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DISCLOSIIRE STATEf�!' FOR OWIJER CITY OF ZSPHYRBTI�LS SIIILDIIITG DBPARZR�At'T I, �T t J�&�� a��e- have read aa8 fully uaders�aad and agree to �he psovisiaas o� this iastrumeut. The uaclersigaed states sad aff3,rms that he or she is desirous af cons�ructiag, reaovat3ngr, adding ta or reroofiag his or her awa domiciie, that he or she aetualZy accupies, ar �,*ill accupy by � said domicile, a.ad same is not for xent, Zea�e or sale. Tha� he or she sha31 comply u•3.th the fo2lowiag aaaditionsa 1. That �he owaer aad he or she alone ehall act as the builder for all phases of construc�ioa. 2. Tha� the owner will comply with al� provisioas af the City of Zephyrhills ardiaaaces and aades pertis�,eat to the bu3.Idiag. 3. That ia the event various phasea of construct3oa are subcoatraatec3, he �*ilI eagage only properly liceased subeoatractors aad wiZl persoaally supervise such �rork. 4. That ia �he evertt the Su3ldiag Iaspector sb.a11 require corrections to be made, the otaner will ase�m�e fu13. re�paasibility to inaure �hey are made, and upaa comgletion wi21 ca21 for � xeinspection before proceediag with the building. 5. That the owner sha11 aesume fu1Z r�sgone3bili�y fax the coa�tsuction aad will I nat expect aupervision of h3.s wark from the C3ty of Zephyrh3.�.ls Suildiag Depastmeat. i b. That priar ta fiaal iae�pection aay additioaal �ees, iacludiag xeiagpect3.on fe�s, must be paid ia �u11. R tvritten request fram this affice ehaZl coasti�ute aa official aotice to pay additiaaa•1 fees, � 7. That the owaez �hall compl�► with a3.1 City: State �ad Fec�exa3 laws ia regard to I� social security, workman's compensation, lien laws, etc. , whete applicable. ' 8. That the owues sha7.1 comply ivith aZI the �afety aodes i�sued by the Florida� Iadustrial Cammiss�.aa. 9. State law requires eoastructiat� to be done bgr licensed coatraetors. You have applied for a pex�►3t uader aa �emptioa ta that law. The +wacemptioa allaws you, as the ov�aer of your proper�y, to ac� as your own contractor wi.th certain �, restrictions evea thangh you da not have a li.ceaae. You mus� provide dixect onsite supervisioa of the coastructa.oa yourself. You raay'builc� or improve a one-family ar two-�'amily residenee or a farm outbuildiag. You may also build ar improve a cammexcial bui].dfag, provis�ed your costs do aot exceed $75,000. �he build3ag or resideace mu�t be far your owa use or ocaupaacy. It m�y not be built ar eulastaatially impraved for sale or leas�. I�£ you sell ar lease a bui3.diag you have built or substantially improved yauraelf withia 1 year after the caastruetion is eomp2et�, �h� lav�r wiZl psesume �hat you built or sub�ataatially 3m�roved if �or sale or Zease, whieh is a violation af thie exe�mptioa. You may aot hire aa u�nl3c�as�d perBon ta act aa your coatractor ar to supervise people warkiag oa your built3ing. It is your responeibility to make ause that people employed by yau have licenses required by s�ate law aad � by ecvatg or mtaaiei.p�1 liceasiag ordiaaaceB. You may ao� delegate the ' respoasibility far supervisiag s�ark to a 33eeased coatraGtcr wha 3.s aat liceaeed to perfaxzn the woxk be3.ag doae. Aay peraoa vaorkiag on your buildiag who is uot liceased muet work under yaur direct anpexvision aud must be employed by you, which means that you mu�t deduat B.I.C.A. sad withholdiag tasc ' i and pxovide vPorkers' compeasatian for that emp3oyee, alI a� prescribed by law. �� Your canstructioa mt:st eomp3:y with �1]. appliaab2e laws, ordinaaces, buildiag codea, aad zaniug r�gulatians. . F OWL�7ER�8 SI6NATURE DATE �� I � �� ��RssS 57.3'7 T , r�c-�- Z� I � PH02�TS WTTNESS PSRM'CT # � _ , I . �