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DISCLOSURE STATEMBNT FOR OWNER CITY OF ZEPBY.RBILLS BUJ:LDJ:NG DBPARTHENT I, P ~ U l- m A V have read and ful~y understand and agree to the provisionsfof this instrument. The undersig:t:1ed states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own damici~e" that he or she actua~~y occupies, or wi~~ occupy by said damici~e, and same is not for rent, lease or sa~e. That he or she shal~ comply with the fo~lowing conditions,: ~. That the owner and he or she a~one sha~l act as the bui~derfor all phases of., construction. That the owner wi~~ comply with a~~ provisions of the City of Zephyrhills ordinances and codes pertinent to 'the bui~ding. That in the event various phases of construction are subcontracted, he will engage on~y properly licensed subcontractors and wi~~ personally supervise such work.. That in the event the Building Inspector sha~l require corrections to be made, the owner will assume ful~ responsibi~i ty to insure they are made, . and upon completion wi~i call for a reinspection before proceeding with the 'building. That the oWner shall assume fulJ. responsibi~ity for the construction and wi~l not expect supervision of his work from the City of Zephyrhi~ls Bui~ding Department. That prior to fina~ inspection any additional fees, including reinspection fees, must be paid in full. A written request from this office shall ,constitute. an officia~ notice. to pay additional fees. That the owner shall comply with a~~ City, State and Federal laws' in regard to social security, workman's compensation, lien laws, etc., where applicable. That the owner shall comp~y wi th a~l the safety codes issued by the Florida Industrial Commission. . State law requires construction to be done by licensed contractors. You have applied for a peJ:mit under an exemption to that law. The exemption a~lows you, as the owner of your property, to act as your own 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 impr~e .a one-family or two-family residence or a far.m outbui~ding. You may also build or improve a commercia~ building, provided your costs do not exceed $25,000. The building or residence must be for your own use or occupancy, It may not be built or. sUbstantial~y improved for sa~e or ~ease. If you sea~ ;or lease a building yoti. have built orsubstantiaJ.ly improved your.se~fwi thin 1 year after the construction is complete, the law wi~~ presumeth&t you bui~t or substantial~y improved if for sa~e or lease, which is a, violation of this exemption. You may not hire an ~icensed 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 ~icenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibi~ity 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 supervi.sion and must be employed by you, which means that you must deduct F.I.C.A. and w~thholding tax and provide workers' compensation for that emp~oyee, all as prescribed by law. Your construction must comply with a~~ applicable laws, ordinances, building codes, and zoning regulat10ns. ~;;:;;::~ 1;1-6" ~ ~CJ - fib} ':L. ' ' 2. 3. 4. 5. 6. 7. 8. 9. OWNER'S SIGNATURE ADDRESS 3 y ~ / PHONE 7o~- DATE o ~ \ .;l.d 0 (", r WJ:TNESS PEBKIT #