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"'~:;.:".~;:::;::;Z;.;.:,' " "':".." ':';'~.':: )::,.><,:,:.-,,"'.,,;,:'- ,;.:.~,,,..,,: ,:". "-~:O-~'____~"-~=~':- -.~~~>. ",,","~'-.....-..;=-"'~""""''' ,.-'- -'._,->.' .". - ......,. ---~'''' STATEMENT OF FACT BY OWNER DESIRING TO CONSTRUCT HIS OWN RESIDENCE STATE OF FLORIDA CITY OF ZEPHYRHILLS Before me this day personally appeared (! J,f/l/f L /?S who, being duly sworn, deposes and says as follows: "I and fully understand the provisions of this instrument." (] 0 cD c,u have read The undersigned states and affirms that he or she is desirous of constructing his or her own domicile, that he or she actually occupy, or will occupy said domicile, and that he or she shall comply with the following conditions: 1. That the owner and he alone shall act as the builder for all phases of construction. 2. That the owner will comply with all provisions of the C:lty of Zephyrhills ordinances and codes pertinent to the build- _ ing. 3. That in the event various phases of construction are sub- contracted, he will eng~ge only properly licensed subcon- tractors and will personally supervise such work. 4. That in the event the Building Inspector shall require corrections to be made, the owner will assume full re- sponsibility to insure they are made, and upon completion will call for a reinspection before proceeding with the building. 5. 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. 6. That prior to final inspection any additional fees, in- cluding reinspection fees, must be paid in full. A written request from this office shall constitute an official notice to pay additional fees. 7. 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. 8. That the owner shall comply with all the safety codes issued by the Florida Industrial Commission. The undersigned further agrees that he shall, should he be unable to comply with the above requirements, hire a licensed building contractor to take over and complete the job in strict compliance with the City of Zephyrhills' Building Codes. SWORN T0 fu~0 S~BSCRIBED BEFORE HE THIS c5J(~ DAY OF Lhu. , 19 gL. i2P~AT. ~'~'N PUBLIC STATE OF FLORIDA AT LARGE (SEAL) {y~~ H~ Owner .' Signature 31lt> k~~. ~o1J.~-,. (J~tl~ 1J2 Address ~~~~- BUILDING PERMIT NUMBER NOTARY PUBLIC, ST.I\ TE OF~ ~lO~I~~!\ Mycomm'ccion r.v,'.'cs ."". '. }--'_.') i30ndtrj t::r.. P t~ "-