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I, agree to the provisions of this instrument. Je tf~' DJ:SCLOSlJRE STATEMENT FOR OWNER CJ:TY 01" ZEPHYRBJ:LLS BUJ:LDJ:NG DEPARTMENT Ct9 () L E yo have read and "fuJ.~y understand and The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own damici~e" that he or she actua~~y occupies, or wi~~ occupy by said damici~e, and same is not for rent, ~ease or sa~e. That he or she sha~~ comp~y with the fo~~owing conditions: ~. That the owner and he or she a~one sha~~ act as the bui~der for a~~ phases of construction. 2. That the owner wi~~ comp~y with a~~ provisions of the City of Zephyrhi~~s ordinances and codes pertinent to the bui~ding. 3. That in the event various phases of construction are subcontracted, he wi~~ engage o~y proper~y ~icensed subcontractors and wi~~ persona~~y supervise such work.. 4. That in the event theBui~ding J:nspector sha~~ require corrections to be made, the owner wi~~ assume fu~~ responsibi~ity to insure they are made, and upon comp~etion wi~~ ca~~ for a reinspection before proceeding with the bui~ding. 5. That the oWner sha~~ assume fuJ.~ responsibi~i ty for the construction and wi~~ not expect supervision of his work from the City of zephyrhi~~s Bui~ding Department. 6. That prior to fina~ inspection any additiona~ fees, inc~uding reinspection fees, must be paid in fu~~. A written request from this office shal~ constitute an official notice,to pay additiona~ fees. 7. That the owner shall comply with a~~ City, State and l"ederaJ. ~aws in regard to social security, workman's compensation, lien laws, etc., where applicable. 8. That the owner shal~ comp~y with a~l the safety codes issued by the F~orida J:ndustria~ Commission. 9. State ~aw requires construction to be done by ~icensed contractors. You have app~ied for a permit under an exemption to that law. The exemption a~~ows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a license. You must provide direct onsite supervision of the construction yourself. You may bui~d or impr~ea one-fami~y or two-fami~y residence or a far.m outbuilding. You may also build or improve a commercial bui~ding, provided your costs do not exceed $25,000. The bui~ding .or residence must be for your own use or occupancy. J:t may not be bui~t or substantial~y improved for sale or lease. J:f you sel~ or lease a bui~ding you have bui~t or substantially improved yourself within 1 year after the construction is comp~ete, the law wil~ presume that you built or substantia~ly improved if for sale or lease, which is a vio~ation of this exemption. You may not hire an un~icensed person to act as your contractor or to supervise peop~e working on your bui~ding. J:t is your responsibility to make sure that people employed by you have ~icenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all app~icable laws, ordinances, building codes, and zoning ~r gulations. OWNER'S SIGNATURE ~ DA'l'B I Z-- /,ohs r ADDRESS ~< 1; ScJl? { .&.2 /C" Rtf,' I f PHONE .r/3 -? p(""-- ~ 5"' r'7 WITNESS PERHJ:T #