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' « DISCLOSIIRS STAT�iT FOR OWN�R CITY OF ZEPHYRHILLS BIIILDING DSPARTMENT _. Pr,o.v�i+�. c7�'�nmOr"S have read aad fully understand and agree to the provisioas of this instrumeat. The undersigned states and affirms that he or she is desirous of constructiag, renovatiag, adding to or reroofiag his or her own domicile, that he or ahe 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: l. That the owaer and he or she alone shall act as the builder for all phases of conatruction. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordinaaces and codes pertinent to the buildiag. 3. That in the eveat various phases of coastructioa are subcontracted, he will engage oaly properly licensed subcoatractors and will personally supervise such work. 4. That ia the event the Buildiag Iaspector shall require correctiona to be made, the owaer will assume full responsibility to iasure they are made, and upon , completion will call for a reinspection before proceediag with the building. 5. That the owaer shall assume full respoasibility for the construction aad will - not expect supervisioa of his work from the City of Zephyrhills Suildiag Department. 6. That prior to fiaal inspection aay additioaal fees, iacluding reiaspection fees, must be paid ia full. A writtea request from this office shall constitute an official notice to pay additioaal fees. 7. That the owner 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 owaer shall comply with all the safety codes issued by the Florida Iadustrial Commiasioa. 9. State law requires coastructioa to be done by liceased 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 even though you do aot have a license. You must provide direct oasite supervisioa of the constructioa yourself. You may build or improve a one-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 own use or occupancy. It may aot be built or subatantially improved for sale or lease. If you sell or lease a building you have built or substaatially improved yourself withia 1 year after the constructioa is complete, the law will presume that you built .or substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an unlicensed persoa to act as your coatractor or to supervise people workiag on your buildiag. It is your responsibility to make sure that people employed by you have liceases required by state law aad by couaty or municipal licensiag ordinances. You may aot delegate the responsibility for aupervisiag work to a licensed coatractor who is aot licensed to perform the work being doae. Aay persoa working oa your buildiag who is not licensed must work under your direct supervision aad must be employed by you, which means that you must deduct F.I.C.A. and withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordiaaaces, buildiag i� codes, and zoning regulatioas. _ - �-''<%� J � OWNER'S SIGNAT DATE �� -� /�G ADDRESS �/� /�?�� S�' �cof,v:l�'l/S F/ PgorrE ��3 �id a 9a r � ,� AIITNESS PERMIT # ,/ / _ /� �