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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT :I. . <: h" nC lk ":i,)"J'l have read and fully understand and agree to the provisi s 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 domici1e, that he or she actua11y occupies, or wi~1 occupy by said domici1e, and same is not for rent, 1ease or sa1e. That he or she sha11 comp1y with .thefo11owing conditions: 1. That the owner and he or she a10ne sha11 act as the bui1derfor a11 phases of construction. 2 . That the owner wi'11 comp1y with a11 provisions of the City of Zephyrhi11s ordinances ~d codes pertinent to .the bui1ding. 3. That in the event various phases of construction are subcontracted, he wi11 engage on1y proper1y ~icensed subcontractors and wi11 persona11y supervise such work. 4. That in the event the Bui1ding Inspector sha11 require corrections' to be made, the owner wi11 assumefu11 responsibi1ity to insure they are made, and upon comp1etion wi11 ca11 zor a reinspection before proceeding with the bui1ding. 5. That the owner sha11 assumeful.:1 responsibi~i ty for the construction and wi11 not expect supervision of his work from the City of Zephyrhills Bui1ding Department. 6. That prior tofina1 inspection any additiona1 fees, inc1uding reinspection fees, must be paid in fu11. A wri:tten request from this office sha11 constitute an officia1 notice to pay additiona1 fees. 7. That the owner sha11 comp1y wi tha11 City, State and Federa1 1aws in regard to socia1 security, workman's compensation, 1ien 1aws, etc., where app1icab1e. 8. That the owner sha11 comp1y with a11 the safety codes issued by the F10rida Industria1 Commission. 9. State 1aw requires construction to be done by 1icensed contractors. You have app1ied for a permit under an exemption to that 1aw. The exemption a110ws 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 construction yourse1f. You may bui1d or improve a one-fami1y or two-fami1y residence or a farm outbui1ding. You may a1so bui1d or improve a commercia1 bui1ding, provided your costs do not exceed $25,000. The bui1ding or residence must be for your own use or occupancy. It may not bebui1t or substantia11y improved for sa1e or 1ease. If you se11 or 1ease a bui1ding you have bui1t or substantia11y improved yourse1f within 1 year after the construction is comp1ete, the 1aw wi11 presume that you bui1t or substantia11y improved if for sa1e or 1ease, which is a vio1ation of this exemption. You may not hire an un1icensed person to act as your contractor or to supervise peop1e working on your bui1ding. It is your responsibi1ity to make sure that peop1e emp10yed by you have 1icenses required by state ~aw and by county or municipa1 1icensing ordinances. You may not de1egate the responsibi1ity for supervising work to a 1icensed contractor who is not 1icensed to perform the work being done. Any person working on your bui1ding who is not 1icensed must work under your direct supervision and must be emp10yed by you, which means that you must deduct F.I.C.A. and withho1ding tax and provide workers' compensation for that emp1oyee, a11 as prescribed by 1aw. Your construction must comp1y with a11 app1icab1e 1aws, ordinances, bui1ding QWNECOdeRs: sansdI~:::: ~regu1:' n~~~ _~U_ ~~ DM'E 7' /0 Z<r:? ADDRESS 377 '~'i d - /"., /1 c:/ '> ?~~ PHONE 'i/~" ,,<~ ~ 7\-") 3 WITNESS PERMIT #