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, , � DISCLOSUR.S STATEMENT FOR OWNEs'R � ,� .. .� CITX OF ZEPHYI2HILLS SUIi,DING DEPARTI'�1QT �''� � I. � �a•4`U Y� � � ��,�,vY""� have read and ful ly uaders�and and I agree to the pravisions o� this iastrument. , The undersigaed states and affirms that he ar she is dasirous of canstructing, ; reaovati.ag, addiag to or reraafing his ar her own dom3.cile, that he or she . actually occupies, or will occupy by said domsca.le, aad same is aat for rent, Iease or sa1e. That he or she sha1l comply with the follocaing candita.ans: l. That the owaer aad he or she alane sha12 act as �he buildez for all phases af coastructioa. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordiaauces and codes pertiaent ta the building. 3. That ia the eveat various phases of coastruc�ioa are eubcoatracted, he will engage aaly properly lieensed subeoatractors aad will. personally supervise such work. ' 4. Tha� in the event the Building Iaspector shall require correctioas to be made, the owner vrill assume £u12 respoasibility to insure they are made, and upon. completion wi11 ca11 for a reiaspectioa before praceediag with the building. 5. That the awner shall assume fu3.Z respoasibi].zty for the caastructiaan and will not expect supervisioa of his work from the City af Zephyrhills Buildiag Depaxtmeat. 6. That priar to fiaal iasgec�ion aay additional fees, includiag reinspectioa fees, must be paid in full. A writ�ea request fram this office shall constitute an afficial natice �o pay additianal fees. 7. That the owner shall comply with a11 City, S�ate aad Federal laws ia regard �o social security, warksaan's compensation, lien laws, etc. r where agplieab2e. 8. That the owner ahall comply with all the safety cades issued by' the Florida Iadustrial Commi�sioa. 9. Sta�e law requires constructian to be doae by Iiceased coa�rac�ors. Yau have applied for a permit under aa exemp�ion to that law. The exemptioa allov�rs you, as the owner af your propexty, to act as your own caa�rae�or with aertaiu res�rictions evea though you do not have a license. You must provide direct oasite supervision of the coas�ructioa yourself. You may build or improve a one-familg or t�«ro-family resideuce or a farm outbuildiag. You may also build or improve a commercial building, provided your casts do aot exceed $75,000. The buil.diug or resideuce must be for yaur owa use ar oceupancy. It mag not be built or 'substaatially improved �or sale as lease. If you sell ar lease a bnilding you have buil� or substaatially impraved yourself withia 1 year after the coastruction is camplete, �he law will presume that you built or substaatially improved if for sale ar lease, which is a violatiaa o£ thi.s exemptian. You may not hire aa ualicensed person to act as your caantractor ar to �upervise ,people warkiag oa your building. It is your respoasibility to make sure that people emgloyed by you have liceases required by sta�e I.aw aad by count�y or municipal liceasing ordiaaaces. You may rsot delegate �he responsibility for superva.siag work to a liceased conGxactor wha is not licensed to perform the wark being done. Any pezsoa working on your building who is aat licensed must work under your direct supervisian aad must be employeci by yau, which meaas that you must deduct F.I.C.A. and ro�rithhaldiag ta�c and provide workers' compensation for that emzaloyee, a11 as prescribed by law. Your coastructioa must comply wsth all applioable laws, osdinaaces, building cades, and zauing regulatioa . owrr�Rr s szcri v�� mE 1 c -Z� - C7 ' ADDRESS �� L �- PHONE P-1� _� � '�� n � . "�}�_—��. �� WITNESS PERMIT # � � . , � _