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` DI�CLOSIIR� STATEY��fi FOR OWNBR ITY OF ZBPIiYRHILLS BUIT�D�NG DEPART� I, /� `J� ha.ve read arad fully uac3esstaad aad � a re� to the provisions of this instrument. The vac4ersigned states aad affirms that he or sl�e is deaizous of caastructing, r�aovatiag, addiag ta or reroafiag his o��her own doznieiZe, that he or she actually ocaugi�e, or will occ�py� by said domie3.le, aad same 3s nat for reat, lease or sale. That he or she shall comply with th� followiag conditiaas: 2. '1'hat the awuer aad h� or she aloae shall act as the builder for all phases of coastzuetion. � � 2. That the a�svaer will comply �ith all provisions of the City o£ Zephyrhi3ls ardiasnces and cad�s pertinent to the b�a�.ldiag. 3. That ia the even� var3ous phaees of caa�atructiaa are subcoatracted, he wxll engage cnly properly licen�eci subcontaractars aad +c,�ill p�rsan�lly supervise such work. 4. That in the event the BuiZding Iaspec�or shall requira correctioas to be made, the owaer �c,rill assume full sespciasibi2ity �o insure they axe made, �ad upan complet3oa will c�11 �or a reiaspectian b�fore praceediag with the buildiag. 5. That the owaer shmll aseume fu11 •reepaasibility for the construction aa� wi11 aot expect supeavisioa at l�is work �rom the Gity of Zephyrhills Suildiag , Depar�m�at. � 6. Th�t prior to �iaal iaspee�ion aay arlciitiaaal fees, ine2udia� r�iaspec�ioa � fee�, muet be pmid ia full. A *�►rit�ea request �rom th3� of€ice sha13 ' , conatitute aa official aot3c� to pay additioa�l fees. 7. That the owaer sha11 comply with �11 City, Stat� aad Federal Iavas ia reg�xd to social secur3.ty, workman's compensation, lien I�ws, etc. , �ahexe applicable. 8. T2�at the owa�r shall coingly with a1I the sa�ety cades a.ssu�d by the Fiorida Iadustrial Commis8ian. 9. State 1aw requirea coastxuctiaa ta b�e doae by lic�ased coatractars. You h�ve appli�d fos a� permit under an exemption to that law. The. exemptioa allows yon, as the owaer oE your property, to act acs yaur owa cautractor wi�h certaia restri.etiozzs evea thaugh yau da aot have a Ii�ense. You muat prov%d� direc� oasite supervis3.on of the caast�uctioa gourself. Yau may •build ar imprave a one-f�.tnily or tvao-fami.lg residence or a fasm outbu3ldiag. Yau may a.lso build or impxove a commercia], buildiag, prav3ded your coets do aot exceed $75,000. The buildiag or r�sidence mus� be for your owu useror accup�acy. It may aot be bui2.t or substant3ally improved far sale or lease. If yau sell or lease a buildiag you have built or substaati�ily impsoved yourself withia 1 year �fter the aonstruction 3.s comgl�te, the lavr will presume that you bui3t or aubstaatially improved if for sale or lease, which is a v3olation of this eacem,ptioa. Ycu may ao� hir� a�,n ualiceased persoa to act ae your coatraatar ar to supervise people workiag or� your builda.ag. It is your r��ponaiba.lity to mak� sure that p�opl� employed by ycu 3iave licenses r�quiret� by stat� law and by couaty ax muslieipal liceasiag oxdiaances. You may aot �.e3ega�� th� r�spansibil3ty for eupervis3ng work :�o a liceased contrac�or wrha is aot liceased to perform the work beiug doae. Aay persoa workiag oa your buildiag who is not licensed must work unr3er your direct superviaian snd must be __—___ _�3oyed byxou� whac�.sn�aae�hat._y�mus�-ded�et-F.-�.-�:-�i.-�ad-mit�l-dsag tax------ —_ and pravide workers'' eampeasation �ar that emgloyee, a31 as prescribed by 2aw. � Yaur caastructian muet com g wibh a11 applica2�le law�, ord3aaacesj buildiag codes, aad aoaiag zegu . i � OWt�iER`S SIGNRfi " DATE " ', `rr�� ADDRBSS c�fd � '" �i PHONB � inTl'IRdESS F8R'tY[I7C # � _ i