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> . DISCLOSIIRS STATEi�NT F4R OWNL3R CITX OF 28PF1YRIiILLS BIIILD=NG DEPARTN.�NT I, have read and fully understaad aad agree ta the provisioas of this instrumeat. The undersigaed states aad aff3.ims tfiat he a'r she �is�d'e'sirous of constructing, reaovat3ag, addiag ta or reroo�iag his ar her owa domicile, that he or ohe actually occupies, or will occupy by said domicile, aad same i� nat for reat, lease or sale. That he or she shaZl comply with the followiag con.ditiaas: I. Tha� the a�vner aad he or she alone shall act as the buzlder fof all phases of coastruction. 2, That the owaex will camgly with all provisioas of the City of ZephyrhilZs ordiaances and codes pertiaent to the buildiag. 3. That in the eveat variaus phases of coas�ruc�ioa are subcoatracted, he will engage anly pzoper3y 2ie�ased subcontrae�ars and will persaaally supervise such wosk. . 4, That ia the eveat the BuiZdiag Inspector shall reguire correctioas to be made, the owaer wil.l' assume �ull respaasibility to iasure they are made, aad upon completion wil.l call for a reiaspection before proceediag with the buildiag. 5. Tha� the owner sh�ll assume full resgonsa.bili�y far the construatioa and will not expect supervisioa of his work from �he C3ty af Zephyrhills Suilding Depaztmeat. 6. That prior ta fiaal iaspec�ioa aay additional fees, iacluiiing reiaspectian fees, must be paid ia full.. A wxitt�ea reque"s"t' from this office shaZ2 ' � canstitute an off3.cia1 aatice to pay additional fees. ` � � ' . . • 7. That the owaer sha11 comply with all City, S�ate and Federal laws in regard .ta sacial securi�ty, workmanrs compensa�ion, Zien Zaws, ete. , where, app2i.cabl'e. 8. That the owaer sha11 comply with all the safety codes issued by the Florida :. _ Iadustrial Comtniss3.oa. ' 9. Sta�e law requires coastruation to�be doae by liceased contractors. You have applied for a permit under aa eacemptioa �o that law. The exemption allows yau, as �he •owner of your property, �o aet as yaur own contraetar wi�h certain restrict3oas even though you do ,not have a licease, Yau must provide direct onsite supervisioa of the coastrueti.oa yourse2,f. Yau may build or improve a one-£amily or two-tamily resideace ar a �arm autbuildiag. You may also build. or improve a commexcial buildiag, provided yaur casts do aot exceed $75,040. The buildiag ar residence must be far your awn use or oacupancy. It may aot be built or substaatially i.mproved far sale or lease. If you sell or lease a buildzag you have buiZt or substaati.ally improved yourself �,rith3.a 3 year after the coas�ructioa is complete, the la,w wiZl presume that you built or subsbaati.ally improved if for sale or lease, which is a violatioa o£ this exemptios�. Yau may no� hire an txnliceased person to act as your coa�raator or to supervise people workiag on your buildiag. It 3s your respoasibility t�o acake sure that people emplayed by yau have licenses required by state law and by cauaty or municipal liceasing ordsaaaces. You may aot delegate the respoasibility for supervisiag work �o a lice»sed contractor who is ziot liceased to perform the work being doae. Aay person workiag on your building who is aot liceased must wark uader your direc� supervisioa and must be employed by you, whieh meaas that you mus� deduct F.I.C.A. aad w3thhoZding taac and provide workers' compensatiari for that employee, all as prescribed by law. Your construc�a.oa mus a mg2y with all applicable laws, ordiaaaces, building codes, aad zoaing gu tiaas. � . OWI�TER'S 3IGNATL7RE - �� DATE .��j— �CJ � .b ADDRESS PH02�E -- Z 5 WITN',ESS P8RMIT #