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DISCLOSIIR$ STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DSPARTMENT I, have read and fully understaad and agree to the provisions of this instrumeat. The undersigned states and affirms that he or she is desirous of constructing, reaovating, adding to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by said domicile, aad same is aot for rent, lease or sale. That he or she shall comply with the followiag conditioas: 1. That the owner aad he or she alone shall act as the builder for all phases of construction. - 2. That the owaer will comply with all provisioas of the City of ZephyrhiLls ordinances aad codes pertinent to the buildiag. 3. That ia the eveat various phases of construction are subcontracted, he will engage oaly properly licensed subcontractors and will personally supervise such work. , , 4. That in the eveat the Buildiag Inspector shall require corrections to be made, the owaer will assume ful�l,, respoasibility to iasure they,are made, aad upon completion will call for a reiaspection before proceediag .with the buildiag., 5. That the owner shall assume full responsibility for the coastruction and will aot expect supervision of his work from the City of Zephy,rhills Building Departmeat. 6. That prior to final inspection aay additional fees, including reiaspection fees, must be paid in full. A writtea request from this office shall constitute an official notice to pay additioaal fees. 7. That the owner shall comply with all City, State and 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. I 9. State law requires construction to be doae by liceased coatractors. You have applied for a permit un.der an exemption to that law. The exemptioa allows you, as the owner of your property, to act as your owa coatractor with certain restrictions evea though you do aot have a license. You must provide direct onsite supervision of the constructioa 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 resideace must be for your owa use or occupancy. It may aot be built or substantially improved for sale or lease. If you sell or lease a building 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 violation of this exemption. You may aot hire aa unliceased persoa to act as your coatractor or to supervise people working on your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law and by county or municipal licensing ordiaaaces. You may aot delegate the respoasibility for supervising work to a licensed contractor who is not liceased to perform the work beiag doae. Aay persoa working on your building who is aot liceased must work under your direct supervision aad must be employed by you, which means that you must deduct F.I.C.A. and withholdiag tdX and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordiaances, building codes, aad zoniag regu ations. OWNER'S SIGNATURE �LL�� DATE ADDRESS ,✓:�" C PHONE � ��p ^ �Z LiIITNESS PFsRMIT # �� I