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� f R DISCLOSURE STATII�NT FOR OWNER CITY OF ZLPHYFLHILLS BL7ILDING DFFPARTMENT I, have read and fully vaderstaad aad agree to the provisioans o� this instriuneat. Th� �undersigned statea and affirms that he or she is desiraus af eaustruetiug, renovati�g, addiag to ar reroofing his ar her own domicile, that he or she actually occupies, or will occupy by said domicile, aad same is no� for rea�, lease or sale. That he or she sha11 eomply �caith the followiag coaditioas: I. Tha� tha owaer and he or she aloae shall act as the builder fa�r all phases of conatruct�ion. 2. Tha� the awaer will camply writh all provisioz�s af the City of Zephyrhilis ordiriaaces aad codes pertiaeat �o the buildiag. 3. Tha� ia �he eveat variaus phases of construct3on are subcoatracted, he will eagage only proparly Iiceased subaasztrac�ors and cvill persanally supervise such work. 4. That in the event the Buildiag �nspeetor sha11 reguire carreeti.ons ta be made, the owaer wi11 asavme full respaasibility to iasure they are made, aad upon completiaa will call for a reinspection before proceeding with t�he building. 5. That the owaer shall assume full respons3,bili�y far the canstructioa and will aot expect supervisioa of his work from �he City af Zephyrhills Buildiag D�paztment.� 6. That prior ta fiaal iaspectioa aay additional fees, iacludiag reiaspection ' fees, must be paid in �uli. A writtea request from this office shall constitu�e an off�.cial notice to pay additioaal fees. 7. That the owner shall camply with all City, State aad Federal laws ia regard ta social security, workman's aompensation, lien laws, ete. , where appZi.cab3.e. 8. That the owaer shall comply with all the safety cades issued by the Florida Industrial Commission. 9. State law requires coastruatioa to be doae by licensed contractors. You have applied for a permit under an escemption �o that law. The exemption allows yau, as the avsner af your pragerty, to act as yaur own coatraetor with certain restrictioas even though you do aot have a licease. Yau mu�t provide direct ausite supervisioa of the caastructzca yaurself. Yau may buiid or imprave a oae-�amily or two-family resideance or a farm outbuildiag. You may also build or improve a commercial bui,l.ding, provided your costs do ao� exceed $75,000. The buildiag ar resideace must be for yaur awu use or accupaney. It may aot be built or substaatially improved Ear saZe or lease. If yau sell or lease a building you have buil� ar svbstantially improved your�elf withiu I year after • the aoas�ruc�ioa is camplete, the law will presume that you built or svbstaatially improved if for sale or lease, which is a vialatioa of this exemptioa. You may no� hire an ualiceased pexson �o act as you= contraetor or to supervise people working on yc5ur building. It is your respoasibility to make sure tha� people emplayed by you have liceases required by state law aad by aouaty or znuniaipal liceasing ordiaaaaes. You may aot delegate the respoasibi.lity for sugervising wark ta a 3.iceused contraetor wha is not Iiceased to perform the work beiag doae. ,8ay persoa workiag on your building who a.s aot licensed must work uader your direct supervision and must be employed by you, which means that yau must daduct F.I.C,A. aad wa.thhoZdiag ta�c and provide workers' compensation far that employee, all as presaribed by law. Your caa�truction must camply wi�h a12 a�plicable laws, ardiaanees, buildiag codes, aad zaaing regulatiaas. OWNER'S SIGNA'rURE �'�-�—`-^—�'" DATE j f__�_ ADDRESS PFI4Ni� WITNESS PERMIT #