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D2SCI,OSL7RE STATEMENT .FOR OWNER CZTY OF ZEPFiYiZHII�LS SVII+DSNG DEPARTi�NT _ • have read and fully understand and , agree •to the provisions of �this i.nstrument• .The undersigned .states and affirms that he or she is desirous of constructing, rex�ova�ting, adding to or seroofing his or her own domicile, •that he or she actually occupies, or svi11 occupy by said domicile, and same is not for •rent, lease or sale. That he or she shall comply with the following conditions: 1. That the owsier aad.he or she alone sha11 act as the buil.der for all phases of constsuction. 2. That the owner will comply with a11 provisions of the City of Zephyrhills ordinances and codes pertineat to the builcls.ag. 3. That in the event various phases of construction are subcontracted, he will en�age ozil.y •psopPSly liceased subcontractors and will personally sispervise such work. 4, That in the eveat the Building Inspector sha11 requ�.re correctioas to be made, the o�aner �vil1 assume full responsibility to ixisure •they are made, and upon completion will ca13 for a reinspectioa before proceeding with the building. 5, That the oovner sha11 assvme fu11 responsibility for the constrsiction and vTi11 not gxpact_ supervision of his work from the City of Zephyrhills Building Departmerit. 6. That prior to final inspection aay additional fees, including reinspection fees, must be paid ia full. A writtan requsst from this office sha11 constitute an official notice rto pay additiosia]. fees. . 7. That the owner sha11 comply with a11 City, 5ta.te and Federal laws in regasd to social sacurity, workman's compensation, lien laws, etc. , where applicable. 8. That the ovmer sha11 comply with all the safety codes issued by the Florida 2adustrial Commi.ssion. 9. State law re�,;res constrLiction to be done by licensed contractors. You have applied for a permit under an exemptioa to t�at law. The exemption allows you, as the owner of your property, to act as your owa contractor Fritfi ce*�-=;*+ restrictions even though you do not have a license. You must provide direct onsite supervision of the constructioa yourself. You may build or �.mprove a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial bvilding, provided your costs do xiot e�cceed $25,000. The building or residance must be for yovr own use or occupancy. It may not be built or substantially i�proved for sale or lease. If you sel.l or lease a building you have built or substasitially i�proved yovrself within 1 year after the constxuction is complete, the law will presume •t�at you built or substanti.ally improved •if for sale or lease, which is a violation of thi.s exe�ption. You may not hire an valic�nsad p2='soa to act as yovr contractor or to supervise people working on yovr bvilding. It is your responsibility to make sure that people employed by you have licenses rec�,;red by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for supervisi.ng work to a licensed contractor who is not. licesised to per£orm the work beiag doaa. Any person working on your building who is not licensed must work vnd�r your direct supervision and must be employed by you, which means that you must deduct E.I.C.A. and withholdiag tax and provide workers' compensation for that e�ployee, all as prescribed by law. Your construction must comply with a11 applicable laws, ord�siances, building codes, and zoning ra atioas. �- OWNER'S SIGLZATC7RE , Dp+'1'E C�'� — � � l� ADDRESS �� _ �j PHONE W2TNES5 PERMIT #