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� , � DISCLOSIIRE STATEN�N'I' FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DSPARTNdsNT 2, �C�Q l��iL <<}��,� �j have read and fully understaad and agree to the provisions of this iastrumeat. The undersigned states and 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 reat, lease or sale. That he or she shall comply with the followiag coi�c�itions: 1. That the owaer and he or she alone shall act as the builder for all phases of construction. 2. That the owner will comply with all proviaions of the City of Zephyrhills ordiaances and codes pertiaeat to the buildiag. 3. That in the event various phases of construction are subcontracted, he will engage only properly liceased subcoatractors and will peraoaally supervise _ such work. . 4. That in the eveat the Buildiag� Inspector shall require correctione to be made, the owaer will- assume full respoasibility to insure tliey are made, aad upoa completion will call for a reinspection before proceeding with the building. 5. That the owner shall assume full. responsibility for the coastruction and will aot expect supervisioa of his work from the City of Zephyrhills Building Departmeat. � 6. That prior to fiaal inspectioa any additioaal fees, iacludiag reinspectioa fees, must be paid in full. A writtea request from thia office shall constitute aa official notice 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 owaer shall comply with all the safety codea issued by the Florida Industrial Commission. 9. State law requires constsuctioa to be doae by liceased contractors. You have applied for a permit uader aa exemption to that law. The exemption allows you, as the owner of your property, to act as your own coatractor with certaia restrictioas evem though you do aot have a licease. You must provide direct oasite supervision of the coastruction 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 costs do aot 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 substaatially 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 aot hire an ualicensed persoa to -act as your contractor or to supervise people workiag on your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law and by couaty or muaicipal licensiag ordiaances. You may aot delegate the responsibility for supervising work to a licensed contractor who is aot liceased to perform the work beiag doae. Aay person working on your building who is aot licenaed must work under your direct supervisioa aad muet be employed by you, which meaas that you must deduct F.I.C.A. aad withholding tax and provide workers� compensation for that employe2, all as prescribed by law. Your construction must comply with all applicable laws, ordiaaaces, buildiag codes, �aad zoning regulations. OWNER'S SIGNATURE DATE � �� I� ADDRBSS a� J 7 CS • 6 5 Z PHONB WITNESS Pl3RMIT # ��73 D 2 ,