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DISCLOSlJRE STATEHENT FOR OWNER CI,TY OF ZEPHYRHILLS BUILDING DEPARTKENT I, I ~~ t... o4crl'\-.. have read and ful~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 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,: L That the owner and he or she a~one sha~~ act as the bui~der for a~~ phases of construction. That the owner wi~~ comp~y with a~~ provisions of the City of Zephyrhi~~s ordinances and codes pertinent to "the bui~ding. That in the event various phases of construction are subcontracted, he wi~~ engage on~y proper~y ~ice:c.sed subcontractors and wi~~ perso~~y supervise such work.. That in the event the Bui~ding Inspector sha~~ require corrections to be made, the owner wi~~ assume fu~~ responsibi~ity to insure they are made, and upon comp~etion wi~i ca~~ for a reinspection before proceeding with the 'bui~ding. That the owner sha~~ assume f~ respoI1Sibi~i ty for the construction and wi~~ not expect supervision of his work from the City of Zephyrhi~~s Bui~ding Department. That prior to fina~ inspection any additiona~ fees, inc~uding reinspection fees, must be paid in fuJ.~. A written request from this office sha~~ constitute an officia~ notice. to pay additiona~ fees. 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. That the owner sha~~ comp~y with a~~ the safety codes issued by the F~orida Industria~ Commission. ' State ~aw requires construction to be done by ~icensed contractors. You have app~ied for a pe:cmi t 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 impr'!Ve ,a one-fami~y 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 improved 'for sa~e, or ~ease ~ If you seJ.~' ;or' ~ease a bui~ding you,have bui~torsubstantia~~y improved you:r.se~f within ~ 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 bui~ding. It is your responsibi~ity to make sure that peop~e emp~oyed by you have ~icenses required by state law and by county or municipa~ licensing ordinances. You may not de~egate the responsibi~ity for supervising work to a ~icensed contractor who is not licensed 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 empJ.oyed by you, which means that you must deduct F.I.C.A. and wj,thho~ding tax and provide workers' compensation for that emp~oyee, aJ.~ as prescribed by ~aw. Your construction must comp~y with aJ.~ app~icab~e laws, ordinances, building codes, and zoning reguJ.ations. ~~ OWNER'S SIGNATURE '.. .' ADDRESS 4731.. te,/'- St-~ PHONE C!.17.-76J-U1'- 2. 3. 4. 5. 6. 7. 8. 9. DATE aY--z.5 - 00 r WJ:TNESS PERMJ:T #