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� � � • DISCLOSIIRE STATII�NT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DSPARTNII�NT I, ��n L" ' � E'w� � ` have read aad fully understand and agree to the provisions of this instrument. The undersigned states and affirms that he or she is desirous of conatructing, reaovatiag, addiag to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by said domicile, aad same is not for reat, lease or sale. That he or she ahall comply with the followiag coaditioas: 1. That the owner and he or she aloae shall act as the builder for all phases of ' construction. 2. That the owner will comply with all provisions of the City of Zephyrhills ordiaances and codes pertinent to the buildiag. � 3. That ia the event various phases of constructioa are subcontracted, he will engage only properly liceased subcontractors aad will personally aupervise such work. 4. That ia the eveat the Building Inspector shall require correctioas to be made, the owaer will assume full responsibility to iasure they are made, aad upoa completioa will call for a reinspection before proceeding with the building. 5. That the owner shall assume full responsibility for the construction and will aot expect supervision of his �vork from the City of Zephyrhills Building Departmeat. 6. That prior to fiaal iaspection aay additioaal fees, ineluding reiaspection fees, must be paid in full. A written request from this office shall coastitute an official notice to pay additional 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 Industrial Commission. 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 coatractor with certain restrictions evea though you do not have a licease. You must provide direct onsite supervision of the coastructioa yourself. You may build or improve a oae-family or two-family residence or a farm outbuilding. You may also build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The building or residence must be for your owa use or occupaacy. It may not be built or subatantially improved for sale or lease. If you sell or lease a buildiag you have built or substaatially improved yourself withia 1 year after the conatruction 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 aa unlicensed persoa to act as your coatractor or to aupervise people workiag oa your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law aad by county or municipal licensiag ordiaances. You may aot delegate the responsibility for aupervising work to a liceased coatractor who is aot licensed to perform the work beiag done. Any person workiag on your building who is aot licensed must work under your direct supervision 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 prescribed by law. Your coastruction must comply with all applicable laws, ordiaauces, building codes, and zoaiag regulations. OWNER'S SIGNATURE � • DATE �� ADDRESS SdZ�1 �? �2 � S L PxorrE �I 3= 3 5,�— � 7 3 1 in1ITNESS PERMIT #