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CONDITIONS OF PERMIT AFFIDAVIT . A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be may be more restrictive than City regulations. The compliance with any applicable deed restrictions. B. 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 City of Zephyrhills Building Department, 813-788-6611. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "Contractor SectionsH of this application for which they will be responsible. If you, as the owner signs as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that may be an indication that he is not properly licensed and is not entitled to permitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided with a copy of "Florida's Construction lien Law - Homeowner's Protection GuideH prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other that the "ownerH, I cerify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "ownerH prior to commencement. E. 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, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governmental 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 Regulation-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 *U.S. Environmental Protection Agency-Asbestos abatement I also certify that, if fill material is to be used in Flood Zone "AH or "A,etc.H, it is understood that a drainage plan addressing a "compensating volumeH will be submitted which is prepared by a professional engineer registered in the State of Florida prior to permit issuance. 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 requi~ing a correction of errors in plans, construction, or violations of any code. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of issuance, or if work authorized by the permit is suspended or abandoned for a period of six months after the time the work is commenced. One 90 day extension of time may be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An approved inspection must be logged during each six month period, or the project will be 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 OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENTH. iJ 11 ro / 1tff --d<< SIGNA: U : OWNER OR AGENT STATE OF FLORIDA DA~ COUNTY OF ~LO The foregoing instrument was acknowledged Before me this ~ day of NOV~Mf)(i~ >>2.tb ( by ~~ (nameqof person acknowledged) ~o is personally known to me, or subject to "deed restrictionsH which undersigned assumes responsibility for SI~~&TAAtZ ~ PAS L 0 STATE OF FLORIDA COUNTY OF The foregoing instrument was a~~~~edged Before me ~his -ffii;Jay of Mvl/lYl(Y w, ~ 2IJo ( by c1:fft; /- ~~(name of person acknowledged) ~ho is personally known to me, or o who has produced (type of identification) and whoD did [H-did not take an otlth. ~ 4, Od~ Signature of person taking acknowledgement o who has produced (type of identification) and who Ddid ~not take an oath ~A.~ Signature of person taking acknowledgment C3fl-Uc€' A, A~f5I;L- Name typed, printed or ~~~A~ CC74f!1S11 ~a- *M'I commIlSiOI' *.WJ.r exp\r8I J\II'l8 22, 21)02 ~'tlf'" [3fl-UCct /l. It 5 BEL Name typed, printed B~KJi,Nlped ~M'I Commission CC74ee77 ~_j' expires June 22. 2002 ... If "