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• D2SCLOSLTR� S'r'A'f'�•M�'NT .FOR OWI�R CITY OF ZEPH7�tFi=I+LS Bt7II.�ING DEPARTA�NT 2� } /1Q�,�� /!17 have read arsd fully understand aad v agree •to the provisions of -this instzument• .The undersigned sta.tes and affirms that he or she is desisous of constructing, renovating, adding to or reroofing his or her oan domicile, •that he or she actually occupies, or wi11 occupy by said domicile, arsd same is not for •rent, lease or sale. That he or she shall comply vrith the followiing conditions: 1. Tl�at -the ov�raer aad�he or she alone sha11 act as the bui].der for al1 phases of construction. 2. That the owxier will comply with a17 provisions of �the City of Zephyrhills ord.inances and codes ��';nent to the build�.ag. 3. That in the enent various phases of' construction are subcontracted, he will Bngage orily •properly licensed subcontractors and will persozially supervise such work. 4, That in the event the Building Inspector shall rec�,;*-e corrections to be made, the owner vPill assume full responsibility to irisure •they are made, and upon completion will ca11 for a reinspection before proceed.ing with the building. b. That the owner sha11 assume fu11 responsibility for the const-sucti.on aad vTi11 not axpect_ suppsvision of his work from the CitY of' Zephyrhill� Building Depart�ent. 6. That prior to final ;n_�ction axiy additional fees, including r.eiaspection f'aes, must be paid ia full. A written requast from this office sha11 constitute an official notice -to pay additional fees• 7. That the owner sha11 comply vrith a11 City, State and Federal laws in regasd to social security, workmaa's compensation, lien laws, etc. , where applicable. 8. That the owner sha11 comply with all the safety codes issued b_y the Florida 2ndustrial Commission. 9. State 1aw rec�,;=es construction to be done by licensed contracitors. You have applied for a �*�+++;t under an eaemptiaa to that law. The exemption allows you, as the owner of your property, to act as your owa contsactor Frith certain restrictions even though you do not haQe a licease. You must _provide direct onsite supe=vision of the coastruction yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build ar improve a commercial bvilding, provided your costs do not exceed $25,000. The building or resideace must be for yovs own use or oceupancy. 2t may not be built or substantially i�proved for sale or lease. If you se1:l or lease a building you have bvilt or substantialZy improved yourself within 1 year after the construction is complete, the la�v �'ill prest�e �that you built or substantially i.�proved if for sale or l�ase, which is a violation of this exemption. You may not hire an unlicensed person t� act as your contractor or to supervise people aorking on your building. It is your responsibility to make sure that people e�ployed by you hane licenses rec�,;red by state law and by county or municipal liceasing ordi.nances. You may not delegate the responsibility for supervising v�ork to a licensed contractor who is not. licensed to perform the work beiag done. Ariy p�'son working c,ri your building who is not licensed must work under your direct supervision arxd must be 2�ployed by you, which meaas that you must deduct E.I.C.A. ancl withholding tax and provide workers' compensatioa for t�at employee, a11 as px�escr3.bed by law. Yous construction must comply with a11 applicable laws, ordiaances, building codes, and zoning regulatioas. � OWNER'S SIQ�;TURE ` R rI` �p+-T� _ I �(� -/ Z--- ADDRESS - PHONE W2TNE55 �•R►�TT #