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11-12663
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11-12663
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Last modified
6/20/2012 2:43:12 PM
Creation date
6/20/2012 2:42:33 PM
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Building Department
Company Name
SLEEPY HOLLOW MH SUB DIV
Building Department - Doc Type
Permit
Permit #
11-12663
Building Department - Name
MALINOWSKI,JOHN 7 JACQUELINE
Address
38701 REMORA AVE
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' ' DISCLOSURE STATEMENT FOR OWNER <br /> CITY OF ZEPHYRHILLS -.BUILDING DEPARTMENT <br /> <� 1' <br /> �, .� r1. .[� K� have read and fuliy understand and agree to the <br /> provisions of this instrument. <br /> The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or <br /> reroofing his or her own domicile, that he or she actually occupies, or wili occupy by said <br /> domicile, and same is n.ot for rent, lease or sale. That he or she shall comply with the following <br /> conditions: <br /> 1. That the owner and he or she alone shall act as the builder for all phases of construction. <br /> 2. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes <br /> pertinent to the building. <br /> 3. That in the event various phases of construction are subcontracted, he will engage only <br /> properly licensed subcontractors and will personally supervise such work. <br /> 4. That in the event the Building Inspector shall require corrections to be made, the owner will <br /> assume full responsibility to insure they are made, and upon completion will call for a <br /> reinspection before proceeding with the building. _ <br /> 5. That the owner shall assume full responsibility for the construction and will not expect <br /> supervision of his work from the City of Zephyrhills Building Department. <br /> 6. That prior to final inspection any additional fees, including reinspection fees, must be paid in <br /> full. A written request from this o�ce shall constitute an official notice to pay additional fees. <br /> 7. That the owner shall comply with all City, State and Federal laws in regard to social security, <br /> workman's compensation, lien laws, etc., where applicable. <br /> 8. That the owner shall comply with all the safety codes issued by the Florida Industrial <br /> Commission. <br /> 9. State law requires construction to be done by licensed contractors. You have applied for a <br /> permit under an exemption to that law. The exemption allows you, as the owner of your <br /> property, to act as your own contractor with certain restrictions even though you do not have <br /> a license. You must provide direct onsite supervision of the construction yourself. You may <br /> build or improve a one-family or two-family residence or a farm outbuilding. You may also <br /> build or improve a commercial building, provided your costs do not exceed $75,000. The <br /> building or residence must be for your own use or occupancy. It may not be built or <br /> substantially improved if for sale or lease, which is a viofation of this exemption. You may not <br /> hire an unlicensed person to act as your contractor or to supervise people working on your <br /> building. It is your responsibility to make sure that people employed by you have licenses <br /> required by state law and by county or municipal licensing ordinances. You may not delegate <br /> the responsibility for supervising work to a licensed contractor who is not licensed to perform <br /> the work being done. Any person working on your building who is not licensed must work <br /> under your direct supervision and must be employed by you, which means that you must <br /> deduct F.I.C.A. and withholding tax and provide worker's compensation for that employee, all <br /> as prescribed by law. Your construction must comply with all applicable laws, ordinances, <br /> building codes, and zoning cegulations. <br /> OWNER'S SIGNATURE 1 DATE / o� v � / <br /> ADDRESS _ �� •— � <br /> PHONE � •— � <br /> WITNESS � c � <br /> '� PERMIT <br /> UMasterForms/OwnersAffidavit/Nov07 <br />
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