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D:ISCLOStIRE STATEMENT FOR OWNER C:tTY OF -ZEPRYRB:ILLS BtrJ:LDJ:NG DEPARTMENT :I, ( , have read and fuJ.J.y understand and agree to the -provisions of thi:s instrument. The undersigned states and affi:rms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicile ~,that he or she actually occupies, or will occupy by said domicile, and same is not for rent, J.ease or sale. That he or she shall comply with the :following conditions,: J.. That the owner and he or she alone shaJ.l act as the buiJ.der -for all phases of.. construction. :2. That the ownerwiJ.J. compJ.y with a.J.J. provisions of the City of ZephyrhilJ.s ordinances and codes pertinent to -the building. 3.. That in the event various phases of construction are subcontracted, he will engage onJ.y properJ.y J.icensed subcontractors and will personaJ.ly supervise such work.- 4. That in the event the BuiJ.ding :Inspector shaJ.l require corrections to be made, the owner wiJ.J. assume fulJ. responsibility to insure the.y are made, and upon compJ.etion wiJ.i caJ.J. for a reinspection before proceeding with the building. S. That the oWner shalJ. assume full responsibiJ.ity for the construction and wiJ.J. not expect supervision of his work from the City of ZephyrhilJ.s BuiJ.ding Department. 6. That prior to tinal inspection any additionaJ. fees, inCluding reinspection fees, must be paid in fulJ.. A written request from this office shall ,constitute' an officiaJ. 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. - 9. State J.aw requires construction to be done by licensed contractors. You have applied for' a pe:cnit under an exemption to that law. The exemption allows 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 build or impr~e -a one-family or two-family residence or a far.m outbuilding. You may also build or improve a commercial building, provided your costs do not exceed $25,000. The building or residence must be for your own use or occupancy. :It may not be built or. sUbstantialJ.y improved 'for sa.J.e or lease. :If you seJ.l ;or" lease a buiJ.ding yotihave buiJ.t orsUbstantia.J.J.y ~roved your.self within 1 year after the construction is complete, the J.aw will presume 'that you buiJ.t or substantially improved if for saJ.e or lease, which is a. violation of this exemption. You may not hire an unJ.icensed person to act as your contractor or to supervise people worJci.ng on your building. :It is your responsibiJ.ity to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibiJ.ity for supervising work to a licensed contractor who is not J.icen.sed to perfo:rm the Work being done. Any person working on your building who is not J.icensed must work under your direct supervision and must be empJ.oyed by you, which means that you must 'deduct F.I.C.A. and wi.thhoJ.ding tax and provide workers' compensation for that empJ.oyee, aJ.J. as prescribed by iaw. Your construction must compJ.y with aJ.J. appJ.i-cable laws, ordinances, buiJ.ding codes, and zoning regulat~ons. ' OWNER'S SIGNATURE ADDRESS PBONE: DATE r 7/ . ~ -' WJ:'l'NESS PERKI:T '. #: