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DISCLOSIIRE ST�TEMENT FOR OWNER CITY OF ZEPHYRIiILLS BIIILDING DSPARTI�N'P 2, �qv�/� �uQ r�� have read and fully understaad and agree to the provisioas of this instrumeat. The undersigned states and affirms that he or she is desirous of constructing, reaovatiag, addiag to or reroofiag his or her owa domicile, that he or �he actually occupies, or will occupy by said domicile, and same is not for reat, lease or sale. That he or she shall comply with the followiag coaditioas: 1. That the owner aad he or she aloae shall aet as the builder for all phases of coastruction. 2. That the owner will comply with all provisions of the City of Zephyrhills ordinaaces and codes pertineat to the buildiag. 3. That ia the eveat various phases of coastruction are subcoatracted, he will engage only properly licensed subcontractors aad will persoaally supervise such work. 4. That in the event the Building Inspector shall require corrections to be made, the owaer will assume full respoasibility to iasure they are made, aud upon completioa will call for a reiaspection before proceeding with the building. i 5. That the owner shall assume full responsibility for the constructioa and will aot ect su ervision of his work from the Cit of Ze h rhills Buildia �P P Y P Y � Departmeat. 6. That prior to fiaal inspection aay additional fees, iucluding reinspectioa fees, must be paid in full. A written requeSt from this office shall constitute an ogficial aotice to pay additional 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 owuer shall comply with all the safety codes issued by the Florida Industrial Commissioa. 9. State law requires coastructioa to be doae by licensed contractors. You have applied for a permit uader an exemption to that law. The exemptioa allows you, as the owaer of your property, to act as your own contractor with certain restrictions evea though you do not have a licease. You must provide direct onsite supervision of the coastructioa yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial buildiag, provided your coets do aot exceed $75,000. The buildiag or resideace must be for your owa use or occupancy. It may not be built or substaatially improved for sale or lease. If you sell or lease a 'al i rov d our elf within 1 ear after buildiag you have built or substaati ly mp e y s y 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 not hire aa ualicensed persoa to act as your contractor os to supervise people workiag oa your buildiag. It is your respoasibility to make sure that people employed by you have licenses required by state law aad by county or municipal licensiag ordiaaaces. You may aot delegate the responsibility for supervisiag work to a licensed coatractor who is aot licenaed to perform the work being done. Aay person working on your building who is not liceneed must work under your direct supervisioa aad must be employed by you, which means 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, and zoaing regul tioas. OWNER'S SIGNATURE � DATE � ( � ! �S ADDRBSS I �-ln�l L a- PHONS s�� -�-39-d��a � WITNBSS PBRMIT #