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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT I, AA+hcJ~ m<Lmu~ have read andfu~~y understand and agree to the provisions of this in trument. The undersigned states and affirms that he or she is desirous of constructing, renovating, adding to or reroofing his or her own domici~e, that he or she actua~~y occupies, or wi~~ occupy by said domici~e, and same is not for rent, ~ease or sa~e. That he or she sha~~ comp~y with the fo~~owing conditions: 1. That the owner and he or she a~one sha~~ act as the bui~der for a~~ phases of construction. 2. That the owner wi~~ comp~y with a~~ provisions of the City of Zephyrhi~ls ordinances and codes pertinent to the bui~ding. 3. That in the event various phases of construction are subcontracted, he wi~~ engage on~y proper~y licensed subcontractors and wi~~ persona~~y supervise such work. 4. That in the event the Bui~ding Inspector sha~~ require corrections to be made, the owner wi~~ assume fu~~ responsibi~i ty to insure they are made, and upon comp~etion wi~~ ca~~ for a reinspection before proceeding with the bui~ding. 5. That the owner sha~~ assume fu1~ responsibi~ity for the construction and wi~~ not expect supervision of his work from the City of Zephyrhi~~s Bui~ding Department. 6. That prior to fina~ inspection any additiona~ fees, inc~uding reinspection fees, must be paid in fu~~. A written request from this office sha~~ constitute an officia~ notice to pay additiona~ fees. 7. That the owner sha~~ comp~y with a~~ City, State and Federa~ ~aws in regard to socia~ security, workman's compensation, ~ien ~aws, etc., where app~icab~e. 8. That the owner sha~~ comp~y wi th a~~ the safety codes issued by the F~orida Industria~ Commission. 9. State ~aw requires construction to be done by ~icensed contractors. You have app~ied for a permit under an exemption to that ~aw. The exemption a~~ows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a ~icense. You must provide direct onsite supervision of the construction yourse~f. You may bui~d or improve a one-family or two-fami~y residence or a farm outbui~ding. You may a~so bui~d or improve a commercia~ bui~ding, provided your costs do not exceed $25,000. The bui~ding or residence must be for your own use or occupancy. It may not be bui~t or substantia~~y ~proved for sale or ~ease. If you sel~ or ~ease a bui~ding you have bui~t or substantia~~y ~proved yourse~f within 1 year after the construction is comp~ete, the ~aw wi~~ presume that you bui~t or substantia~~y improved if for sa~e or ~ease, which is a vio~ation of this exemption. You may not hire an un~icensed person to act as your contractor or to supervise peop~e working on your building. It is your responsibi~ity to make sure that peop~e employed by you have ~icenses required by state ~aw and by county or municipa~ ~icensing ordinances. You may not de~egate the responsibi~ity for supervising work to a ~icensed contractor who is not ~icensed to perform the work being done. Any person working on your bui~ding who is not ~icensed must work under your direct supervision and must be emp~oyed by you, which means that you must deduct F.I.C.A. and withho~ding tax and provide workers' compensation for that emp~oyee, a~~ as prescribed by ~aw. Your construction must comp~y with a~~ app~icable laws, ordinances, building codes, and zoning regulations. fl~v7''Z.(rA. - y// OWNER'S SIGNATURE ADDRESS PHONE DATE WITNESS PERMIT #