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7 � DISCLOSIIR$ STAT&MENT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DSPARTN�NT � I. have read and fully uaderstaad and agree to the provisioas of this iastrumeat. The undersigned states and affirms that he or she is desirous of constructing, 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 aot for reat, lease or sale. That he or she shall comply with the followiag conditions: � 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 provisions of the City of Zephyrhills ordiaances and codes pertiaeat to the buildiag. 3. That in the event various phases of coastruction are subcontracted, he will engage only properly licensed subcontractors aad will personally supervise such work. 4. That ia the event the Buildiag Iaspector shall require correctioas to be made, the owaer will assume full responsibility to insure they are made, aad upon completion will call for a reiaspectioa before proceeding with the building. 5. That the owaer shall assume full responsibility for the coastruction and will not expect supervision of his work from the City of Zephyrhills Suildiug Department. 6. That prior to fiaal iaspection any additional fees, iacludiag reiaspection fees, must be paid in full. A written request from thia office shall constitute an official aotice to pay additional fees. 7. That the owaer shall comply with all City, State aad Federal laws ia regard to social security, workman's compensation, lien laws, etc. , where applicable. 8. That the owner shall comply with all the safety c.odes issued by the Florida Iadustrial Commission. 9. State law requires constructioa to be doae by licensed contractors. You have applied for a permit uader aa exemptioa to that law. The exemption allows you, as the owner of your property, to act as your own coatractor with certain restrictions eveu 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 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 resideace must be for your owa use or occupancy. It may aot be built or aubstaatially improved for sale or lease. If you sell or lease a building you have built or substaatially improved yourself withia 1 year after the coastruction is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violatioa of this exemption. You may not 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 licenses required by state law and by county or municipal liceasiag ordinaaces. You may aot delegate the responsibility for aupervisiag work to a licensed coatractor who is aot licensed to perform the work beiag done. Any persoa workiag oa your buildiag who is not liceased must work under your direct supervision and muat 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, ordinaaces, building codes, and zoaing regulations. OWNER'S SIGNATURE ��G4i2� DATE �� ^ZD I� ADDRESS �� L( ,�-y�'�'� -c�!' � pxorrE ��-� �� 3��3 WITNESS PERMIT #