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/ D:ISCLOSlJRE STATEMENT FOR OWNER CITY OF ZEPRYRBILLS BUJ:LDING DEPARTMENT /1AJct{./J tD; I /~.-5 I, agree to the provisions of thi:s instrument. have read and fuJ.~y understand and The undersi~ed states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own dam:i.cile~, that he or she actually occupies, or will occupy by said dom:i.ci~e, and same is not for rent, ~ease or sale. That he or she shall comply with the :following conditions.: L That the owner and he or she alone shall act as the builder for all phases of.. construction. That the owner will compJ.y with a.J.l provisions of the City of ZephyrhiJ.J.s ordinances and codes pertinent to .the building. That in the event various phases of construction are subcontracted, he will engage o~y properJ.y J.icensed subcontractors and wilJ. personaJ.J.y supervise such work.. That in the event the Building :Inspector shalJ. require corrections to be made, the owner wil~ _ assume fulJ. responsibiJ.i ty to insure they are made, . and upon compJ.etion wiJ.J. caJ.J. for a reinspection before proceeding with the buiJ.ding. That the oWner shaJ.J. assume fuJ.~ responsibi~i ty for the construction and wiJ.J. not expect supervision of his Work from the City of ZephyrhiJ.J.s BuiJ.ding Department. That prior to :finaJ. inspection any additionaJ. fees, inCluding reinspection fees, must be paid in fuJ.J.. A written request from this office shaJ.J. . constitute. an officiaJ. notice. to pay additional fees. That the owner shaJ.J. compJ.y with aJ.J. City, State and Federal J.aws' in regard to sociaJ. security~ workman's compensation, J.ien laws, etc., where applicabJ.e. That the owner shaJ.l comply with alJ. the safety codes issued by the FJ.orida J:ndustriaJ. Commission. State J.aw requires construction to be done by J.icensed contractors. You have appJ.ied for a permit under an exemption to that J.aw. The exemption aJ.J.ows you, as the own.er of your property, to act as your own contractor with certain restrictions even though you do not have a J.icense. You must provide direct ons:Lte supervision of the construction yourself. You may buiJ.d or improve .a one-famiJ.y or two-famiJ.y residence or a far.m outbuiJ.ding. You may aJ.so'buiJ.d or improve a commerciaJ. buiJ.ding, provided your costs do not exceed $25,000. The buiJ.ding or residence must be for your own use or occupancy. :It may not be buiJ.t or. s~stantiaJ.J.y improved for saJ.e or J.ease~ If you s~l ;or J.ease a buiJ.ding you. have buiJ. tor .substantiaJ.J.y improved YOu:Cseif within J. year after the construction is compJ.ete, the J.aw wiJ.J. presUme .tha:t: you buiJ.t or substantiaJ.J.yimproved if for sale or J.ease, which is a. vioJ.ation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise peopJ.e work:ing on your buiJ.ding. :It is your responsibiJ.i ty to make sure that peopJ.e empJ.oyed by you have J.icenses required by state J.aw and by county or municipal J.icensing ordinances. You may not. deJ.egate the responsibility for supervising work to a J.icensed contractor who is not J.icensed to perform the work being done. Any person working on your building who is not J.icensed must work under your direct supervision and must be empJ.oyed by you, which means that you must deduct F. J:. C.A. and wi thhoJ.d.ing tax and provide workers' compensation for that empJ.oyee, alJ. as prescribed by iaw. Your construction must compJ.y with aJ.J. appJ.icabJ.e J.aws, ordinances, buiJ.ding codes, and zoning regulations. OWNER'S SIGNATURE ~ . ADDRESS 72,j ~€ E'BONE 3 - 5' - s-s-? 7 2. 3. 4. 5. 6. 7. 8. 9. DATE "It) ftqfdc. d f r WITNESS PERMIT .. #: