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DISCLOSURS STATffi�NT FOR OWNER CITY OF ZEPHYRHILLS BIIILDING DEPARTMENT _~F `�I, __ have read aad fully understand and agree to the provisions of this iastrumeat. The undersigned states and affirms that he or she is desirous of coastructing, renovating, adding to or reroofing his or her own domicile, that he or she actually occupies, or will occupy by said domicile, and same is not for rent, lease or sale. That he or she shall comply with the following coaditioas: 1. That the owner 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 ia the event various phases of coastructioa are subcontracted, he will eagage oaly properly licensed subcontractors aad will persoaally supervise , such work. , 4. That in the eveat the Buildiag Inspector shall require corrections to be made, the owaer will assume full respoasibility to iasure they are made, and upoa completiou will call for a reinspection before proceeding with the building. � 5. That the owner shall assume full respoasibility for the constructioa aad will I aot e ect su ervisioa of his work xp p from the City of Zephyrhills Buildiag � Departmeat. 6. That prior to fiaal inspectioa any additional fees, includiag reinspectioa fees, must be paid ia full. A written request from this office shall , coastitute aa official aotice to pay additioaal fees. ' 7. That the owaer 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 Industrial Commission. � 9. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemptioa to that law. The exemptioa allows � you, as the owner of your property, to act as your own contractor with certaia restrictions evea though you do aot have a licease. You must provide direct oasite supervssioa of• the constructioa yourself. You may build or improve a , oae-family or two-family resideace or a farm outbuilding. 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 own use or occupaacy. It may not be b��ilt cr st:bstantially impr�ved for sale or lease. If you seil or lease a building you have built or substantially improved yourself within 1 year after the coastructioa is complete, the law will presume that you built or substaatially improved if for sale or lease, which is a violation of this exemptioa. You may aot hire an unlicensed persoa to act as your contractor or to supervise people working on your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law aad by county or municipal liceasing ordiaaaces. You may aot delegate the respoasibility for supervisiag work to a licensed contractor who is aot liceased to perform the work beiag doae. Any person workiag on your buildiag who is aot liceased must work under your direct supervisiou and 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 coastructioa must comply with all applicable laws, ordiaances, buildiag codes, and zoaing regulations. OWNER'S SIGNATURE �"��/�'t-�/t/ DATE Z,-J I� ADDRESS 3�J (� F ,j�� ' PHONE jI - 7 7� WITNESS PERMIT #