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s DISCLOSIIRE STATSI�NT FOR Oin�NER CITY OF Z}3PHYRIiILLS SIIILDIPTG DEPARTMENT I, �I��`� /�-��y�,��7 have read aad fully uaderstaad and agree to the provisioas of this iastrumeat. The undersigaed states aad af�irms that he or she is desirous of coastructiag, renovatiag, adding to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by �CGu said domicile, and same is aot for reat, lease or sale. That he or she shall comply with the followiag conditions: � 1. That the owaer and he or she aloae shall act as the builder for all phases;of coastruction. 2. That the owaer will comply with all provisions of the City of Zephyrhills ordiaaaces and codes pertinent to the buildiag. 3. That ia the eveat various phases of coastructioa are subcontracted, he will engage oaly properly liceased subcoatractors aad will persoaalTy supervise such work. 4. That ia the eveat the Suildiag 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 reiaspection before proceediag with the buildiag. 5. That the owaer shall assume full responsibility for the coastruction and will not expect supervisioa of his work from the City of Zephyrhills Buildiag .- Departmeat. 6. That prior to fiaal inspection aay additional fees, including reiaspectioa fees, must be paid in full. A written request from this office shall coastitute an official aotice to pay additional fees. - 7. That the owaer shall comply with all City, State aad Federal Taws 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 Commissioa. 9. State law requires constructioa to be doae by liceased contractors. You have applied for a permit under aa exemptioa to that law. The exemption allows you, as the owner of your property, to act as your owa coatractor with certain restrictions even though you do aot have a license. You must provide direct onsite 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, pro.vided your costs do not exceed $75,000. The buildiag or residence must be tor your owa use or occupaacy. It may not be built or substaatially improved for sale or lease. If you sell or lease a • building you have built or sub�.tantially improved yourself withia 1 year after the coastructioa is complete, the law will preaume that you built or substaatially improved if for sale or lease, which is a violation of this exemptioa. You may aot hire an unliceased person to act as your coatractor or to supervise people working oa your buildiag. It is your respoasibility 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 respoasibility for supervisiag work to a licensed coatractor who is not liceased to perform the work being doae. Any persoa workiag on your building who ia aot liceased must work under your direct supervision and 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 coastruction must comply with all applicable laws, ordinances, buildiag codes, and zoaiag regulatious. OWNER'S SIGNATURE 'r� i'L DATE cj`��/� ADDRESS / PHONE �5'�lfl,/-�3 �) �.S3y 7 v - WITNESS PERMIT #