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DISCLOSIIRE STATEMENT FOR OWNSR CITY OF ZEPHYRHILLS BIIILDING DEPARTMENT I. ��1'C \O �...\�i�\�Y1 have read and fully uaderstand and agree to the pro isioas of this iastrument. � The undersigned states and affirms that he or she is desirous of constructing, reaovatiag, addiag to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, aad same is aot for rent, lease or sale. That he or she shall comply with the following conditions: 1. That the ov,mer aad he or she aloae shall act as the builder for all phases of construction. 2. That the owner will comply with all provisions of the City of Zephyrhills ordinaaces and codes pertinent to the buildiag. 3. That ia the event various phases of coastructioa are subcontracted, he will engage oaly properly licensed subcontractors aad will personally supervise such work. 4. That ia the eveat the Buildiag Iaspector shall require correctiona to be made, the owner will assume full respoasibility to insure they are made, aad upon completion will call for a reiaspection before proceeding with the buildiag. 5. That the owaer ahall assume full respoasibility for the construction and will aot expect supervisioa of his work from the City of Zephyrhills Building Departmeat. 6. That prior to final inspection any additional fees, iacludiag reinspection fees, must be paid ia full. A writtea request from this office shall coastitute an official aotice to pay additioaal fees. 7. That the owner shall comply with all City, State and Federal laws ia regard to social security, workman's compensation, lien laws, etc. , where applicable. 8. That the owaer shall comply with all the safety codes issued by the Florida Industrial Commission. 9. State law requires constructioa to be doae by licensed contractors. You have applied for a permit uader aa exemptioa to that law. The exemptioa allows you, as the owaer 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 supervision of the constructioa yourself. You may build or improve a one-family or two-family resideace or a farm outbuildiag. You may also build or improve a commercial building, provided your costs do aot exceed $75,000. The building or residence must be for your owa use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or substantially improved yourself withia 1 year after the coastruction 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 aa ualiceased persoa to act as your coatractor or to supervise people workiag on your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law aad by couaty or municipal licensing ordiaaaces. You may aot delegate the responsibility for supervisiag work to a liceased contractor who is aot liceased to perform the work beiag doae. Any person working on your buildiag who is aot licensed must work under your direct supervision and must be employed by you, which meaas that you must deduct F.I.C.A. aad withholding tax and provide workers' compensation for that emplayee, all as prescribed by law. , Your construction must comply with all applicable laws, ordiaances, building codes, aad zoning regulations. �WNER'S SIGNATURE G� " �� / " DATE �J� � [� � ��,� ADDRESS , °v� o PHONE WITNESS PERMIT # ��ZD� �