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� nxscr.osc� S'�'A'�•�•NT .FOR OWI�R C2TY OF ZEPEiYR132I�LS BUILD2NG DEPARTMENT I, � O� t ('� �o NA have read and fv11y understand and agree to the provisions oP �th�.s instrum�t. The undersigned states and a.ffirms that he or she is desirous of constructing, renovating, adding to or seroofing his or her own domicile, •that he or she actually occupies, or wi11 occupy by said domicile, and same is not for •rent, lease or sale. That he or she shall comply with the f'ollowing conditious: 1. That the owriar and_he or she alone sha11 act as the builder for a11 phases of construction. . 2. That the ov�ner w3:11 comply with a1'1 provisions o£ �the City of Zephyrhil'ls ordinances and codes pertinent to the buildiag. 3. That in the event various phases of construction are stsbcontracted, he wi11 engage only •properly licensed subcontractors and will personally supervise such vrork. 4. That in the event the Hui.lding Inspector shall rei,;Te corrections to be made, the owner o�ill assume full responsibility to iasure •they are made, aad upon completion will ca11 for a reixispectioa be£ore proceeding arith the building. 5. That the ooaner sha11 assume fu11 responsibility for the constsuction aad wi11 not expect_ supervision of his work from the City of Zephyrhills Building Department. 6. That prior t� firial inspection any additional £ees, including reinspection feas, must be paid ia full. A written request from this office sha11 constitute an official notice -to pay add:itioaal fees.. 7. That the owner sha11 camply with a11 City, 5tate and Federal laws in =ega.rd to social security, workman's compensatioa, liesz 1aFrs, etc. , where applicable. B. That the owner sha11 comply �vith a11 the safe.ty codes issued by the Florida Industrial Commission. 9. State 1aw ree+,;*-es construction to be done by licensed contractors. You have applied for a pexmit under an exemptioa to that law. The exemption allows you, as the owner of your property� to act as your own contractor with cer�=;T restsictions even though you do not ha.ve a license. You must provide direct onsite supervision of the coastructioa yourself. You may build or improve a one-family or two-family resideace or a farm outbuilding. You may also build ar improve a commerci.al building, provided your costs do not exceed $25,000. The building or resideuce must be for yovr own use or occupancy. It may not be l�uilt or substaati.ally �.�proved for sale or lease. If you se1:l or lease a building you bave bvilt or substantially improved yourself withia 1 year after the conststictioa is complete, the law wi.11 pres�e �that you built or substantially improved •if for sale or laase, which is a violation of this exemption. You may not hire an unlicensed person to act a"s yovr contractor or to supervise people working on your build,iag. It is your responsibility to make sure that people employed by you have licesises rez,;red by state law and by county or muui.cipal liceasi.ng ordiaaaces. You may not delega.te the responsibility for supervising work to a licensed contractor �rho is not licensed to perform the ovork bgisag dona. Asiy parson working ori yovs building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.=.C.A. and withholding tax and provide workers' compensation for that employee, a11 as prescribed by law. Your construction must co ly with 1 applicable laws, ordiriaaces, building codes, and zoning regul OWNER' S S2�/'►'��F ' �`� � fln�r�^ ADDRESS Sl S .� -_ PHONE " — W2TNESS PERL�T #