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'�� ' DISCLOSIIRE STATEN�NT FOR OWNFR CITY OF ZEPHYRHILLS BIIILDING DSPARTNffsN'P I, have read and fully uaderstaad and agree to the provisions of this inatrumeat. 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 ahe actually occupies, or will occupy by said domicile, aad same is not for rent, lease or sale. That he or she ahall comply with the following conditioas: 1. That the owner aad he or she aloae shall act as the builder for all phases of construction. 2. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes pertiaeat to the building. 3. That in the eveat various phasee of coastruction are subcontracted, he will engage oaly properly liceased subcoatractors and will personally supervise such work. 4. That ia the event the Buildiag Inspector shall require correctiona to be made, the owaer will assume full responaibility to iasure they are made, aad upon completion will call for a reiaspection before proceediag with the building. 5. That the owner shall assume full respoasibility for the coastruction and will aot expect supervisioa of his work from the City of Zephyrhills Buildiag Department. 6. That prior to final inspection aay additional fees, iacludiag reinspection fees, must be paid ia full. A written request from this office shall constitute an 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 owaer shall comply with all the safety codes issued by the Florida Iadustrial Commiasion. 9. State law requires coastruction to be doae by licensed coatractors. You have applied for a permit uader aa exemption to that law. The exemptioa allows you, as the owner of your property, to act as your own coatractor with certaia restrictioas evem though you do aot have a license. You must provide direct onsite superviaioa of th� coastruction 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 building or residence must be for your owa use or occupancy. It may aot be built or aubstantially improved for sale or lease. If you sell or lease a building 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 violation of this - exemptioa. You may aot hire an unlicensed peraoa to act as your contractor or to aupervise people workiag on your buildiag. It is your responsibility to make sure that people employed by you have liceases required by state law aad by couaty or municipal licensiag ordiaaaces. You may aot delegate the respoasibility for supervising work to a licensed coatractor who is uot licenaed to perform the work beiag done. Any person workiag oa your buildiag who is aot licensed must work under your direct aupervisioa 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 as prescribed by law. Your construction must comply with all applicable laws, ordiaaaces, buildiag codes, and zoniag regulations. owwx�R�s szcN�u� �cx� l �(/�_��v-�-- n�E C'6_ 27 - 1 5 ADDRBSS PHONS ��2 2,� C9`�.� WITNSSS PSRMIT #