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• M <br /> DISCLOSIIR� STATEMENT FOR OWNER <br /> CITY 4F ZLPAYRt�iILLs BUZLDING DSPARTN.�L+IT <br /> _, -%y����� ���'��'�� have read aad fully uaders�aad aad <br /> agree ta the provisioas of this ins�rum�at. <br /> The uadeacsigaed states aad affi.rms that h� or she is desi�rous of construatiag, <br /> reaovatiag, addiag to or reroo�'iag his or her own domicil�, that he or she <br /> actuallg oceupies, or will occupy by sa3d domicile, aad same is not for <br /> reat, l�ase or sale. That he or she shaZl comply with the follawing con.ditioas: <br /> 1. Tha� the awaer and he or she a1aa� �hall aet as the buildeac for al2 phases of <br /> coastructioa. <br /> 2. That the own�r hri31 camply with all provisioas of the City of Z�ph�rhills <br /> ordiaaaaes and codes pertineat to the buildiag. <br /> 3. That in the event various phases of cons�ruction are svbcoatracted, he wi11 <br /> eagage oaly propezly licensed subeoatrae�ars and will persaaallg sup�rvise <br /> such worls. <br /> 4. Tha� ia �he event the Buildiag Iss.spectar shall r�quire corz�ections to be made, <br /> the awner wi7.1 as�ume full xespoasibility to iasure they are made, �ad upon <br /> campletioa will call for a reiaspection before proceeda.ag with �he buildiag. <br /> 5. That the owa�r shall assume fuZl respoasibility far the constructiaa and will <br /> aot expect supervieioa of his wark from the City af Zephyrhills Suilding <br /> Departmeat. <br /> 6. Tha� prior to final iaspec�ion any additioaal fees, iacludiag reinspectiaa <br /> fees, must be paid ia �ull. A wzittea request from this office sha11 <br /> constitute an offiaial not3ce to pay additioaal fees. <br /> 7. That the owner shall camply with all City, State and Federal laws ia regard to <br /> sacial seeurity, workaraa's compensatian, lien laws, eta. , where applicable. <br /> S. Tha� the owner shall comply with all the safety cades i.ssued by the I�'lorida <br /> Industrial Cammissioa. <br /> 9. State law require� con�truction to be doae by liceased contractors. You have <br /> applied for a gerrnit uader aa eeyccemption to that law. The exemption allows <br /> you, as �he ov�ra�r af your pxopeztg, �o act as your owa caatraator with certaia <br /> res�rictions even though yau do aot have a� liaease. Ycu must provide direct <br /> oasite augervisioa of �h� coastructioa yaurs�lf. You may build or imprave a <br /> oae-family or two-family residet�ce or a farm autbu�.ldia,g. You may also build <br /> or imprave a commercial building, provided your ca�ts do nat exaeed $75,Op0. <br /> The buildiag or resideace must be for yotzr owa use ar ocaupaacy. It may aot <br /> be built or substaatially improved for sale ar lease. If yau 8e11 ar lease a <br /> buildiag you have built or subsGantially impraved yaurself witha.a 1 year after <br /> , the construction is complet�e, the law will presume that you built or <br /> substaat3ally impraved if far sale or lease, which is a violatioa of this <br /> exemptioa, Yau may ao� hire an ua3iceas�d pezsoa to aet as your coutraotar ar <br /> to supervise peop].e working on your building. It is your respoasibility to <br /> make sure that peaple emglayed by yau have lia�nses reguired by state law aad <br /> by ccunty or municipal liceasiag ordinances. You may aot deleg�te the <br /> responsa.bility far supervising wark to a liaenaed coatractar who is ssot <br /> liceased to perform the worls besag daae. Any person workiag on your building <br /> who is not liceased mu�t work uader your direct supervisioa aad must be <br /> employed by you, whieh meaas that you must deduat F.I.C.A. aad withholding t�sc <br /> and provide workers' compensaticrn far that employee, a11 as prescribed by law. <br /> Yous cosistruction must ccmply with all applic�ble 1aws, ordiaances, buildiag <br /> codes, aad zoaing regulatiaas. <br /> OWNER'S SIGNAR'URE DATE <br /> ADDRESS �` <br /> PHON33 <br /> WITNESS PERMIT # <br />