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' DISCLOSUR� STATEI��NT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT I, Il��"`��'i� ��1 CP _ have read and fully understand and agree to the provisioas of this iastrument. The undersigned states and affirms that he or she is desirous of constructiag, reaovating, addiag to or reroofiag his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for rent, lease or sale. That he or she shall comply with the following coaditions: l. That the owaer and he or she aloae shall act as the builder for all phases of constructioa. 2. That the owaer will comply with all provisioas of the City of Zephyrhills ordinances and codes pertiaent to the buildiag. 3. That in the event various phases of construction are subcontracted, he will eagage oaly properly licensed subcoatractors and will persoaally supervise such work. • 4. That in the eveat the Building Inspector shall require corrections to be made, the owaer will assume full responsibility to iasure they are made, and upon completioa will call for a reinspectioa before proceeding with the buildiag. 5. That the owaer shall assume full respoasibility for the construction and will I not expect supervisioa of his work from the City of Zephyrhills Building Departmeat. 6. That prior to final iaspection any additioaal fees, including reiaspectioa fees, must be paid ia full. A written request from this office shall constitute an official aotice to pay additional 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 owner shall comply with all the safety codes issued by the Florida Iadustrial 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 owaer of your property, to act as your own contractor with certain restrictioas even though you do not have a license. You must provide direct onsite supervisioa of the constructioa 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 aot exceed $75,000. The buildiag or resideace must be for your own 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 yourself withia 1 year after the coastruction is complete, the law will presume .that you built or subatantially improved if for sale or lease, which is a violation of this exemption. You may not hire an ualicensed 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 licenses required by state law and by couaty or municipal licensiag ordiaaaces. You may aot delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work beiag doae. Any person working oa your buildiag who is aot licensed must work under your direct supervision aad must be employed by you, which means 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, ordinances, building codes, aad zoniag regulat' . OWNER'S SIGNATURE ' ` DATE (N �`� � � ADDRESS JA'7 � O PHONE � ' 2,-� g WITNESS PERMIT # I