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DISCLOSIIRE STATEMENT FOR OWNER CITY OF Z}3PHYRHILLS BIIILDING DBPARTMENT I, „/of//I� l��f� � have read aad fully uaderstaad and agree to the provisions of this iastrument. � The undersigned states aad affirms that he or she is desirous of constructing, reaovatiag, adding to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by �' said domicile, and same is not for rent, lease or sale. That he or she ahall comply with the followiag conditions: i 1. That the owaer aad he or she aloae shall act as the builder for all phases of construction. i 2. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes pertineat to the buildiag. 3. That ia the event various phases of coastructioa are subcoatracted, he will engage oaly properly liceased subcontractors aad will persoaally supervise such work. . i . � 4. That in the eveat' the Building Iaspectoi shall require corrections to be made, the owaer will assume full responsibility to iasure they are made, and upon completion will. call for a reiaspectionibefore proceediag with the building. 5. That the owaer shall assume full respon'sibility for the construction and will not expect supervision of his work from� the City of Zephyrhills Building Departmeat. ' I 6. That prior to final inspectioa any additioaal fees, including reinspectioa fees, must be paid in full. A written 'request from this office shall constitute an official notice to pay additioaal fees. 7. That the owaer shall comply with all Ciity, 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 thle safety codes issued by the Florida Industrial Commissioa. � 9. State law requires construction to be doae by licensed contractors. You have I applied for a permit under aa exemptioa� to that law. The exemption allows you, as the owaer of your property, to 'act as your own coatractor with certain restrictioas even though you do aot hav�e a license. You must provide direct onsite supervision of the coastructioa yourself. You may build or improve a one-family or two-family residence or a� farm outbuilding. You may also build or improve a commercial building, 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 substantially improved for �sale or lease. If you sell or lease a buildiag you have built or substantiall�y improved yourself within 1 year after the coastructioa is complete, the law will presume that you built or substaatially improved if for sale or l�ease, which is a violatioa of this exemption. You may aot hire aa ualicensed person to act as your coatractor or to supervise people workiag oa your bui�lding. It is your respoasibility to make sure that people employed by you have licenses required by state law aad by couaty or muaicipal licensiag ordinances. You may aot delegate the respoasibility for supervising work to ;a liceased coatractor who is aot liceased to perform the work being done. Any person workiag oa your buildiag who is not liceased must work under your direct supervision and must be employed by you, which meaas that you :nust 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, building codes, aad zoaing regulat' ns. ,r I ! � OWNER�S SIGNATURE � DATE r�� ADDRESS � � � PHONE / — � � WITNESS PERMIT #