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DISCLOSDltB STA'f'BMBII'1' I'OR 0IIlUm CITY OP ~Uxw1nT.T.A BUJ:LDDiIG DBPUT.MID1'l' I, }/d-rrlf 13()(L)/.eJ have read and fu1ly understand aDd agree to ~ provisions of this instrument. The undersigned states and affi%ms that he or she is desirous of constructing, renovating, .~~i 'rig to or reroof:I.Dg his or her own domicile, that he or she actually occupies, or w:l.ll occupy by said domicile, and same is not for rent, :Lease or sale. That he or she shal:L ccxaply w:l. th the following conditions: 1. That the owner and he or she alone shall act as the builder for alJ. phases of construction. That the owner will ccxaply with all provisions of the City of Zepl:t.yrhi11s ordi """"""'es and codes perti.DeDt to the buildiDg. That iu the event various phases of construction are subcontracted, he wi11 engage only proper1y licensed subcontractors and rill personal.ly supervise such work.. That in the event the Bui1diDg J:xuIp4lctor shal1 require corrections to be made, the owner wi11 assume fu1l responsibility to iDaure they are made, and upon comp1et:1on rill call for a redDepection before proceeding with. the building. "l"hat the owner shal1 assume fu1l respcmsibi1i ty for the construction and will not expect supervision of his work from the City of Zephyrhills BuildiDg Depart:meDt. That prior to f:inal inspection any additional. fees, iD.c1uciing reinspection fees, must be paid iu fu11. A written request from this office shall constitute an official notice to pay additional. fees. That the owner shal.1 comply with all City, State and Pederal. laws in regard to social security, workman's cOlllpeD.Sation, lien 1aws, etc., where app1icable. That the owner shall ccxaply rith &11 the safety codes issued by the P10rida J:ndustrial COIIIlBission. State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption al1cnrs you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a 1icense. You must provide direct onsite supervision of the CODStruction yourself. You may bui1d or improve a one-fami1y or two-family resicieuce or a faxm. outbui.1diDg. You ~ also bui1d or improve a cOllllll8rcial building'.. provided your costs do not exceeci $25, 000 . The buildiDg or resicieuce must be for your own use or occupancy. J:t may not be bui1t or substantially improved for sale or 1eas.. If you sell or 1ease a . buildiDg you havebui1t or substantially improved yourse1f within 1 year after the construction is COIIIp1ete, the 1aw will presume that you built or substant:1allyiDlproved if for sale or 1ease, which is a violation of this exemption. You may not hire an unlicensed persOn to act as your contractor or to supervi.se people working on your building. It is your respcmsibility to make sure that people elllp10yed by you have 1iceuses required by state law and by county or JIlUDicipal. 1icensing or~i""ances. You may not delegate the respOlUlihility for superv:i.s:I.Dg work to a 1iCeDaed contractor who is not 1icensed to perform the work being done. AD:y person working on your building who is not 1iceused must work 'UDder your direct supervision and must be employed by you, which means that you must decluct P.I.C.A. and withholding tax and provide workers' compensation for that eaployee, all as prescribed. by law. Your construction must comply with all applicab1e 1aws. ordi-"aD<:'es, building codes, and zoning regulations. 5mBM"ORB ~ ~ ~ :JSOl; P~r( ~ ' .;...JL 7R,o'-Jri....lli .J:1. 33~V() 2. 3. 4. 5. 6. 7. 8. 9. OWJIBR.' S ADDRBSS PBORB 01./ ,;J. ~I 0 S' DATE ~~.&-~l wJ.TASS PBRKIT # PASCO PCRMIT SEnVICE 1-866-824-7894 Toll Free