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. i DISCLOSIIRE STATII�NT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DBPARTMENT 2. rLl.I�1Gl�.l 1�1adUka_. have read aad fully understand aad agree to the provisions of this inatrumeat. The undersigned states and affirms that he or she is desirous of constructing, renovatiag, 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 following conditions: 1. That the owaer 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 phasea of coastructioa are aubcoatracted, he will engage only properly liceased subcontractors aad will personally supervise such work. 4. That ia the eveat the Buildiag Inspector shall require correctioas to be made, the owner will assume full respoasibility to insure they are inade, aad upon completion will ca�l for a reiaspection before proceeding with� the building. 5. That the owner shall assume full responsibility for the coastructioa and will aot expect supervision of his work from the City of Zephyrhills Building Department. , 6. That prior to fiaal inspectioa aay additional fees, includiag reinspection fees, must be paid ia full. A writtea request from this office shall coastitute aa official aotice to pay additional 'f.ees. 7. That the owner shall comply with all Ci�y, 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 th� safety codes issued by the Florida Industrial Commission. 9. State law requires coastruction to be doae by liceased contractors. You have applied for a permit under an exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your own coatractor with certaia restrictions evea though you do aot have a license. You must provide direct onsite supervisioa of the construction yourself. You may build or improve a one-family or two-family 'reaidence or a farm outbuilding. You may also build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The building or residence must be for your owa use or occupaacy. It may aot be built or substantially improved for �ale or lease. If you sell or lease a, buildiag you have built or aubstaatially improved yourself withia 1 year after the coastructioa is complete, the law w�ll presume that you built or substaatially improved if for sale or lease, which is a violation of this exemptioa. You may aot hire au unlicea� ed person to act as your coatractor or to aupervise people working oa your bui�ding. It is your responsibility to make sure that people employed by you have licenses required by state law aad by couaty or municipal licensing ordiaaaces. You may aot delegate the responsibility for supervising work to � licensed contractor who is aot liceased to perform the work beiag done� Auy person working on your buildiag who is not liceased must work uader your direct supervision and must be employed by you, which meaas that you must deduct F.I.C.A. aad withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your coastructioa must comply with all applicable laws, ordinaaces, buildiag codes, aad zoaing regulatioas. OWNER'S SIGNATURE DATE � • Z�^/S� ADDRESS 55OZ l� j � l,S � , Pxorrs �I 3-'I 8 3- � I WITNESS P}3RMIT # �6 S 3�