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DISGLOSURB STATSi�NT FOR OY�NRR CITY QF ZI3PHYRHILLS BUILDING DZ*IPARTt�1�T I, have read aad fully understand aad ' agree to the provisians of this iastrum+eat. The undersigued states aad aftirms that he ar she is desiraus of canstructiag, reaovatiag, addiaag to or xeroo�iag his ar her owa dom3cile, that he or she = " � •� ac�ually ocaupies, or W�iz occupy by said domicile, aad same i� nat for reat, lease or sale. That he or she shall camply with the followiag couditiaas: ' ' • � 1. Tha� the owxier and he or she alane shall act as the builder fas all pha�es af construction. � 2. That the owa.er wi11 camgly with a1Z provisioas of the City af Zephyrhil2s ordiaaaces and codes pertinent to the buildiag.� � ' � ' 3. That ia �he eveat various phases of coastruc�ioa are subcoa�racted,• he wi11 engage ayaly proper2y licensed subcontrae�ors and vrill persax�ally sup�rvise , such work. � • 4. That ia the eveat th� Builc�ing Iaspector sha11 require correetioas �o be made, the owaes will as�ume full. respaasib�ility to insure they are made, aad' upoa completiaa wa.11 call fox a reia�peet�3on before proceediag with the build3ag. 5. Tha� the oianer ahall aasume full respons3bility far the coYsstruatioa and will ' aot expect supervision of h3.s work fxom �he City of Zephyrha.11s 8uildiag Department. 6. That prior ta fiaal ia�pec�fon aay additioaal feea, iacludizag reiaspectioa fees, must be paid in full. A writ�ea sequest from this office shall coastitute aa official aotice to pay additioaal fees. 7. That the owner shall camply with all City, State aad Federal laws ia regard to � social seeurity, workman's compensa,tion, Zien laws, ete. , where appla.cable. 8. Tha� the owaer shall camply with all the safe�y cades issued by the Florida Iadustrial Commissian. 9. Stat�e law requiree coastruction to b� doae by liceased coatractors. You have applied for a permit under an eacemptioa ta th�t law. The exemp�ioa allows you, as �he cv,riner of your praperty, to act as yaur owa contractar with certain' restrictioas even though you do not have a licease. You must pravide direct onsite supervisi.on af the construati.ou gourself. Yau may build ar improve a �I oae-�am�].y or two-famiZy re�sideace or a £arm autbuildiag. You atay.also build ' or improve a commercial buildiag, provid�d your coets da aa� exaeed $75,OOQ. The building or resideace must be for your ov�a use or occupaacy. It may aot be built or substantially improved far sale ar lea�se. If you se7.1 or lease a` � buildiag yau hav� built ar subs�aatially imgrovec3 yourself cvithi�n 2 year after (�, the aoastruction is complete, the law wil]. preaume tha� you built or substaat3ally impxoved if far sale or lease, which is a violatioa o€ this exemptiou. You may not hire au unliceased persoa �o act as your contractor or to supervise people wor}cing oa yaur buildiag. It is yaur respoasibi7.ity �o inake sure that p�aple employed bg you hav� liceases sequired by state law and by aounty or muaicipal liceasiag ordiaaaces. You tnay aot delegate the respoasib3].ity for supervisiag work �a a liceaaed caatractor who is aat liceased to perform the work beiag doae. Any persaa warking oa your building who is aot liceased must work uader your direct snpervision aad must be employed by you, which m�aas tha� you. must deduet F.I.C.A. and wf.thholding ta�c and provide workers' compensatian for tha� employee, all as prescribed by law. Xour coastruc�ioa must comply wi�h all applicable Zaws, ordiaaaces, build3ag , cades, and zoniag regulatioas. OWNER'S Urr�n/U�RE C/ Y...� , Y' i''��i�„�, DATE ADDRESS �"atc� PHONE WITNESS PERMZT #