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,• �� ` DISCLOSIIRE STATffi�N'P FOR OWNER CITY OF ZBPFIYRHILLS BIIILDING DBPARTMENT _, have read aad fully uaderstaad and agree to the provisions of thia instrument. The undersigned states and affirms that he or she is desirous of coastructiag, renovatiag, addiag to or reroofiag his or her own 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 followiag coaditioas: 1. That the owaer and he or she aloae shall act as the builder for all phases of coastructioa. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordiaaaces aad codes pertinent to the buildiag. � 3. That ia the eveat various phases of coastruction are subcoatracted, he will engage oaly properly licensed aubcoatractors and will personally supervise such work. 4. That in the eveat the Buildiag Inspector shall require corrections to be made, the owner will assume full respoasibility to insure they are made, aad upon completion will call for a reinspection before proceediag with the buildiag. 5. That the owner shall assume full reaponsibility for the construction and will not expect supervisioa of his work from the City of Zephyrhills Building Department. 6. That prior to final iaspection aay additional fees, iacluding reiaspectioa fees, must be paid in full. A writtea request from thia office ahall coastitute an official notice to pay additional fees. 7. That the owaer shall comply with all City, State and 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 Commission. 9. State law requires construction to be done by liceased contractors. 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 owa coatractor with certain restrictions evea though you do not have a licease. You must provide direct oasite supervision of the coastructioa 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 aot exceed $75,000. The building or reaideace must be for your owa use or oc�cupancy. It may aot be built or substaatially improved for sal�e or lease. I,f you sell or lease a buildiag you have built or substantially improved yourself within 1 year after the construction is complete, the law will preavme that you built or substantially improved if for sale or lease, which is a violatioa of this exemption. You may aot hire an ualiceased peraon to act as your contractor or to supervise people workiag on your buildiag. It is your responsibility to make sure that people employed by you have licenses required by state law aad by county or municipal liceasing ordiaances. You may not delegate the respoasibility for supervising work to a licensed contractor who is aot licenaed to perform the work being done. Aay person working on your building who ia not licensed must work under your direct supervisioa aad must be employed by you, which meaas that you must deduct F.I.C.A. aad withholdiag tax and provide workers' compensation for that employee, all as preacribed by law. Your construction must comply with all applicable laws, ordiaaacea, buildiag codea, aad zoaing regulationa. OWNER'S SIGNATURE D�E L I��I�� ADDRSSS ` 3 j�'j— PHONS WITNESS PLRMIT #