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n2sczosv� S'�'�'�'F�•NT .FOR (7WNER CZTY OF ZEPHYRHII:ZS BIIII�D2NG DEPAQ'�'M�'NT = have read and fully understand and , agree •to the provisions of �'rhis instrume�t. The undersigned sta.tes and affirms that he or she is desirous of constructing, resiovating, adding to or reroofing his or her own domicile, •that he or she actually occupies, or will occupy by said domici:le, and same is not for •rent, lease or sale. That he or she sha11 comply with the followi:ng conditions: 1„ That the owner and�he or she alone sha11 act as the builder for a11 phases of constructton. � 2. That the owaer will comply with a.11 provisions of �the City of Zephyrhills ordinances and codes pertinent to the building. 3. That in the enesit various phases of construction are subcontracted, he will en�age only �properly licansed subcontractors and will perscnally supervise such work. 4. That in the event the Huilding Inspector sha11 rec�'�re corrections to be made, the owner wi11 assume full responsibility to insure •they are made, and upon co�pletion will ca13 for a reinspection before proceeding with the building. 5. T2iat the owner sha11 ass�e fu11 responsibi.lity for the constsuction aad v�i11 not axpect_ supervision of his work from the City .of Zephyrhills Building Depastme.rtt. 6. R'hat prior to final inspection any additional fees, including reinspection fess, must be paid in full. A writtan requast f'rom this office sha11 constitute an official notice -to pay additional fees. 7. That the owner sha11 comply with a11 City, 5tate and Eederal laws in regard to social security, workman's compensation, lien 1aws, etc. , where applicable. 8. That the ownps shal.l comply with a11 the�safety codes issued by the Florida Industrial C��ssion. 9. State 1aw re�,;res construction to be done by licensed contractors. You have applied for a permit under axi exemptioa to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a license. You must provide direct onsite supexvision of the construction yourself. You may build or i�prove a one-family or two-family residence or a fasm outbuildiag. You may also build or improve a commercial building, provided yovr costs do not exceed $25,00�. The building or residance must be for your own use or occupancy. It may not be built or substantially improved for sale or lease. If you se]:l or lease a bvildi.ng you have built or substantially improved yourself within 1 year after the constrtictioa is complete, the law will pres�e �that you built or substantially improved •if for sale or lease, which is a violation of this ex�ption. You ma.y not hire an unlicensed pErson to act as your contractor or to supervise people working on your buildiag. It is your responsibility tc make sure that people employed by you have licenses rez,;red by state law and by county or municipal licansing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not. liceased to perform the work being doae. Any person working on your building who is not licensed must work under yovr direct supervision and must be P�ployed by you, which means that you must dQduct F.=.C_A. and witllholding tax and provide workers' compensatioa for that employee, a11 as prescribed by law. Your constsuction must comply with a11 applicable laws, orclinances, building codes, and zoniag regulations_ OWNER' S SIGDIATLTRE DATE � -o��-�3 ADDRESS 8 " - N cS PHONE '�/ �7 -.�7 P'/� 0'1'7 7 � WITNESS PERMIT #