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�� Y DISCLOSIIRE STATEt�Q:I�iT FOR OWNER CITY OF ZSPBYRHILI.B BIIILD2NG DEFARTMENT I I: have read aad fu21y unc3�rstaud anr� + agree �o the pravisioas of this inst�ent. � I The uad�rsigaed states aad affirms tha� he or she is d�sirou� of canatructiag, reaova�iag, add3ag to or reraafiag his or her owa domicile, that he as she actually oecupies, or wi21 occupy by said damicile, an8 same 3s not for reat, lease or sale. That he ox she sha1Z camply with the iEollowiag ecnditions: ' 1. That th� owaer aud he os she alone sha11 aet as �he builder for all phases of constructi.on. � 2. That the awuer will comply �aith all prcvisiaas of the City o� s^.ephyxhills ordia�aces and codes gextineat to the buildiag. 3. That ia the eveat various phasea of caastruotioa �re subcoatra�ted, he wiZl engage anly properly liceased subcoatractars aad will Qezsanally supervise such work. �. That in the eveat the Buildit�g Iaspector shaZl require correatioas �o be made, the o�,m�r will assume full r�sponsibi2i�y tc iasure they are made, �.nd upon completion w311 call for a r�iaspection before gsroeeeda.ag with the build3ag. 5. That the owaer shall assume fu11 reepaaeibility for the aoastructioa and will not eacpect supervisfon a� his work from the City af Zephyrhills Suildimg Departmaat. 6. That priar to �ival iaspectiau any add'itional tees, iacludiag reiaspection feea, must be p�id ia fu1Z. A �,arittea rsqezest �rom thi� office shail coastitute aa afficial aotice to pay �dditioaal fees. 7. That the o�aaer shall comply wfth all City, State and F�d�ral laws ia regard ta social security, workman's campensation, lien laws, etc. , where appli.cable. 8. That t3se awaer shall comply with a1Z the saf�ty cades issued by the Florida Iadus�rial Commission. 9. State �.aw requiraa coastruction to be doue by Zieeased cantractazs. You have ' applied �or a permit vader aa exemptio�. to that law. The eacemption alloses you, as the awaer of your property, to aat as yaur owa coatractor wi�h certaia restrictioas evea though you do aot have a licease. Yau must provid� direct oasite sup�rvision of the caastruation yaurself. Yau may build or impxove a otte-family or tvro-family residene� or a farm outbuiidiag. You may alsa bui2d or improve a aommercial buildiag, provided your coata do not �ceed $75,OQQ, Tb,e bu3lding or resideace mus� be �or your own use or occnp�acy. It m�y aot ' be built or substaatially improwed for sale or lease. Tf yau sell or lease a buildiag yau have buil� cr substaatially im�ssroved youraelf withiu 1 y�ar after the aoastructiou xe comglete, the 1aw wiZl presume that you built or substaat3.ally impsoved if for saTe or lea�se, which is a vs.alatioa of this � e�cem,ptioa. You may aot hire a�a ualiceased pexsaa to act as your coatractar or to supervise people workiag on your buildaag. It a.s your r�eponaibility t�o make sur� that pecpZ� employed by you hav� license� required by state Iaw aad ! by couuty ar muaicipai iiceasing ozdiaanees. You may not de3eg�te the respansibility �or sugexva.aiag work ta a liceased coatraetor who is aot liceased to perfozm bhe work beiag done. Atxy persaa workiag orY your buildiag who fa aot licenaed must work unde�c your direct supervisioa and must be ----------e�2oyed bv vou._ which__m�aae that__y.oxs_must-deduc-t-II�.-2:C-:•�:--�d--withho3-di�ng-t�x---------- aad provide workers' compensation for that employee, all. as prescribed by Iaw. Your caastructiaa muet comply wi�h all applieable Zaws, ardiaazices, buildiag codes, aad zoaiag regulationa. OWNER'S SI�NA'rrURE`-'" DATE ADDRLSS PHONI:_ T�ITYdBSS PERi�2IT # �