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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT I, JIII'1f'/ -r;"(k~o~ have read and fuJ.J.y understand and agree to the provisions 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 domiciJ.e, that he or she actuaJ.J.y occupies, or wiJ.J. occupy by said domiciJ.e, and same is not for rent, J.ease or saJ.e. That he or she shaJ.J. compJ.y with the foJ.J.owing conditions: 1. That the owner and he or she aJ.one shaJ.J. act as the buiJ.der for aJ.J. ph~~s of construction. 2. That the owner wi.J.J. compJ.y with aJ.J. provisions of the City of ZephyrhiJ.J.s ordinances and codes pertinent to the buiJ.ding. 3. That in the event various phases of construction are subcontracted, he wiJ.J. engage onJ.y properJ.y J.icensed subcontractors and wiJ.J. personaJ.J.y supervise such work. 4. That in the event the BuiJ.ding Inspector shaJ.J. require corrections to be made, the owner wiJ.J. assume fuJ.J. responsibiJ.ity to insure they are made, and upon compJ.etion wiJ.J. caJ.J. for a reinspection before proceeding with the buiJ.ding. 5. That the owner shaJ.J. assume fuJ.J. responsibiJ.ity for the construction and wiJ.J. not expect supervision of his work from the City of ZephyrhiJ.J.s BuiJ.ding Department. 6. That prior to finaJ. inspection any additionaJ. fees, incJ.uding reinspection fees, must be paid in fuJ.J.. A written request from this office shaJ.J. constitute an officiaJ. notice to pay additionaJ. fees. 7. That the owner shaJ.J. compJ.y with aJ.J. City, State and FederaJ. J.aws in regard to sociaJ. security, workman's compensation, J.ien J.aws, etc., where appJ.icabJ.e. 8. That the owner shaJ.J. compJ.y with aJ.J. the safety codes issued by the FJ.orida IndustriaJ. Commission. 9. State J.aw requires construction to be done by J.icensed contractors. You have appJ.ied for a permit under an exemption to that J.aw. The exemption aJ.J.ows you, as the owner of your property, to act as your own contractor with certain restrictions even though you do not have a J.icense. You must provide direct onsite supervision of the construction yourseJ.f. You may buiJ.d or improve a one-famiJ.y or two-famiJ.y residence or a farm outbuiJ.ding. You may aJ.so buiJ.d or improve a commerciaJ. buiJ.ding, provided your costs do not exceed $25,000. The buiJ.ding or residence must be for your own use or occupancy. It may not be buiJ.t or substantiaJ.J.y improved for saJ.e or J.ease. If you seJ.J. or J.ease a buiJ.ding you have buiJ.t or substantiaJ.J.y improved yourseJ.f within 1 year after the construction is compJ.ete, the J.aw wiJ.J. presume that you buiJ.t or substantiaJ.J.y improved if for saJ.e or J.ease, which is a vioJ.ation of this exemption. You may not hire an unJ.icensed person to act as your contractor or to supervise peopJ.e working on your buiJ.ding. It is your responsibiJ.ity to make sure that peopJ.e empJ.oyed by you have J.icenses required by state J.aw and by county or municipaJ. J.icensing ordinances. You may not deJ.egate the responsibiJ.ity for supervising work to a J.icensed contractor who is not J.icensed to perform the work being done. Any person working on your buiJ.ding who is not J.icensed must work under your direct supervision and must be empJ.oyed by you, which means that you must deduct F.I.C.A. and withhoJ.ding tax and provide workers' compensation for that empJ.oyee, aJ.J. as prescribed by J.aw. Your construction must compJ.y wi.th aJ.J. appJ.icabJ.e J.aws, ordinances, buiJ.ding codes, and zoning requJ.ations. OWNER'S SIGNATURE A- ~ ADDRESS )'$p~,p LJ/Io.J_"", ~____ :!'rJ/,. fI ,1,7f1/1.. PHONE $O-71'-I.rlr f DATE / ,)./>- 07 WITNESS PERMIT #