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D:ISCLOStIRE STATEMENT FOR OWNER CJ:TY OF ZEPEtYIUt:ILLS BUJ:LDDrG DEPARTMENT :I, r7 I, G- hA e I '';2, rr> I-11ZC;)ve'F:6 ' have read and fuJ.~y understand and agree to the previsions of th:i:s instrument. The undersigned states and affirms that he or she :is desirous of construct:i.ng, renovating, adding to or reroofing h.:i.s or her own dom:i.cile~, that he or she actually occupies, or w:i.ll occupy by said dam:i.cile, and same is not for rent, ~ease or sale. That he or she shall comply with the :following conditions.: L That the owner and he or she alone shall act as the bu:i.lder .for all phases of.. construct:i.on. That the owner will comply with all provisions of the City of Zephyrh:i.lls ordinances and codes pertinent to -the bu:i.lding. That in the event various phases of construction are subcontracted, he w:i.ll engage only properly licensed subcontractors and w:i.ll personally supervise such work.. That in the event the Bu:i.lding :Inspector shall require corrections to be made, the owner will assume fullrespons:i.bility to insure they are made, and upon completion w:i.li call for a re:i.nspection before proceeding w:i.th the build:i.ng. That the oWner shall assume full respoDS:i.bi~ity for the construction and will not expect supervision of h:i.s work from the City of Zephyrh:i.lls Bu:i.ld:i.ng Department. That prior to final inspection any additional fees, including re:i.nspection fees, must be paid in full. A written request from this office shall ,constitute. an official notice. to pay additional fees. 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. That the owner shall comply w:i. th all the safety codes issued by the Florida :Industrial Commission. . State law requires construction to be done by licensed contractors. You have applied for a permit 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 d:i.rect onsite supervision of the construction yourself. You may bu:i.ld or improve .a one-family or two-family residence or a far.m outbuild:i.ng. You may also "build or improve a commercial bu:i.ld:i.ng, provided your costs do not exceed $25,000. The building or residence. must be for your own use or occupancy. :It may not be bu:i.lt or sUbstantially improvedf.or sale or lease. :If you s&ll ;or' lease a bu:i.lding yoti. have buil torsubstantia.J.ly :i.mproved yow:-seif. w:i. thin. 1 year after the construction is complete, the law will presUme'tha:t you built or substantially improved if for sale or lease, wh:i.ch is a. violation of this exemption. You may not h:i.re an unlicensed person to act as your contractor or to supervise people working on your bu:i.lding. :It is your respons:i.bili ty to make sure that people employed by you have licenses required by state law and by county or municipal licens:i.ng ord:i.nances. You may not delegate the respons:i.bility 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, wh:i.ch means that you must deduct F.:I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by iaw. Your construction must comply with all applicable laws, ordinances, building :=::::~~~~. .. .u " DATE /!hlo~ ADDRESS -5:1/0 / _ '~/ZEcECT<' l 1 FRONE '? Bc.>- V 617 '3 8/3 >; WITNESS 2. 3. 4. 5. 6. 7. 8. 9. r PEIUaT.. #