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. DISCLOSIIRE STATEMENT FOR OWNSR • CITY OF ZEPHYRHILLS BIIILDING DSPARTMENT 2, have read and fully understaad and agree to the provisioas of this instrumeat. The uadersigned states and affirms that he or she is desirous of constructing, reaovatiag, adding 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 followiag coaditions: 1. That the owner and he or she aloae shall act as the builder for all phases of coastruction. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ordinaaces aad codes pertineat to the buildiag. 3. That in the eveat various phases of construction are subcontracted, he will engage only properly licensed subcoatractors aad will persoaally supervise auch work. 4. That in the eveat the Building Inspector shall require corrections to be made, the owaer will aesume full respoasibility to insure they are made, and upon completioa will call for a reinspection before proceeding with the building. I 5. That the owaer shall assume full respoasibility for the coastructioa and will aot expect supervision of his work from the City of Zephyrhills Building Department. . I 6. That prior to fiaal inapection aay additional fees, iacluding reinspectioa fees,. must be paid in full. A writtea request from this office shall coastitute an official notice to payr additional 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 Industrial Commission. ' • 9. State law requires construction to be doae by licensed .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 contractor with certaia restrictions evea though you do aot have a license. You must provide direct onsite supervisioa of the con�tructioa yoursel'f. You may build or improve a ', one-family or two-family residence or a farm outbuilding. You may also build �I or improve a commercial buildiag, provided your costs do aot exceed $75,000. I The buildiag or residence must be for your owa use or occupancy. It may aot � be built or subataatially improved for sale or lease. If you sell or lease a buildiag you have built or substaritially improved youraelf 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 aot hire an unlicensed persoa to act as your coatractor or I to aupervise people workiag on your buildiag. It is your responsibility to make sure that people employed by you have licenses required by state law and by couaty or municipal liceasiag ordinances. You may aot delegate the responsibility for aupervisiag work to a licensed contractor who is aot liceased to perform the work beiag done. Aay persoa workiag on your building I who is uot liceased must work under your direct supervision 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, ordiaances, building codes, aad zoaiag regulations. .. OWNER'S SIGNATURE � . DATE i ADDRESS � a 3�� 3 "�� PSONE � ' WITNESS PERMIT #