale or lease, which is a violation of thi.s exemption. You anay aot bire aa unl3cenaed peraoa to act as your coatractor or to euperviee peopZ• workiag oa your buildiag. It ia your responaibiT,i�y to make eure that people em�ioyed by you have licenses rec�ired by atate law and by couaty os muaicipal licensiag ordinaacea. You may aot delegate the reaponsibility for supervisiag work to a licease8 contractor aho ie not liceased to perform the �rork beiag doae. IAay pereoa svorkiag on yous building •vho ie not licenaed muet work uader your direct auperviaion aad must be employed by you, which meaas that you muar 8educt F.I.C.l�i. aad wi.thholdiag tax and prrnride workers' co�pensation for that employee, all ae pzescr3bed by law. Your conetruc�ioa must comply ovith all applicable lawa, ordinaacee, buildiag codea, end zoniag ragulatione. � / OWH$R'3 SIGNATIIRE^I 4/ `""`�"^� DATL ��5 annt�ss oa� ka r ,^. ' � ; � ►-- �. Paor� I 3 - S _ 3 I ws�xgss � psRruT # 6�v�