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` � . DISCLOSIIRE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DEPARTNlBN'P I, ��,-�v/k�� M�� ,^�he'L have read and fully understand and agree to the provisions of this iastrumeat. The undersigaed states and affirms that he or she is desirous of coastrueting, 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 , rent, lease or sale. That he or she shall comply with the following coaditions: 1. That the owaer 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 ordinaaces and codes pertinent to the building. 3. That ia the event various phases of construction are subcoatracted, he will engage only properly liceased subcontractors aad will personally supervise such work. 4. That in the eveat the Building Iaspector shall require corrections to be made, the owaer will assume full responsibility to iasure they are made, aad upon completioa will call for a reinspectioa before proceeding with the building. 5. That the owner shall assume full responsibility for the coastruction aad will not expect supervision of his work from the City of Zephyrhills Building Department. 6. That prior to fiaal iaspectioa aay additional fees, iacludiag reinspection ' fees, must be paid ia full. A written requeat from this office shall constitute an official aotice 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 owner shall comply with all the safety codes issued by the Florida � Industrial Commissioa. 9. State law requires construction to be done by licensed coatractors. You have applied for a permit under aa exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your owa coatractor with certaia ' restrictions even though you do aot have a licease. You must provide direct onsite supervision of the constructioa yourself. You may build or improve a one-family or two-family resideace or a farm outbuildiag. You may also build I ' or improve a commercial buildiag, provided your costs do not exceed $75,000. 'i The buildiag or residence muat be for your own use or occupancy. It may aot i , be built or substantially improved for sale or lease. If you sell or lease a � buildiag you have built or subatantially improved yourself within 1 year after the construction is complete, the law will presume that you built or substantially improved if for sale or lease, which is a violation of this �' exemptioa. You may aot hire an unlicensed persoa to act as your coatractor or to supervise people working oa your buildiag. It is your responsibility to make sure that people employed by you have liceases required by state law and by county or muaicipal liceasing ordinances. You may aot delegate the responsibility for supervisiag work to a liceased coatractor who is aot licensed to perform the work being done. Any person working on your buildiag who is aot liceased must work under your direct supervisioa aad must be employed by you, which meaas that you must deduct F.I.C.A. aad withholding tax i and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must comply with all a licable laws, ordinances, building � codes, and zoaing regulatioas. �.OWNER'S SIGNATURE, yDATE � -fl l. 1 Cp ry� ADDRESS �b 32 y� ST1r�T � 5 (�L �iONE �S L.2a(P .2(0 �� WITNESS PERMIT #