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i � DISCLOSIIRE STATENl�N'P FOR OWNER � � I . CITY OF ZEPHYRHILLS BIIILDING DBPARTI�NT • � � I� have read aad fully understand aad , agree to the provisioas of this iastrumeat. The undersigaed states and affirma that he or she is desirous of coastructing, reaovatiag, adding to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is aot for rent, lease or sale. That he or ahe shall comply with the followiag coaditions: 1. That the owner and he or she alone shall act as the builder fo= all phases of conatruction. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ordiaaaces and codes pertineat to the buildiag. 3. That in the event various phases of construction are subcontracted, he will engage oaly properly licensed subcontractors aad will persoaally supervise such work. 4. That ia the eveut the Building Iaspector shall require corrections to be made, the owaer will assume full respoasibility to iasure they are made, and upon completioa will call for a reinapectioa before proceediag with the buildiag. 5. That the owaer ehall assume full reapoasibility for the coastruction and will not expect supervision of his work from the City of Zephyrhills Buildiag Departmeat. 6. That prior to fiaal inspection aay additioaal fees, iacludiag reinapection fees, must be paid in full. A written request from thia office shall coastitute an official aotice to pay additional fees. • 7. That the owaer 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 Commiesion. 9. State law requirea construction to be doae by licensed contractors. You have applied for a permit under an exemptioa 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 onsite supervisioa of the constructioa yourself. You may build or improve a oae-family or two-family reaidence or a farm outbuilding. You may also build or improve a commercial buildiag, provided your coats do aot exceed $75,000. The buildiag or resideace must be for your owa use or occupaacy. It may aot be built or substantially improved for sale or lease. If you aell or lease a building you have built or substantially improved yourself withia 1 year after the construction ie complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violatioa of this exemption. You may aot hire an unTicensed person to act as your coatractor or to supervise people workiag on your building. It is your responaibility to make sure that people employed by you have licenses required by state law and by county or municipal licensiag ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is aot licensed to perform the work being doae. Aay person workiag on your building k who is aot licensed must work uader your direct supervision aad must be employed by you, which meaas that you must deduct F.I.C.A. aad withholdiag tdX and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must comply with all applicable laws, ordinances, building codes, aad zoaiag regulations. i OWNER�S SIGNATURE DATE �G� ��l,j ADDRESS Gi�r / - f� � ' ', 7�i�'i Z PHONE �/J�7Y�r-3�l1� WITNESS Pl3RMIT #