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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS Before me this day personally appeared 0 g ihHJ (~ .b dJ who, being duly sworn, deposes and says as follows: "I have read and fully understand the provisions of this instrument." The undersigned states and affirms that he or she is desirous of constructing his or her own domicile, that he or she actually occupy, or will occupy said domicile, and 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 all 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 pe!sonally 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 s<apervision of his work from the City of Zephyrhills Building Department. 6. That prior to final inspection any additional fees, including reinspect ion 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, workman's compensation, lien laws, etc., where applicable. 8. That the owner shall comply with all the safety codes is.sued 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 your own contractor even though you do not have a license. You must supervise 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 at a cost of $25,000 or less. The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease more than one building you have built yourself within 1 year after the construction is complete, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. Your construction must be done according to building codes and zoning regulations. 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. ownVZ~/(bt;-f :3~ () /7 c/( JJ ,I) -r1'i /II/IE Address Zc;/JA(P/J/liJ,. 17(J~iifil BUILDING PERMIT NUMBER ::J4, I f? ~ SlATE OF FLORIDAQ COUNTY OF fL.Ct..4-A.-o The fOregOi~g in trum ent was acknowledged before II}~ tpis _~ I , 19~ by 4YJ-_ L1,/~I!-P who is personally known to me 9[ who has produced E'1- f)'- D ~O /7087.af"1'dentifi- cation and who did/did not take an oath. {J}~ ~~ # O'f-7tJtff:, NOT~; -SIGNtfURE ,A!RN(!'f 4r./)~-z..- NOTARY NAME TYPED, PRINTED OR STAMPED i~OTARY PUBLIC - -, '.'>.~