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DISCLOSURE STATEMENT FOR OWNER CJ:TY OF ZEPHYRBILLS BUILDING DEPARTMENT I, s+c ~eV\ ~. ~row" agree to the rovisions of this instrument. have read and fully understand and The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or ~er own domicile" that he or she actua11y occupies, or wi11 occupy by ,~/DI/DG said damici1e, and same is not for rent, 1ease or sa1e. That he or she shall comply with the following conditions: 1. That the owner and he or she a10ne shall act as the builder for a11 phases of construction. That the owner wi1l comply with a1l provisions of the City of Zephyrhi11s ordinances and codes pertinent to'the bui1ding. That in the event various phases of construction are subcontracted, he will engage on1y properly licensed subcontractors and will persona1ly supervise such work. That in the event the Bui1ding Inspector sha11 require corrections to be made, the owner wi1l assume full responsibility to insure they are made, and upon completion will ca11 for a reinspection before proceeding with thebui1ding. That the owner sha1l assume fu1l responsibi1ity for the construction and will not expect supervision of his work from the City of Zephyrhi11s Building Department. That prior to final inspection any additiona1 fees, inc1uding reinspection fees, must be paid in fu1l. A written request from this office sha11 constitute an officia~ notice. to pay additional fees. That the owner sha11 comp1y with a1l City, State and Federal 1aws in regard to social security, workman's compensation, 1ien laws, etc., where app1icable. That the owner shall comp1y with all the safety codes issued by the Florida Industria1 Commission. State 1aw requires construction to be done by licensed contractors. You have app1ied for a pexmit under an exemption to that 1aw. The exemption a110ws you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a 1icense. You must provide direct onsite supervision of the construction yourse1f. You may bui1d or impr~ve a one-family or two-family residence or a farm outbui1ding. You may also build or improve a commercial bui1ding, provided your costs do not exceed $25,000. The building _or residence must be for your own use or occupancy. It may not be built or. substantially improved for sa1e or lease. If you s~1 ;or 1ease a building you have bui1t orsubstantia1ly improved yourse1f within 1 year after the construction is comp1ete, the 1aw wi11 presume that you bui1t or substantially improved if for sa1e or lease, which is a vio1ation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise peop1e working on your building. It is your responsibi1ity to make sure that peop1e employed by you have 1icenses required by state 1aw and by county or municipal licensing ordinances. You may not de1egate the responsibility for supervising work to a 1icensed 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.J:.C.A. and withholding tax and provide workers' compensation for that employee, a11 as prescribed by 1aw. Your construction must comply with a11 app1icable laws, ordinances, building codes, and zoning regu1ations. SIGHATnRB ~ 4. ~ Sin 6eri ~ Dr.) - '; I J3~LI J (,L~) /7_=--_ . 2. 3. 4. 5. 6. 7. 8. 9. OWNER'S ADDRESS PHONE :2 /~/o~ r DATE WITNESS PERKIT #