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• DISCLOSDRE STATII��NT FOR OWNER ; � CITY OF ZBPHYRHILLS BIIILDING DEPARTMENT ' 2, ��S��v�� 'n�1�D��} �Q�� have read aad fully understand and agree to the provisions of this iastrument. The undersigaed states and affirms that he or she is desirous of constructing, renovatiag, addiag to or reroofiag his or her owa 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 sha 1 comply with the following conditions: 1. That the owner and he or she aloae shall act as the builder for all phases of coastructioa. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ordinaaces and codes pertinent to the building. 3. That in the event various phases of coastruction are aubcoatracted•, he� will engage oaly properly liceased subcontractors aad will personally aupervise such work. , 4. That in the event the Building Inapector shall require correctioas to be made, � the owner will assume full respoasibility to iasure they are made, and upon completion will call for a reiaspection before proceediag with the building. 5. That the owaer shall assume full respoasibility for the constructioa and will not expect supervisioa of his work from the City of Zephyrhills Suildiag Departmeat. 6. That prior to fiaal inspectioa aay additional fees, includiag reinspectioa fees, must be paid ia full. A written request from this office shall constitute 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 Iadustrial Commissioa. 9. State law requires construction to be doae by liceased contractors. You have applied for a permit under an exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your owa contractor with certaia restrictions evea though you do aot have a license. You must provide direct onsite supervision of the coastructioa yourself. You may build or improve a oae-family or two-family residence or a farm outbuilding. You may also build or improve a commercial buildiag, provided your costs do aot 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 substaatially improved youraelf 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 violation of this exemption. You may not hire aa unlicensed person to act as your coatractor or to supervise people working on your buildiag. It is your responsibility to make sure that people employed by you have liceases required by state law and by county or muaicipal licensiag ordinances. You may aot delegate the responsibility for supervisiag work to a liceased coatractor who is aot liceased to perform the work beiag doae. Any persoa workiag on your buildiag who is aot licensed must work under your direct supervision aad must be employed by you, which meaas that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must comply with all applicable laws, ordinances, buildiag codes, and zoaiag regulatioas. OWNER'S SIGNATURE ��,!_!�`.�� DATE ADDRESS� � ,�� t7 I PHONE g (�j Q��If��T WITNESS PERMIT #