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DISCLOSIIRS STATEN�SNT FQR OWNER CITY QF ZSPHXRHILLS BIITLDING DEPARTMBNT I, 1 r�,��/,P /��r r,cl'c.� have read aad �ul1y uaBersGaad aad agree to the pravisian8 af thia iastrumeat. The undersigned states an.d affirms �hat he or she is desirous af coastructing, �, reaavatiag, addiag ta or reroofiag his ar her owm domicile, that he or she �� actually accugies, or will accupy by said domicile, aad same is no� for I reat, Iease or sale. That he ar she shall comply with the fol3owing conditiaas: 1. Thet the owner aad he ar she aloue shall act as the builder for all phases af conatructioa. , 2. That the owaer wi11 camp2y with all pravisioas of the Cit�r af Zephyshills ordiaances and codes pertiaeat �o the buildiag. 3. That in the event variaus phasee of cons�ruction are subcositrac�ed, he wi11 ' " eagage oaly proper2y I.iaensed subcontrac�ors aad will persaaally supervise auch work. � 4. Tha� ia the eveat the Suilding =aspectar sha22 require eorrectioas to he made, the owaer will assume �ull respaasibility to atasure they are made, a�d upon , eompletion wiZl call for a xeinsgection before proceediag with �he buildiag. I; 5. That the oranes shall aasume full responsibility far the constructioa aad will aot expect supervxsioa of his work from the City a£ Zephyrhills Suildiag ' Departa�ent. 6. That prior ta fiaaZ iaspectioa aay additiaaal fees, includiag re3aspectioa fees, must be paid in full, A yvritten request from this of�iee �halZ canstitu�e aa official aotice ta pay additional fees. � 7. Tha� the awaer shall camply with all City, State and Federal la�ws ia regard to soea.al seeuri�.y, workman's compensation, 3ien laws, etc. , where applicable. 8. That the ownex shall caznply with all the safety cades issued by the Flori$a Industrial Commission. . 9. State law requires constructioa to be doae by lice,nsed contractars. You have applied for a permit uader aa eacemptioa to that law. The exempt3on a7.lov�rs yau, as the awaer af yaur pxaperty, to aet as your own contractar with certaia restrictians even though yau do xaot have a licease. You muat pravide direct oasite supervssioa af �he caastructioa yourself. You may build or improve a ' one-famiZy or two-family remideace or a farm outbuildiag. You may aZso build or improve a commexcial buildiag, provided your cotsts 8o ao� exceed $75,000. The bui2diag or resideace must be for you= own use or cccupancy. It may not be built or aubst,antially improved for sale oz lease. sf yau sell or- lease a buildiag yau have built or substaatia2ly imgroved yourself arithisz 1 year after the aonstructioa is complete, the law will preeume that you built or substaatially impraved if for sale or lease, whieh is a violaticYt of this exemptioa. You may no� hire an ualicensed person to ac� as your cont�ractor or , to supervise people workiug oa your building. It is your responsibility to � , make sure tha� peap3� employed by you have licenses required by state laiv and ' by caunty or municipal liceasiag ordiaancea. You tnay aat delega�e the responsibility for supervisiag work �o a liceaeed contsactar who is aot l.iceased to perform the work beiag daae. Any persaa workiag on your buildiag who is aot licensed must work uader yaur direct supervisioa and znuat be employed by you, whieh means tha� you must deduet F.I.C.A. aad withholding tax and provicie workers' compensation for tha� employee, all as prescribed by Zaw. Your construc�a.aa must camply with al2 applicable laws, ordia.aaees, buiZding codes, and zoaiag regulations. - pWNERr S SSGNATURE � %�s.r'�PA� ��t�rv�=.s-'�� I3ATE ADDRESS d 9 r Z //° 1'4 � �xorrr� �,L3 ,3 S"5 3 � _"v WITNESS PERMIT # � � -