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' DISCLOSiJRE STAT�NT FOR OWN�R � � CITY OF ZEPHYRHILLS BIIILDING DBPARTMENT I I, have read and fully uaderstand and agree to the provisions of this iastrument. � The undersigaed states aad affirms that he or she is desirous of constructing, renovatiag, adding to or reroofing 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 she shall comply with the followiag coaditions: 1. That the owuer and he or she alone shall act as the builder for all phases of coastruction. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordiaances and codes pertinent to the building. 3. That ia the eveat various phases of coastructioa are subcoatracted, he will engage oaly properly liceased subcoatractors and will persoaally supervise such work. 4. That ia the eveat the Building Iaspector shall require corrections to be made, the owaer will assume full responsibility to iasure they are made, and upon completion will call for a reiaspection before proceeding with the building. 5. That the owner shall assume full responsibility for the coastruction and will aot expect supervision of his work from the City of Zephyrhills Building Departmeat. 6. That prior to fiaal iaspection aay additional fees, iacluding reinspection fees, must be paid in full. A writtea request from this office shall coastitute an official aotice to pay additioaal 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 owaer shall comply with all the safety codes issued by the Florida Industrial Commission. 9. State law requires construction to be done by licensed contractors. You have applied for a permit under aa exemptioa to that law. The exemptioa 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 ousite supervision of the coastructioa 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 building, provided your costs do aot exceed $75,000. The building or resideace 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 constructioa is complete, the law will presume that you built or i substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an unliceased person to act as your coatractor or to su ervi e o le workin n p s pe p g o your buildiag. It is your respoaszbility to make sure that people employed by you have liceases required by state law and ' by couaty or municipal liceasing ordinances. You may aot delegate the responsibility for supervisiag work to a licensed coatractor who is aot liceased to perform the work being done. Any person workiag on your building who is aot liceased must work under your direct supervisioa and 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 as prescribed by law. Your coastruction must comply with all applicable laws, ordiaances, buildiag codes, and zoniag re la 'oas. OWNER'S SIGNATUREoi� DATE //� �� ADDRESS �Qy3 1�� S-�f�e� 2.2pLtYrl�:�ls 1=L 33S'YZ PHONE WITNSSS PERMIT #