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; T . , . � DISCLOSIIRE STATEMENT FOR OVaNER I CITY OF ZEPFiYRHILLS BUILDING DEPARTMENT 2, A,,� ��f'letr have read and fully understaad and agree to the provisions of this iastrument. The undersigned states aad affirms that he or she is desirous of constructiag, renovatiag, addiag to or reroofiag his or her own domicile, that he or she , actuaTly occupies, or will occupy by said domicile, aad same is aot for reat,� lease or sale. That he or she shall comply with the followiag coaditioas: 1. That the owaer and he or she alone shall act as the builder for all phases of coastruction. 2. That the owaer will comply with all provisions of the City of Zephyrhills ordiaaaces and' 'codes pertinent to the building. 3. That ia the event various phases of constructioa are subcoatracted,� he will engage oaly properly liceased. subcontractors and will persoaally supervise such work. 4. That in the eveat the Building 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 reiaspection before proceeding with the building. , 5. That the owner shall assume full responsibility for the coastructioa and will not expect supervision of his work from the City of Zephyrhills Building Department. � 6. That prior to fiaal inspectioa any additional fees, iacludiag reiaspectioa fees, must be paid ia full. A written request from this office shall constitute aa officia:l notice to pay additional 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. 8. That the owaer shall comply with all the safety codes issued by the Florida Iadustrial Commissioa. 9. State law requires coastructioa to be done by liceased contractors. You have applied for a permit under aa exemptiou to that law. The exemption allows you, as the owaer of your property, to _act as your owa contractor with certaia restrictions even though you do not have a license. You must provide direct onsite supervisioa of the constructiou yourself. You may build or improve a oae-family or two-family residence or a farm outbuildiag. You may also build � or improve a commercial building, provided your,costs do aot exceed $75.,000. The buildiag or residence must be for your owa use or occupaacy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or substantially improved yourself within 1 year after the coastruction is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violatioa of this : exemptioa. You may aot hire an ualicensed person to act as your coatractor or to supervise people working on your building. It is your respoasibility to make sure that people employed by you have liceases required by state law and by couaty or municipal licensiag ordiaances. You may aot. delegate the responsibility for supervisiag work to a licensed contractor who is aot licensed to...perform the work being doae. Any persoa working on your building who •is not T�censed must work under your direct supervision and must be employed by you, which means that you must deduct F.I.C.A. aad withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordiaances, buildiag codes, aad zoaiag regulatioas. OWNER''S SIGNATURE DATE � [g � ADDRESS �j?j0 a�j� % (,. PHONE SI3 - "[43 -. 3y7 . WITNESS PERMIT # , , , ; . . , � - I ,