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' � DISCLOSIIRE STATEN�NT FOR OWNER ' I CITY OF Z?3PFIXRFIILLS SU2LDING DBPARTN.�NT � 4 I, ' have rsad and fulZg uad�rstaad aad agree to the provisioxis of this ins�rumeat. The, uadersiga�,ed states aud affizms �hat he ox she is desirous af constructing, reaiavatiug, addirig to or reroofiag his or her owa domicile, tha� he ar she act9a.a31y oceupies, or will occupy by sa3.d domic3.le, aud sa:ne i.s aot for reat, lease or sale. That he or she shall camply with the followiag coaditioas: I. i'Tha� the ov�ner and he ar ehe alaa� eha1Z aet as the bua.2der for all phases of �coaotruc�ion. 2. Tha� the awner arill comply with aII provisioas of the City of Zeghprhi3.2s ' ordivaaces aad codes pertinent �o the buildiag. 3. ,That in the eveat various phases of cons�ructioa axe subcoatracted, he will eagage only proper�.y Iicensed subcontrac�ars and will persaaa3ly eupervise such work. 4_. Tha� ia �h� event th� Buildiag Iasp�etor shall require correetians to be made, the awaer will assume full xespoasibility to a.asure th�y are made, and upoa eompletioa will call for a xeinspection befare praaeediag with the building. 5. That the owaex shall at�sume full re�ponsibili�y far the coastructioa and will - aot expect supervisioa of his wark fxom the City of Zephyrhills Suildiag Departmesit. 6. '�That priar to �iaa1 iaapection aay additiox�al fees, includiag reiasp�ctioa � jfees, mu�t be p�id in �1711. A writtea request from this offic� shaZl "coastiEut�e an official aotiae ta pay addstional fees. _ 7. Thati the awaear shall comply with all City, State aad 8ederal laws in regard to soc3.al security, workman's campensation, Zien laws, etc. , where applicable. 8. That the awner shall camply with all the safety codes issued by the Florida +Iadu�trial Commisaioa. 9. State law requires coastruction to be doae by Ziceased contxactoss. Yau have applied for a germit uader an e�cemptioa to that law. , The eacempGion allows you, as the o`vaer of yaur proper�y, to ac� as your owa cantractor with certain �zestrictiaus evea though you do aot have a licease. Yau mus� provide direat onsite superv3.sion of the caastructioa yourself. You sn�y build or improve a �oae-family or two-£amily res3deaae ox a farm autbuildiag. You may also build �or improve a commexcial buil8iag, provided your coets do not exceed $?5,040. The lauildiag or reaideaae must be for your owa use or occupancy. =t may aot be built os substantially improved for sale or lease. sf you sell or lease a building you have built ar eubstaatially improved yourseZf withia i year after �he constxuction ig complete, the law will presume that you buil� or suhstantia2ly impzcved if fox sa1� or �ease, whieh 3s a vialatioa a€ �his �c�.xemption. Yau may aot hire aa ualiceased person ta act� as your aontractar or �o superv3se people workiag an yaur buildiag. Tt is your responeibility to inake sure that peaple ea�ployed by yau have licenses required by state 2aw aad �y couaty or municipal liceasiag ordisaancea. You may aot delegate the xespousibility for supervising work to a lieeased coatractor who is aot �.iceaa.�aed to perform the work being daae. Any persoa workiag oa your building �vho is ao� liceased must work uader your dfrect supervisioa a,ad muat be einpZoyed by you, whieh meaas that you mus� deduct F.I.C.A. aad wi�hhoSdiag ta�c and psovide warkers' compensation for that employee, all as pxescaribed by law. Your cons�ruet3aa must comply wi�h al2 agpi.icable 2aws, ordi�naaces, building codes, aad zoaiag regulatioas. , p � � OWNER'S 3IGAZATURE . DATE 1 ADDRESS � "cZi'.3 d ; ��iONF � �'� "�L� '"— ��?' � ! i w12TNESS PI3RMIT # I; - , � �� _.