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� ' ' � DISCLOSiJRE STATII�N'P FOR Oi�1NSR CITY OF ZEPHYRHILLS BUILDING DBPARTMENT I, �� /� � �, c� j�"��(have read and fully understand and agree to the provisioas of this instrumeat. The uadersigaed states and affirms that he or she is desirous of constructiag, reaovatiag, ad ' to or reroofiag his or her own domicile, that he or she actual y occupies, or will occupy by said domicile, aad same is not for ient, lease or sale. That he or she shall comply with the following coaditions: l. That the owaer aad he or she alone shall act as the builder for all phases of coastruction. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordinaaces and codes pertiaeat to the building. 3. That in the eveat various phases of coastructioa are subcoatracted, he will engage only properly liceased subcontractors aud will persoaally supervise such work. 4. That ia the eveat the Buildiag Iaspector shall require correctioas to be made, the owaer will assume full respoasibility to iasure they are made, aad upoa completioa will call for a reinspection before proceediag with the building. 5. That the owaer shall assume full responsibility for the construction aad will aot expect supervisioa of his work from the City of Zephyrhills Building Departmeat. 6. That prior to final inspection aay additioaal fees, includiag 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 owaer shall comply with all the safety codes issued by the Florida Iadustrial Commission. I� 9. State law requires coastruction to be doae by licensed contractors. You have applied for a permit uader an exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your own coatractor with certain restrictions evea though you do not have a licease. 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 outbuilding. You may aleo build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The building or resideace must be for your owa use or occupancy. It may aot be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or substantially improved yourself withia 1 year after the coastructioa is complete, the law will preaume that you built or substaatially improved if for sale or lease, which is a violation of this exemption. You may aot hire an unliceased persoa to act as your coatractor or to supervise people working on your buildiag. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or muaicipal licensiag ordinaaces. You may aot delegate the respoasibility for supervising work to a licensed contractor who is aot liceased to perform the work beiag doae. Any persoa working on your building who is aot liceased must work under your direct aupervisioa aad must be employed by you, which means that you must deduct F.I.C.A. aad withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordiaaaces, buildiag codes, aud zoaing regulatioas. OWNER'S SIGNATURE � fTat�iYVLOq DATE �" � �-- l 5 ADDRSSS 3Ff$O� �"L /+vF PHONE �/ - 7S - 7S►S� WITNFdSS PERMIT # I6��S � �C%��"/ ✓ � -- Cr � '