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I � � DISCLOSIIRE STATEMENT FOR OWNF•R CITY OF ZEPHYRHILLS BUILDING D33PARTMENT I, ��i ti,�� ]��Cl�'L�' have read aad fully understand and agree to the provisions of this iastrumeat. The undersigned states and affirms that he or she is desirous of constructiag, renovatiag, adding to or reroofing his or her own domicile, that he or she actually occupies, or will occupy by I said domicile, aad same is not for reat, lease or sale. That he or she shall comply with the following coaditions: 1. That the owaer and he or she aloae shall act as the builder for all phases of constructioa. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordiaances and codes pertineat to the building. 3. That ia the event various phases of construction are subcontracted, he will engage only properly liceased subcontractors and will personally supervise such work. 4. That in the event the Buildiag Iaspector shall require correctioas to be made, the owner will assume full responsibili y to insure they are made, and upon completion will call for a reinspectioa�before proceediag with the buildiag. 5. That the owaer ahall assume full responsibility for the construction and will not expect supervisioa of his work from the City of Zephyrhills Building Department. 6. That prior to final inspectioa any additional fees, iacludiag reiaspectioa fees, must be paid ia full. A writtea =equest from this office shall constitute an official aotice to pay ad�ditioaal fees. 7. That the owaer shall comply with all City, State aad Federal laws in 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 Industrial Commission. 9. State law requires constructioa to be done by liceased coatractors. You have applied for a permit uader aa exemption to that law. The exemption 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 aupervision of the coastructioa yourself. You may build or improve a oae-family or two-family residence 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 own 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 construction is complete, the law w�ll presume that you built or substaatially improved if for sale or lease, which is a violation of this exemption. You may aot hire an ualicensed persoa to act as your contractor or to supervise people working on your buil�ding. It is your responsibility to make sure that people employed by you have liceases required by state law and by couaty or municipal licensiag ordiaances. ' You may aot delegate the respoasibility for supervising work to a licensed contractor who is not liceased to perform the work being doae. Aay person working on your buildiag who is not liceased must work under youl direct supervisioa aad must be employed by you, which meaas that you m�st deduct F.I.C.A. aad withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your coastructioa must comply with all applicable laws, ordinances, building codes, and zoning regu tioas. OWNER'S SeIyGNATURE �.- ' DATE � �/� I ADDRESS / � (J!� / / S ' PHONE - Q' - I WITNESS PERMIT #