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D:ISCLOSURE STATmmNT FOR OWNER. C:ITY OF ZEPRYRB::ILLS B'D':ILD:ING DEPARTKBNT :I, J);'(~ ~t. ;l+ /..-I.n~ J1 aiorz</..L have read and ful.~y understand and agree to the provisio 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 domici~e" that he or she actua~~y occupies, or wi~~ occupy by said domici~e, and same is not for rent, ~ease or sa~e. That he or she sha~~ comp~y with the fo~~owing conditions.: ~. That the owner and he or she a~one sha~~ act as the bui~der for a~~ phases of " construction. .2 . That the owner wi~~ comp~y with a~~ provisions of the City of Zephyrhi~~s ordinances and codes pertinent to -the bui~ding. 3. That in the event various phases of construction are subcontracted, he wi~l engage on~y proper~y licensed subcontractors and wi~~ persona~~y supervise such work.. 4. That in the event the Bui~ding :Inspector sha~~ require corrections to be made, the owner wi~~ assume ful.~ responsibi~ity to insure the.y are made, and upon comp~etion wi~i cal~ for a reinspection before proceeding with the 'building. 5. That the oWner shall assume ful.~ responsibi~ity for the construction and wi~l not expect supervision of his work from the City of Zephyrhil~s Bui~ding Department. 6. That prior to final inspection any additional fees, inc~uding reinspection fees, must be paid in ful.~. A written request from this office shall constitute' an officia~ notice. to pay additional fees. 7. That the owner shall comply with al~ City, State and Federal laws'in regard to social security~ workman's compensation, lien laws, etc., where applicable. 8. That the owner shall comply with a~l the safety codes issued by the Florida :Industria~ Commission. . 9. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certain. restrictions even though you do not have a license. You must provide direct onsite supervision of the construction yourse~f. You may bui~d or impr~e ,a one-family or two-family residence or a far.m outbui~ding. You may also build or improve a commercia~ bui~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 built or. sUbstantial~y improved for sa~e or lease. :If you sea~ ;or. lease a bui~ding you, have bui~t or substantially improved youi::self within 1. year after the construction is complete, the law wi~l presume.thAt you bui~t or substantial~y improved if for sa~e or lease, which is a, violation of this exemption. You may not hire an un~icensed person to act as your contractor or to supervise people working on your building. :It is your responsibi~ity to make sure that peop~e emp~oyed by you have ~icenses required by state law and by county or municipal licensing ordinances. You may not de~egate the responsibi~ity 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 1.icensed must work under your direct supervision and must be employed by you, which means that you must deduct F.:I.C.A. and withho1.ding tax and provide workers' compensation for that emp1.oyee, &1.1. as prescribed by ~aw. Your construction must comply wi th a~~ applicable ~aws, ordinances, building =:s-;":-~Jffi/:~uauJL DATE ~J/(o/Q~ ' :~:SS ~{~~L..L>~ __~;J C# . , WJ:TNBSS PERKIT " #