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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS—BUILDING DEPARTMENT iid noes S r2 have read and fully understand and agree to the provisions of this instrument. The undersigned states and affirms that he or she is desirous of constructing, 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 conditions: 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 ail provisions of the City of Zephyrhills ordinances and codes pertinent to the building. 3. That in the event various phases of construction are subcontracted, he will engage only properly licensed subcontractors and will personally supervise such work. 4. That in the event the Building Inspector shall require corrections to be made, the owner will assume full responsibility to insure they are made,.and upon completion will call for a reinspection before proceeding 'with the building. 5. That the owner shall assume:full responsibility for the construction and will not expect supervision of his work from the City of Zephyrhills Building Department. 6. That prior to final inspection any additional fees, including reinspection fees, must be paid In full. A written request from this office shall constitute an official notice to pay additional fees. 7. That the owner shall comply with all City, State and Federal laws in regard to social security, workmaWs compensation.lien laws,etc.,where applicable. 8_ That the owner shall comply with all the safety cafes 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 exemption to that law. The exemption allows you, as the owner of your property,to act as_yourown contractor with certain restrictions even though you do not have a license. You must provide direct onsite supervision of the construction yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial' building, provided your costs do not exceed $75,000. The building or residence must be for your own use or occupancy. It may not be built or substantially improved if for sale or lease,which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done. Any person working on your building who is not licensed must work under your direct supervision and must be employed by you, which means that you must deduct FJ.C.A.and withholding tax and provide worker's compensation for that employee,all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes,and zoning regulations. OWNER'S SIGNATURE `' � �- DATE ' S ADDRESS 3 v SO i .f% A v ! s Fi- PHONE Rt3 997 1-5Sa WITNESS PERMIT ItMasterfoims10wneasAffidavitlNov09