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� DISCLOSIIRE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT I, (�Z�- have read aad fully understaad aad agre�e to the pr v' oas of this iastrumeat. The undersigned states aad affirms that he or she is desirous of conatructing, renovating, addiag to or reroofing his or her o domicile, that he or she actually occupies, or will occupy by - - said domicile, aad same is not for rent, lease or sale. That he or she shall comply with the following coaditioas: 1. That the owaer aad he or she alone shall act as the builder for all phases of conatruction. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordinances and codes pertineat to the building. 3. That in the eveat various phases of coastructioa are subcoatracted, he will engage only properly liceased subcontractors and will personally supervise such work. 4. That ia the eveat the Building Iaspector shall require corrections to be made, the owner will assume full respoasibility to iasure they are made, and upon completion will call for a reinspection before proceeding with the building. 5. That the owaer shall assume full respoasibility for the coastruction aad will aot expect supervision of his work from the City of Zephyrhills Suildiag Departmeat. 6. That prior to final inspection any additioaal fees, iacludiag reinspection fees, must be paid ia full. A writtea request from this office shall constitute an official aotice to pay additioaal fees. 7. That the owaer shall comply with all City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc. , where applicable. S. That the owaer shall comply with all the safety codes issued by the Florida � Industrial Commission. 9. State law requires construction to be doae by liceased contractors. You have applied for a permit under aa exemptioa to that law. The exemptioa allows ' you, as the owner of your property, to act as your owa contractor with certain restrictions evea though you do aot have a licease. You must provide direct onsite supervisioa of the coastructioa yourself. You may build or improve a one-family or two-family residence or a farm outbuildiag. You may also build � or improve a commercial buildiag, provided your costs do not exceed $75,000. The buildiag or residence must be for your owa use or occupaacy. It may not be built or substaatially improved for sale or lease. If you sell or lease a buildiag you have built or substantially improved yourself withia 1 year after the constructioa is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violatioa of this exemption. You may aot hire an ualicensed person to act as your contractor or to supervise people working on your buildiag. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensiag ordiaances. You may aot delegate the responsibility for supervising work to a liceased contractor who is not liceased to perform the work beiag done. Any person workiag on your building who is aot licensed must work uades your direct aupervision aad muat be employed by you, which means that you must deduct F.I.C.A. aud withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must comply with all applicable laws, ordinances, buildiag codes, aad zoning regulations. OWNER'S SIGNATURE ��Y� ., _ DATE ��''p(��7 ADDRLSS .�sdS v' � �e S PHOIdE �/�_,��`�f�''r� WITNBSS PLRMIT #