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` ' DISCLOSUR� STATEP'�'sNT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DFsPARTMIs'NT 2,��. ,`t] / /v� have read aad fully understand and agree to the provisioas of this iastrumeat. , The undersigaed states and affirms that he or she is desirous of constructiag, �� renovatiag, adding to or reroofiag his or her owa domicile, that he or she actually occupies, or will occupy by said domicile, and same is aot for reat, lease or sale. That he or she shall comply with the following coaditions: l. That the owner aad he or she alone shall act as the builder for all phases of �, construction. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordinances and codes pertineat to the building. 3. That ia the eveat various phases of construction are subcontracted, he will engage only properly licensed subcontractors and will personally supervise such work. 4. That ia the eveat the Buildiag Inspector shall require correctioas to be made, the owaer will assume full responsibility to insure they are made, and upon completion will call for a reiaspectioa before proceediag with the building. 5. That the owner shall assume full respoasibility for the construction and will not expect supervisioa of his work from the City of Zephyrhills Buildiag Department. 6. That prior to fiaal inspectioa any additioaal fees, includiag reinspectioa fees, must be paid ia 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 ia regard to social security, workman's compensation, lien laws, etc. , where applicable. 8. That the owner shall comply with all the safety codes issued by the Florida Industrial Commissioa. 9. State law requires constructioa to be done by liceased contractors. You have applied for a permit under an exemptioa to that law. The exemptioa allows you, as the owaer of your property, to act as your owa coatractor with certain restrictioas evea though you do aot have a license. You must provide direc,t onsite supervision of the coastructioa yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial building, provided your costs do not 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 building you have built or substaatially 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 aot hire aa unlicensed persoa to act as your coatractor or to supervise people working on your buildiag. It is your responsibility to make sure that people employed by you have licenses required by state law aad by county or municipal liceasing ordinaaces. You may aot delegate the responsibility for supervisiag work to a liceased contractor who is aot licensed to perform the work being done. Any persoa workiag oa your buildiag who is not liceased must work under your direct supervisioa aad must be employed by you, which means that you must deduct F.I.C.A. aad withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply wit a licable laws, ordiaances, buildiag codes, aad zoaing regula ioa OWNER'S SIGNATURE DATE iI ' � / � ADDRESS PHONE WITNESS PERMIT #