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(-- - DISCLOSIIRS STATEMENT FOR O�R CITY QF ZSPIiYR�iILLB BII�LDING DBPARTMEENT I, have read aad fulZy vaderstaad aad agree ta the provisioas o� this instrumeat. � The undersigaed states aa� aff3.rms that he ar she is desirous of CO218tS11Ct1ACJ, reaovatiag, addiag to or �reroofiag his or her owa domicile, that he or she actuallg occupies, or will occupy by said domicileJ aad sam� is aot for reat, lease ar sale. That he ar she shall comply with the folZowiag coadi�iaas: 1. That the ozvuer and he or she aloae shall act as the builder for all phases of construction. 2. That the owner will comgly c+rith all prov3.sioae of the Gity of Zephyrhi3ls ordiaaaces and codes perti�aeat to the buildiag. ' 3. That in the event various phases of aoastructioa are aubco».tracted, he will engage only prcperly liceased subcontractors and will persoaal3y supervise such work. � 4. That ia the eveat the Buildiag Iaspeetor sha11 require corrections to be made, ' the owaer will ase�ume tull respaasibility to iasure they are made, aad upon completioa wiTl ca11 for a reinspec�ion before proceediag with tihe buildiang, 5. That the owaes shall assume full responsibility far the constructioa aad will not expect supervision of his work £rom the City o� Zephyrhills Building Department. 6. Tha� prior to fiaal iaspec�3oa aay additioaal fees, iacludi�,g reinspectiar► fees� must be paid ia fnll. A writt�ea sequsst from this office ahall � canstitute an offi.cial aotiae to pay additioaal fees. � 7. That the owaer shall comply with all City, State aad Federal laws ia regard ta social seeuri.ty, warkman's aompensation, lien laws, eta. , wheze appZieabZe. 8. That the owaer shall comply with all the safety codes issued by the Florida Iadustrial Caramission. 9. State law requires coastruction to be doue by liceased coatractass. You have applied for a permit uuder aa e�cemptioa to that law. The exemp�aioa allows you, as the awner of your praperty, to act as ycur ovaa contxactar wi�h certain res�rictioas even though you do aot have a licease. You must provide direct onsite supervisioa af �he canstruetioa yoursel£. You may build or imprave a one-�amily or two-family 'resideace ar a f�rm autbuildiag. You may also build or i.mprove a commercial buildiag, provided your costs do aat exceed $75,000. The 3suilding or residence must be for your owri. use or accupaacy. It may aot be bt�.ilt or substaatially improved for sale ar leaee. If you se11 ar lease a building you have built or substaatial].y imgroved yourself �,rithiu 1 year after the aonstructioa is camplete, the law wi].1 presume that you built os substaatially impxoved if far sale or lease, whicla is a violatioa of this exernption. Yau may aot hire aa unlie�nsed pessoa to act as your con�ractor or �, to supervise people workiug on your building. It is your respoa�ibility to make sure that people employed by you have liceases required by state 7.aw aad by cauaty or municipal liceasiag ordiaanaes. You may aat delegate the respoasib3litg for supervisiag work �o a liceneed coatractor who is aot liceased to perforta the work beiag dane. Any persaa workiag on your buildiag who is aot liceased must woxk uuder your direct supervieion and must be �mglayed by yau, which meaas that yau must deciuct F.I.C.A. aad w3.thholding ta�c and provide warkers' campensatian for that employee, al,l as prescribed by law. , Your construe�ioa must camply w�.th all applicable 1aws, ardinan.ces, buildiag aodes, aud zor�}ag regulations. - OWNER`S 82GNA2'URE ct �. � l I7ATE �.'1,�.-l��} ADDRESS l"Z l�r.n. 't--c 1. 1-, f-' �!2 .• ` FHON�3� FF!7-t�7:5"4 � �1 to SLa . WITN8S5 P'ERMIT #