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D:ISCLOSlJRB S"l"A.TBIImr.r FOR 0WJ1BR C:tTY 0.1' ZBPBYU:tLLs BtJ:tLDJ:1IG DBPARTJIBRT I:, f1a~ L... 0d.J/'<; have read and ful.~y understand and agree .to provisions of this instrument. The ~ersigned states and affixms that he or she is desirous of constructing, renovalting, add:i.ng to or reroofing his or her own daa:i.ci~e, that he or she actuaJ.l1.y occupies, or wi~~ occupy by said daa:i.ci~e, and same is not for rent, ~ease or sa~e. That he or she shaJ.~ compl.y with the fol.l.owing conditions: ~t the owner and he or she al.one sha~~ act as the bui~der for al.l. phases of :t::tion. t the owner wi~~ comp~y with al.~ provisions of the City of Zephyrhi~~s o es and codes pertinent to the bui~ding. ~t in the event various phases of construction are subcontracted, he wi~~ age on1y proper~y ~icensed subcontractors and wi~~ personal.~y supervise work.. t in the event the Bui~d.:i.ng :tnspector sbaJ.~ require corrections to be made, owner wi~l. assume ful.~ responsihi~ity to insure they are made, and upon ~etion wil.~ cal.~ for a reinspection before proceeding with the bui~Cling. t the owner shal.~ assume ful.~ responsibi~i ty for the construction and wi~~ = expect supervision of his work from. the City of Zephyrhi~~s Bui~ding D artment. t prior to final. inspection any addi t:Lonal. fees. inc~uding re.inspection feejs, must be paid in ful.L A written request from this office shaJ.1. c~titute an official. notice to pay additional. fees. ThaIt: the owner shal.~ comp~y wi th al.~ C:i. ty, State and Pedera~ ~a'WS in regard to sociial. security, workman's compensation, ~ien ~aws, etc., where app~icab~e. Tha/t the owner shal.~ comp~y with a~~ the safety codes issued by the P~orida :tn+Stria~ Commission. Sta~e ~aw requires construction to be done by ~icensed contractors. You have applied for a permit under an exemption to that ~aw. The exemption al.~ows youti as the owner of your property, to act as your own contractor with certain res rictions even though you do not have a ~icense. You must provide direct ons te supervision of the construction yourse~f. You may bui~d or improve a one fami~y or two-fami~y residence or a farm outbuil.ding. You may al.so bui~d or :J.mprove a COlDlllerCial. buil.ding, provided your costs do not exceed $25,000. The i bui~ding or residence must be for your own use or occupancy. :It iDay not be l!>ui~ t or substantia~~y improved for sal.e or ~ease. :If you se1~ or ~ease a . bui~ding you have bu:i.~ t or substantial.~y improved yourse1.f wi thin 1 year after the I construction is comp~ete, the 1aw wi~~ presume that you bu:i.~t or sub tantial.~y:i.mprOVed if for sal.e or ~ease, which is a vio~ation of this tion. You may not hire an unl.icensed person to act as your contractor or erv:ise peop~e working on your bui~ding. :It is your responsihi~ity to sure that peop1e emp~oyed by you have ~icenses required by state ~aw and ounty or municipal. 1icensing ordinances. You may not de~egate the onsibi~i ty for supervising work to a ~icensed contractor who is not ~ic ed to perform the work being done. Any person working on your bui~Cling who lis not ~icensed Dl11St work under your direct supervision and must be emp~OYed by you, which means that you Dl11St deduct P.:I.C.A. and withho~Cling tax aD:irOVide workers' compensation for that emp~oyee, al.~ as prescribed by 1aw. Y construction must comp~y wi th al.~ app~icab~e ~aws, ordinances, bu:i.~ding c , and zoning reguJ.ations. , S S:IGRATURB L 2. 3. 4.. 5.. 6.. 7. 8. 9. DATE q-d,q-Dfp PBRKIT ,.