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. 1 DISCLOSIIRS STATEMENT FOR OWNER II CITY OF ZEPHYRHILLS BIIILDING DEPARTMENT �"� n �r I, �.D�}' [/� ��(/ �� have read and fully uaderstand and ' agree to the provisions of this iastrumeat. The undersigaed states and affirms that he or she is desirous of constructing, renovatiag, adding to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for reat, lease or sale. That he or she shall comply with the followiag coaditions: 1. That the owaer aad he or she aloae ahall act as the builder for all phases of coastruction. 2. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes pertiaent to the building. 3. That ia the eveat various phases of coastructioa are subcoatracted, he will engage oaly properly liceased subcontractors and will persoaally supervise such work. 4. That ia the event the Building Iaspector shall require correctioas to be made, the owaer will assume full responsibility to iasure they are made, and upon completion will call for a reiaspection before proceediag with the building. ' S. That the owaer shall assume full respoasibility for the conatruction and will aot expect supervision of his work from the City of Zephyrhills Building Department. 6. That prior to final inspection aay additional fees, including reinspection fees, must be paid ia full. A written request from this office shall coastitute an official aotice to pay additioaal fees. 7. That the owaer ahall comply with all City, State aad Federal laws ia regard to social security, workman's compensation, lien laws, etc. , where applicable. S. That the owner shall comply with all the safety codes issued by the Florida Industrial Commission. 9. State law requires constructioa to be doae 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 contractor with certain restrictions even though you do aot have a licease. You must provide direct onsite supervision of the coastructioa 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 building, provided your costs do aot exceed $75,000. The building or residence must be for your own use or occupancy. It may aot be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or substantially 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 violatioa of this exemption. You may not hire aa unlicensed persoa to act as your contractor or to supervise people workiag oa your building. It is your responsibility to make sure that people employed by you have liceases required by state law and , by couaty or municipal liceasiag ordiaances. You may aot delegate the responsibility for supervisiag work to a licensed contractor who is aot liceased to perform the work beiag doae. Any persoa working oa your building who is not licensed must work uader your direct supervisioa aad must be employed by you, which meaas 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, ordinances, building codes, and zoniag regula 'oas. OWNER'S SIGNATURE K/ ��if�� DATE � ��/� � � �- �. I ADDRESS O r G, �� PHONE fv �j �S �8 � WITNESS PERMIT #