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. " D:ISCLOSlJRE STATEKENT FOR OWNER CITY OF ZEPEEYRB:ILLS BU:ILD:ING DEPARTMENT :I, _LARRi COSTI bAN" have read and fuJ.~y understand and agree to the provisions of this instrument. The undersi9%.1ed states and affixms that he or she is desirous of constructing, renovating, adding to or reroofing his or her ow:a. dom:i.ci~e" that he or she actua~~y occupies, or wi~~ occupy by said damici~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. That the ow:a.er wi~~ comp~y with a~~ provisions of the City of Zephyrhi~~s ordinances and codes pertinent to 'the bui~ding. That in the event various phases of construction are subcontracted, he wi~~ engage on~y proper~y ~icensed subcontractors and wi~~ pers~~y supervise such work., That in the event the Bui~ding :Inspector sha~~ require corrections to be made, the owner wi~~ assume fuJ.~ responsibi~i ty to insure they are made, . and upon comp~etion wi~i ca~~ for a re~spection before proceeding with the bui~ding. That the ow:a.er sha~~ assume fuJ.~ responsibi1.ity for the construction and wi~~ not expect supervision of his Work from the City of Zephyrhi~~s Bui~ding Department. That prior to fina~ inspection any additiona~ fees, inc~uding reinspection fees, must be paid in fuJ.~. A written request from this office sha~~ .constitute an officia~ notice. to pay additiona~ fees. That the ow:a.er sha~~ comp~y with a~~ City, State and Federa~ ~aws' in regard to socia~ security, workman's compensation, ~ien ~aws, etc., where app~icab~e. That the owner sha~~ camp~y with a~~ the safety codes issued by the F~orida :Industria~ Commission. State ~aw requires construction to be done by ~icensed contractors. You have applied for a permit under an exemption to that law. The exemption a~lows you, as the ow:a.er of your property, to act as your own contractor with certain. restrictions even though you do not have a ~icense. You must provide direct onsite supervision of the construction yourself. You may build or impr~e .a one-family or two-family residence or a far.m outbuilding. You may also build or improve a commercia~ bui~ding, provided your costs do not exceed $25,000. The bui~ding or residence must be for your own use or occupancy. :It may not be built or, sUbstantia~~y improved for sa~e, or lease. :If you se.ll';or' lease a bui~ding you. have bui~t orsubstantial~y imp;z::oved yoW:.seif within 1 year after the construction is comp~ete, the law wi~~ presume .that you bui~t or substantia~~y improved if for sa~e or ~ease, which is a vio~ation of this exemption. You may not hire an un~icensed person to act as your contractor or to supervise people working on your bui~ding. :It is your responsibility to make sure that people employed by you have licenses 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 licensed must work under your direct supervision and must be employed by you, which means that you must deduct l!".:I.C.A. and withholding tax and provide workers' compensation for that emp~oyee, a~l as prescribed by iaw. Your construction must comply with a~l app~icab~e laws, ordinances, building codes, and zoning regu~~ns. ( _ OWNER'S S:IGNATURE~~ ~ ADDRESS 5701 4:-'/:rr " ,2' . . FL. ';;;354 2- PHONE bl~ }7~~ 2.002- t:ll ~ l /J 3 2DI S" 2. 3. 4. 5. 6. 7. 8. 9. DATE (::) -2?-o6 r W:ITNESS PElUI:IT #