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I, agree DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT J.eah Le8.rtJ_S have '-ead and fully understand and to the provi ons 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 c.omicile, that he or she actually occupies, or will occupy by saic. domicile, and same is not for rent, lease or sale. That he or she shall comply ~dth the following conditions: 1. That the owner and he or she alone shall act as the builder for all phases of construction. That the owner will comply with all provisions of the City of Zephyrhills ordinances and codes pertinent to the building. That in the event various phases of constructie.n are subcontracted, he will engage only properly licensed subcontractors ~.d will personally supervise such work. That in the event the Building Inspector shall require corrections to be made, the owner will assume full responsibility to iI:.sure they are made, and upon completion will call for a reinspection before proceeding with the building. That the owner shall assume full responsibilitx' for the construction and will not expect supervision of his work from the Ci t.y of Zephyrhills Building Department. 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. That the owner shall comply with all City, Stat;e and Federal laws in regard to social security, workman's compensation, lien laws, etc., where applicable. That the owner shall comply with all the safety codes issued by the Florida Industrial Commission. 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 x'our own contractor with certain restrictions even though you do not have a lice.nse. 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 o~Ltbuilding. You may also build or improve a commercial building, provided you%" costs do not exceed $25,000. The building or residence must be for your own use or occupancy. It may not be built or substantially 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 preflume that you built or substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an unlicensed perflon 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 1icElnses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibili ty for supervising work to a 1icenfled 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 F.I.C.A. and withholding tax and provide workers' compensation for that emp:.oyee, all as prescribed by law. Your construction must comply with all applic~)le laws, ordinances, building codes, and zoning regulations. / ~ OWNER'S SIGllATURE ~~ '-;;J' ~'704 DATE 'I-frO;' ADDRESS .i J' 70ti> . /~/I)t< ti A :5 tttl # PHONE L -lIS' - "LSV - 7390 "-S</~ {'t~ C~D-~L 2. 3. 4. 5. 6. 7. 8. 9. WITNESS PERMIT #