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DISGLOSIIR� STATII�NT FOR OWNER Y OF ZF;PH7CRHILLS SUTLDING D]sPARTMENT I, 2 -e� have read and fully un.derstaad and agree ta the provisians of this ias�z�unceat. The undersigaed states and affirms that he or she is desirous af eonstruetiag, renovatiag, addiag to or reroofing his or her own. domi.cile, that he or she actually occupies, or w�ill occv.py by said domicile, aad same is aot for reat, lease csr sale. That he qr she sha2Z comply with the follawiag conditious: l. That the owner aad he or she aloae shall aet as the bu3lder far all p2xases of � constructioa. 2. That� the owaer will camply with aZl provisioas of the City of Zephyrhills ordiaances aud codes pertinent �a the bui,ldixa,g. 3. That ia �he eveat various p'b,ases of aons�ructioa are subcoatracted, he will eagage ozsly pxoperly liceased subcoatrac�ors aad wiZl persoaally� supervise such work. " 4. Tha� ia the event the Builc3iag Iaspector shall require carrectious ta be made, . i the avaaer will assume full respaasib3lity to iaasure they are made, asld upon completioa will call for a reiaspect3oa before proceedixlg w3th the buildiag. 5. That the ovaner shall. assume ful.l resgonsi.bili�y for the construction and v�rill aot expect supervissioa of his work from t�he City af Zephyrhills Building I?epartmeat. 6. That priar ta fiaal iaspection auy additional fees, includiang rea.aspectioa fee�, must be paid in full. A writtea request fram this office shall cans�itu�e an officiaZ uotice to pay additional faes. 7. That the owaer shall comply with all City, State and Federal laws ia regard ta � sacial seourity, warkman's compensation, I.ien Iaws, etc. , vahere applieable. 8. That the owaer shall comply with all the safe�y codes issued by �he Florida Iadustrial Commissa.on. I� 9. State law requires construction to be doae by liceused contraetors. You have applied £or a permit .uader an exemption ta that law. The exemptioa allows gou, as �he owner of your pxoperty, �o aet as yaur own contxaator with ceztain res�rictians evea though you do aot have a licease. Yau muat provide direct oasite supervision of the eonstructiaa yoursel.f. You may build ar improve a oae-family or two-family resideuce or a farm autbuildin,g. You may also build or improve a commercial buildiag, provided your costs do ao� exceed $75,000. fihe builtting or residence must be for ycur awu use or aceupaucy. It may azot be built ar substaatially improved far sale or lease. xf yau sell or lease a builda.ag yau have buil� ar substaatially improved yourself withia 1 year after �he coastructioa is complete, the law will presume that you built or substaatially aimproved if for sale or lease, �ahich is a violatiot� of this exempticn. Yau may aat hire aa ualiceased persaa �o aat as your coa�aractar or to supervise people working on yaur buildiag. It is yaur respoasibility to make sure that people employed by you have licenses reguired by sta.te Iaw and by couaty or muaicipal liceusiag ordiaaaces. You may aot delegate the responsibility for supervising work �a a licen�ed aaatractor who is aot Iicensed to perfarm the work beixig doae. Aay persoa warking oa your building who 3s aa� liaensed must work uader your direct supervi�ion and must be emgloyed by yau, which meaas tha� you mus� deduet F.I.C.A. aad w3.thho3diag tax � and provide wa=kers' campensatian for that emp].oyee, all as presarib�d by law. Yous coastructioa mus , camply with all applicable 1.aws, ordiaaaces, buildiag codee, aad zoning re 1 tious � �OWNER'S TGNATURE '�`P�c.0 `�'ATE c�" l �� � ADDRFsSS ,cl i �� � PAONE _ � t/�T WITNESS PERMIT #