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DJ:SCLOSURE STATEMENT POR OWNER CJ:TY OF ZEPHYRHJ:LLS BtrJ:LDJ:NG DEPARTMENT J:, 'A I/U Q /1 . O/(J L '-Tif /~/ have read and fu~J.y understand and agree to the prov~s~ons of ~s ~nstrument. The, unders~~ed states and aff~r.ms that he or she~s des~rous of construct~ng, renov.at~ng, adding to or reroofing his or her own damic~~e;, that he or she actua~~y occup~es, or wi~~ occupy by 'sa~d damic~J.e, and same ~s not fqr rent, J.ease or sa~e. That he or she sha~~ comp~y w~th the fo~~ow~ng condit~ons,: J. . That the owner and he or she aJ.one sha.l~ act as the bui~der 'for a~~ phases of.. construct:Lon. .2. That the owner w~~~ comp~y w~th aJ.J. prov~s~ons of the C~ty of Zephyrhi~~s ordinances and codes pert~nent to 'the bui~ding. 3.. That ~n the event var~ous phases of construct~on are subcontracted, he w~~l engage only properly ~~censed subcontractors and wi~~ persona~~y superv~se such work., ' 4. That~n the event the Bui~d~ng J:nspector sha~~ require correct~ons to be made, the owner w~ll assume f'UJ.~ responsib~~~ty to ~nsure they are made, 'and upon comp~et~on wi~i ca~~ for a re1nspect~on before proceeding with the building. S. That the oWner shaJ.~ assume f~ respo:nsib~J.~ty for the construct~on and w~ll not expect superv~s~on of his Work from the C~ ty of Zephyrhi~ls Bui~ding Department. 6. That pr~or to f~nal 1nspect~on any addit~ona1 fees, including re~nspect~on fees, must be pa~d ~n fuJ.~. A wr~tte;L request from this off~ce shall ,const~tute' an off~c~a~ not~ce,to pay addit~ona~ fees. 7. That the owner shal~ comp~y w~th a~~ C~ty, State and Pederal laws' ~n: regard to soc~al secur~ty, workman's compensat~on, ~~en laws, etc., where app~~cab~e. B . That the owner shal~ comp~y wi th a~~ the safety codes ~ssued by the Flor~da J:ndustr~a~ Ccmmiss~on. . 9. State ~aw requires construct~on to be done by ~~censed contractors. You have app~~ed for a permit under an' exempt~on to that law. The exempt~on a~~ows you, as the owner of your property, to act as your own contractor with certa~n restr~ct~ons even though you do not hav.e a ~~cense. You must prov~de direct ons~te superv~s~on of the cOI1Struct~on yourself. You mci.y bui~d or impr~e ,a one-family or two-fami~y res~dence or a far.m outbui~ding. You may also bu~ld or ~mprove a commerc~a.l bu~~ding, prov~dedyour costs do not exceed $25,000. The bui~ding or res~dence, must be for your own use or occupancy. J:t may not be bui~t or. sUbstant~a~~y improved 'for sa~e or ~ease. J:f you seJ.l;or' lease a bui~d~n~! yoti, have bu~~ torsubstant~a.J.~y improved yourse~f w~ thin ~ year after the construct~on ~s complete, the ~aw w~~~ presume.that you bui~t or substant~a~~y improved ~f for saJ.e or ~ease, which ~s a. v~o~at~OI1 of this exempt~on. You may not hire an ~~censed person to act as your contractor or to superv~se people world.ng on your bu~lding. J:t ~s your responsib~~~ ty to make sure that peop~e employed by you have l~censes required by state law and by county or mun~c~pa~ ~~cens~ng ordinances. You may not, delegate the responsib~~~ty for supervis~ng work to a l~censed contractor who ~s not ~~censed to perform the work be~ng done. Any person work~ng on your bui~ding who ~s not l:i.censed must work under your d:i.rect superv~s~on and must be employed by you, wltich means that you must deduct !'.I.C.A. and withhold:i.ng tax and prov~de workers' compensat:i.on for that employee, all as prescribed by iaw. Your construct~on must comp~y w~th a~l app~:i.cab~e laws, ord:i.nances, bu~ld:i.ng codes, and zon.i.ng reguJ.at'~ons. . /') ~_, / ' OWNER'S SIGNATURE A t>2-~/~ DATE ~~. .:5(yft? ADDRESS 45/.:2...5 ///eQ <;;''':::::'-<.~ S~~. ,. :E'BONE ~.3 - 7 -5'Z:' - Rr 9 "") WITNESS PERMIT '. #