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DISCLOSIIR.E STATII�NT FOR OWNER CITY OF ZEPHYRHILLS BUxLDING DE�'ARTMENT I, have read aad fulZy uaders�and aad agree to the pravisioas af this instrument. , i The undersigned st�ates and affirms that he or she is desiraus af caastructiag, � renovata.ag, addiag to or reroofing his ar her owa domicile, that he or she actually occupies, or will occupy by said domicile, aad same �.s not for rent, lease or sa2e. That 'he or she .shal�l comply with the following conditians: 1. Tha� the osvaet aad he or sh� alone shall act as the builder for a1Z phases of construction. 2, Tha� the owner will�camgly with a].1 provisioa.s of the City af Zephyrhi].ls ordiaaaces aaad codes p�rtineat to the building. 3. That ia the event varzous phases of cons�ruct3.on are subcontrac�ed, he wa.11 engage cnly proper2y liaensed subeontractors aud �cviZl persanally supervise such work. 4. Tha� ia the eveut the Suildiag Iaspector shala require corrections to ba made, the owaer will aseume full respansibility to iasure they are made, aad upon completian wi11 ca11 far a reiaspection before proceeding with �he building. 5. That the ownex shall ass�xme full respoasibility for the construetion aad wi1Z aot expect supervisioa of his work from �he City af Zephyrhills Building Department. 6. Tliat priar to fiaal iaspectaon aay addita.onal fees, includiang reiaspectiaa fee�, must be paid in full. A written request fram this of�ice shall canatitute aa offi.cial notice to pay additioaal fees. 7. Tha� the owaex shall comply with all City, State and Federal laws in regard to , saeial seeurity, workman's compensati.an, 2ien Iaws, etc. , where appZa.cable. 8. That the osvaer shall camply with all the safe�y cades assued by the Florida Tndustrial Commissioa. 9. State Iaw requires coastruction to be doae by liceased coa�ractars. You have appl3ed for a permit wnder aa exemption t�a that law. The exemp�ion allows yau, as �he awner of your property, to act as your owa contractor with certain xestrictions even though you do anot have a license. You must pravide direct oasitie supervisioa of the coastruction yourself. Yau may bv,ild or improve a one-famiZy ar two-�amily residence ox a farm autbuildiag. You may also build or improve a aommercial buildiag, pravided your costs da aot exceed $75,000. The building ar reside�o.ce must be for youz awn use or oecupaacy. It may aa�at i be built or substaa�.tially improved far sale or lease. If yau sell or lease a building yau have built� or subs�antia2ly improved yourself tvithi.a I. year after the construction is com,plete, the law wi11 presume tha� you built or substaatially improved if for sale or lease, which is a viol.ation of this � exemptian. Yau may not hire an unlicensed person ta act as your coa�ractar ar !, to supervise people wor]ting on your buildiag. It is yautr respoasibility to ' make sure that geapZe emp2ayec3 bg yau have licenses required by state law and by aounty or municipal licensiag ordiaances. You may aat delegate the respansibility for superviaiag work �o a ].iceased coatractor who is aot licesnsed to gerform the work beiag daue. Any persoa warking on your building who is aot licensed must work uader your direc� supervi�ioa and must be emgloyed by you, c�rhieh means that yost mus� deduct F.I.C.A. and withholding ta�c a and provide workers' campensatian for that employee, all as preacribed by 1aw. Xour coastructioa must aomplg wiGh all app�.icable laws, orda.naaces, buildiug codes, aud zoning re latiat�,s. I QWNER'S SI�NA'rURE �a,� —�...- DATE �"'�"1 0 , ADDR]'sSS �S'��' �„ ' S �xor� ' WITNESS PFsRMIT #