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�I �R S DISCLOSIIRE STATEMENT FOR OWNER CITSI OF ZEPHYRIiILLS BIIILDING DSPARTN�NT _, �� 1 � "'�G"— have read aad fully understaad aad agree to the provisioas of this iastrumeat. The undersigned states aad affirms that he or she is desirous of constructiag, renovatiag, addiag to or reroofiag his or her own 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 comQly with the following conditions: 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 ordiaaaces aad codes pertiaent to the buildiag. 3. That ia the event various phases of coastructioa are subcoatracted, he will engage only properly licensed subcoatractors aad will personally supervise such work. 4. That ia the eveat the Buildiag Iaspector shall require corrections to be made, the owaer will assume full respoasibility to iasure they are made, aad upon completion will call for a reinspection before proceeding with the building. 5. That the owaer shall assume full respoasibility for the constructioa aad will aot expect supervisioa of his work from the City of Zephyrhills Suilding Department. 6. That prior to fiaal inspection any additioaal fees, iacluding reinspection fees, must be paid ia full. A written request from this office ahall constitute an official aotice to pay additional fees. 7. That the owner shall comply with all City, State aad Fedexal laws in 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 Industrial Commission. 9. State law requires construction to be doae 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 contractor with certaia restrictions evea though you do aot have a licenae. You must provide direct onsite supezvision of the coastructioa yourself. You may build or improve a oae-family or two-family residence or a fasm outbuilding. You may also build or improve a commercial buildiag, provided your costs do not exceed $75,000. The buildiag or residence must be for your own use or occupancy. It may aot be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or substantially improved yourself withia 1 year after the construction is complete, the law will presume that you built or subetaatially improved if for sale or lease, which is a violation of this exemption. You may aot hire au ualicensed persoa to act as your contractor or to aupervise people workiag oa your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law aad by couaty or municipal liceasiag ordiaaaces. You may aot delegate the respoasibility for supervising work to a licensed coatractor who is not liceaeed to perform the work being done. Aay person working on your building who is aot licensed muBt work under your direct supervision aad must 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 construction must comply with all applicable laws, ordinaaces, buildiag codes, aad zoaing regulations. OWNER'S SIGNATURE DATE ��U�� ADDRESS �- PHONS � i�1ITNESS PERMIT #