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� . DISCLOSIIRE STATSMENT FOR OWNF'R CITY OF ZEPHYRHILLS BIIILDING DEPARTMENT I, �ry C,��,o� have read and fully understaad and agree to e provisions of this instrument. The undersigned states and affirms that he or she is desirous of coastructing, reaovating, addiag to or reroofing his or her owa domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for reat, lease or sale. That he or she shall comply with the following conditioas: 1. That the owaer and he or she aloae ahall act as the builder for all phases, of coastructioa. � 2. That the owner will comply with all provisions of the City of Zephyrhills ordinaaces and codes pertinent to the building. 3. That in the eveat various phases of coastructioa are subcontracted, he will engage only properly licensed subcontractors and wi,ll personally supervise such work. 4. That in the eveat the Buildiag Inspector shall require correctioas to be made, the owner will assume full responsibility to iasure they are made, aad upon completion will call for a reinspectioa before proceediag with the buildiag. 5. That the owner shall assume full respoasibility for the construction aad will not expect supervisioa of his work from the City of Zephyrhills Buildiag Department. 6. That prior to final inspection any additional fees, iacluding reinspection ' fees, must be paid in full. A writtea request from this office shall coastitute an official notice to pay additioaal fees. 7. That the owner shall comply with all City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc. , where applicable. I 8. That the owaer 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 aa exemption 'to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a licease. You must provide direct oasite supervision of the constructioa yourself. You may build or improve a oae-family or two-family resideace or a farm outbuildiag. You may also build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The building or residence must be for your own use or occupancy. It may aot I be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved yourself withia 1 year after- the coastructioa is complete, the law will presume that you built or substantially improved if for sale or lease, which is a violation of this exemption. You may aot hire an unlicensed persoa to act as your contractor or to supervise people working oa your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by atate law and by county or muaicipal licensiag ordiaances. You may aot delegate the responsibility for supervisiag work to a licensed contractor who is not licensed to perform the work being done. Any person working on your buildiag who is aot 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 with all applicable laws, ordinaaces, buildiag codes, and zoning regulations. OWNER�S SIGNATURE�� _ DATE Il �Z ! � ADDRESS D(� �'LcrG e c�� PHONS �/3 �77 9822. WITNESS PERMIT # I