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DISCLOSURE STATII�NT FOR OWNSR CITY OF ZSPHYRHILLS BUILDING DEPARTMENT I, have read and fully uaderstand and agree to the provisioas of this instrumeat. The undersigsied states aad affirms that he or she is desirous of constructiag, reaovatiag, adding to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by said domicile, and same is aot for rent, lease or sale. That he or she shall comply with the followiag conditioas: 1. That the owner and he or she aloae shall act as the builder for all phases of coastruction. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ordiaances and codes pertineat to the buildiag. 3. That ia the event various phases of coastruction are subcontracted, he will eagage only properly liceased subcontractors aad will persoaally supervise such work. 4. That ia the eveat the Buildiag Iaspector shall require correctioas to be made, the owner will assume full respoasibility to iasure they are made, aad upon completion will call for a reiaspectioa before proceeding with the building. 5. That the owaer shall assume full respoasibility for the coastructioa aad will aot expect supervisioa of his work from the City of Zephyrhills Building Departmeat. 6. That prior to final inspection aay additioaal fees, iacluding reiaspection fees, must be paid in full. A written request from this office ahall constitute aa official aotice to pay additional 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 owner shall comply with all the safety codes issued by the Florida �I Industrial Commissioa. � 9. State' law requires 'coastruction to be done by licensed contractors. You have applied for a permit under aa exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your owa coatractor with certain restrictioas even though you do aot have a license. You must provide direct onsite supervisioa of the coastructio,a yourself. You may build or improve a oae-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 own use or oecupancy. Tt may aot be built or subatantially improved for sale or lease. If you sell or lease a buildiag, you have built or subataatially 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 exemptioa. You may not hire an unlicensed person to act as your contractor or to supervise people workiag oa your bui'lding. It is your reBponsibility to make sure that people employed by you }iave licenses required by state law and by couaty or municipal liceasiag ordiaaaces. You may aot delegate the respoasibility for supervisiag work to• a licensed coatractor who is aot liceased to perform the work beiag doae. Aay persoa working on your building who is aot liceased must work under your direct supervisioa aad muat be employed by you, which meaas that you must deduct F.I.C.A. and withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must comply with all applicable laws, ordiaances, buildiag codes, and zoaing r lations. � `j�nTNER'S S UgE , DATE OJ'� �� G/� �ADDR8S3 PHONE WITNESS PERMIT #