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� DISCLOSIIRE STATEN�NT FOR OWNFR CITY OF ZEPHYRHILLS BIIILDING DEPARTMENT I, have read aad fully uaderstaad and agree to the provisioas of this iastrumeat. The undersigned states and affirms that he or she is desirous of constructing, reaovatiag, adding to or reroofiag his or her owa domicile, that he or ahe actually occupies, or will occupy by said domicile, and same is not for reat, lease or sale. That he or she shall comply with the following conditions: l. That the owner and he or she aloae shall act as the builder for all phases of coastruction. 2. That the owaer will comply with all provisions of the City of Zephyrhills ordiaaaces and codes pertineat to the buildiag. 3. That ia the event various phases of coastruction are subcontracted, he will engage only properly liceased subcontractors aad will personally supervise such work. 4. That ia the event the Building Iaspector shall require correctiona to be made, the owner will assume full responsibility to iasure they are made, aad upon , . completioa will call for a reinspectioa before proceeding with the building. 5. That the owaer shall assume full responsibility for the construction and will aot expect supervision of his work from the City of Zephyrhills Buildiag Department. 6. That prior to fiaal inspectioa aay additional fees, iacluding reiaspection fees, must be paid in full. A written request from this office shall constitute aa 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 Iadustrial Commission. 9. State law requires construction to be doae by licensed contractors. You have applied for a permit under aa exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your owa coutractor 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 oae-family or two-family residence or a farm outbuildiag. You may also build or improve a commercial buildiag, provided your costs do not exceed $75,000. The building or residence must be for your owa use or occupancy. It may aot be built or substaatially improved for sale or lease. If you sell or lease a buildiag you have built or substantially 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 violatioa of this exemption. You may aot hire aa unlicensed person 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 licenses required by state law and by county or municipal licensiag ordiaances. You may aot delegate the responsibility for supervising work to a licensed contractor who is aot licensed to perform the work being done. Any person working on your building who is aot liceased must work under your direct supervisioa aad must be employed by you, which meaas that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your coastructioa must comply with all applicable laws, ordiaances, building codes, and zoning regulatioas. > -7 < .� OWNER'S SIGNATURE DATE �� /'/✓ ADDRESS �7 CI S ' � a �' �`I� , - - PxorrE �r�3 .� �� WITNSSS PERMIT # L�� `