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DI:SCLOStJRE STATENBNT FOR OWNER C::tTY 01" ZBP:BYXEJ:LIiS Bm:LDJ:NG DEPARTMENT J:, 1\1 fj fJ leY G ~ A RN ({5 have read and ful~y understand and agree 'to the provisions of this instrument. The undersigned states and affirms that he or she i:s desirous of constructing, renovating, adding to or reroofing his or her own domi.ci~e" that he or she actua.J.~y occupies, or wi~~ occupy by ~"^"?.j!J-said domi.ci~e,and same is not for rent, ~ease or sa.J.e. That he or she shal~ comp~y with the fo~~owing conditions,: ~. 'That the ow.c.er and he or she a~one shal~ act as the bu:i.~der for a~~ phases of, construction. :2. That the ow.c.er wi~~ comp~y with a.J.l provisions of the City of Zephyrhi~~s ordinances and codes pertinent to the bu:i.~ding. 3 . That in the event various phases of construction are subcontracted, he wil~ engage onJ.y proper~y ~icensed subcontractors and wi~~ personaJ.~y supervise such work., 4. That in the event the Bu:i.~ding J:nspector shall require corrections to be made, the owner wi~l assume fuJ.~ responsibi~ity to insureth~ are made, 'and upon comp~etion wi~~ cal~ for a reinspection before proceeding with the bu:i.lding. 5. That the oWner shal~ assume ful~ responsibi~i ty for the construction and wi~~ not expect supervision of his Work from the City of Zephyrhi~~s Building , Department. 6. That prior to final inspection any additiona~ fees, ~c~uding reinspection fees, must be paid in full. A written request from this office shal~ ,constitute' an officia2 notice. to pay additi~ fees. 7. That the owner sha~l comply with a~~ City, State and Federa~ laws' in regard to socia~ security, workman's compensation, lien laws, etc., where app~icable. 8. That the ow.c.er shal~ comp~y with all the 'safety codes issued by the Florida Industria~ Commission. 9. 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 ow.c.er 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-fami~y residence or a farm outbu:i.~ding. 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. J:t may not be bui~t or sUbstantia~ly improved for sale or lease. If you sell or lease a building you, have buil tor ,sUbstantial~y improved yourseif within 1 year after the construction is complete, the ~aw wi~l presUme 'th&t you built or substantial~y improved if for sa.J.e or lease, which is a violation of this exemption. You may not hire an~icensed person to act as your contractor, or to supervise p~op~e working on your building. J:t is your responsibility to make sure that people emp~oyed 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 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, which means that you must 'deduct !'.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by iaw. Your construction must comply wi th al~ appliccable laws, ordi:c.a:c.ces, building codes, and zoning a ions. OWNER'S ADDRESS PBONE DATE / WITNESS PER!C:T " #: