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��, f .� s�j �' DISCLOSURE STATEMENT FOR QWNER � CITY OF Z�PIiYRHSLLS BIIILDSN� DEPAR.Ti�`N'.P ( z� � have r�ad aad fu21y uaderstaad aad agree ta the provisioas of this instrument. , The uxzdersigned sta�es aad affirnts that he or she is desiraus of constructiag, reaovating, addiag �o ox reraofiag his or her owa domicile, that he or she actiia3ly occupies, or wi21 oecupy by �said domicile, aad same is uot for reat, lease or sale. That he or �he shall comply with the followiag coadita.ons: �{ l. E'That the awaer and l�e or she alane shall aat as the builder fax a12 phaees af ��caastructiaa. 2. lTk�at the owaer will eomply with all provisiaus af the City of Zephyrhill.s ordiaances aad codes pertiaen� to the build3.ag. 3. That in the evexst va.rious phaaes of construatioa are subcontraeted, he wi].1 eagage anly praperZy lie�ansed subcontractors and will pereoaally supervise such work. 4. That ia the evettt the Bui2diag Iaspectar shall zequire carr�etiaas to be made, th� owaer will assume full respoasi.bili�y to insure they are made, aad upon comple�3on w311 aall for a reiuspectian befare praeeed3.ng with the building. 5. That the owaer .shall assvme full respousibility �or �he coastructioa and will ' no� expect supervisiaa of his work from the City of Zephyrhills 8uilding . Departmt=at. ` 6. That prior �a fi,aal iaspectioa aay additioaa7, fees, iacludiag reiaspectian . feesr snust be pa3d ita full. A writtea xequest from this affice shall coao,stitute aa official notice �o pay additiaaal fees. 7. That the owner shall compl� wi�h a11 City, State aad Fecieral laws ia rsga�d ta social seeurs.ty, workman's compensatian, Iien Iaws, etc. , where applicable. 8. That the owaer shall comply wi�h all the safety codes issued by the Florida Iadustrial Commiasian. 9. State law requires coastructioa to be doae by licensed coa�ractars. You have �applied for a permit under aa exemption to th�t law. The exemptioa allows �you, �s the owaer af your property, ta act as your owa coatractor with certaia restric�iona even though you do aot have a licease. Yau must provide direct aas3.te supervisioa of the coaetruetion yourself. Yau may build ar improve a oae-fam3ly or twa-fam3,ly residet�,ce ar a £arm outbuild3ag. Xou may also build or improve a commercial buildiag, pravided your costs do aot �acceed $75,OQQ. The buildiag or residenc� must be far yaur owa us� or occupancy. I� may aot be built or substaatially improved �'or sale cr lease. =f`yau sell ar lea�se a bui3diag you h�ve bui2t or substantially .imgzaved youreeZf within.l year aftet �the construction is cample�e, the lav�r wi11 presume that you built or substanbatally imgraved if for sale or lease, whieh is a vialation o� this exemptian. Yau may no� hire an ualicensed persoa to aat as your coatractar or �to superviae peop].e working on your building. It is your reapoaaib3.lity to make sure that peaple emgI.oyed by yau have liceases required by state la�r and � by aounty or muaicipal liceasiag ordinaaces. You may aot delegate the sespaasibility for supervisiag wark ta a liceased contractor who is x�ot �liceased to perfarm the work being doae. Any pereoa worki»,g on yous buildiag ��who ia aot liaeased muat woxk under your direct supervisios: and must be employed by you, which meaas tliat you must deduct F.I.C.A. and withholdiag tau �and provide workexs' compensation far that employee, all as prescribed by law, , Youx constructioa must comgly wath a1Z apgliaab2e laws, ordiaaaec�s, bui3diag - codes, and zoaaing r atioas �, Oii1ATERj S STGNATURE DATE � �►�t�Z.( ZO��A q iADDR8S5 "Z„ . �a � �� HONS �� '�7��""'t. ^� �+�e� �� .. . �� . �WITNBSS I'�RMIT # �