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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT I, ~Ut..J/S r CiA YIt:(r j ,At \"Ge. have read andful.l.y understand and agree to the provisions of this ~nstrument. The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domicil.e, that he or she actual.l.y occupies, or wil.l. occupy by said domicil.e, and same is not for rent, l.ease or sal.e. That he or she shal.l. compl.y with the fol.l.owing conditions: ~. That the owner and he or she a~one shal.l. act as the buil.der for al.l. phases of construction. 2. That the owner wil.l. compl.y with al.l. provisions of the City of Zephyrhil.l.s ordinances and codes pertinent to the buil.ding. 3. That in the event various phases of construction are Subcontracted, he wil.l. engage onl.y properl.y licensed subcontractors and will personall.y supervise such work. 4. That in the event the Building Inspector shal.l. require corrections to be made, the owner wil.l assume full responsibil.ity to insure they are made, and upon compl.etion wil.l. cal.l. for a reinspection before proceeding with the building. 5. That the owner shal.l. assume full responsibil.ity for the construction and wil.l. not expect supervision of his work from the City of Zephyrhil.l.s Buil.ding Department. 6. That prior to final. inspection any additional. fees, incl.uding reinspection fees, must be paid in full. A written request from this office shal.l. constitute an official. notice to pay additional. fees. 7. That the owner shal.l. compl.y with al.l. City, State and Federal. l.aws in regard to social. security, workman's compensation, l.ien l.aws, etc., where appl.icabl.e. 8. That the owner shal.l. compl.y with al.l. the safety codes issued by the Fl.orida Industrial. Commission. 9. State l.aw requires construction to be done by l.icensed contractors. You have appl.ied for a permit under an exemption to that l.aw. The exemption al.l.ows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a l.icense. You must provide direct onsite supervision of the construction yoursel.f. You may buil.d or improve a one-famil.y or two-famil.y residence or a farm outbuil.ding. You may a1.so buil.d or improve a commercial. bUil.ding, provided your costs do not exceed $25,000. The buil.ding or residence must be for your own use or occupancy. It may not be buil.t or substantial.l.y improved for sal.e or l.ease. If you sel.l. or l.ease a buil.ding you have buil.t or substantial.l.y improved yoursel.f within 1 year after the construction is compl.ete, the l.aw wil.l. presume that you buil.t or substantial.l.y improved if for sal.e or l.ease, which is a viol.ation of this exemption. You may not hire an unl.icensed person to act as your contractor or to supervise peopl.e working on your buil.ding. It is your responsibil.ity to make sure that peopl.e empl.oyed by you have l.icenses required by state l.aw and by county or municipal. l.icensing ordinances. You may not del.egate the responsibil.ity for supervising work to a l.icensed contractor who is not l.icensed to perform the work being done. Any person working on your bui~ding who is not l.icensed must work under your direct supervision and must be empl.oyed by you, which means that you must deduct F.I.C.A. and withhol.ding tax and provide workers' compensation for that empl.oyee, al.l. as prescribed by l.aw. Your construction must compl.y with al.l. appl.icabl.e l.aws, ordinances, buil.ding codes, and zoning regul.a ons. OWNER'S ADDRESS PHONE DATE ~7-/~-J? WITNESS PERMIT #