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DISCLOSURE ST�TEM�NT FOR OWNER CITY OP' ZBPHYRHIZ,LS BIIILDSNG �LPART�7T =r �0�.�,�2,$ t �.'b �Vl�p+-. h�ve read aad fully uaderstaud aad agree to the pravisioas of �his instrument. The und�rsigned statee aad af�irm� that he or she is deairous of caastructiag, reaovatiug, addiag to cr reroa�iag hi.s or her own clomiaile, that he or she actual3y `oecupies, ar will oecugy by said domie3.Ie, aad same is nat �ar reat, lease ax sale, Tha� he or she sha11 comply vrith the followiag caaciitions: 1. That the owaer aad he or she alone sh�l]. act as the builder for all phases of canetsuctioa. 2. That �he oaTn�r wiZl comply w3.th ali pravisiaas of the City of Zephyrhi2ls ordiaaaees azid codes pertiaeu,t ta the buildiag. 3. That ia the eveat various phases of caastruct�aa are subcontraated, he will eagage aaly properly licea�ed subcontractors aad will persoaall.y supervi�e such work. 4. That ia the eveat the Buildiag Inspector s]�.a11 require carrections to be made, the ocva.er will assum� fulZ responsibility to iasure they are made, and upon completion will ca11 far a r�inspection befare proaeediag with the buil@iag, 5. Tha� �he o`vaer ahall assume �u11 re�poasa.b3lity for the constxuati.oa and will not escpect supervss3on o£ his work from the City af Zeph}�rhills Suilding Departmeat. 6. That gsior ta final inspeetiaa aay additioaal fe�s, iacludiag reiaspectioa feea, must be paid ia full. A writtea request trom this affice shall. constitute aa o�f3.cial notiae to pay additioaal fees. 7. That the ovaner shall comply with all City, Stat� and Federal laws ia regaxd to sacial security, workman's compeasation, lien l�ws, etc. , whete applicable. 8. That the awaer shall compZy witTn aIl the sa�ety codes iseued by th� Florida Irtdustria3 Commissioa. 9. 3�ate 1aw reguire� coaatruction to be cioae by lieeased aautzaetars. You have applied �or a permit uader aa exempt3on to that 1aw. The eacemption allows you, as �he own�r of yaur property, to act as your owa coatractoz wi�h certaia restrict3.ons even though you do aot have � Ziceaee. Yau must provide direct ' onsite Supervis3.on af th� aanstruetiaa yausself. You m�y'build or improve a oa�-family or two-fa,xni2y resideaee or a farm autbuildiag. Yau m,ay also bztild or improve a commercial build3a�, grovided your coats da ao� eacceed $75,40Q, The bu3ldiag ar reeideace mus� be for your owa use or cccupa�acy. xt may aot be built or �ubstaat3ally improved fos sa.1e or lease. Tf yau se11 or lease s builc�isa,g ya�u have buil� or substantiaTly impsaved yoursel� withia 1 year a�ter the cons�ructiou is comglete, the 2aw will presume that you buiZt ar substaati.ally irnproved i£ for sa1� or lease, whiah a.s a violatian af this exemption. Yau may aot h3re aa ua].icensed perso�o. to act as your contractor ar , to supervise people workiag oa yaur buildiag. It is your respoaeibility to make sure that people emgsloyed by you have licenses required by state law and by couaty or muaicipal lieeasiag ordiaances. Yau may nat delegat� the r�spozisibility for supezvi.siag work to a licea�ed cantra�etor wha is aat liceszsed to pezform �he work beiag doa�. Aay pexsan s,rorkiag on yoax buildiag who is aot licenaed must work under your direct supervisioa sad must l�e emplayed by you, which meaas tha� you mus� deduct F.I.C.A. aad withholdiag tax and provide workers' compensatian for ttiat emp3oyee, alI as presaribed by Zaw. Your ccnstructioa mu�t comp3y wi� all app�icable I.aws, crdiaaaces, buildiag codes, aad zoaing re lat3on ,..,�---��-- OWNER'S SI6I�TATURE DATE �� I RDDR88S PHONS WITNESS P8RMIT # � I �