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I • I I DISGLOSURE STATII�2ENT FOR OWNER CITX OF ZFsPHYRHILLS BUILDING DEPARTMENT I, �t�� [,�� j�Q,�� have read and fully uaderstand and agree to the provisiaas o� this instrumeat. The undersigaed states aad affirms that he ar she is desirous of coastructing, reaovatiag, addiag to or reroofing his or her awa domi.cile, that he or she actually occupiea, or will occupy by said damicile, and same is not for rent, 7.ease or sale. That he or she shall comply with the folZowis�,g couditions: 1. That the owaer and he ar she alane shall act as the buildex for all phases of construction. i 2. That the owner will comply with all provisioas o£ the City of Zephyrhills , ordiaances and codes pertinent ta the buildiag. : 3. That in the event variaus ,phases of coasGructioa are subcoatracted, he will , eagage oaly proper�.y liceased subcoatraetors aad wa.Il gersonally supervise such work. I 4. That ia the event the Buildiag Iaspector sha11 require correctioas to be made, � the owner will assume full responsibili�y ta insure they are made, and upon ! completiaa wi11 ca11 £ar a rein.spec�ion before proceeding with the build3.ng. � 5. Tha� the owaer sha11 assume full reapansibility for the constructiox2 and will � not expect supervision of his wark from the City af Zephyshills Building Department. � 6. Tha� prior to fiaal iuspection any additional fees, including reinspectiaa ; fees, must be paid in full. A writ�en request fram this office shall � i constitu�e an affiaial nota.ce to pay additioual fees. � 7. Tha� the own.er ahall comply with all City, State and E'ederal lawa ia regard �o j social secnrity, warkman's compensation, lien laws, etc. , where appliaable. � 8. That the owaer shall aomply with a1Z the safety codes issued by the Florida Iadustrial Commissioa. � 9. State law requires eoastruetioa to be doae by licensed contraetors. You have ; applied for a permit uader an exemp�ion to that law. The exemp�ion allaws , yau, as �he owner of yaur property, to aat as your ov�ru eoatrac�ar with certain � restrictions evea though you do aot have a licease. You mus� provide direct onsite supervisioa of the constructioa yaurself. You may build or improve a ' ane-family or t*ero-family resideace ar a farm outbuildir�g. You may also build or improve a aommercial buildiag, provided yaur casts do not exaeed $75,000. � �he buil.diag or residenee must be for your ot�. use ar oecupancy. It may aot ; be built or substautially impraved �or sale aar lease. If you sell ar lease a i buildiag gou have built or substaatially improved yourself withia 1 gear after the cons�ruction 3s comple�e, the law will presume that you built or substaatially improved if for sale or lease, which ia a violatioa of thi� e�cemption. You may aot hire an unliceased persoa ta act as your contraetor or to supervise people warkiag on your buildiag, It is yraur respoasibility to make sure that peagle employed by you have liceases required by sta�e lava� aud by aouaty or municipaZ licensing ordinaaaes. You may aot delegate �he respansibility for supervisiag work to a licensed cont�ractor who is not liceased to perform tha work beiag done. Any person workiag on your building who is nat liaenged muat wark u.nder your direat superva.sioa and must be empl.oyec3 by you, whieh means that you must deduet F.I.C.A. aad withholding ta�c and provide workers' aompensation f r that employee, all as pre�cribed by law. Your construation must comply with 11 applicable 1aws, ordiaaaces, buildiag � codes, aad zaning r ulatioas. � /� I OWN.L�'R`S SIU'A7�+a9.' �J-'�_...� DATE �v 7�� ; ADDRESS q�pQQ , � —� 33� i, Pxorr� S!�7�"�-!5�7 Ce!( �f i� -�a 1- ��75 - - � � WITNESS �� PERMIT # � i �� —