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! r �, DISCLOSt7RE STAT�T FOR OiVNER . Cl2`Y OF ZBPHYRHILLS BIIILDIATG DBPAR'!'�NT ,I, have aread aad fully wxderstand ans� a�re� �o tbe grovisians of th3s instzasm�nt. The uadersigned states aad affirms that he ar she is deairous of caastructiag, � reaova�iag, addiag �o or rexoafiug his or her o�va domicile, that he or she � actually occupies, or will occupy by said domicile, �ad eam� is aot �or I � reat, lease as �ale, That he or she sha11 aomply with the fol2awiag aouditions: ; � 1. That the owaer aud he or she aloae shall aat aa the builder far a21 phases of j construction. I 2. That the owa�r will comgly with alI prov,isioas of the City of Z+ep2ay�hilie � osdiaaaces arad eades pertiaent te the buildiag. 3. That ia the ev�nt var3.aus ghases of eag.structiaa are subcaatracted, he wi31 ; eagage o,nly propexly liceased subcoantractors aad +�viZl persoaally s�apervi�� ' such woxk. g. That ia the eveat the Buildiag Iaspector slsall requ3re carrectiaas to be made, . the owaer tvill asevrne full respaasibility to snsure they are made, a�nd upon � comp3etion wi21 call far a reiaspect�.ou befoze praceedisag �rith th� buildiag. 5. Tha� tihe ovmer sha11 aasume full xespoas3bility for the constzuctiaa �sud will aot expect �upervisioa o£ his wark fxom the City aiE aephyrb311s Su3lding � Departmeut. 6. That prior to �iaal inspeetioa any addit3oaal fees, 3.acludiag reiasp�ction I fees, mu�t b� p�id 3n full. �i written request �rom thie of�ice sh�l�. ' coasti.tu�e au o�fatcial aotice ta p�gr additional fees. 7. That the owaer shall comply with a11 Ca.ty, State aad Federal laws in regard to i sacial security, workmaa�s compens�tion, lien laws, ete. , where applicable. , , 8. fihat the owaer shall comply with a11 the safety codes is�ued by the Floxida � Ind�striai Cama►is�iaa. j , 9. State law requires construetian to b� doa� by lieeased caatractors. 'SCou have ! i applied �or a permit uad�r aa eacea►ptioa to �hat law. The e�cempt3on allows you, ae tla� ovPner of yaur pxoperty, �o act aa your owa coa.tr�ctor with certaia r�strictione ev�a,though you do ao� have a licea�ae. You must provide d3.rect � oasi�e supervisioa of the coastructiaa yourself. You may build ar improve a ane-faxu�.ly or t�a-family resic�eaee os a farm outbuilding. You :aay al�o bu3ld or improve a comm�xcial buildiar�, prov3ded yoiar coats do aot e�cceed $75,Q00. � The buildiag ar re�idence must be for yaux awa uee or occupasicy. It may aot ' be built or substaantially i�proved for eale or lease. xf you eell or lease a � buildiag yan hav,� built or s�abstaatially improved yourself withia 1 year a�ter th� eonstsuetion is camp2ete, �he I�.w ivill psesvme that you built or ' substaatially iatproveci if for sale ar le�se, which is � viaiatiaa ot thie ; ieacemptioa. Yau may aot hire aa ual�.cen�ed p�rsaa to �et as your cautractox or � i ' to superv3se people workiug oa your buildiag. It is y�our respoasib3la.ty ta inak� sure that people emplayed by you have liceas�s required by sta�e law aad by couaty or muaieipal liaensiag ordiaaaces. Yau may aot c�elegate the , xeapansibil3ty frir supervi�i�sg wark to a lic�ased eaatractor who zs aat ' , liceased �o pexfcrm the work bea.ng c�os►e. Any perso�s workisug on yaur bnildiag ; who is uot liceased mus� �ork under yolax� direct superviaion a.nd musG be: i ' ------- _.�lo_yed_byyouu� whi��n��ns �at-_3r�u--must-dedac-�-R�-�:C-�--ead-witlrho-tdin+T tax_ �----- ---- -- -- and provide workers' compensation fcsr that employee, aII as prescribed by law. Your cons�ruatioa must c ly vaith aI appli�able laws, O�tI�.IIa3ii4'�S� bu33diag � codes, aad zonia� regulati s. � OitiiNERr S SIC;2Z��., �L... DATE' �v D�'Z„_� 2.r�l ) � ADDR8S3 � �-+t� ; PHONS, 1 2'� iAITT�TsSS P8RP2IT # I i � ; �