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1 � . DISCLOSIIRE STATEI��NT FOR OWNFR CITY OF ZEPHYRHILLS BIIILDING DBPARTN�NT I, ��l f�,{ �re�QT have read and fully uaderstand and agree to t e provisioas of this instrum' at. The undersigned states and affirms that he or she is deairous of constructiag, reaovatiag, addiag to or reroofiag his pr her own domicile, that he or she actually occupies, or will occupy by I said domicile, and same is aot for rent, lease or sale. That he or she sh411 comply with the followiag coaditions: 1. That the owaer and he or she alone hall act as the builder for all phases of � ' construction. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordinaaces aad codes pertiaent to t e building. 3. That ia the event various phases oflconstruction are subcoatracted, he will eagage oaly properly liceased subcoatractors aad will personally eupervise such work. 4. That ia the event the Suilding Iaspiector shall require corrections to be made, the owaer will assume full respoasibility to iasure they are made, aad upon completion� will call for a reinspecl�tioa before proceediag with the building. � 5. That the owner shall assume full re�ponsibility for the coastructioa and will aot expect supervision of his work �from the City of Zephyrhills Buildiag Departmeat. 6. That prior to final inspection aay additional feea, includiag reinspection fees, must be paid in full. A writ�ten request from this office shall coastitute an official aotice to pa additioaal fees. 7. That the owner shall comply with all City, State aad Federal laws in regard to social security, workman's compensation, lien laws, etc. , where applicable. 8. That the owaer shall comply with all the safety codes iseued by the Florida ! Iadustrial Commission. 9. State law requires construction to e done 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 coatractor with certaia restrictions evem though you do ao have a licease. You must provide direct onsite supervisioa of the coastruc a.oa youraelf. You may build or improve a oae-family or two-family residence�or a farm outbuildiag. You may also build or improve a commercial building, provided your costs do aot exceed $75,000. ' � The buildiag or resideace must be or your owa use or occupancy. It may not be built or substaatially improved for sale or lease. If you sell or lease a buildiag you have built or substan ially improved yourself within 1 year after the construction is complete, the aw will presume that you built or subetaatially improved if for sale or lease, which is a violatioa of this exemption. You may aot hire aa un iceased person to act as your contractor or to supervise people working on you� buildiag. It is your responsibility to make sure that people employed by you have liceases required by state law aad by couaty or muaicipal licensiag osdiaaaces. You may aot delegate the responsibility for supervising work to a licensed contractor who is aot liceased to perform the work beiag done. Aay person workiag on your buildiag v�ho is aot liceased must work uader� your direct supervision aad muat be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation or that employee, all as prescribed by law. Your constructioa m t co ly with all applicable laws, ordinances, building codes, and zoniag r la i s. � OWNER'S SIGNATURE DATE ` �3� ` � ADDRESS' I pxorrs '7�� -- lrL.U��/�g I WITNSSS PSRMIT #