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The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicile" that he or she actua11y occupies, or wi11 occupy by said damici1e, and same is not for rent, 1ease or sale. That he or she sha11 comply with the f0110wing conditions: 1. That the owner and he or she a10ne shall act as the builder for al1 phases of construction. 2. That the owner wi11 comp1y with a11 provisions of the City of Zephyrhi11s ordinances and codes pertinent to -the bui1ding. 3. That in the event various phases of construction are subcontracted, he will engage on1y proper1y licensed subcontractors and will persona11y supervise such work.. 4. That in the event the Building Inspector sha11 require corrections to be made, the owner will assume full responsibility to insure they are made, and upon comp1etion will ca11 for a reinspection before proceeding with thebui1ding. 5. That the owner shal1 assume full responsibi1ity for the construction and wil1 not expect supervision of his work from the City of Zephyrhi11s Bui1ding Department. 6. That prior to fina1 inspection any additiona1 fees, including reinspection fees, must be paid in ful1. A written request from this office sha11 constitute an officia~ notice. to pay additiona1 fees. 7. That the owner sha11 comp1y with all City, State and Pedera1 laws. in regard to social security, workman's compensation, 1ien 1aws, etc., where app1icab1e. 8. That the owner shal1 comp1y with al1 the safety codes issued by the P10rida Industrial Commission. 9. State 1aw requires construction to be done by 1icensed contractors. You have app1ied for a pexmit under an exemption to that 1aw. The exemption al10ws you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a 1icense. You must provide direct onsite supervision of the construction yourse1f. You may build or impr~ea one-fami1y or two-fami1y residence or a far.m outbuilding. You may a1so bui1d or improve a commercial bui1ding, provided your costs do not exceed $25,000. The building .or residence must be for your own use or occupancy. It may not be bui1t or substantia11y improved for sa1e or 1ease. If you s&a1 ;or 1ease a bui1ding you have built orsubstantia11y improved yourself within 1 year after the construction is complete, the 1aw will presume that you built or substantially improved if for sale or 1ease, which is a vi01ation of this exemption. You may not hire an un1icensed person to act as your contractor or to supervise peop1e working on your bui1ding. It is your responsibility to make sure that people employed by you have licenses required by state 1aw and by county or municipal 1icensing ordinances. You may not delegate the responsibility for supervising work to a 1icensed contractor who is not 1icensed to perfor.m the work being done. Any person working on your building who is not 1icensed must work under your direct supervision and must be emp10yed by you, which means that you must deduct P.J:.C.A. and withh01ding tax and provide workers' compensation for that emp10yee, a11 as prescribed by 1aw. Your construction must comp1y with al1 applicable 1aws, ordinances, bui1ding codes, and zoning r gulat10 OWNER'S ADDRESS PHONE DATE c2- 3--66 r WITNESS PERKtT #