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�' DISCLOSURE STATEN�tdT FOR OWNER CITY OF �BPIiYRIiII�LS BIIILDING DEPARTMI'sN'� I, �`{"�ht )� ti�t..�-��`�C�'-�_ � have read and fu11y unders�and aad agree to the pravisious of thie iastrumeat. The undersigaed states and affirms that h� ar she is desirous af caastsucting, reaovatiag, addiag ta or reroofiag his ar h�r owu domicile, that h� or she ac�ual3.y occupies, or wil.l aceupy by said domicile, an� same is not fax reat, lease or sale. That he ar she shall camply with the followia� coaditiaas: I. That the owaer aad he or she aloae �hall act as the builder far all phases of construc�ioa. 2. That the awner wiZl compZy c,Tith all grovisioas of the City of Zephyshills ordiaaaces aad cades pertiuent to the buildiag. 3. Tha� ia the eveat various phases of conetructioa are subeoatrae�ed, he s,ri31 engage aaly properly licensed subcontractors aad will p�rsaaally supervi�e such work. 4. Tha� in the eveat the Suilding Zasgeator sha2l requir� carrectians to be made, the owaer wi11 aseume full respoasibility to iasure they are made, and upon completion will call �or a reiaspect3an before pzoaeediag wa.th the builditig. 5. Tha� th� owaer shali a�sume fu11 respoasibility for the coastructioa and will aot expeat supervisioa of b.is work from t�he City o� Zephyrhills Building Degartmeat. 6. That prior �o fiaal iaspectiion aay additioaal fees, iaaludi�ng r�iaspectioa fees, muat be paid ia full. A wzittea reguest frpm this af�ie� shall constitu�e aa official aotiae to pay additioaa�l fe�es. 7. Tha� the owaer shall comply with all City, State aad Federal law� in regard to social security, workman's aompensation, lien laws, eta. , where applicable. 8. Tha� the owaer shall camply with all the safeGy cades 3.ssued by the E'lorida Iadustrial Commissian. � 9. State law requires conetruction to be doaxe by liceased contractars. You have agplied far a permit uader aa exempGion ta th�t law. The exemptioa allows you, as th� awa�r of your property, to act as youx owa coatractar wi�h certaia zestrictioas even though yau do not Szave a license. Yau must prcvide direct onsite supervisioa af the coastruetioa yourseZf. Yau m�.y build ar improve a one-�'amily or two-tamily resideace or a tarm outbuildiag. You may also build or 3mprove a eomme=cial buildiag, provided yaur costs da aot exceed $?5,004. The build3ag ar reeideace must b� £os yout owa use or accupaacy. It may aot be built or substsatially improved for sale or le�se. zf you sell or leaee a building you have built or substaatially i.mpsov�d yourself withiss 1 year aftes the coastructioa is complete, the law will presume that you built or substaati.ally improved if faz sa�.e or I.ease, mhieh is a violatiaa of �his exemptioa. Yau m�y aot hire an ualicens�d person to aaG as your contractor or to supervise people working oa your buildiag. It is your respoasibility �o ma3ce sure tha� geag�e emglayed by you have Iicenses rec,�uired by stat� 2aw aad �y cauaty or municipal liceuaiag ordiaances. You may aat delega�e the responsib3.lity for supezvisiag work to a I.iceased contractos who is aot licensed �o perform the work beiag daae. Aay persaa workiag on your building who ia nat liceased must wor7s under your direct supervision and must be employed by yau, whicl� meaae that yau �►us+� a�au�t F'.I.C.A, and withhalding tax and provide worker�' compensatian for that employee, a1Z as prescribed by law. Your constzuetioa must comgly wi�h a12 applicab2e I.aws, ordis�aac�s, buildiug codes, aad zo�.iag regulatioas. ` .C� L.`--`�-�'"��''`.-- DATE L� �� "�� ( OWNER S SS6NP.�URE ADDRBSS ��o�.'7' 1� lQ 3 ��"Jr�Q PHd1�7E �'1 � WITNBSS Pl3RMI2 #