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' ' ' DISCLOSIIRE STATEN�NT FOR OWN�R � CITY OF ZFFPHYRIiILLS BIIILDING DSPARTN�NT ~2, have read and fully uaderstand and agree to the provisions of this instrument. The undersigaed atates aad affirms that he or she ie desirous of conatructing, reaovatiag, adding to or reroofing his or her own domicile, that he or she � � ' actually occupies, or will occupy by said domicile, aad same is not for reat, lease or sale. That he or she shall comply with the following conditions: 1. That the owaer aad he or she alone shall act as the builder for all phases of � coastruction. 2. That the owaer will comply with all proyiaions of the City of Zephyrhills ordinances aad codes pertiaeat to the buildiag. ' 3. That ia the eveat various phases of coastruction are subcontracted, he will engage only properly licensed subcontractors and will personally supervise such work. � 4. That in the eveat the Building Inspector ahall require correctioas to be made, � the owaer will assume full responsibility to insure they,are made, aad upon completion will call for a reinspection before proceeding with the buildiag. 5. That the owaer ahall assume full respoasibility for the coastruction and _wil�l not expect supervision of his work from the City of Zephyrhills Building Department. 6. That prior to final iaspection aay additional fees, including reinspectioa fees, must be paid in full. A written request from thia offibe shall: coastitute an official aotice to pay additional fees. 7. That the owaer 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 isaued by the Florida Iaduatrial Commission. - 9. State law requirea construction to� be doae by licensed contractors. You have , applied f6r a permit under an exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your owa coatractor with certain - restrictioas even though you do aot have a licenae. 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 also build or improve a commercial building, provided your costs do not exceed $75,000. The building or resideace 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 building you have built or substantially improved yourself within 1 year after the conetructioa is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violation of this , exemption. You may not hire an unliceased persoa to act as your coatractor or to aupervise people workiag on your building. It is your responsibility to make sure that people employed by you have liceases required by state law aad by county or municipal licenaiag ordinances. You may aot delegate the responaibility for aupervising work to a licensed coatractor who is aot liceased to perform the work being doae. Aay peraon workiag on your building ' who ia not licensed must work under your direct aupervision aad must be employed by you, which means that you must deduct F.I.C.A. and withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordiaances, buildiag ' codes, aad zoaing regulations. . OWNER'S SIGNATURE DATE J� ' -S " L� /,� ADDRESS / � ' 33 ,�� PHONS c5 J S� ' 9�d ' �Z Z � WITNESS PSRMIT # �