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<br />DJ:SCLOStr.RE STATBHBNT FOR OWNER. <br />CJ:TY OF ZEP:a:YRBJ:LLS Bt1J:LDJ:NG DEPAR'l'HBN'l' <br /> <br />J:, CAi(I<.Y k/tI)t-- have read and fully understand and <br />agree to the provisions of this instrument. <br /> <br />The undersi9t:l.ed states and affi:rms that he or she is desirous of constructing, <br />renovating, adding to or reroofing his or her own domicile" that he or she <br />actually occupies, or will occupy by 'said domicile, and same is not for <br />rent ,lease or sale. That he or she shall comply with the following conditions,: <br /> <br />1. <br /> <br />That the owner and he or she alone shall act as the builder for all phases of, <br />construction. <br />That the owner will comply with all provisions of the City of Zephyrhills <br />ordinances and codes pertinent to the building. <br />That in the event various phases of construction <br />engage only properly licensed subcontractors and <br />such work., <br />That in the event the Building J:nspector shall require corrections to be made, <br />the owner will assume full responsibility to insure they are made, and upon <br />completion will call for a reinspection before proceeding with the building. <br />That the oWner shall assume full responsibi~ity for the construction and will <br />not expect supervision of his work from the City of zephyrhills Building <br />Department. <br />That prior to final inspection any additional fees, including reinspection <br />fees, must be paid in full. A written request from this office shall <br />. constitute' an official notice. to pay additional fees. <br />That the owner shall comply with all City, State and Federal laws in regard to <br />social security, workman's compensation, lien laws, etc., where applicable. <br />That the owner shall comply with all the safety codes issued by the Florida <br />Industrial Commission. <br />State law requires construction to be done by licensed contractors. You have <br />applied for a permit under an exemption to that law. The exemption allows <br />you, as the owner of your property, to act as your own contractor with certain. <br />restrictions even though you do not have a license. You must provide direct <br />onsite supervision of the construction yourself. You may build or impr~vea <br />one-family or two-family residence or a farm outbuilding. You may also build <br />or improve a commercial building, provided your costs do not exceed $25,000. <br />The building or residence must be for your own use or occupancy. It may not <br />be built or sUbstantially improved for sale or lease. J:f you sell or lease a <br />building you have built or substantiallY improved yourself within 1 year after <br />the construction is complete, the law will presumeth4t you built or <br />substantially improved if for sale or lease, which is a violation of this <br />exemption. You may not hire an unlicensed person to act as your contractor or <br />to supervise people working on your building. It is your responsibility to <br />make sure that people employed by you have licenses required by state law and <br />by county or municipal licensing ordinances. You may not delegate the <br />responsibility for supervising work to a licensed contractor who is not <br />licensed to perform the work being done. Any person working on your building <br />who is not licensed must work under your direct supervision and must be <br />employed by you, which mea.ns that you must deduct F.I.C.A. and withholding tax <br />and provide workers' compensation for that employee, all as prescribed by law. <br />Your construction must comply with all applicable laws, ordinances, building <br />codes, and zoning re~ations. <br /> <br />OWNER'S SIGNATURE ($ 1."-'7 /~."'" <br />ADDRESS 3GB 'Ie (JAIl) /.1<-,-:;' / y <br />PHONE '(fJ3 71;. 1<j~.3 <br /> <br />2. <br /> <br />3. <br /> <br />are subcontracted, he will <br />will personally supervise <br /> <br />4. <br /> <br />5. <br /> <br />6. <br /> <br />7. <br /> <br />B. <br /> <br />9. <br /> <br />DATE 62. 10"1/ c 7 <br /> <br />r <br /> <br />WITNESS <br /> <br />PERMIT #: <br />