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y DISCLOSIIRE STATENIENT FOR OWNER �� CITY OF ZfiPHYRHILLS BUILDING DEPARTMENT / r I, Cj�//<<-� �f✓ have read and fully understand and agree to the provisions of this instrumeat. The undersigned states and affirms that he or she is desirous of coastructiag, reaovating, adding to or reroofing his or her owa domicile, that he or she . actually occupies, or will occupy by said domicile, and same is aot for reat, lease or sale. That he or she shall comply with the followiag coaditions: l. That the owaer and he or she alone shall act as the builder for all phases of construction. 2. That the owner will comply with all provisioas of the City of Zephyrhills ordinances and codes pertiaent to the buildiag. 3. That in the eveat various phases of coastruction are subcontracted, he will engage oaly properly liceased subcoatractors aad will personally supervise such work. 4. That ia the event the Buildiag Iaspector shall require corrections to be made, the owner will assume full responsibility to iasure they are made, aad upoa completion will call for a reinspectioa before proceeding with the building. 5. That the owner shall assume full responsibility for the coastructioa and will not expect supervisioa of his work from the City of Zephyrhills Buildiag Department. , 6. That prior to final iaspectioa any additional fees, iacluding reinspection fees, must be paid ia full. A written request from this office shall constitute an official aotice 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 owner shall comply with all the safety codes issued by the Florida Iadustrial Commissioa. 9. State law requires construction to be done by licensed contractors. You have applied for a permit uader an exemptioa to that law. The exemption allows you, as the owner of your property, to act as your owa coatractor with certain restrictions even though you do aot have a licease. You must provide direct oasite supervision o£ the construction 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 not exceed $75,000. The buildiag or resideace must be for your own use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a buildiag you have built or substantially improved yourself withia 1 year after � the constructioa is complete, the law will presume that you built or substantially improved if for sale or lease, which is a violatioa of this exemptioa. You may not hire an unlicensed person to act as your contractor or to supervise people working on your building. It is your respoasibility to make sure that people employed by you have licenses required by state law and by county or municipal licensiag ordinances. You may not delegate the responsibility for supervisiag work to a liceased contractor who is aot licensed to perform the work beiag doae. Aay persoa working 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. and withholdiag tax , and provide workers' compensation for that employee; all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildiag � codes, and zoaing re ti ns. I OWNER'S SIGc,NATURE DATE I /�3 ADDRESS c7� �c y i / L- PHONE '"��' c�'D 9 WITNESS PERMIT # � I - I