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f , ______ __ _ __ . � . ` DISCLOSIIRS STATEI�BENT FOR OWNER p ; i CITY' OF ZBPIiYR.FIILT�S BIIIZ�DING DBPARTI�N'P I, , have read and fully uaders�aad and agxee to the provisiaas of thie instrumeat. The� undersigued states and affirms that he oz she is desirous of caastruating, reaovatiag, addiag to or reroofiag his ar her o�,m domicile, that he or she ac��ally occupies: or wrill occupy by said domicile, aad same is aot for rea�, lease or sale. That he or she shall camply with the followiag couditioas: 3. That th� owaer aad he ar she aloae shall aet as the buildes� for all phases of coaetructioa. 2. That� the owner �ai21 comply svith a1Z provisioas of the City of Zephy=hills ordiaances aad cades pertinent to the buildiag. 3. That� in �he even.t various phase� of aoastruction a�re subcoatrac�ed, he will engage aa2y propezly la.ceased subcontractors aad will persaaally supervise such work. 4, 'That ia �he eveat the Buildiag Saspector sha22 require carreations to be made, the owaer will aesume full arespaasibility to iasure they are made, aad upan aompletion wiZl call for a zeinspeetion before proceeding with the buildiag. 5. Tha� the ovanes slia3l assum� full reepoasibility far the conetruatioa and ivill aot expect supervisiou of his work from �he City a� Zephyrhills Suilding Depaactmestt. 6. Tha� prior to fiaal iaspectioa aay additiaaal �'ees, iacludiag re3nspectioa fees, must be g�id in full. A writtea reques� fram this office shall constitu�e aa offioial notice to pay additioaa3 fees. 7. That the owaer shall comply with all City, State and Federal. laws ia regaxd to soczal security, workman's campensata.an, Iien laws, etc. , where app23.aable. 8. IThat the owaer sha11 camply with all the safety cades issued by the Florida fIadustrial Cammissian, 9. State law requires construction to be done by liceased aontractors. You h�.ve applied �ar a perm3t uader sa exemptioa to that law. The eacemptian allows ,you, as the own�r of your praperty, �a act as yaur avaa coatractar wi�h certaia �Cestrictiaas even though you do aot have � license. You muat provide direat oasite supervision af the constructioa yourself. You may build or improve a one-�Eamily or �wo-family residence or a £�rm outbuildiag. You may also build por improve � cammescial buiZding, pravided your coats da aot exceed $?S,OOQ. �h� buildiag or resideace must be for your awa use or occupaucy. It may not e built ar substaatially improved far sale or lease. zf yau se11 or lease a �uilding you hav� buil� or avbstaatially improved yauraelf ivithia Z ye�r after �he construction is com,plet�, the lata will pret�ume that you built or substaata.ally improved 3f for sale or Zease, which is a violat3oa of this �emptioa. You may ao� hire an ualicensed peraon to act ae your coatractor or po supervise people wor]cing an yonr buildiag. It is your responsibility �o 6make sure that people employed by you have licenses requireci by state Iaw aad � �y cauaty or muaiaipal liceasiag ord3aancea. You may aat delegate the � �espansibility for snpervisiag wazk �a a licensed aoatractor who a.s aat • �� liceaaed to perform the work beiag doae. Any persaa warkiag on your buildiag i �ho is aat licensed mus� work un,der yaur direct supervision aad must be emp2oyed by you, whieh means that you, must deduet F,I,C.A. aad withha2ding t�x �nd provide workers' campensation for that employee, all as prescribed by 1aw. Xour coas�rua�ioa must comp2y with all applicable laWs, ardinaaaes, buildiag �I codes, aad zouiag regulatioas. ' �wr�R�s sz��u� i�d�G� � �� 7�iZ�1G 1�.DDRBSS S9Y3 /9'rN SI'Rt�'?"� �H4NS �81��;,�9'3?l 7 WITNSSS PERMIT # � j' i u � � I 1 -— --- I