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. DISCLOSIIR.� STATSM�NT FOR OWNER � CITY OF ZEPHYRHILLS BIIILDING D�PARTMENT _, ��d/'Z�j /�(��--? have read aad ful].y understand and agree to the provisions of this instrumeat. The undersigaed states and affirms that he ar she is desirous af constructing, reaovati.ng, adding to or reroa£ing his or her owa domicile, that he or she actually occupies, or wi11 occupy by said damicile, and same is aot for ' rent, I.ease or sale. That he ax she` sha11 comgly with the fallocaiag coaditi.aus: ! �, 1. That the owaer and he or she alone shall act as the builder for all phases of � construction, 2. That the owaer wi11 comply with all provisioas of the City of Zephyrhills ordiaances and codes pertiaent to the buildiug. 3. That ia �he event various phases of coas�ruc�a.on are subcoatracted, he will engage oaly praperZy zi��s�a subcoatractors and will persoaaZZy supervise such work. 4. Tha� ia the eveat the Building Iaspector sha11 rec�uire correctioas to be made, the ownez will assusne full respansibility ta insure they are made, a.ad upoa completioa will ca11 far a reinspec�ioa before proceediag with the building. 5. That the owner shall assume full. responsibil.ity for the constructioa an.d will aot expect supervi,sion of his work �rom the City af Zephyrhills Building Departmeat. 6. Tha� prior ta fiaal inspection any additional fees, iucluding reinspectioa fees, must be paid in full. A writ�en request fram this o�fice shall eonstitute an official natice to pay additioaal fees. 7. Tha� the owner shall comply wi�h all City, St�ate aad FederaZ laws ia regard �o social security, workman's compensatian, lien laws, eta. , where applicable. 8. Tha� the owaer shall comply with al1 the safety codes issued by the Florida Iadustrial Commission, 9. Sta�e Zaw requires eoustruction to be done by liceused contrac�ors. You hava applied for a permit under an exemption to that law. The exemptioa allaw�s you, as the owner of your property, to act as your owa coatractor with certaia rest�rictioas even, though you do not have a license. You must provide direct oasite supervisioa of the coasCructioa yourself. You may build or improve a one-family or two-family resideace ar a farm outbuildiag. Yau may also build or a.mprove a commercial building, provided your costs do not exceed $75,000. The buil.diag or residence must be for yaur owa use or aceupaacy. It may aot be built or substaatially improved for sale ar lease. If you sell ar lease a building you have built or substanGially imp�aved yourself within 1 year after the caastruatioa is complete, the law wi12 presume that you built or subetantially improved if for sale or lease, which is a violation of this exemptian. You may aot hire aa vnlicensed persoa ta aet as yaur eontractor or to supe�rise people workiag on your building. It is yaur respansibility to �� malte sure that peapZe employed by you have lxcenses required by state law and ; by coun�y or municipaZ Iiceasiag ordinances. You may aot delegate �he responsibility for supervi�ing work to a liceased coatractor who is aot licensed to perfarm the wark being done. Any persan workixzg on your building who is aot liaensed must work under your direct superva.siazi aad mus� be employed by you, which meaas that you must deduct F.I.C.A. and withhaldin.g ta�c and provide workers' compensation far that employee, all as prescribed by law. Your coastruction mus�, comply with all agplicable laws, ordiaances, buildiag codes, aad zoaing regulatioas. O�+TNER`S SIGNATURE � /� DATE I�,� � ADDIZESS � PHONE � WITNESS PERMIT # I � (,� � ,--