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DISCLOStJRE STATEMENT FOR OWNER CITY OF -ZEPRYRHJ:LLS BtT.I:LDING DEPARTMENT I, agree ~c, (},,, vcJ to prov.is.ions of have read and f~~y understand and th:i:s .instrument. The unders.ig1;1ed states and aff.i:rms that he or she :Ls des.irous of construct.ing, renovat.ing, add.ing to or reroof.ing h.is or her own dam.ic.i~e~, that he or she actua~~y occup.ies, or wi~~ occupy bysa.id dom.ic.i~e, and same .is not for rent, ~ease or sa~e. That he or she sha~~ comp~y w.ith the fo~~ow.ing cond.it.ions.: ~. That the owner and he or she alone sha~~ act as the bu:i~der -for a~~ phases of.. construct.ion. 2. That the owner w.i~~ comp~y w.ith a~~ prov.is.ions of the C.ity of Zephyrh.i~~s ord.inances and codes pert.inent to 'the bu:i~d.ing. 3 . That.in the event var.ious phases of construct.ion are subcontracted, he wi~~ engage on~y properly ~.icensed subcontractors and wi~~ persona~~y superv.ise such work.. 4. That.in the event the Bu:i~d.ing Inspector sha1~ requ.ire correct.ions to be made, the owner w.i~~ _ assume f~~respons.ib.i~.i ty to .insure the.y are made, . and upon comp~etion wi~~ ca~~ for a re.inspect.ion before proceed.ing with the bu.i~d.ing. 5 . That the oWner sha~~ assume full respons.ibi.~.i ty for the construct.ion and w.i~~ not expect superv.is.ion of h.is Work from the City of Zephyrh.i~~s Bu:i~d:i.ng Department. 6. That pr.ior to f.ina~ .inspect.ion any add.it.iona~ fees, inc~ud.ing re.inspect.ion fees, must be paid .in f~~. A wr.itten request from this off.ice sha~~ .const.itute- an offic.ia~ not.ice_to pay add.itio~ fees. 7. That the owner shal~ comp~y w.ith a~~ C.ity, State and FederaJ. ~aws. in: regard to soc.ia~ secur.i ty, workman's compensat.ion, ~ien ~aws, etc., where app~icab~e. 8. That the owner shal~ comp~y wi th a~~ the safety codes issued by the F~or.ida Industr.ia~ Comm.ission. 9. State ~aw requ.ires construct.ion to be done by ~.icensed contractors. You have app~.ied for a peDD..i t under an exempt.ion to that ~aw. The exempt.ion a~~ows you, as the owner of your property, to act as your own contractor with certa.in restr.ict.ions even though you do not have a ~.icense. Yo'll; must prov.ide d:i.rect ons.ite supervis.ion of the construct.ion yourse~f. You may bu:i~d or improve .a one-fam.i~y or two-fam.i~y res.idence or a farm outbu.i~d.ing. You may a~so.bu:i~d or .improve a comm.erc.ia~ bu.i~d.ing, prov.idedyour costs do not exceed $25,000. The bu.i~d.ing or res.idence. must be for your own use or occupancy. It may not be bu.i~t or s~stant.ia~~y improved for sa~e or ~ease. If you se1~ :o~ lease a bu:i~d.ing you have bu.i~t orsubstant.ia.J.~y ~roved yourse~f within ~ year after the co:c.struct.ion .is comp~ete, the ~aw w.i~~ presUme-that you bui~t or substant.ia~~y .improved .if for sa~e or ~ease, wh.ich is a vio~ation of this exemption. You may not h.ire an u:c.1icensed person to act as your contractor or to superv.ise people work:i.ng on your bu.i~d.ing. It is your respo:c.sib.i~i ty to make sure that peop~e emp~oyed by you have ~.icenses requ.ired by state ~aw and by county or mun.icipa~ ~icens.ing ord:i.nances. You may not de~egate the responsibi~.it~ for supervis.ing work to a ~.icensed contractor who .is not l.icensed to perform the work be.ing done. Any person work.ing on your bui~d.ing who :i.s not l:i.censed must work under your d.irect superv:i.s:i.on and must be employed by you, wMch means that you must deduct F.I.C.A. and withhold..ing tax. and provide workers' compensation for that employee, all as prescribed by iaw. Your construct.ion must comp~y wi th a~~ app~:Lcab~e ~aws, ord.inances, build.ing codes, and zon.ing regulations. OWNER'S ADDRESS :E'HONE SIGl!ATlJRE .l~~ (J L ..s (\)jO IJ ~ 'Y/.1 Yc;(G ')? fbo jarI,-~ J ,~ DATE /0// .</tJ(C r WITNESS PERlaT.. #: (0 (7 "