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DISCLOSIIRS STATEI+�NT•FOR OWNER CITY OF Z$PHYRIiILLS BIIILDING DEPARTI�NT I =. have read and fully uaderstand aad ' agree to the provisions of this instrumeat. Thelundersigned states and affirms that he or she is desirous of conatructing, rea vatiag, adding to or reroofiag his or her owa domicile, that he or she act�ally occupies, or will occupy by said domicile, and same is aot for rea , lease or sale. That he or she shall comply with the following coadi�ions: 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 ordiaaaces aad codes pertinent to the buildiag. 3. That in the eveat various phases of coastruction are subcontracted, he will eagage oaly properly licensed subcontractors and will personally supervise such work. 4. That ia the eveat the Buildiag Inspector shall require correctiona to be made, the owaer will assume full respoasibility to insure they are made, aad upon completioa will call for a reiaspection before proceeding with the building. 5. , That the owner shall assume full respoasibility for the constructioa and will not expect supervision of his work from the City of Zephyrhills Buildiag Departmeat. I6. That prior to fiaal inspectioa any additional fees, includiag reiaspection fees, must be paid in full. A written request from this office shall constitute an official notice to pay additiona�l fees. 7. That the owaer shall com 1 with all Cit p y y, State and 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 Commisaion. 9. State law requires construction to be doae by licensed coatractors. You have applied for a permit uader aa exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your own coatractor with certain restrictions evea though you do aot have a license. You must provide direct onsite supervision of the coastructioa yourself. You may build or improve a one-family or two-family reaideace 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 owa 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 substaatially improved youraelf within 1 year after the coastruction is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violation of this exemptioa. You may aot hire aa unlicensed person to act as your coatractor or to supervise people workiag on 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 ordinances. You may aot delegate the respoasibility for supervisiag work to a licensed contractor who is aot licensed to perform the work beiag doae. Aay persoa workiag oa your buildiag who is aot liceased muat work under your direct supervision and must be employed by you, which meaas that you must deduct F.I.C.A. aad withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your constructiou must comply with all applicable laws, ordiaaaces, buildiag � codes, and zoning regulations. OWNER'S SIGNATURE i � 1lM�l� O� n � \��.. DATE � � � 1 ADDRESS PHONE . Q WITNESS PSRMIT #