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DISCLOSIIRE ST�TEA�NT FOR OWNF.R CITY OF ZEPHYRHILLS BIIILDING DEPARTN�NT 2, have read and fully understaad aad agree to the provisions of this inatrumeat. The undersigned states aad affirms that he or she is desirous of constructiag, renovatiag, adding to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and eame is not for rent, lease or sale. That he or she shall comply with the followiag conditions: 1. That the owner aad he or she aloae shall act as the builder for all phasea of construction. 2. That the owaer will comply with all provisioaa of the City of Zephyrhills ordiaaaces and codes pertinent to the buildiag. 3. That ia the eveat various phases of coastruction are subcoatracted, he will engage only properly liceased aubcoatractors aad will persoaally supervise such work. 4. That in the event the Suilding Iaspector shall require correctiona to be made, the owaer will assume full respoasibility to iasure they are made, and upon completioa will call for a reinspectioa before proceediag with the building. I5. That the owaer shall assume full respoasibility for the conatructioa and will aot expect supervision of his work from the City of Zephyrhills Buildiag Departmeat. � 6. That prior to fiaal inspectioa aay additional fees, includiag reiaspection fees, must be paid in full. A written request from this office shall coastitute aa official aotice to pay additioaal fees. 7. That the owner shall comply with all City, State aad 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 Iadustrial Commis�ion. , 9. State law requires construction to be done byr licensed contractors. You have applied for a permit uader aa exemption to that law. The exemptioa allows you, as the owaer of your property, to act as your owa coatractor with certaia 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 residence or a farm outbuildiag. You may also build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The buildiag or residence must be for your owa uae or occupaacy. It may aot be built or aubstaatially improved for sale or lease. If you sell or lease a buildiag you have built or substaatially improved yourself withia 1 year after the constructioa is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violatioa of this exemptioa. You may aot hire an unliceased persoa to act as your coatractor or to supervise people workiag on your buildiag. It is your respoasibility to make aure that people employed by you have licenses required by state law and by couaty or municipal liceasiag ordiaaaces. You may aot delegate the respoasibility for superviaiag work to a licensed coatractor who is uot liceased to perform the work beiag doae. Aay person working on your building who is not licensed must work uader your direct supervision aad must be employed by you, which means that you must deduct F.I.C.A. aad withholdiag tax and provide workers' compensation for that employee, all ae prescribed by law. Your constructioa must comply with all applicable laws, ordiaaaces, buildiag codes, aad zoniug regulations. �OWNER'S S IGNATURE ��5,��-�- DATE � /'��/5 ADDRBSS ('.+�$a� 4a.!<<res�- �� �-PHONE �So -;yZ�!-a.o90 WITNESS PSRMIT #