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� DISCLOSUR$ STATEI�NT FOR OWNSR � CITY OF ZTPHYRFIILLS BUILDING DSPARTMENT I, _��Vs�`�n {f � .��cJ�.r� �✓ have read and fully understaad aad agree to the provisions of this iastrumeat. The uadersigaed states and affirms that he os she is desirous of caastructiag, tenovatiag, adding to or reroofiag his ar her own domicile, that he or she aetually accupies, or wi11 occupy by" said damieile, aad same is not for reat, lease or sale. That he or she ishall comply with the followiag coaditioas: 1. That the owner aud he ar she aloae sha11 act as the builder far all phase� of constructian. 2. That the owaer wi11 aomply with all provisions of the City of Zephyrhills ardiaances and codes pertineat to the building. 3. That ia the eveat various phases of coustruation are subcontracted, he will engag� only properly licensed subcaatraators and will persoaally supervise such work. 4. That in the eveat the Ptuildiag Taspector shall require correctioxis to be made, the owaer- vaill assume full respoasibility to insure they are made, and upoa completion. will aall for a reiaspectian before proaeediag with the buildiag. 5. That the o�vner shall assurne full responsibility for the construetiou and will not expeet supervision of his work from the City of Zephyrhills Building Department. 6. That prior to final iaspeatian aay additioaal fees: iacludiag reiaspectian £ees, must ba paid in full. A writtea request from tlais office shall coastitute an official aotice to pay additional fees. 7. That the awuer shall comply with a11 City, State and Federal laws in regard to social security, warkman's campensation, lien 1aws, etc. , where applicable. 8. That the ownar shall camply with all the safety codes issued by the FTorida Iadustrial Cammissioa. 9. State law requires constructioa to be done by liceased contraetars. Yau have applied tor a permit under aa exemptioa to that law. The exemptian allows you, as the owaer of your property, ta act as your owa coatractor with certaia restrictioas evea though you do not have a licease. You must provide c3.ireat oasite supervisioa of the constructiaa yourself. You may build or improve a ane-family ar two-family residence ox 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 far your own use or occupancy. It may aot be built or substantially impraved for sale ar lease. If you sell or lease a buildiag you have built or substantially improved yourself within 1 year after the eoastructiaa is complete, the law will presume that you built or substantiallg improved if for sale or lease, which is a violation af this exemptioa. You may aot hire aa unlicensed persoa to act as your contractor or to superva.se people working on. yaur buildiag. It is your respansibility to make sure that peaple employed by you have liceases required by state law aad by couaty or muaicipal licensiag ordinaaces. You may aot delegate the respoasibility for sugervisiag tivark to a licensed coutractar who is not licensed to perfarm the work beiag done. Any persan warkiug oa your buildiag who is aot� liceased must work under your direct supervisioa and must be employed by you, which means that you must deduct F.I.C.A. a.nd withholdiag ta�c � arid pravide workers' compensatian for that employee, all as prescribed by law, Your caastruction must camply with all applicable laws, ordinanees, building aodes, aad zoaing regulatioas. �._ � `�.- QWNER'S SIGNATURE DATE j �j�.-�b E K ADDRBSS - PHONE WITNTSS PSRMIT # �