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DI3CL03IIRS STAT�'P FOR 06�1NSR CITY OF ZSPHYBSILLB BIIILDING DBPASTI�NT _, ��t/-1Cq �C�� -�/ have read. and fn7.Iy uaderstaad aad agree t the provisians of this instrumeat_ - The uadersigaed states aad affirms tha,t he or she is deairous of canstructiag, renavatiag, adding to or reroofiag his or her o�va dom3,cile, that he or she actually occupies, or will occupy by said d�ici3e, aad same is aot for reat, lease or sale_ That he or she shall comply arith the fo3.Iowi.ag con.ditioas: 1. That the oovaet� aad he or she alone shail act as the bai.lder for all pha.ses of aonstruction.. 2_ That the ooQaer vr3.11 comply with all provisions of the City o€ Zephyrhills ordiaaaces aad codes pertineat to the bnilda_ag. 3_ That ia the eveat various phases pf ceastruction. ase svbcontracted, he will E!IIgage on1Y Properly licensed subcoatrac�ors and mill pessoaally supem.se such �vorlc. 4. That ia the eveat the Buildi.ng Iaspector shall require corrections to be made, the owaer �rilZ assume full respoasibility ta insnre they are made, and upon completioa w:ill call for a reiaspectioa before proceediaq with the bnilding. 5. Tha,t the ownex shall assnme ful.l responsibility for the coastruction and ovill not expect supervision of his work from the City o£ Zephyrh:i.11s Bnilding Depa�ttmeat. 6. That prior to final iaspectioa aay additioaal fees, includiag saiaspectioa �ees, mv.st I�e pa.id ia ful,l. A v�ritten, reqaest fr� this office sha.11 coasti.tute an official notice to pay add:itioaal €ees. 7. That the oNaer shall comply wi.th al.l City, State aad Federal lav�s ia regard to sociat security, arflrlanaa•s compea,sation, lien la�vs, etc., �here applicable. $- That the owss.er shall comply v�ith all the safety cades issued by the Florida Industrial Commi.ssioa. 9. State ].aw requ:i.res construction to be done by licen,sed coatractors. You have applied for a permi.t under aa exemptioa to that law. The eaemptioa allo�s you, as the owner of yonr property, to act as yonr own coatractor mith certaia restsictions evea thongh you do not have a liaease. You must provide direct oasite supervision of the coastruction yovrself. You may build or improve a one-fam:i.Iy or tzao-family reside�ce or a farm outbuildiag. You may also build or imprave a coaomercial bvi.ldi.ag, provi,ded your costs do aot exceed $25,oao. The 3�ui.lding or resideace mnst be Eor your owa use or occupaaay. It may aot be bu3.lt or substantially improved for sale or lease. If you sel.l or lease a -hui.ldiag you have built os substaatially iarpsoved, yovrself wi.thia 1 year after the canstructioa is compl.ete, the Ia�v �vi.11 presume that you bui3t or snbstantially improved if for sale or lease, �vhich is a vialatioa of this ��P�ZOII- y�� Y �t �e aa unliceased persoa to act as yeur contractar or to supervise people ovorking oa yous bviidiag_ It is your responeibility to �aa,ke snre that people employed by you have licenses required by state law and by cpuaty or mnai.cipal licensing ordinaaces. You may aot delega�e the responsibility for stxpervisiag work to a licensed contractor who is aot licensed to per€orm the �vark beinq doae. Aay persoa workinq oa you� bui3diag who is aat licensed must ovorlc nader your da,rect supervision aad must be employed by you, which meaas that yon must deduct F.I.C_A. and vrithhelding }�Y aad provide workers' coaapensatioa fer that employee, all as prescr3bed. by lam_ Your constructioa must corygly �vith a11 applicable lams, ordinaaaes, bn,i,Zdi.ng aades, aad zoaa.ag regu�f j'� � O�i�iSR.'S SIG�TQ�g � ,,/� v ` 7}ATS �-� �'�� Avn�ss _ Sd/� e �c . paor�s WITRSSS ` �� PERMIT #