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1,i • � ��L.�� R DISCLOSIIRS STATII�NT FOR OWNER CITY OF ZEPHYRHILLS SIIILDING DEP1�aRTMENT I, have read and fully understand and � agree to the provisions of this instrumeat. The undersigaed states aad affirms that he or she is desirous of constructiag, renovatiag, addiag to or reroofiag his or her own domicile, that -he or ahe 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 coaditioas: 1. That the owner and he or she aloae shall act a's the builder for all phases of coastruction. 2. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes pertineat to the buildiag. 3. That ia the event various phases of constructioa are subcontracted, he will engage only properly liceased subcoatractors and will personally supervise such work. 4. That in the event the Building Iaspector shall require corrections to be made, ' the owner will assume full respoasibility to iasure they are made, aad upoa completioa will call for a reiaspectioa before proceeding with the buildiag. 5. That the owaer ahall assume full responsibility for the conatruction and will � aot expect supervision of his work from the City of Zephyrhills Buildiag Departmeat. � 6. That prior to fiaal inspection any additional fees, includiag reinspectioa fees, must be paid in full. A written request from this office shall constitute an official aotice to pay additioaal fees. 7. That the owaer shall comply with all City, 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 Commission. 9. State law requires construction to be doae by liceased contractors. You have applied for a pexmit under aa exemption to that law. The exemption allows you, as the owner of your property, to act as your own coatractor with certain restrictions even though you do aot have a license. You must provide direct oasite supervision of the coastructioa 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 occupaacy. It may uot be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or subataatially improved yourself withia 1 year after the constructioa is complete, the law will presume that you built or substaatially 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 supervise people working on your building. It is your responsibility to make sure that people employed by you have liceases required by state law aad by county or municipal licensing ordinaaces. You may aot delegate the responsibility for supervisiag work to a licensed contractor who is aot licensed to perform the �,rork being doae. Aay persou workiag on your building who is aot liceased must work uader 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 coastructioa must comply with all applicable laws, ordiaaaces, buildiag ' codes, and zoniag regulations. OWNER'S SIGNATURE � DATE 2•� �j � � � ADDRESS ' � /�, Pxor� '3S'2 —e.l��,_O 2 �� WITNESS PERMIT #