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DISCLOSIIRE STATEN�NT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DSPARTMENT I, � have read and fully understand and agree to the provisioas o this astrumeat. The undersigaed states and affirms that he or she is desirous of constructiag, reaovatiag, adding 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 rent, lease or sale. That he or she shall comply with the following coaditions: 1. That the owner aad he or she aloae shall act as the builder for all phases of coastruction. 2. That the o�vner will comply with all provisioas of the City of Zephyrhills ordinaaces aad codes pertinent to the buildiag. 3. That ia the eveat various phasea of construction are subcontracted, he will engage only properly licensed subcoatractors aad will persoaally supervise such work. 4. That in the event the Buildiag Iaspector shall require correctioas to be made, the owaer will assume full responsibility to iasure they are made, aad upon completion will call for a reiaspectioa before proceediag with the buildiag. 5. That the ov�er shall assume full responsibility for the constructioa and will aot expect supervisioa of his work from the City of Zephyrhills Buildiag Departmeat. 6. That prior to fiaal inspection any additional fees, including reinspection fees, must be paid ia full. A writtea request from this office shall coastitute aa official aotice to pay additioaal fees. 7. That the owner 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 construction to be doae by liceased coatractors. You have applied for a permit under aa exemptioa to that law. The exemptioa allows you, as the owner of your property, to act as your own coatractor with certain � restrietioas evea though you do not 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 outbuildiag. You may also build or improve a commercial buildiag, provided your costs do not exceed $75,000. The buildiag or residence must be for your owa 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 aubataatially improved yourself withia 1 year after the construction is complete, the law will presume that you built or , substaatially improved if for sale or lease, which is a violation of this exemptioa. You may not hire aa unliceased persoa to act as your contractor or to supervise people working on your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by atate law and by couaty or muaicipal liceasing ordiaaacea. You may not delegate the respoasibility for supervising work to a licensed coatractor who is aot licenaed to perform the work being done. Any person working on your building who is not liceused 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 coastructioa must comply with all applicable laws, ordinances, buildiag codes, aad zoaing r latioas. � OWNER'S I NATURE � � DATE � l , � ADDRSSS - PHONE WITNESS PERMIT # CG �dS�