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j � A DISCLOSDRE STATEA�NT FOR OWNER CITY OF ZF�FFIYRIiILLS BIIILDING DBPARTMls'NT I, have read and fullyr understand and agree to th� prav3sions af this iast�rumeat. The undersigned states aad affizms �hat he ar she is desirous of coastructiag, reaovatiag, adding to or reroofiag his or her own domicile, that he or ahe actually occupies, or will occupy by said damicile, and same is no� for reat, lease ar sa1e. That he ox she sha11 comply with the followiag conditioas: l. Tha� th� ocvner and he or she aloae shall act as the builder far all phase� of conetructioa. 2. That the owner wi11 comply with all prov3.sioae of the Ca.ty of Zephyrhille ordiaaaaes aad codes pertiaent �o the building. 3. That ia �he eveat variaus phase� of coastruction are subcoatracted, he will eagage oaly proper3y liceased stsbcoutrac�ars aad will persoaaliy supervise such work. 4. Tha� in �he eveat the Builda.ng Taspector shall require correctians to be made, the owaer will assume full respoasibility to iasuxe they are made, aad ugan completiaa will call far a reinspectioa before proceediag with the buildiag. 5. Tha� the awner shall aesume full respansibility far the coustruction aad wiZl aot expect supervi�ion of his work Erom �he City of Zephyrhills Suilding Departmeat. 6. Tha� prior to fiaal iaepec�ion aay additional feee, includiag reinspectian fees, must be paid in �ull. A writtea reques� from this oEfice shall coaatitu�e aa official aotice ta pay additiaaal fees. 7. Tha� the owaer shall comply with all City, State and FederaZ laws in regard �o soaial security, workatan's aampensation, lien laws, etc. , where applicab3.e. 8. That the owaer shall aomply witb: all the safety codes isaued by the Florida Industrial Commission. 9. Sta�e law requires construction to he done by lieensed contractars. You have applied �or a permit uader aa e�cemptioa �Ga that law. The exemptioa allowe you, as the awaer of yaur pzoperty, �a aet as your own cantractoz with certaia res�rictioas evea though you do aot have a licenae. You mu�t provide direct onsite supervisior� of �he construation yours�lf. Yau may build or improve a one-famiI.y or two-£amily resideace or a �arm autbuildiag. You may also build or improve a commercial buildiag, provided your costs do ao� exceed $75,000. The buildiag or resideace must be fcr yout awn use ar ocaupaney. It may nat be built or substaatially improved for sale or lease. xf you sell ar leaae a building gou have buiit cr substaatiall� impraved youraelf withia 1 year after the coas�ructioa ie complete, the law wi11 presume tha� you built or substaatially improved if �or sale or lea�e, which is a violatioa of this e�cemptioa. You may not hire an ualicensed persaa �o act as your caat�raetor ar to superviae people working on yaur buildiag. It is yaur responsibility to make sure tha� people employed by yc�u have licenses required by state law and by couaty or municipal licetssiag ordinances. You may aot delegate the respoasibility for supervisiag work to a licensed contractox who is not Iiaensed to perform the work beiag done. Aay� persan workiag on your building who is aat liaeased mu�t work uader your direct supervisioa aad must be emgloyed by you, whieh meaas that yau must deduct F.I.C.A. aad withholding ta�c and provi.de workers' compensatian for that employee, a],1 as prescribed by law, Your canstruc�iaa must comply with all applicable laws, ordinaaces, buildiag codes, and zoaing xegula ians. OWNER'S SIGN.�,'.�URE� ' DAT� f f�� ADDRESS � � ' � PHONE�'?C �� /� O "'r-1/�� WITNLSS PERMIT #