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i DISCLOSURS S"TATEMENT FOR OT��INSR , , � CITY OF ZBPHYRIiILLS BIIILD2NG DEPARTM�NT � I, � �'�� v(/ f lF'��'"�! have read aact fu1ly uaderstand an8 I ag�ee t�o�.e provisions af this instrument. • , i i r The uadersigned states and aff3rms that he or she is desiraus af coastructiag, I re�ovatiag, addiag to or reroofiag his or h�r owa domicile, that he or she ' � aa�ually ocaupies, or will. accupy by said domicile, and sam�is not far j reiit, lease or sale. Tha� he ar she shall aomply with the fo7,lowiag couditions: � I. Tha� the cwaer and he or she alone shall act as the builder for all phases o£ � coaetructioa. - , 2. That the ov�mer will comply with a21 prcvisioas of the City of Zephyrhills ; ordiaances aad codes pertitsent to the buildiag. i ,/3. Tha� ia the even� various phasee of coastruc�ion are subcoatraeted, he wiZl � engage ouly prapesly liceased svbcozxtractors and will persaaally 'supervise • i such work. � 4. That in the eveat th� Bui.ldiag Iusp�etor shal.l require correations �o be made, � the owner will assume full respoaeibility to iasure they are made, aad upon ! completion will call for a reiasp�e�ian befar� proceediag with the buildiag. � 5. That the owaer shall aesume ful]. `ree�poasa.bility far the construation and will i aot expeat superv3.sioa of his work from the City of Zephyrhills 8uilding , Departmeat. 6. Tha� prior �o fiaal iaapecta.on aay additioaaZ fees, includ3.ag reiaspectian feea, must be paid ia �ull. A writtea request from tSis a�fice sha21 coa8titute aa official aotice to pay additioaal fees. J 7. Tha� the owaer shall compiy with all City, State aac3 Fedesal lavrs ia regard to � soaial security, workman's campensatian, lien laws, etc. , whete appli.cabl:e. � 8. Tha� the owaer shall camply with all the safety codes 3.ssued by the F1ori,da �adustriaZ Cammissian. ? 9. Sta�e law requiree� constructioa to b� doae by liceased contractors. You have � applied for a persnit uader aa e.�cemptioa ta that law. The exempta.on allows ; yau, as the avun�r of your praperty, �o act as yaur own coatractar with certaia � restrict3.oas even though yau do aot k�ave � licease. Yau must provide direct ansita supervi.siou of the canstructiaa yaurself, You may 'build or improv� a i one-family or two-family reeideaae or a farm outbuildi�.g. You may also build or 3mprove a commercial building, provid�d your costs do no� e�cceed $75,OOQ. i The buildiag or resideace must k►e for your owa use or accupaacy. It may aot be built or substa�ntially improved far sa�le or lease. If ycu sell or lease a , buildiag you have buil� or substaatialZy improved yourself withia 3 year after the construction is complete, th� law will preaume tha� you built or ! substaatially impxoved i.f far sale or lease, which is a violatioa af this exemption. Yau may ao� hire 'an ualicen8ed person to act as your coa�ractar or ' to supervise people workiag oa your buildiag. It 3.s your respoasibility tio , � m�ke sure tha� peopl� employed by you h�ve licenses required by state Iaw and � by covaty or muaica.pal liceusiag ord3ssaaces. You may aot delegate the ; responsibi7�ity for supervisiag work t�o a liceased coatraetor who is aot � licensed to perform the work beiag daae. Any persca warkiag oa your building who is aot liceased must work un,der your direct supervision aad must be . employ�d by you, whieh meaas tha� yotx must dedt:et F.I.C.A. and withhalding tax and provide warkers' compensatian for tha� employee, all as prescrib�d by�law. i Your aanstructioa must ca�nply with a11 applicable Ia�+rs, ordinaaees, bui2ding � cocYes, aad zoaing lationa. _ � � (O't+aRIER'S BSGNAT ' DATE JI �I� _ ADDRESS S cS�.Z � �Pxorr� S 2 ; FVITNL�SS PSRNlIT # '_ � � I - �