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I, agree to DISCLOSlJRE STATEMENT FOR OWNER CI.TY~F ZEPHYRBILLS BmLDING DEPARTMENT ~ ~.... l/J . I II trn11l5 I ::YYJE-r have read and fulJ.y understand and the provisions 0 this instrument. The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domiciJ.e" that he or she actuaJ.J.y occup~es, or w~J.J. occupy bysa~d domic~J.e, and same ~s not for rent, J.ease or saJ.e. That he or she shaJ.J. compJ.y with the foJ.J.ow~ng conditions.: ~. That the owner and he or she aJ.one shaJ.J. act as the buiJ.derfor aJ.J. phases of construction. 2. That the owner w~J.J. compJ.y w~th aJ.J. prov~s~ons of the C~ty of ZephyrhiJ.J.s ordinances and codes pert~nent to 'the buiJ.d~ng. 3. That in the event various phases of construction are subcontracted, he wiJ.J. engage onJ.y properJ.y J.~censed subcontractors and wiJ.J. personaJ.J.y superv~se such work.. 4. That~n the event the BuiJ.ding Inspector shaJ.J. require correct~ons to be made, the owner w~J.J. assume fulJ. responsib~J.~ ty to insure they are made, . and upon compJ.etion wiJ.i caJ.J. for a reinspect~on before proceeding with the bu~J.ding. 5. That the oWner shalJ. assume fuJ.J. responsib~'J.~ty for the c:onstruct~on and w~J.J. not expect supervis~on of his Work from the City of ZephyrhiJ.J.s Bui~ding Department. 6, That prior to finaJ. inspection any addit~onaJ. fees, incJ.uding reinspect~on fees, must be pa~d in fulJ.. A wr~tten request from this office shaJ.J. .constitute an off~c~aJ. notice, to pay additionaJ. fees. 7. That the owner shall comply w~ th aJ.J. C~ ty, State and Federal J.aws' in regard to soc~al security~ workman's compensat~on, l~en laws, etc., where appl~cabJ.e. 8. That the owner shalJ. compJ.y with aJ.J. the safety codes issued by the Florida IndustriaJ. Commission. . 9. State law requ~res construct~on to be done by l~censed contractors. You have appJ.~ed for a permit under an exempt~on to that J.aw. The exemption allows you, as the owner of your property, to act as your own contractor w~th certa~n. restr~ctions even though you do not have a license. You must provide direct onsite superv~s~on of the construction yourself. You may build or impr~ea one-family or two-family res~dence or a f~ outbu~J.ding. You may aJ.so buiJ.d or improve a commerciaJ. buiJ.ding, provided your costs do not exceed $25,000. The building or residence must be for your own use or occupancy. It may not be bu~lt or s~stantiaJ.J.y improved 'for sale or lease. If you s&J.l;or' lease a buiJ.ding you. have buiJ.t or substantially improved yourself within 1 year after the construct~on is complete, the J.aw wiJ.J. presume .that you buiJ.t or substantially improved ~f for saJ.e or J.ease, which is a vioJ.at~on of this exemption. You may not hire an unJ.icensed person to act as your contractor or to supervise peopJ.e working on your buiJ.ding. It is your responsib~J.ity to make sure that people employed by you have licenses required by state law and by county or mun~cipaJ. 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 buiJ.ding who ~s not licensed must work under your direct supervis~on and must be employed by you, which means that you must deduct F.J:.C.A. and withholding tax and provide workers' compensat~on for that employee, all as prescribed by law. Your construct~on must comply w~~ alJ. appJ.ic~e-taws, ordinances, building codes, and zoning regulations. . /) / ' OWHI!:R' S S,-.TllRB ~~'h=t~'x~~ DATE 'S (-z./f /06 ; :~:SS ~/~:--~J'1 ~1~~.s ~~~";~ _{}(PII ~. ' WITNESS PERHJ:T #