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DISCLOSUI2E STATII�NT FOR OWNER CITY OF Z$PHYRIiILLS BIIILDING DEPARTN�N'P 2, ' , L'� � e��`� have read and fully understand and agree to th rovisions of t 's iastrumeat. 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 occupiea, _or will occupy by said domicile, aad same is not for rent, lease or sale. That he or she shall comply with the followiag coaditioas: 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 provisions of the City of Zephyrhills ordiaaaces and codes pertineat to the building. 3. That in the eveat various phases of coastruction are subcoatracted, he will engage only properly liceased subcoatractors aad will persoaally supervise such work. 4. That ia the eveat the Building Iaspector shall require correctioas to be made, the owaer will assume full respoasibility to iasure they are made, aad upon completion will call for a reiaspection before proceediag with the building. 5. That the owaer shall assume full respoasibility for the coastructioa and will aot expect supervisioa of his work from the City of Zephyrhilla Suilding Departmeat. 6. That prior to fiaal iaspection any additional fees, includiag reiaspection fees, must be paid ia full. A written request from this office shall constitute an official aotice to pay additional fees. 7. That the owaer shall comply with all City, State aad Federal law� 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 coastruction to be done by licensed contractors. You have applied for a permit uader an exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your own contractor with certaia restrictions evea though you do aot have a licease. You must provide direct oasite supervisioa of the coastruction yourself. You may build or improve a one-family or two-family reaidence or a farm outbuildiag. You may also build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The buildiag or resideace must be for your own use or occupancy. It may not be built or aubstaatially improved for sale or lease. If you sell or lease a buildiag you have built or substaatially improved yourself within 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 aa ualicensed persoa to act as your coatractor or to supervise people workiag on your buildiag. It is your respoasibility to make sure that people esnployed by you have licenses required by state law and by county or muaicipal licensiag ordiaaaces. You may aot delegate the responsibility for supervisiag work to a licensed coatractor who is not liceased to perform the work beiag done. Aay persoa workiag on your buildiag who is aot licensed must work uader your direct supervisioa and muat be employed by you, which meaas that you muat deduct F.I.C.A. aad withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your coastructioa must comply with all applicable laws, ordiaaaces, buildiag codes, aad zoniag regulations. OWNER'S SIGNATURE �, � DATE ��„ �0�,� I ADDR]3SS ~I o� �h PHONS � � � � � WITNBSS PERMIT #