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DISCLOSIIR$ STATII�NT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DEPARTN�NT _, have read aad fully uaderstand aad agree to the provisions of this instrument. The undersigned states and affirms that he or she is desirous of constructing, reaovatiag, addiag to or reroofiag his or her own 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 shall comply with the following conditions: 1. That the owner and he or she aloae shall act as the builder for all phases of construction. 2. That the owaer will comply with all provisione of the City of Zephyrhills ordiaaaces and codes pertinent to the building. 3. That ia the eveat various phases of coastructioa are subcontracted, he will engage only properly liceased subcoatractors aad will persoaally supervise such work. 4. That in the eveat the Buildiag Iaspector shall require corrections to be made, the owner will assume full respoasibility to iasure they are made, aad upon completion will call for a reinspection before proceediag with the building. 5. That the owaer shall assume full responaibility for the coastruction and will aot expect supervision of his work from the City of Zephyrhills Suildiag Department. 6. That prior to fiaal iaspection any additioaal fees, iacludiag reiaspection fees, must be paid in full. A written request from this office shall � constitute an official notice 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 Industrial Commission. 9. State law requires construction to be doae by licensed contractors. You have � applied for a permit uader an exemptioa to that law. The exemption allows you, as the owner of your property, to act as your owa contractor with certain restrictions eveu though you do aot have a license. You must provide direct oasite supervision of the construction yourself. You may build or improve a oae-family or two-family residence or a farm outbuildiag. You may aleo build or improve a commercial building, provided your costs do not exceed $75,000. The buildiag or resideace must be for your own use or occupaacy. It may aot ' be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or substaatially 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 violation of this exemption. You may not hire aa unliceased persoa to act as your coatractor or to supervise people working oa your building. It is your respoasibility to make sure that people employed by you have liceases required by state law and by couaty or municipal licensiag ordinances. You may not delegate the responsibility for supervisiag work to a liceased coatractor who is not licensed to perform the work being done. Any persoa workiag on your buildiag who ia aot licensed must work under your direct supervision and must be employed by you, which meaas that you must deduct F.I.C.A. aad withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must c ply with all applicable laws, ordiaances, building codes, and zoniag regu ioas. �OWNER'S SIGNATURE / DATE �^Z Z—�6 �1ADDRESS 2 S �f" PHONE ��3 - 2Y.�- �a �� WITNl3SS PERMIT #