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' � DISCLOSIIR� STATEMENT FOR OWNER � CITY OF ZEPHYRHILLS BUILDING DEPARTMENT I. have read and fully understand aad agree to the provisions of this instrumeat. The undersigned states aad affirms that he or she is desirous of constructing, reaovatiag, adding to or reroofiag 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 conditions: 1. That the owner and he or she aloae shall act as the builder for all phases of coastructioa. 2. That the owner will comply with all provisions of the City of Zephyrhills ' ordinaaces and codes pertiuent to the buildiag. � 3. That in the event various phases of coastructioa are subcontracted, he will engage oaly properly liceased subcoatractors and will personally supervise such work. 4. That ia the event the Suildiag Iaspector shall require corrections to be made, ' the owner will assume full responsibility to iasure they are made, and upon ' completion will call for a reinspection before proceediag with the building. 5. That the owaer shall assume full responsibility for the constructioa aad will aot expect supervisioa of his work from the City of Zephyrhills Suildiag Department. 6. That prior to fiaal inspection aay additional fees,, includiag reiaspection fees, must be paid in full. A writtea request from this office shall coastitute an 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 owaer shall comply with all the safety codes issued by the Florida Industrial Commiasion. ' 9. State law requires coastruction to be doae by liceased contractors. You have applied for a permit uader an exemptioa to that law. The exemptioa allows you, as the owner of your property, to act as your own coatractor with certain restrictions even though you do not have a license. You must provide direct oasite supervisioa of the coastruction yourself. You may build or improve a �i oae-family or two-family resideace or a farm outbuilding. You may also build or improve a commercial buildiag, provided your costs do aot exceed $75,000. The buildiag or resideace must be for your own use or occupancy. It may not be built or subataatially improved for sale or lease. If you sell or lease a building you have built or substantially improved yourself within 1 year after the construction is complete, the law will presume that you built or substantially improved if for sale or lease, which is a violation of this exemption. You may aot hire an unliceased persoa to act as your contractor or to supervise people workiag oa your buildiag. It is your respoasibility to make sure that people employed by you have liceases required by state law and by couaty or municipal liceasiag ordinances. You may not delegate the respoasibility for supervising work to a liceased coatractor who is aot licensed to perform the work beiag done. Aay person workiag on your building who is aot liceased must work uader your direct supervissoa and must be employed by you, which meaas that you must deduct F.I.C.A. aad withholdiag tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordiaances, buildiag codes, and zoaing regu ioas. OWNER'S SI ATURE DATE �D Y'��b O/X ADDRESS � Z °�� PHONE WITNESS P�RMIT #