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DISCLOSlJRE STATEMENT FOR OWNER , J CITY OF -ZEPRYRBILLS BUILDING DEPARTMENT I, :-JaU/..L-:/ {;&~ . - " ' havereacl ancl fuJ.J.y agr~~o the provisions of t~s instrument. unclerstand and The undersignecl states and affirms that he or she is clesirous of constructing, renovating, aclding to or reroofing his or her own damicile~, that he or she actually occupies, or will occupy by said clamiciJ.e, and same is not for rent, J.ease or sale. That he or she sha.J.l comply with the :following conditions-: J.. That the owner and he or she alone shall act as the buiJ.der -for all phases of" construct::i.on. That the owner wilJ. comply with alJ. provisions of the City of Zephyrhills ordinances ancl codes pertinent to 'the building. That in the event various phases of construction are subcontracted, he will engage only properly licensecl subcontractors and will personally supervise such work.- That in the event the Building Inspector shall require corrections to be made, the owner wilJ. assume fuJ.l responsi.biJ.i ty to insure they are made , 'and upon completion will call for a reinspection before proceeding with the building. That the oWner shall assume ful.J. responsi.bi1.ity for the construction and will not expect supervision of his Work from the City of Zephyrhills Building Department. That prior to final inspection any additional fees, ~ncluding reinspection fees, must be paid in fuJ.l. A w:r:i tten request from this office shall ,constitute' an officiaJ. notice. to pay additionaJ. fees. That the owner shall comply with aJ.l City, State ancl 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 your own contractor with certain restrictions even though you d.o not have a license. Yo'l.1; 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'builcl or improve a commercial building, provided your costs clo not exceecl $25,000. The building .or residence must be for your ow.n use or occupancy. It may not be built or, substantially improveclfor sale or lease. If you seal :or' lease a builcling yotihave builtorsubstanti~ly improvecl yourseif within 1 year after the construction is complete, the law wilJ. presume-that you built or substantially improved if for sale or lease, which is a violation of this exemption. You may not hire an unlicens'ecl person to act as your contractor or to supervise people work:i.ng on your building. It is your responsi.bili ty to make sure that people employecl by you have licenses required by state law and by county or municipal licensing ordinances. You may not delegate the responsibility for supervlsing work to a licensecl contractor who is not licensecl to perform the work being d.one. Any person working on your builcling who is not licensecl must work uncler your direct supervision and must be employecl by you, whi ch means that you 1I1US t 'clecluct P'. I . C _ A. ancl wi. thholding tax' and provide workers' compensation for that employee, all as prescribed by 1aw. Your construction must comply with all appl:Lcable laws, ordinances, building codes, ancl zoning r~lations. ' OWNER'S SIGNAT1JR1t-, t1~1 'VU _ J [;;;t,-1t~ ADDRESS 3.9 '7 7 ~J lj :A' L ::,,7.-"~ C! i ~_ PRONE .5/ ~ - ? fa -. 9' (), I)Cf 2. 3. 4. 5. 6. 7. 8. 9. DATE IJec ? ob r WITNESS PERMIT #: