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DISCLOSIIRS STATEMENT FOR OWN�R . � CITY OF ZSPHYRFIILLS BIIILDING DEPARTMENT I� have read aad fully understaad aad agree to the provisioas of this iastrumeat. The undersigned states aad affirms that he or she is desirous of constructing, reaovatiag, addiag 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 reat, lease or sale. That he or she shall comply with the following conditiona: 1. That the owner and he or she aloae shall act as the builder for all phases of coastruction. 2. That the owner will comply with all proviaioas of the City of Zephyrhills ordinances aad codes pertinent to the buildiag. 3. That in the eveat various phasea of coastruction are subcontracted, he will eagage only properly liceased subcontractors and will persoaally supervise such work. 4. That ia the eveat the Buildiag Iaspector shall require corrections to be made, the owaer will assume full respoasibility to iasure they are made, and upon completion will call for a reiaspection before proceediag with the building. 5. That the owaer shall assume full respoasibility for the construction and will aot expect supervision of his work from the City of Zephyrhills Suilding Department. 6. That prior to fiaal iaspectioa auy additional fees, including reinspectioa fees, must be paid in full. A writtea request from this office shall constitute an official notice to pay additioaal fees. 7. That the owaer shall comply with all City, State and Federal Taws ia regard to social security, workman's compensation, lien laws, etc. , where applicable. 8. That the owaer shall comply with all the safety codes issued by the Florida Iadustrial Commission. 9. State law requires constructioa to be done by licensed contractors. You have applied for a permit under an exemptioa to that law. The exemption allosvs you, as the owner of your property, to act as your own contractor with certain restrictioas evea though you do aot have a license. You must provide direct oasite supervision of the constructioa youraelf. You may build or improve a oae-family or two-family residence or a farm outbuildiag. You may also build or improve a commercial buildiag, provided your costs do not exceed $75,000. i The buildiag 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 � buildiag you have built or substaatially improved yourself withia 1 year after the coastructioa ie complete, the law will presume that you built or subataatially improved if for sale or lease, which is a violation of this exemptioa. You may not hire aa unlicensed persoa to act as your contractor or to supervise people workiag on your building. It is your respoasibility to make sure that people emploj►ed by you have liceases required by state law aad by county or muaicipal liceasiag ordiaances. You may aot delegate the responsibility for eupervisiag work to a liceased contractor who is not liceased to perform the work beiag doae. Any persoa working oa your buildiag who is aot licensed must work uader your direct supervisioa and must be employed by you, which meaas that you must 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, ordinaaces, buildiag codes, and zoning regu ations. OWNER'S SIGNATURE --�� G�/��7"`�1 DATE �� `� � ADDRESS /D �'L 3 3 �f a PHONE I � -'7 WITNESS PERMIT #