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O � � DISCLOSIIRE STATEMSNT FOR OWN£R CITY OF ZEPHYRHILLS SIIILDING DSPARTN�,NT I, have read and fully understand and agree to the provisions of this iastrumeat. The undersigned states and affirms that he or she is desirous of constructing, renovatiag, addiag to or reroofiag his or he� own 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 shall cl mply with the followiag conditions: 1. That the owner aad he or she aloae shall act as the builder for all phases of construction. � - 2. That the owaer will comply with all provIisions of the City of Zephyrhills� ' ordinances and codes pertineat to the bdildiag. 3. That ia the event various phases of coa�truction are subcontracted, Iie will engage only properly'licensed subcontrac�tors and will personally supervise._ such work. 4. That ia the eveat the Buildiag Inspecto� shall require correctioas to be made, the owaer will assume full respoasibilit�y to iasure they are made, aad upon completioa will call for a reinspection before proceeding with the building. 5. That the owner shall assume full respoa ibility for the construction and will aot expect supervision of his work from the City of Zephyrhilla Building Departsneat. 6. That prior to final inspectiou any additional fees, iacluding reinspection fees, muat be paid ia full. A written s�equest from this office shall constitute an official notice to pay ad�itional fees. 7. That the owaer shall comply with all Ci�y, State and Federal laws ia regard to social security, workman's compensation1 lien laws, etc. , where applicable. 8. That the owaer shall comply with all the safety codes issued by the Florida Industrial Commissioa. 9. State law requires coastruction to be d ae by liceused coatractors. You have applied for a permit under aa exemption to that law. The exemption allows you, as the owner of your property, to act as your owa coatractor with certain restrictions evea though you do aot have a licease. You must provide direct onsite supervisioa of the coastructioa yourself. You may build or improve a one-family or two-family reaidence or alfarm outbuilding. You may also build or improve a commercial building, provided your costs do aot exceed $75,000. The buildiag or residence must be for your own use or occupancy. It may not be built or substaatially improved for sale or lease. If you sell or lease a building you have built or substaatiall�r improved yourself withia 1 year after the coastruction is complete, the law will presume that you built or substaatially improved if for sale or l�ase, which is a violatioa of this eacemptioa. You may aot hire an unlicensed person to act as your contractor or to supervise people workiag on your building. It. is your respoasibility to make sure that people empl.oyed by you h�ve liceases required by._ s.tate law and by couaty or municipal .licensiag ordinaaces. You may aot delegate the respoasibility €or supervising work to �a licensed contractor who is aot licensed to perform the work beiag done. Any persoa workiag oa your building who is aot licensed must work under you direct supervision and must be employed by you, which meaas that you must deduct F.I.C.A. aad withholding tax and provide workers' compensati for t empl ee, all as prescribed by law. Your constructioa must c ly th all ppli le laws, ordiaaaces, building codes, and zoaing regu on . I OWNER'S SIGNAT , DATE I 1 ADDRSSS b / 3S�/Z PHONF 7 I WITNSSS PERMIT #