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i ,; ' DISCLOSIIRE STATII�NT FOR OWNFR CITY OF ZEPHYRHILLS SIIILDING DEPARTMENT I, have read and fully understand and agree to the provisioas of this iastrumeat. The undersigaed states aad affirms that he or she is desirous of constructing, 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 rent, lease or sale. That he or she shall comply with the following conditioas: 1. That the owaer aad he or she alone shall act as the builder for all phases of constructioa. 2. That the owaer will comply with all provisions of the City of Zephyrhills ordinances aad codes pertinent to the buildiag. 3. That ia the event various phases of constructioa are subcontracted, he will engage oaly properly liceased subcoatractors aad will personally supervise such work. 4. That in the eveat the Buildiag Iaspector ahall require corrections to be made, the owner will assume full responsibility to iasure they are made, and upon completion will call for a reiaspection before proceediag with the building. 5. That the owner shall assume full respoasibility for the constructioa aad will not expect supervision of his work from the City of Zephyrhills Building Departmeat. 6. That prior to final iaspectioa aay additional fees, iacluding reiaspection fees, must be paid ia full. A written request from this office shall coastitute an official notice to pay additional fees. 7. That the owner shall comply with all City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc. , where applicable. 8. That the owner shall comply with all the safety codes issued by the Florida Iadustrial Commission. 9. State law requires construction to be done by liceased contractors. You have applied for a permit under an exemptioa to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certaia restrictions evea though you do not have a license. You must provide direct onsite supervisioa of the constructioa yourself. You may build or improve a one-family or two-family residence or a farm outbuildiag. 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 own use or occupancy. It may aot be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved yourself within 1 year after the coastructioa is complete, the law will presume that you built or aubstaatially improved if for sale or lease, which is a violatioa of this exemption. You may not hire an unlicensed persoa to act as your coatractor or to supervise people working on your building. It is your respoasibility 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 respoasibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person workiag on your buildiag who is aot licensed 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 ae prescribed by law. Your constructioa must comply with all applicable laws, ordiaaaces, building codes, and zoning regulations. OWNER'S SIGNATURE � DATE ' ��?��/�� ADDRESS ?j� � �„9po t� ��-� PHONE 5 -�('7 Q i WITNESS PERMIT # �2 � J� ' � S