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� I►ISCI.OSURE ST.A.TEE�N�' FOR OiVREIt •t ' CZTY OF ZBPHYR$ILLS BIIILDING DEPARTP�IdT �, ' h�v� read aad fu11y �aerst�a aad agree to the provisions af thie instrument. The uadersigaed states aad affirms th�t he o= she is deairous of conetructiag, r�aavatiag, addiag to o= reroaf3ag his as her oyaa domieile, that h� os she actually oecupies, or will occupy by gaid domicile, aad sasne i$ no� for rent, lease cr sale. That h� ar she sh�11 comply with the foZlawfag coaditians: 1. That the or�mer aad he or she aloae sh�ll act as the buildes for all y�hases of aonBtructian. � 2. Tb.at the owner will. comply �rrith all provisiaas of the Cit}► of Zephy=hi3Zs osdiasaees aad codes pertineat to the buildia$. 3. That ixc the eveat variaus phas�s of ean�tructioa are subcantracted, he �viZZ engage only gsropexly Zicensed subcontrac�ors �ad wi�.l per�aaally superviae ` such work. � 4. That ia the eveat the Suildia.g Iaag►ectar ehaZ1 require correetions to be made, f the owaes tvill assume full reeponsibil�.ty ta iasure they �ze made, aad upoa j compl�tioa will call fot a reiaspectioa before praceediagr xitla the buildiag. ; 5. That the owaes sha21 as�uzde fuZ3 respoaagibility for tha constructioa and wi1Z � not expect supervi�sion of his raosk �rom the City af Zephyxhills SuiZdiag ` 77epartaiemmt. � 6. That pxiar to �iaal iaspectioa aay additioaal fees, iaaludiag xeiaspectioa i fees, muat be paid ia fu3.1. A writtea r�quest from f:his of�ice shall � coa�tstute aa af�iaial nat3ce to pay ac�itioaa3 fees. 7. That the awaer shal]. eomply with all Citg, State aad Federai lavas ia segard to sociaZ security, workmaa's eomperssation, lien Zawa, ete. , where applicable. 8. Tbat the ovaaer shall comply t,rith all the safety cades issue8 by the Fl.oric� Industrial Commisaiaa. 9. State law requires eonstruction to be doae by liceaBed caatr�ctors. You have applied for a permit uac�er as exemptioa to �hat law. Th� exemptioa allaws you, as the ovaner a� your property, to act as your awa contsactar with eexfisia zestrictioas even though you da aot have a licease. You must provide direct onsite supervision of the coaetruetioa y�ourself. Yau may build or iaeprave a one-fsm;i.Iy ar two-famfZy resideace or a f�rm outbu3ldiag. Yau may also build or impsov� a commercial buildiag, pravided your aoets do aot �,xcead $75,000. � The buiZdiag or xes3.deac� must be for your own uee or oocupaacy. Zt may nat I be b�iZt or substaatially improved for $aie oz lease. If you sell or lease a 3 bui3diag you have built or stabstaat3a11y 3mproved yaurselt withia 2 year �ft�r � _ the caustruction is complete: the l�w will gresume that you built or � substaatially improved a.f fo= sale cr lease, which is � vialatiaa oiE thf$ � exemption. Yau sn�y aot i�ire aa ualiceased persan to act ae your caatractoac or ' to supezv3.ee peaple warkiag aa yaur buildiag, Tt is yous respoas3bility to � make sure that g�eople employed by yott h�v� licenses requir�d by state -law aad � by couaty or muaicipa3 Iic+ensiag ardia�aes. You may aot deZegate the =: i respoasibility far supervising vaork ta a liceneed aontractor �ho is not � liceneed ta pexfarm the wark bea.ag done. Aay persaa working on gour buildiag who is aot liceased muet work uader your ciixect �upervi�ion aad mt�.st be � __ _. ea�loyed_by.xou� wh��h.��as._�ha��•�ou-must-dect�xQ�-I�.-�-:�:�:-�ad--wit3r�:�2-ciiag-ta�c_. ._.__ ._ --- -- -- j and provide worlcers' compensation for that employee, all ae prescribed by 1aw. ; Your conBtructiors must camply with all appli.ca�sle lases, ord3.aaucee, building j codes, and zaniag regu a� ; � OTrtINER'S 3T6NATURE � �''� DATE �/ ! � j � , i � �va�ss � ` � psoia�a. t I WITNSSS PERMIT #