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DJ:SCLOStr.R.E STATEMENT FOR OWNER CITY OF ZEPRYRBJ:LLS BtJJ:LD:ING DEPARTMENT I, 'w / I F/-c:-J R agree to the provis:i.ons of q-" Ne ~ this instrument. have read and ful~y understand and The undersig:l:l.ed states and affinns 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 domici~e, and same is not for rent, ~ease or sa~e. That he or she shal.l comply with the following conditions,: ~ . That the owner and he or she a1.one sha.J.l act as the builder for a~l phases of" construction. :2. That the owner will. comply with all provisions of the City of Zephyrhills ordinances and codes pertinent to "the building. 3 . That in the event various phases of construction are subcontracted, he wil.l engage onl.y properly l.icensed subcontractors and will personally supervise such work., 4. That in the event the Buil.ding J:nspector shal.l require corrections to be made, the owner will assume full responsibility to insure they are made, 'and upon completion wili call for a reinspection before proceeding with the building. S. That the oWner shall assume full responsibi~ity for the construction and will not expect supervision of his Work from the City of Zephyrhills Building Department. 6. That prior to final inspection any additional fees, fncl.uding reinspection fees, must be paid in full.. A written request from this office shall ,constitute' an official notice. to pay additional fees. 7. That the owner shall comply with all City, State and Federal l.aws' 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 law requires construction to be done by l.icensed 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 direct onsite supervision of the construction yoursel.f. You may build or improve ,a one-famil.y or two-family residence or a fa.r.m outbuilding. You may also 'build or improve a commercial bU:Ll.ding, provided your costs do not exceed $25,000. The building or residence must be for your own use or occupancy. J:t may not be built or, s~stantially improved 'for sale or lease. If you s&ll ;or' lease a building you,have builtorsubstantia1.ly .improved yourself within: 1. year after the construction is complete, the law will presUme 'that you built or substantially improved if for sale or lease, which is a, violation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise people world.ng on your building. J:t is your responsibility 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 responsibility for supervising work to a licensed contractor who is not l.icensed to perfoJ:1ll the work being done. Any person working on your building who is not 1.icensed must work under your direct supervision and must be emp1.oyed by you, which means that you must deduct P. J:. C.A. and wi thho1.di.ng tax and provide workers' compensation for that employee, a1.1. as prescribed by law. Your construction must comply with all. appli'cable laws, ordinances, building =:::~::r;)~@.. ~ DATE /<2-2-07' ADDRESS :3877(, Va I .IV ; . ~C ' ~ G-l-t1v..e. PRONE ?I..:~ - "'"1 - I '3 t. j , ' WJ:TNESS PERMJ:T # (,,~ q f