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� D2SCI,OSiJRE S'f'A'►'F*�'NT .FOR OW1�R CZTY OE ZEPFiYRI32I�+S SUIT�D2NG DEPAR'�'�•NT _ • have read asid fu11y understand atid agrae �to �e provisions of �this instrument• The undersigned states and affirms that he or she is desirous of constructing, renovati.ng, adding to or reroofiag 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 sha11 comply �.th the followiing condi-tions: 1_ That, the owner and�he or she alone sha11 act as the buildar for a11 phases of construction. 2. That the owner wi11 comply with a11 provisions of the City of Zephyrhills ordinances and codes �*-�;neat to the buildiag. 3, That in the enent various phases of construction are subcantracted, he wi11 engage only �properly licensed subcontractors and will personal�y supervise such work. 4. 2'kiat in the event the Suildixig Inspector shall re?,'re corrections to be made, the owner �vi11 assume fu11 responsibility to insure •they are made, and upon campletion will cal3 for a rp�T�ection before proceecling with the building. 5. That the owner sha11 assume full respons�bility for the constsuction aad vPi11 not axpect_ supervision of his work from the City .of Zephyrhills Building Depart�ent. 6. That prior to final inspection aay additional fees, including reinspection f�as, must be paid in full. A �ritten requast from ttiis office shall constitute an official notice rto pay additional. £ess. , 7. That the ownes sha11 comply with a11 City, State and Federal laws in regard to social sacurity, workman's compensation, liea laws, etc. , where applicable. B. That the owner sha11 co�ply with a11 the safety codes issued by the Florida Industrial Commissioa. 9. State 1aw ree+,;ras coast.r�iction to be done by licensed contractors. You have applied for a permit under asi exempt�-on to t3�at law. The exemption allows you, as the owner of' your property, to act as your �wn contractor with certain restrictions even though you do not have a license. You must provide direct onsite supervision of tlze coastsuction yovrself. You may build or improve a one-family or two-family residaace or a farm outbuildiag. You may also build or improne a commercial building, provided your costs do not exceed $25,000. The building or.residence�must be for yovr own use or occupancy. =t may not be built or substantially improved for sale or lease. If you sel:l or lease a building you have built or substantially improved yourself within 1 year aftES the constructian is complete, the law will presume �that you built or substanti.ally improvad �if for sale or laase, which is a violation of this eaemption. You may not hire an ualiceasad person to act as your contractor or to supervise people working on your building. 2t is yovr responsi.bility to make sure that people e�ployed by you have licenses rez,;red by state law and by county or muriicipal liceasa.ng ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not. licensed to perform the work being dnne. Any p�rsoa working on your buildi.ng who is not liceused must work under your diract supervisioa and must be employed by you, which means that you must deduct E.I.C.A. and vrithholding }=T and provide workers' compensation for that employee, all as p=esaribed by law. Your constrtiction must comply with all applicable laws, ordixaances, building codes, and zoning re ations. owr�R�s s=c�a� ,�,cN' . '' n� %- � 7— /`� ADDRESS PHONE W=TNESS ' PEFtMIT #