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Frorri: 05l18J20�� 0:49 #d-�4 P.00� I � � � DxSCLOSiTRB STATSi+1�NT FOR O�PNER � GITX OH Z8P13YRHTLLS BIIILDIIdC3 bSPAR'iRdBNT �, x. I�l�'7��'Pl� ��'�Y'7C. !L ��.�re rea� a�ad L�1].g us�uerai�snd �ad ' agree to the pravieions af �his 3astzumeat. The�undersigned s�atas aad a£fisme that h� or ahe ie desiroua af coastructing, reaovating, x�dctiag to or reroofing hia �r her own dom3ci3.e, that h� or ehe ac�tiially occupies, or wiil occupy by said domiG3le, aad eame is not for rea�, lease or saZe. T'hat he or she shall compl.y with the £ollawiag coaditioae: 1. 'Pha� the owae� aad he or ehe aloae shall act ae the builder for all phaee� o� canstructiaa. 2. That the owaex� will comg2y w3Ch a].Z provis�ons of the City of �ephyxhills ordi�naaces aad codes pertineut to Che build3ag. 3. That 3n tha eveat variaue phases af aoastruct3art are subcoutracterl. he �t.11 engage oalg pxo»esl�r liaenaQd su3�aonbraators and will peresoaal�.y supezvise such �vo�lc. 4. That ia �he eveat tbe Bu9.ldimg =aepea�ar shali xeguire aazractioas �.o be made, ithe o�vaer wiil assvme full respoaeibility ta iaaure �hey are made, and upon con�pletian will ca11 �or a refaepect3an beEore groceadiag with the building. S. That the owaer shal.l aaeume �'ull reapaaaibility �or the cascetrnctioa aad wili aat e�sect snpesviei.on of h3s work from the City o� Zegl�yrhi.11s Suilding i D��za�. 6. Tha� psiox to final fnapectiaa any addi�ioaa2 �e�s, i�ncluding reinspectioa � fees, mus� be paid 3.a �ull. 1�1 wr3ttea r�queet �'za� t3zis o£fice slza3l icoas�itu�e an affiaiai notice ko �►ay ad8itional fees. ' 7. That the awaer eha11 camply �arith �Z1 Ci�y, atate aad P'ederal la�ta ia regard to Sac3.a2 ser.ur2tyJ woa'kma�'$ t�iQmgan$at�.oa, l.s.ea I.aws, et+r.., SQh�re t�y3g]."a..r.abl.e. 8. That the owaer shal]. comply with all the ea�ety codes isaued by the Florida � �1��BLL�6� LWiYYLOO�CtE�s 9. 3ta�e law requires coastruoticn to be dane by iicensed con�raators. You I1ave j appl3�ed Ecir a permi� uader an exetttptior► to that �,aw. The exempt3oa a�llows � you, as t.,2�te owasr cf yaur groper�y, to act as ya�cir otra contraetot watth cextaia reetr3ctians e�vea though you do aot have a liceuee. You musb provide direct oasi�e supervieicu at the con��suction yourself. You may build or improve a � oae-�amily ar �wo-family resideace ar a €arm autbuild3ag. You may alaa build oz im�rovr� a commnrcial buildiag. Prov3�i�a �^v�r� ��s �a �r�� cea3 �'35.00Q. The }suiidiag or residea�e must be for gour owa use or accupancy. It may not be built or aubebaatisi3.y improved �or aaie or leaee. I� you se�I dr �ease s buildiag you h�ve built or subetaabial�,y improv�d yourael� withia 1 year aftar ' the canstruct3an is c�lete. the la4r will presume that you built or { substcasstir�lly imprcve� i� €os aa�e m� 3.e��ge, w}a�.�h is a vialatioa o� thip exemption. Yau may aot h3re an unlicea�ed persaa ta act as yaur coatraatox ox i to eupervise ��op1.e wo�ckimg aa your bui.lding. =b is �rou�r respoasibi�ity �o ; �nake sure that peopZe em,�►loyed by you have liceae�ea required by state law and , by cauaty or muuicipa2 13.cen�3.ag ardinance�. Yau may aot de3egate the reaponsibility for sugesvisiag work to a lic�used coa�ractor who ie a�ot liceased �o pexform the work beiz►g doae. Any persan worki.ag oa your buildzng - r+�1so ie aot liaenasd must work uader your direct eupervisiaa aad mus� be emplc��►ed b� you, which �eaas th�t you aeust deduct F.I.C.li. and withhaZding taaocc I and grovide workers' campeasafiian fcr that emglcyeer ax3 aa pse�exibad by iaw. Your cans�ruc�ioa must compiy ovi.th all applicable lawe, ordinancee, bui2d3ag i eodea, and zaniztg regul,atione. QWNER�3 SIGNATURE � Gx;<x� DAT"E � �fa �nnn��s � Z ! 3 2 o�o!?a, p- . WIT��B ��%Yt� � P�RIdIT # I