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� DISCLOSIIRE STATII�NT FOR OWNSR CITY OF ZEPHYRHILLS BIIILDING DSPARTMENT I, ` / G�te� have read and fully understand and agr to the p ovisions of this iastrumeat. The undersigned states and affirms that he or she is desirous of constructiag, renovating, adding to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, aad same is not for rent, lease or sale. That he or she shall comply with the followiag conditions: l. That the owaer and he or she alone ahall act as the builder for all phases of � coastruction. 2. That the owaer will comply with all provisions of the City of Zephyrhills ordiaances and codes pertineat to the building. 3. That in the eveat various phases of coastruction are subcoatracted, he will eagage only properly liceased subcoatractors and will persoaally supervise such work. 4. That ia the eveat the Building Inspector shall require correctioas to be made, the owner will assume full respoasibility 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 responsibility for the constructioa and will aot expect supervision of his work from the City of Zephyrhills Building Departmeat. 6. That prior to final inspection any additioaal fees, including reiaspection fees, must be paid ia full. A written request from thia office shall constitute an official notice 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 owner shall comply with all the safety codes issued by the Florida Industrial Commissioa. 9. State law requires coastruction to be doae by licensed coatractors. You have applied for a permit under aa exemption to that law. The exemptioa allows you, as the owaer of your property, to act as your own coatractor with certaia restrictions even though you do aot have a licease. You must provide direct onsite supervisioa of the coastructioa 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 building, provided your costs do aot exceed $75,000. The buildiag or residence must be for your own use or occupaacy. It may aot be built or eubstantially improved for sale or lease. If you sell or lease a buildiag you have built or substantially 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 violation of this exemption. You may aot hire an unlicensed persoa to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may aot delegate the responsibility for supervisiag work to a licensed coatractor who is not licensed to perform the work beiag doae. Any person working oa your building who is not licensed must work under your direct supervisioa aad must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers� compensation for that employee, all as prescribed by law. Your constructioa must comply with all applicable laws, ordiaaaces, buildiag codes, aad zoniag regulations. OWNER'S SIGNATURE �e1'l.c�- DATE �� c5 � f r� J ADDRESS 7 S y ' � / -- �3�� PHONE WITN�SS '��' '�1•L � '-s, / � e� PERMIT # � l7��