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� > DISCLOSIIRE STP�7�F�P1T FOR OWNSR CITY OF ZBPHYRHILT,S SUILDING DEPARTP3�TT �, hav� reat� atad fully uaclers�and aad agree to the provisioas of this iastxumeat. The uadersigaed states aad affirms that he or sh� is d�eirous of caastruetiug, reaovating, adding to or reroofiag hi.s ar her awa domiaile, that he or she actually accupies, ar wi11 occupy by said domiaile, aad same is aot for rent, lease or sale. 7.'hst he ar she shall comply taith the followiag canditfans: �., That the ak*n�r aad he or she aloae sh�ll act as the builc3er for all phaees o� aoastxuatioa. � 2. That the awaer waill comply with aIl provisiaas of the City of Zephyrhills ordia�ac�s and codes pertiaeat �o �he buildiag. 3. That ia the eveat variaus ghases of eoas�ruatian are svbcoatracted, he will enga�� oaly properly iiceasec� subcantrac�ozs aad will per�onally eupervise such work. 4. Th�t ia the eveat the 8uildiag Iaspector shall sequire correetioas to be made, the owa+ar �rill assume fall xespoasibility ta iasure they are made, �d upon eompl�tioa wi1Z call for a reiaspect3.oa b�fore proceediagr with th� buiidiag. 5. That the oFra,ea shall assume £u1Z respoaeibility for the coastructioa asid will not e�cpect supervisioa o� h3.s work from the City of �ephyrhills Suildiag Departmeat. 6. That pra.or to EinaZ iaspeat3.oa a�ay additional fees, iacludiag r�iaspectian f�es, must be paic� ia �u3.1. A �vrittea reque�t �rom this office sha1.1 coastitute aa o��icia3 aatiae to pay additional fees. 7. That �he overaer sha11 comply with a11 City, State aad �'ederal laws i�a. regard to social securit�y, workman's aomp+ensaf:i.an, lien laws, et,c. , where applicable. 8. That the owaer sha21 camply with aII th� saf�ty codes issu�d by th� Florida Industrial Ccmmissioa. 9. S�ate law requir�s coastruction to be doae by liceased aoatractors. You have appliedl for a perm3t uader aa exemp�ioa to that law. Th� exemptioa allow� you, as the owner of your groper�y, to act as your own aoatractor with certaia restri.ctioas even though yau do aot have a Iic�ase. You must psovide direct aasite supervis3oa of the aon�tructiou your�el�. You m�y bu31d or improve a one-fatnily or tvao-Eamily resfdeace or a farm outbuildiag. You may also build ar 3mprove �. camm+�xcial buildia�, provided your costs do aat exaeed $75,Od0. The bu3:ld3a� or resis3eace must be tor your a�rra uee or occupancy. It may aot be built or svbstaatia22y improfr�d for saZe or lease. If you se11 or lease a building you have bu3.lt or substaatislly improved youra�lf withia 1 year after the coastruction is camplete, the ].�w will presume that you built or sulsstaatially isapsoved if foz sale ar Iease, which is � vfolatioa of th3.s eac�mption. Yau may aot hire aa uaaliceased person ta act as your coatractor or to supervise peop2e working oa your buildiag. It ie yaur respaasibility ta make sure that peopl� �saployed by you have licea�es� required by s�ate Zaw and by couaty or muaicipal liceasiatig ard3aances. You may not d�legate th� respotssibility for supervisiag s�ark to �. Z3ceased caatractor w}io �s ao� I.iceased to perfozm the work beiag daae. Any persoa workiaq on yaur buildiag svho ia aot licensed must work uader your direct supervision and must be ------ e�loyed by_ ►�oul which._.me�ns_tha_�v-ou-must--deduc�-l�:I-:G-:�-aad-saithizal-di�agrtax--__^.----- aad pravi.de workers' aomgensation fox that employee, a13 as gresaribed by lav�. Your eonstruetion must comply wi.th a.13 app3icab2e 2aw�, ardiasaces, buildiag codes, an,d zoaiag regulatioas. OWNER'S SIGNATURE � I?ATE -!�� ( � ADDRBS J Q� �r �F!�r .,1'Gb �'' . PHOI�� 1 Z " t?� S�ITN8S5 PSRP3IT # �