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DISCLOSIIRE STATEMENT FOR OWNER ' CITY OF ZEPIiYRHILLS BUILDING DEPARTM.EPiT I, C�t/�z"� c�G1/^'�'�� have read and fully uaders�aad aud agree to. the provisious of this ias�rumeat. The undersiqued states and aff3.�ns �hat he ar she 3s desirous of canstructiag, renovatiag, addiag to ar reraofiag his ar her owu domicile, that he or ahe ac�ually occupies, or will occupy by said domicile, aad same is not for rent, lease or sale. Tha� h.e ar she shall camply with the follawiug caudita.ans: 1. That the awaer an.d he or she aloae shall act as the buildex for all phases of construc�ion. 2. That the owner will camply with al1 provisions of the City of Zephyrhillm ordinanees aad cades pertiaent ta the buildiag. 3. Tha� ia �he event various phases of coas�ruct�ioa are subcozstracted, he will eagage oaly progerly licensed subcoatraetars and c,rill persona2ly supervise such work. 4. That ia the eveat the Building Iaspector shall reguire correctioas to be made, the ov�raer will assume full respaasibility to iasure they are made, and�upon completion will call for a reiaspec�ion before proceeding with the buildiag. 5. Tha� the owaear shall assume full rasponsibila.ty £ar the coxsstructiou. and will not expect supervision of his wark farom �he Gity of Zephyrhills Suilding Departmeat. 6. That prior ta final inspection any addi�ional fees, iaaludiag reinspectiau fees, must be paid ia full. A Hrrittea request from this office sha11 canstitute aa af£a.cial notice to pay additioaal fees. 7. Tha� the owner sha11 comply with all City, State and Federal laws ia regard �o social security, warkman's eampensation, lien laws, e�c. r where applieable. 8. Tha� the owner shall camply with aIl the safety codes issued by the Florida Iadustrial Cammission, 9. Sta�e law requires construction to be done by liceased con�ractors. You have applied �or a permit vasder an exemp�ion to that law. The exemptioa allows you, as the ownes of your property, to act as.your own, eon�zaetaar with certaia restrictioas evea though you da not have a liaease. You must provide direct oasite supervisioa. of the constructian yourself. You may build or iamprove a one-family or two-fams.ly resideace or a farm autbuildiag. Yau may also builci or 9.mprove a aommerciaZ buildiag, pravided your casts do aot exceed $75,q00. The buildiag or sesideace must be for your owa use or oeeupanay. I� mag aat be built or substautially improved £or sale or lease. If you sell or lease a buildiag you have buil� or subs�aatially improved yourself witha.a 1 year after the cons�rucGioa is camplete, the laav will presume that you built or substantially improved if �or sale ar lease, which is a vialatian of this eacemption. You may aat hire an unlicensed person to aot as your eontractor or to �supervise people warkiag oa your buildiag. It is your respansibi].ity to ma.ke sure tha� peaple emplayed by you have licenses required by sta�e law and by county or municipal liceasing ordiaaaaes. You may aot delegate the responsibilit�y for supervisiag work �o a liceased contractor wha is not Zicensed ta perfarm the work being done. Any person working on your building who a.s nat liaeased must wark uader your direat supervision and must be emgl.oyed by you, whieh meaxzs that you must deduct F.I.C.A. and withholdiszg ta�c and provide workers' compensation for that employe�, all as prescribed by law. Your coastruatioa must comply with all applicable laws, ordiaaaces, building codes, ar�,d zoaing re ulations. i' O�+rNER'S SI�NA2'URE DATE ADDRE S S .j �4 s-� +�e /�. /�'iL .3c.�S�..'� PHONE .j,S�S� � .�}d�'� WITNESS PERMIT # 1 i