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� DISCLOSIIRI's STATEMENT FOR OWNER �� OF ZSPHYRFIILLS BIIILDING DEPARTMENT �"� / r.� ! �/1'12�\ �i�`� G� have read and fully understaad and agree to the provisioas of this instrument. The undersigned states and affirms that he or she is desirous of constructing, reaovatiag, adding to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is aot for rent, 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 construction. - 2. That the owner will comply with all provisioas of the City of Zephyrhills ordiaances and codes pertinent to the buildiag. 3. That ia the eveat various phases of construction are subcontracted, he will engage oaly properly liceased subcontractors and will persoaally supervise such work. 4. That in the event the Building Iaspector shall require correctioas to be made, the owaer will assume full respoasibility to insure they are made, aad upon completion will call for a reiaspection before proceeding with the building. 5. That the owaer shall assume full responsibility for the coastructioa and will not expect supervieioa of his work from the City of Zephyrhills Building Departmeat. , 6. That prior to fiaal inspectioa aay additioaal fees, iacluding reiaspectioa fees, must be paid in full. A written request from this office shall coastitute an official notice to a additional fees. P Y 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 owaer shall comply with all the safety codes issued by the Florida Iadustrial Commisaioa. 9. State law requires constructioa to be doae by licensed contractors. You have applied for a permit under an exemptioa to that law. The exemption allows you, as the owner of your property, to act as your own coatractor with certaia restrictions evea though you do aot have a licease. You must provide direct onsite supervisioa of the constructioa yourself. You may build or improve a oae-family or two-family resideace or a farm outbuildiag. You may also build or improve a commercial buildiag, provided our costs do not exceed 75 000 Y $ . . The buildiag or residence must be for your own use or occupaacy. It may not 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 coastruction ia complete, the law will preaume that you built or substantially improved if for sale or lease, which is a violatioa of this exemption. You may aot hire aa unlicensed persoa to act as your coatractor or to supervise people workiag on your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law and by couaty or municipal liceasiag ordiaaaces. You may not delegate the respoasibility for supervising work to a liceneed contractor who is aot licenaed to perform the work beiag done. Aay person workiag oa your building who is aot liceased must work under 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, ordiaances, buildiag codes, and zoning regulatioas. OWNER'S SIGNAT �� '" /G't '� DATE �'� ��(p ADDRESS � Pxor� �/�-779'/09� wixx�ss PERMIT #