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DISCLOSUR$ STATII�NT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DSPARTN�NT I, �(��,�� '�p�,C,�� have read and fully understaad aad agree to the provisions of this instrumeat. The undersigned atates and affirms that he or she is desirous of constructiag, renovatiag, addiag to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, aad same is aot 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 coastruction. 2. That the owner will comply with all proviaions of the City of Zephyrhills ordiaances and codes pertinent to the buildiag. 3. That ia the eveat various phases of coastruction are subeontracted, he will engage only properly licenaed subcoatractors and will persoaally supervise such work. 4. That ia the eveat the Buildiag Iaspector shall require correctioas to be made, the owaer will assume full responsibility to iasure they are made, and upon completioa will call for a reinapectioa before proceediag with the building. 5. That the owaer ahall assume full respoasibility for the coastruction and will aot expect supervision of his work from the City of Zephyrhills Buildiag De artmeat. P 6. That prior to final inspectioa aay additional fees, iacluding reinspection � fees, muat be paid ia full. A writtea request from this office shall coastitute an officia7: notice to pay additioaal fees. 7. That the owner shall comply with all City, State aad 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 Iadustrial Commission. 9. State law requires constructioa to be doae by licensed contractors. You have applied for a permit uader aa exemption to that law. The exemption allows you, as the ovaner of your property, to act as your own contractor with certaia restrictions evea though you do aot have a licease. You must provide direct oasite supervisioa of the coastructioa yourself. You may build or improve a oae-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 building or resideace must be for your own use or occupaacy. It may aot 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 construction is complete, the law will presume that you built or substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an ualiceaeed persoa to act as your coatractor or to aupervise people workiag on your building. It is your responsibility to make sure that people employed by you have licensea required by state law aad by couaty or municipal licensiag ordinaaces. You may not delegate the responsibility for supervisiag work to a licensed coatractor who is aot licensed to perform the work beiag done. Any person workiag on your building who is not liceased must work uader your direct supervisioa and must be employed by you, which meaus that you must deduct F.I.C.A. aad withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your coastruction must comply with all applicable laws, ordiaaaces, buildiag codes, aad zoaiag regulations. OWNER'S SIGNATURE Q/1A� �2.�� DATE ��"' ��'" ZQ I�7 ADDRESS 3F g S� L,Q, „� PHONE - (0 - �Z �] WITNESS (� PSRMIT # ✓ `