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,- , . " DISCLOSIIRE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DBPARTNlEN'P I, �� ,�, ��+'¢'� have read and fully uaderstand and agree to the provisions of this iastrumeat. The undersigned states and affirms that he or she is desirous of constructiag, reaovatiag, adding to or reroofing his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for reat, lease or sale. That he or she ahall comply with the following coaditions: � 1. That the owner and he or she alone shall act as the builder for all phases of constructioa. 2. That the owner will comply with all provisions of the City of Zephyrhills ordiaaaces and codes pertinent to the building. ' 3. That ia the event various phases of coastructioa are subcontracted, he will eagage oaly properly licensed subcoatractors aad will personally supervise such work. 4. That in the event the Building Iaspector shall require corrections to be made, the owaer will assume full responsibility to iasure they are made, aad upon completioa will call for a reiaspectioa before proceediag with the building. 5. That the owner shall assume full responsibility for the coastruction and will aot expect supervision of his work from the City of Zephyrhills Building Departmeat. 6. That prior to fiaal inspectioa any additioaal fees, iacluding reiaspection fees, must be paid in full. A writtea request from this office shall coastitute aa official aotice to pay additional 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 Commission. 9. State law requires construction to be doae by licensed contractors. You have applied for a permit under an exemption to that law. The exemptioa allows you, as the owaer of your property, to act as your owa contractor with certaia restrictions even though you do aot have a license. You must provide direct onsite supervisioa of the coastructioa yourself. You may build or improve a one-family or two-family resideace 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 construction 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 not hire an unliceased persoa to act as your contractor or to supervise people working oa your building. It is your respoasibility to make sure that people employed by you have licenses required by state law and by couaty or municipal licensiag ordiaaaces. You may not delegate the responsibility for supervisiag work to a licensed contractor who is aot licensed to perform the work being doae. Any person working on your building who is aot licensed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. aad withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must comply with all applicable laws, ordinances, building codes, and zoaing re a i OWNER�S SIGNATURE DATE � � ADDRESS � i PHONE � WITNESS PERMIT # l 6 ( G 9 -