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<br />STATEHENT OF FACT
<br />BY OWNER DESIRING TO CONSTRUCT
<br />HIS OWN RESIDENCE
<br />
<br />STATE OF FLORIDA
<br />CITY OF ZEPHYRHILLS
<br />
<br />Before me this day personallY appeared! ,;;' ~ /-;~
<br />who, being duly sworn, deposes and says as follows: II I have n~ad
<br />and fully understand the provisions of this instrument.1I
<br />
<br />The undersigned states and affirms that he or she is desirous of
<br />constructing his or her own domicile, that he or she actually occupy,
<br />or Ylill occupy said domicile, and that he or she shall comply ,-,'ith
<br />the folloYling conditions:
<br />
<br />1. That the owner and he alone shall act as the builder for all
<br />phases of construction.
<br />2. That the owner will comply with all provisions of the City
<br />of Zephyrhills ordinances and codes pertinent to the build-
<br />_ ing.
<br />3. That in the event various phases of construction are sub-
<br />contracted, he will engage only properly licensed subcon-
<br />tractors and will personally supervise such Ylork.
<br />4. That in the event the Building Inspector shall require
<br />corrections to be made, the owner Ylill assume full re-
<br />sponsibility to insure they are made, and upon completion
<br />Ylill call for a reinspection before proceeding Ylith the
<br />building.
<br />5. That the owner shall assume full responsibility for the
<br />construction and will not expect supervision of his work
<br />from the City of Zephyrhills Building Department.
<br />6. That prior to final inspection any additional fees, in-
<br />cluding reinspection fees, must be paid in full. A written
<br />request from this office shall constitute an official notice
<br />to pay additional fees.
<br />7. That the owner shall comply with all City, State and Federal
<br />laws in regard to social security, workman's compensation,
<br />lien laws, etc., where applicable.
<br />8. That the owner shall comply with all the safety codes issued
<br />by the Florida Industrial Commission.
<br />
<br />The undersigned further agrees that he shall, should he be u,nable to
<br />comp 1 Y "it h the above requ i r emen t a. hire a licensed bu 11d ing con t roc tor
<br />to take over and complete the job in strict compliance with the City
<br />of Zephyrhills' Building Codes.
<br />
<br />SWORN TO AND;YBSCRIBE~BEF09'.R
<br />ME l1ilS d?C, DAY OF -'.(ffi--t/ '
<br />19 _.iL' -"7
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<br />~0TAR';' PUBLIC " . ,
<br />f,TAl.'E OF FLORID[\ Ai~qt~~; ftf/' .....
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<br />cii:r;d' Ii. M. J
<br />er's Signature
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<br />BUILDING
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