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� n2sczosvx� STATEMENT .FOR OWNER CITY OF ZEPHYRFiT.SLS BVII.D2NG DEPARTD�NT 2 /��H�� S��R�� have read and fully understand and agrae •to the provisions of �this instrument. .The undersigned .states and affirms that he or she is desirous of constnicting, renovating, adding to or seroofing his or her own domicile, •that he or she actually occupies, or �i11 occupy by said domici:le, and same is not for •rent, lease or sa1e. That he or she sha11 co�ply with the following conditions: 1. That the owner and_he or she alone sha11 act as tlze bu.il.der for a11 phasas of constsuction. 2. That the owner will comply with a11 provisions of the C.ity of Zephyrhills ordinances and codes pertineat to the buildiug. 3. That in the enent various phases of construction are subcontracted, he vrill engage only �properly licensed subcontractors and will personally supervise such work. 4. That in the event the Huilding Inspector sha11 rec�"re corrections to be made, the ov�rner will assume full responsibility �to insure •they are made, and upon completion wi11 cal3 for a reiaspection before proceeding with the buildYng. b. That the owner shall assume fu11 responsibility for the consts-�actioa aad wi11 not expect_ supervision of his work from the City of Zephyrhills Building Depart�mer�.t. 6. That prior to final inspection aay adcL'itional fees, including reiaspection faes, must be paid ia fu11. A writtea raquast from this off'ice sha11 constitute an official aotice -to pay adclitional fees. 7. That the owner sha11 comply with a11 City, State and Federal laws in regard to social securi-ty, workmaa's compensatioa, lien laws, etc. , where applicable. B. That the owner sha11 comply with all the safety codes issued by the Florida Industrial Cammission. 9. State 1aw ree+,;res construction to be done by licensed contractors. You have applied for a ��;t under an exemptioa to that law. The exemption alloFrs you, as the owner of yovr property, to act as your own contractor with certain restsictions even though you do not have a license. You must provide direct onsite supervision of the constxlzctioa yoursel£. You may build or improve a one-family or two-family resid@nce or a farm outbuilding, You may also build or i.mprove a aommercial building, provided your costs do aot eaceed $25,000. The building or residence must be for yovr own use or occupancy. 2t may not be built or substantially �.mproved for sale or lease. If you se1:l or lease a btiilding you have built or substaatially improved yourself within 1 year after the constxuction is ca�plete, the lax wi.l1 pres�e •that you .bui.lt or substantially a.mproved if for sale or laase, which is a violation of th�.s exemptioa. You may not hire an unlicenssd person to act a"s your contractor or to supervise people working on your building. It is your responsibility to make sure that people employed by you have licenses rez,;red by state law and by county or municipal liceasiag ordinances. You may not delegate the responsibility for supervisa.ng work to a liceased contractor who is not. licensed to perform the work being doaa. Aay person working or. your building who is aot licensed must work under your direct supervisioa and must be employed by you, which maans that you must deduct F.2.C.A. axid withholdiag t== and provide workers' compeasation for that employee, a11 as prescri.bed by law. Your construction must comply avith a11 applicable 1aws, ordinances, building codes, and zoning regulations. owr�R�s sz�� U�(, `�� `o1�U DA�,.� � •-l?-2012 ADDRESS $I1{-�j �1QST S'(' 2EPkhY(�.NlLLS � �F'L PxoxE �s�� - �bb- 3ot�d W=TNESS PERMIT #