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:DISCLOSURE STATEMENT .FOR OWNER CITY OF . S - BUILDING DEPARTMENT =, ? (24C V"k t o ! have read and fully understand and • ag ree to the provisions of - this instrument. s t•r- ,,,gent . The undersigned. states and affirms that he or she .is desirous of constructing, renovating, adding to or reroofing his or her own domicile, -that he or she actually occupies, or w1.1l occupy by said domicile, 'and. same is not for ent, .lease or sale. ' That he or she S = comply with the following conditions: 1. That the owner and.he or she alone a}+. act as the builder for all phases of • • construction. of Ze h hills 2. That the owner will comply with all provisions of the City p yr ordinances and codes pertinent -to the 1r 3. That in the event various phases of construct on are subcontracted, he will - engage only .properly licensed subcontractors and will personally supervise such work. 4 That in the event the Building ding Inspector shall regt i e corrections to be made, the owner will assume full responsibility to insure they are made, and upon completion will r =1 for a rein_specti-oa before proceeding with the building. 5. That the owner 51+ = assume full responsibility for the construction and will • Z �+; 1 7 s not expect_ supervision of his work from the City .of ephj= Building • • Department. _ action 6. That prior to f *.p =1 ;*.potion any additional fees, including einsp fees, must be paid in full. A written request from this office ih =11 constitute an official notice -to pay additional fees.. regard to 7. That the owner shall, comply with all City, State and Federal laws in regar social security, worioman' compensation, lien laws, etc., where applicable. 8. That the owner si comply with all the safety codes issued by the Florida Industrial Commission. 9. State law requires construction to be done by.lioensed contractors. You have applied for a permit under an exemption to that law. The exemption allows . - you, as the owner of your property, to at as your own contractor with certain restrictions even though you do not have a license. You must provide direct onsite supervision of the construction yourself. You may build or improve a one - family or two - family residence or a farm outbuilding. You may also build or improve a commercial building, provided your costs do not exceed $25,000. The building or residence• must be for your own use or occupancy. It may not be built or substantially improved for sale or lease. If you. sell or lease a building you have built or substantially improved yourself wit-I -R *1 1 year after . the construction is complete, the law will presume that you .built or substantially improved' if for sale or lease, which is "a violation of this exemption. You may not hire an val.i.cemsed person. to at as your contractor or to supervise people working on your building. 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 delegate the responsibility for supervising work to a. licensed contractor who is not. licensed to per the work being done. A _person working on your builrii ng who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.. C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed, Your construction must comply with all. applicable laws, ordinances, building codes, and zoning re- o s- OWNER'S SIGNATURE `, / , HATE 3 - 10 ADDRESS rn / Y / /�,d. ,t w� Dr 7erkyrli I t !—L 3 354 2 . - PBONE 53 l 3 -- `7 7 Sf - 33S • WITNESS PERMIT • • •