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__ _ __ __ ___ __ � ' � DISCLOSIIRB STATII�NT FOR OWNSR CITX QF ZEPHYRAILLS SLTILDING DEPARTMENT I, have read and fully uaders�.and and agree to the provisious of this astrumeut. The undersigned states aad affirms that he or she is desirous of canstructiag, reaavata.ng, addiag to or reroofing his or her owis domicile, that he or she actuall.y occupies, or will occupy by said domicile, aad same is aot for rent, lease ar sale. ThaC he or she shaZl comply with the fal2awiag caaditiaas: 3. That the owner and he ar she aloae shall aat as the builder for all phases a£ '� construc�ioa. 2. That the owner wil�. comply with all provisioas of the City of Zephyrhills � ardiaaaees and codes pertiaent to the building. 3. That ia �he eveat various phases of cons�ruction are subcontracted, he will eagage oaly pxaperZg liceased subcontraetars and ta�ill persoually supervise such work. 4. That in the eveat the Buildiag Saspector shall require correctiaas �o be made, the owaer wiZl asoume full responsibility to iasure they are made, aad upon completian will ca11 for a reiaspec�ioa before proceediag w3th the buildiag. 5. Tha� the awnes shall assume full responsibility for the eanstructian aad will aot expect supervisioa of his work from �he City af Zephyrhills Building Departmeat. 6. That priar ta final iaspectioa auy additional fees, includiag reinspectioa fees, must be paid in full. A writtea request from this office shall constitute aa official uatice to pay additional fees. 7. That the owuer shall camply with all City, State aad Federal laws ia regard to soci.al security, workman's compensation, lien Iaws, ete. , where appli.cah].e. 8. That the owaer ahall comply with all the safety cades issued by the Florida Iadustrial Commissa.on. 9. State law requires coastructioa to be doae by liceased coatractors. You have applied £ar a permit uader aa eatemption ta that law. The exemption allows you, as the awner of your propezty, �o act as your ovm cantractor ro,rith certaiu res�rictions even though you do aot have a license. You must pravide direct onsite sugervision o€ the construatiaa yourself, You may bu31d ar imprave a one-family or two-fami7.y residence or a farm outbuildiag. You may also build or improve a commercial bua.lding, provided your costs do aot exceed $75,dQ0. The building or resideace must be for youx own use or aceugaacy. It may aot be built ar substan,tially improved fas sale or lea�e. If you sell or lease a building gou have buil� or svbstaatialZy impraved gourself t,rithia l year after the construct3on is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a vio].atioa of this <aeemption. Yau may not hire aa uuliceased person �o act as your coatractor or to supervise people workiag on your buildiag. It is yotsr respoasibility �o make sure tha� people emplayed by you have Zicenses required by state law aad by county or municipal liceasiag ordiariances. Xou may aot delega�e the respaaasibility for supexvisiag work ta a Ziceased contractor who zs uot Iiceased to perfarm the work beiztg daae. Any persan warkiag oa your building ivho is aa� liceased must work uader your d3rec� supervisioa aad muat be emplayed by you, whieh means tha� you mus� det3uct F.I.C.A. and wz.thhaldiag tax � and provide woxkers' compensation for that employee, all as prescribed by 1aw. Your coas�ruction must comply with a11 applicable laws, ordiaances, buildiag oodes, and zoning r gulatioas. OWR7ERr S Z/G�2dAT DATE G�j � ADDR�SS �+-t�/,S �- I�AQNE (p • -.C`� WTTNESS PFsRMIT #