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a � : , � DISCLOSURS STATEM�NT �°OR OYPNER I � CITY OF ZBPFiYRFIII,LS BUILDII�G DSPARR'M�NT � I,� C��j�Yc�'�.� ; �� e.�, have r�ad ancl ful ly vaders taad and � , a�r e e t o t h e p r o v i si o n s o� t h i s ia s t r u m e a t. Th�e uadersigaed states aad affizzcrs that he oz sh� is d�sircius of canstructiag, re�ovatiag, adding ta or reroofing his ar her owu domicile, that he or ahe ac�ually ocaupies, os wi11 aecupy by said damicile, and sam� is aot for reint, lease ar sale. That he or she sha11 comply with the followiag conditioas: I.' That th� owaer az�d he or she �lone shal3. act as the buiZder for all phases af � construat�ioa. 2.; Tha� th� oFm.�t will comply with �11 pravisioas af the City of Zephyrhills � ordivauces aud codes pertiaeat �o the buildiag. , 3.' Tha� ia the event various phase� of coastruc�ioa axe subeontracted, he tv�.11 engage oaly properly lie�ased subcontractors and will persoaally supexvise such work. 4. Tha� ia the event the auildiag Zaspector shall requir� correetions to be made, the owner wil]. aeeume �ull respaasibility to fasure th�}► are made, aand upoa ', completioa vai11 call �ar a reiaspectian before praceed3.ag with the bua.].d3.ng. 5. That the owaer shsll assume full respoasibila.ty far th� constructioa and will aot expect su,pervision of his work from the C3ty of Zephyrhills 8uildiag D�partmesit. 6. Tha� prios ta fiaal iaspection aay �aa�t�.oaaz fees, iacludiag r�iaspectia�n . � fees, �must be paid ia full. A writtea request from this office sha13. . � coaetitu�e aa official aotice ta pay additional fe�s. 7. ' ThaC the owaex sha11 comply with all City, State and Federal laws ia regard to soeial security, warkman's compensation, lien, laws, etc. , where applicable. 8. ' That the owaer sha11 comply with all the safety codes issu�d by the Florida Industrial Commissian. � 9. State law require� construc�ion to be doae by liceased contractors. You have applied far a permit uader aa e;xemptioa ta that law. '�he exemption allows , you, as the awner of your pxoperty, t�o act as yaux awa contractor wi�li. certaia � restrictioas evea though you do aot have a licease. You muet provid� direct oasite sup�rvisiasl of the eoast�uctioa yaurself. You m�y buiZd or improve � � one-�amily or two-�amily resideace or a farm outbuildiag. You may also build , lor imgrove a commexcial buildiag, provid�d pour costs do ao� �ceed $?5,000. jThe building or resideace must be £or your owa use or accupaacy. It may aot �, be built or substantially improved fax sale or lease. If you s�ll or lease a bui].diag you have buil� or substaati.ally i.inpsoved yourself withixz 3. year aft�r the constructioa is complete, the law will pr�svsne that you buil� or � subsbant3ally impxoved if fax sal� or lease, which is a violatioa of this exemption. You m�y aot hire an ualicensed person to act as your cont�ractat or to supervise people wom]cing oa yaur buildiag. It is your respoasibility ta !m�.ke sure tha� people employed by yau have Zic+�nses required by state 2aw and iby cauaty or municipal liceasiag ordiaaaces. You may aot delegate the � respansib3.lity for sup�rvising wark to a 13cen�ed aontraetar who is aot � licensed to perform the work beiag dcae. Any persaa workiag oa your building �who is nat liceased must work uader your direct aupervision aad must be , � `employed by you, wbich meaas that yau mus� de�uct F.I.C.A. aa�d withhalding ta�c ,'and proeide wor3cers' compensation for that employee, all as prescribe�d by law. Your construe�ioa must comgly with a12 app2iaable laws, �ordinaaces, buildis�g � aodes, aad zoaiag regulatioas. � OWY3ER'S S=GNAR'URE , DATE � ��- Z.�—�� �nax�ess h Gr.Lls L :�3 Z ��xoras �t 3 7�� 1'{6 � � 'WITNESS ' PERMZT # j 1 � i i � , � � �