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DISCLOSIIRE STATEMEN'P FOR OWNER ` " CITY OF ZEPIiYRHILLS BIIILDING DEPARTMENT I, have read and fully understaad and agree to the provisions of this instrumeat. The uadersigned states aad affirms that he or she is desirous of constructing, renovatiag, adding to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by said domicile, aad same is aot for reat, lease or sale. That he or she shall comply with the following conditioas: 1. That the owaer and he or she aloae shall act as the builder for all phases of construction. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ' ordiaaaces and codes pertineat to the buildiag. 3. That ia the eveat various phases of constructioa are subcoatracted, he rwill engage only properly liceased subcontractors aad will personally supervise such work. 4. That in the event the Building Iaspector shall require correctioas to be made, the owaer will assume full responsibility to iasure they are made, aad upon , completioa will call for a reinspection before proceediag with the building. 5. That the owaer shall assume full respoasibility for the coastruction and will aot expect supervieion of his work from the City of Zephyrhills Buildiag Departmeat. 6. That prior to fiaal inspection any additioaal fees, iacluding reinspectioa fees, must be paid ia full. A writtea request from this office shall constitute an official aotice to pay additioaal fees. 7. That the owner shall comply with all City, State and 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 issued by the Florida Iaduatrial Commiasion. 9. State law requires construction to be doae by licensed contractors. You have applied for a permit under aa exemption to that law. The exemptioa allows you, as the owaer of your property, to act as your owa contractor with certain restrictions even though you do aot have a licease. You must provide direct onsite supervision of the coastruction yourself. 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 aot exceed $75,000. 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 within 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 violatioa of this exemptioa. You may aot hire an unliceased persoa to act as your coatractor or to supervise 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 liceasiag ordinances. You may aot delegate the responsibility for aupervising work to a licensed coatractor who is not licensed to perform the work being doae. Any person working on your buildiag who is aot liceased must work uader your direct supervisioa aad must be employed by you, which means 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, ordinances, building codes, aad zoaiag regulations. OWNER'S SIGNATiJ�C i DATE ADDRESS� � TJ 33 Psor� 9 WITNESS PERMIT #