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� � y DISCLOSIIRE STATEI�NT FOR OWNER CITY OF ZSPHYRHILIaS BIIILDING DEPARTMENT I. have read and fully understand and agree to the provisioas of this instrument. The undersigned states and affirms that he or she is desirous of coastructiag, reuovating, adding to or reroofiag his or her o�,ra domicile, that he or she actually occupies, or will oecupy by said domicile, and same is aot.for rent, lease or sale. That he or she shall comply with the following coaditions: 1. That the owner and he or she alone shall act as the builder for all phases of construction. 2. That the owaer will comply v�rith all provisioas of the City of Zephyrhills ordiaaaces and codes pertineat to the buildiag. 3. � That in the event various phases of construction are subcontracted, he will eagage oaly properly liceased subcoatractors aad will personally supervise such work. 4. That ia the eveat the Building Iaspector shall recyuire correctioas to be made, the owaer will aesume full responsibility to iasure they are made, aad upon completion will call for a reiaspection before proceediag with the building. 5. That the owaer shall aesu:ne full respoasibility for the constructioa and will aot expect supervisioa of his work from the City of Zephyrhills 8uilding Departmeat. 6. That prior to fiaal iaspection aay additioaal fees, iacludiag reinspection fees, must be paid in full. A written request from this office ahall constitute aa official notice to pay additiona•1 fees. 7. That the owaer 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 Industrial Commission. 9. State law requires constructioa to be done by licensed contractors. You have applied for a permit uader an exemption to that law. The exemption allows you, as the owner of your property, to act as your owa coatractor with certaia restrictioas evea though you do aot have a licease. You,must provide direct oasite superviaion of the coastructioa yourself. You may build or improve a � one-fasnily 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 buildiag or resideace must be for your own use or occupaacy. It may aot be built or substaatially improved for sale or lease. If you sell or lease a buildiag you have built or substaatially improved youraelf within 1 year after the coastructioa is complete, the law will presume that you built or substantially improved if for sale or lease, which is a violatioa of this exemption. You may aot hire an ualiceased person to act as your coatractor or + to supervise people workiag ou your buildiag. It is your responsibility to make sure that people employed by you have liceases required by state law and by county or municipal licensiag ordiaaaces. You may not delegate the �responsibility for supervising work to a licensed coatractor who is uot liceased to perform the work being done. Aay persoa workiag on your building who is aot liceused 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 as prescribed by law. Your conatructioa must coinply with all applicable laws, ordiaaaces, buildiag codes, and zoaing egulatioa . _P,�WNER'S SIGNAT �ATE � � �{ADDRES �) PHONE ^ WITNESS PSRMIT #