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^ " DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRH\LLS—BUILDING DEPARTMENT |. have read and fully understand and agree to the provisions of this instrument. The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicile, that heurshe actually occupies, or will occupy bv said domioi|a, and same is not for rent, |mosm or sale. That he or she ohoU comply with the fnUovvng conditions: 1. That the owner and heor she alone shall act oa the builder for all phases ufconstruction. 2. That the owner will comply with all provisions of the City of Zephyrhilis ordinances and codes pertinent bothe building. 3. That in the event various phases of construction are aubnondmaohad, he will engage only properly licensed subcontractors and will personally supervise such work. 4. That in the event the Building Inspector ahoU require ummooUono to be made, the owner will assume full responsibility to |nmuna they are made' and upon completion will call for o meinspmotion before proceeding with the building. 5. That the owner nMaU assume full responsibility for the construction and will not expect supervision of his work from the City ofZephyrhiUe Building Department. 6. That prior to final inspection any additional fees, including reinspection fees, must be paid in full. A written request from this office shall constitute an official notice to pay additional fees. 7. That the owner shall comply with all City, State and Federal laws in regard to social security, workman'acompeneation. lien laws, etc..where applicable. 8. That the owner mhoU comply with all the safety codes issued by the Florida Industrial Commission. 9. State |ovv requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that |umm' The exemption allows you, as the owner of your pnopedy. i000tasyourovvncontnactorxxithoertainrem4hctionomventhomghyoudonothave m license. You must provide direct one@e supervision of the construction yourself. You may build or improve o one-family ortwo-family residence or a farm outbuilding. You may also build or improve ocommercial bui|din0, provided your costs dm not exceed $75.00D. The building or residence must be for your own use or occupancy. It may not be built or substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or to mopan/iae people working on your building. It is your responsibility to make sure that people employed by you have licenses required by state law and bv county or municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide worker's compensation for that employee, all as prescribed by law. Your construction must comply with all applicable |oxve, ordinances, building codes, and zoning regulations. OWNER'S SIGNATURE ATE ADDRE8S 9& f �y ~ PHONE t . WITNESS PERMIT