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( _ - i . � DISCLOS'�RE ST1�TE�T FOIt OWI�ER , CITY OF �BPHYRHIT,LB SIIILDII�fG DEPART�I1tT I, �., �,�� h�ve read aad fully unc2�rstaad aud agr�e to the prov3sious of this instrumeat. The uadessigaed sta�ea aac� affirms tha� he or she is desiraue of constructiag, renavatiag, addiag �o or rercofiag his ox Yier own domicile, that he ar she aatually oceupie�, ox will aec�p�► by said domicil�, aad same ss not for reat, lease or sal�. That he or she shaZ]. comply with th+� followiug conditi.ons: 3. That th� owner and he ar �h� aloae shall act as the builder for all pha�es oiE eoastruction. � 2. That the ox*a�r will campZy �v:ith aZ2. provisioas of the Cit�r of Zephyrhills ordinsaces �ad cod�s pertiaestt to �he build3.ag. 3. That ia the eveat various phases of coast�cuctioa are subcoatracted, he will engagre oaly properly lioeased subcontractar� aad will persoaal].y supervise suah work. 4. That ia th� eveat the Buildiag Iuspeator sha1l require corrections to b� made, �he o�,raer will assvme full respaasibiZity to iasure they are made, �and upoa complet3on will ca].l fax a reiasp�atiaa b�foxe proaeeding with the bui.ldiag. 5. That th� owaer s�all assume full respaaeibil.ity far the cosistxuct3on a.ad w311 xxot e:�cpect supervisioa af his work �rom th�e City of Zephyrhills Suildi.ag Departm�nt. 6. 3'hat pria� to giaal iaspeetion aay �adclitioaal fees, iacludiag reiaspection £eesj mus� Tae ,paid ia full. A writteu request from this office $hal.3 coastitut� an offi�ial notice to pay adc4itionaZ fees. 7. That �h� owner sh�11 comply with �1]. City, S�ate aad Federal latvs iri r�gard to soca.aZ security, workman's compensa�ian, la.en laws, etc. , where applicable. 8. That the owaer shall camply aaaith all the s�fety cade� issued by the Florid� Indus�rial Commission. 9. State law reguires �onstxuction to be done by liceased coatractars. Ycu have applied fcir � permit uader aa eacemp�ioa to that l�w. �h� exemp�ion allows you, �.s the awaes of yrour praperty, to act as your a^wa cantractar with certaia restrictious ev�a though yau do aat have a licease. Yau must provid�: direct i oasite supervisiou of the coastruCtioa your�elf. You may build or improve a oae-f�mily or two-f�amily resideace as � farm outbuildiag. Yau may also build or 3mprove a cammercial buildiag, provicied yaur cost� do not exceed $75,OQ0, The building or reaideace muat be for your owa use or acaupaacy. Zt may ao� be built or substaatially improved for sale oac Zease. If you sell or lease a bui3diag you have built ar svbstaatial.ly improved yourael� wi�hia 1 year aftes the eoastruetioa ss eamgZet�, the law wi11 presume that yau built or sub�taat3a11y iaiproved iE for sal� or lease, which is a viola�ioa of this exemption. You may aot hire aa ualicexased persoa to act as yaur coatraator or to sup�ervioe people workiag ou your buildiag. zt is yaur reapoasibility to make sure that peaple employed by you have Iicenses required by stat� law aad 'b�r couaty or a►uaicipal Iiceasiag ardinances. Yau may aot de3egat� the r�aponeibilitg foz supervising work to a liceased.acs�traetor �ho is aot liceased ta perfozxn the work being daae. Aay persoa working oa your buildiag who is aot liceased must work uader your direct supervision aad must be ----- --�ployed b�you�rhi�ILmeans-that___.y.ou-must-deduct-I�.-I-.-C:34:—aad-withho-l-ding-tmx---------------- and provide workers' eompensa�Gion far that emplayee, ai2 as prescribeci by Iaw. Yaur caastruatiaa must aomgly Fri.th all app3fcabl� 3aws, ordinances, buildix�.g codes, aad zox►ing sec,�ulat3ons. dWNER'S STGNAfiURE �,J"' DATE ann�ss �zE� tJ��- �czF-� PHONS� V�IITATE;SS PRRPdIT # I 1 !