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�= a DISCLOSIIRE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DSPARTMENT _, have read and fully uaderstand aad agree to the provisio of this instrument. The undersigned states and affirms that he or she is deairous of constructiag, reaovatiag, adding to or reroofing his or her owa domicile, that he or she actually occupies, or will occupy by �� said domicile, and same is not for rent, lease or sale. That he or she shall comply with the following conditions: 1. That the owaer and he or she aloae shall act as the builder for all phases of conatructioa. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ordinances aad codes pertineat to the building. 3. That in the event various phasea of coastruction are subcoatracted, he will engage only properly licensed subcoatractors and will personally supervise such work. 4. That ia the eveat the Building Iaspector ahall require correctioas to be made, the owaer will assume full responsibility to iasure they are made, and upon completion will call for a reinspectioa before proceeding with the buildiag. 5. That the owaer ahall assume full respoasibility for the coastructioa and will not expect supervision of his work from the City of Zephyrhills Buildiag Department. 6. That prior to final iaspectioa any additional fees, iacluding reiaspection 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 aud 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 Commissioa. 9. State law requires conatruction to He doae by liceased contractors. You have applied fdr a permit uader an exemption to that law. The exemption allows you, as the owaer of your property, to act as your owa coatractor with certaia restrictions even though you do aot have a licease. You must provide direct onsite supervision of the constructioa yourself. You may build or improve a one-family or two-family resideace or a farm outbuilding. You may also build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The buildiag or residence must be for your owa use or occupaacy. It may not be built or aubataatially improved for sale or lease. If you sell or lease a building you have built or subatantially improved yourself withia 1 year after the constructioa is complete, the law will preaume that you built or substaatially improved if for sale or lease, which is a violatioa of this exemptioa. You may not hire an unliceased persoa to act as your contractor or 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 liceasing ordinances. You may aot delegate the responsibility for supervisiag work to a licenaed contractor who is aot licensed to perform the work beiag doae. Aay,person working on your building who is not liceased must work under your direct aupervisioa and must be employed by you, which meaas that you must deduct F.I.C.A. aad withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordiaaaces, buildiag codes, aad zoaing gulations. OWNER'S SIGNATURE DATE �,o ^�n- �S ADDRESS PHOfQE - / WITNSSS � PSRMIT # I ��v S