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i I � DISCLOSIIRE ST1�TE1�lENT FOR OWNER CIfiY OF ZBPFiYRHILT.�S BIISLDINU DBPART� Z, h�ve read aad fu13.y uad.�r�taad aa� _ � agree.- ta the provisioans of this ins�rumeut. _ � The undersigaed statee aacY affirms that he or she is deairaus of coustruatiag, � reaovatiag, addiag to or reroo£fag his or h�r owa domicile, that he or ehe aetual3y aceugies, or u•il2 oeeupy by said damiei.le, aszd same is not for I reat, lease ar sale. That he or she shall comply with the �ollawing coaditions: l � 1. 'That the owae= and he ax she aloae shall act as the builder �or all phases of coa��ruc�3oa. 2. That the ovaaer �ai12 comply with all pravisioas of the City of Zephyrhills I ordiamnc�s and co8ea peztiaeat to the building. � 3. That ia the eveat vari.aus ghase� of construetioa are subcan�ractedd he will � engage oaly pxoperly liceased subcoatrac�ors �,nd w311 p�ersoa�lly supervise auch work. ! 4. fihat in the eveat th� Building Iaspector �eha32 require correctioag ta b� made, � the owaer will assume full respoasib3.lity to iasure they ar� made, aad upoa ' completiaa will call fax a reiaspectian b�fore proaeetiixag w3th the building. i 5. That the owaer shall as�ume �ull respaasibility► for th� construc�ioa and arill ; raot expect supervi.eioa of his work from the City of Zephyrhills Building ' Depaztm�at. � 6. Th�t prior to fiaal iaspectxon aaxy additioaal �eee, iacludiag reiasp�ctioa � �ees, muet b� paid i.n ful2. A frrittext reguest fram this office sha3l. constitute aa offiaial �o.otice to pay adldi�ional fees. i 7. That the owaer shal]. com�Iy with aZl G�ty, Sta�� aad Federa3 3.aws a.a re�azd ta social security, warkman's compensation, li.en laws, etc. , whete applicable. 8. 'That the owaer shall compl,► with all the s�fety codes i�sued by the FZorida i Tadustrial Cammissai.on. 9e State law requires construction ta be doae by licensed aontr�ctors. Yau have ' appli�d tc►r a g+�rmit uader aa e�cemptioa to that lat+r. The �emption al.2ows you, as the owner af your proper�y, to act as your o+wn coatractor with certaia restrictio,ns evea though you do riot have a licease. You mus� provide direct oasite sugervisiaa of the aoastructioa yoursel�. You may'build or imgrove a oane-fmmily or �wo-E'�nilyr resideace or a fa�rm outbuilding. You may also build or improve a comntercial buil.ding, provided ycur cas�� o uot �ceed $75,QOQ. The buildiag or res3.denc� must be for your owa use ar occupaacy. Tt may aot be bu31t or substantially improved for sal�s or lease. If you sell or lease a buildiag you hmve built or at�bstantial.I.y imgroved yaurself w3.thin 1 y�ar after �he caastructiaan is compZete, the 1aw tarill preaume �hat you built or substaatially improved if for sale or lease, which 3.s a violation of this �acemptioa. You may aot hire aa unliceansed persoa to act as your caatx�ctor or to supervise peaple workiag oa your bttildiag. Tt is your respoasibilitg to make sure that p�op3.e employed by yo;a have 2iceases =equired by s�ate 1aw aad by couaty or muuicipal liceasiag ordiaaaces. You may ao� delegat� the responsibility far supervisis.�g work to a 13.aeased caatractor wha is aot � licea�ed to perform the work beiag don�. 10iay persoa working aa your buildiag who is aot licensed must work uader ydur direct sup�rvisioa aad must be �mp2ayed by you, which meaas that yau must deduct F.x.C.A. and withholding tax and provide workers� compensation for �hat emplayee, �11 as prescribed by lmw. Your constxuatioa mv.st comply with all ag�plicable I.aws: ordiaauc�s, bui2ding i cades, and zoaiag re ations. , i ,�jt9WNERr S SIGNATURE DA2'E �t - {-t —I � I (��LfDRESS i[q35 l,A►ct-5 ti o C fJ 2 PF�ONF, �10 " ��'r'4�- {-c v 1�' - ( I WITNESS PSRMIT # � � j � � � ,