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.� a DISCLOSURE STATEN�NT FOR OWNSR CITY OF ZEPHYRHILLS SIIILDING DSPARTMSNT I, �,'(Z�_�� 110 have read aad fully understand aad agree to the provisions of this instrument. The undersigned states aad affirms that he or she is desirous of conatructiag, reaovatiag, adding to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, aad same is not for reat, lease or sale. That he or ahe ahall comply with the followiag conditioas: 1. That the owner and he or she aloae shall act as the builder for all phases of conatruction. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ordinaaces and codes pertinent to the buildiag. 3. That ia the event various phases of constructioa are subcoatracted, he will eagage only properly liceased subcoatractors and will persoaally supervise such work. , 4. That ia the eveat the Buildiag Inspector shall require correctioas to be made, the owaer will assume full responsibility to insure they are made, aad upon completioa will call for a reinspection before proceediag with the building. 5. That the owaer ahall assume full responsibility for the coastruction aad will aot expect supervision of his work from the City of Zephyrhills Buildiag � Department. 6. That prior to fiaal iaspectioa aay additional fees, iacluding reinspectioa fees, must be paid in full. A writtea request from this office ahall constitute an official aotice to pay additional fees. 7. That the owaer shall comply with all City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc. , where applicable. S. That the owaer shall comply with all the safety codes issued by the Florida . Industrial Commission. 9. State law requires coastruction to be done by liceased contractors. You have applied for a permit under aa exemptioa to that law. The exemption allows you, as the owaer of your property, to act as your own coatractor with certaia restrictioas evea though you do aot have a licease. You must provide direct oasite aupervisioa of the coastructioa yourself. You may build or improve a oae-family or two-family residence or a farm outbuilding. You may also build - or improve a commercial building, provided your costs do aot exceed $75,000. The buildiag or reaideace must be for your own use or occupancy. It may, not �- be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or substantially improved yourself withia 1 year after the conatructioa is complete, the law will presume that you built or , substaatially improved if for sale or lease, which is a violation of this exemption. You may not hire an unlicensed persoa to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that people employed by you have liceases required by state law and by couaty or municipal licensiag ordinances. You may not delegate the responsibility for supervisiag work to a licenaed contractor who is aot licensed to perform the work beiag done. Any peraon working on your buildiag who ia not liceased must work uader your direct aupervision aad muat be . employed by you, which meaas that you muat deduct F.I.C.A. and withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your constructioa must comply with all applicable laws, ordinaaces, buildiag codes, aad zoaiag regulations. � OWNER'S SIGNAT DATE f � !�S� ADDRESS - b 3 � n /9✓ . �Y�.y��Y�11 S � 335�c�� PHONE '- � " �v�� V WITNESS PSRMIT #