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DJ:SCLOStJRE STATENENT FOR OWNER CJ:.TY OF -ZEPRY.R.BJ:LLS BUJ:LDJ:NG DEPARTMENT '-, rh,' J:,-;ll.l-'( t f/r /. Y'lv6W S have read and fuJ.~y understand and agree to. the provisiens ef this instrument. The undersi~ed states and affirms that he er she is desireus ef censtructing, renovating, adding to. er rereefing his er her ewn damicile~, that he er she actually eccupies, er will eccupy by' said demicile, and same is net fer rent, lease er sale. That he er she shall comply with the fellowing cenditiens,: 1. That the owner and he er she alene shall act as the builder 'fer all phases ef" censtruction. .2. That the owner will comply with all provisiens ef the City ef Zephyrhills ordinances and cedes pertinent to. 'the building. 3. That in the event varieus phases ef censtructien are subcentracted, he will engage enly properly licensed subcentracters and will persenally supervise such work., 4. That in the event the Building J:nspecter shall require cerrectiens to. be made, the owner will assume full respensibility to. insure the.y are made, 'and upen completien wili call fer a reinspectien befere preceeding with the building. S . That the oWner shall assume full. respansibi~i ty fer the censtructian and will nat expect supervisien af his Work from the City ef Zephyrhills Building Department. 6. That prier to. final inspection any additional fees, inclu~g reinspectien fees, must be paid in full. A written request from this effice shall constitute' an afficial notice, to. pay additienal fees. 7. That the owner shall comply with all City, State and Federal laws' in: regard to. secial security, werkman's comp ens ati an, lien laws, etc., wheret applicable. 8. That the owner shall comply with all the safety cades issued by the Flerida J:ndustrial Commissien. 9. State law requires canstructian to. be dane by licensed centracters. Yau have applied fer a pe:rmit under an exemptian to. that law. The exemption allows yau, as the owner ef yeur property, to. act as yaur own centracter with certain restrictians even though yeu do not have a license. Yeu must previde direct ansite supervisien ef the canstructian yeurself. Yau may build or improve a one-family ar two-family residence ar a farm autbuilding. Yau may also. "build er impreve a commercial building, pravidedyeur casts de net exceed $25,000. The building er residence must be fer yeur ewn use ar eccupancy. It may net be built ar, s~stantially improved fer sale ar lease~ J:f yeu s~l:er' lease a building yeti, have buil tersubstantially improved yo.ur.seif within, 1 year after the censtrQ,ctien is complete, the law will presume'thcLt yau built er substantially improved if far sale er lease, which is a vielatian ef this exemptian. Yeu may net hire an unlicensed persan to. act as yeur centracter er to. supervise people warlcing an yaur buil~g. It is yeur respensibili ty to. make sure that people employed by yeu have licenses required by state law and by ceunty or municipal licensing erdinances. Yau may net delegate the respansibility fer supervising wark to. a licensed centracter who. is net licensed to. perferm the werk being done. Any persen working en yeur building who. :i.s net l:i.censed must work under your direct superv:i.s:i.e:c. and must be empleyed by yau, which means that you must deduct F.I.C.A. and withholding tax and provide warkers' compensat:i.an fer that employee, all as prescr:i.bed by iaw. Your construction must co, ~,"Y".~/,p:: ;1-1, 7appl',Cable laws, ordinances, bu:i.lding :=:s~:~~~ regu /~/ DATE //~J?-c?h ' ADDRESS I L. J?HONE 5S 1'"3' - WI'l"NES S PElUC:T" #