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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING.DEPARTMENT "I, rd A{y)~ ~ ..o.("'.}e.. ('" have read and -fu~~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 actuaJ.~y occupies, or wi~'~ occupy l:?Y said domici~e, and same is not for rent, lease or saJ.e. That he or she shaJ.J. compJ.y with the .fo~~owing conditions: .~. That the o~er and he or she aJ.one sha.l:J. act as i:he bui~derfor aJ.~phases of construction. 2. That .the owner wil.l. compl,y wii:h aJ.~ provisions of the Ci t:Y of Zephyrhil.l.s ordinances and codes pertinent to the buiJ.ding. 3. That in the event various phases of construction are subcontracted, he wiJ.~ engage only proper~y J.icensed subcontractors and wiJ.1.personaJ.J.y supervise such work. 4. That in the event the Building Inspector shal.J. require corrections to be made, the ownerwiJ.J. assume ful.l. responsibiJ.i ty to insure they are made, and upon compl.etion wil.l. caJ.l. for a reinspection before proceeding with the buil.ding. 5. That the owner shaJ.l. assume ful.l. responsibil.i:t:Y for the construction and wil.l. not expect supervision of his work from the City of Zephyrhil.l.s Bui~ding Department. 6. That prior to finaJ. inspection any addi tionaJ. fees, incl.uding rei.nspection fees, must be paid in ful.l.. A written request from this office shaJ.J. consti tute an offici.aJ. notice to pay additionaJ. fees. 7 . That the owner sha.J.J. comp~y with aJ.J. City, State and FederaJ. J.aws in regard to sociaJ. security, workman's compensation, J.ien J.aws, etc., where app~icab~e. 8. That the owner sha.J.~. compJ.y with aJ.J. the safety codes issued by the F~orida IndustriaJ. Commission. 9. State ~aw requires construction to be done by J.icensed contractors. You have appJ.ied for a permit under an exemption to that ~aw. The exemption aJ.J.ows you, as the owner of your property, to act as your own con tractor 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.di.ng. You may aJ.so bui~d or improve a commercial. buil.d:ing, 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 buiJ.t or substantiaJ.J.y improved for saJ.e or ~ease. If you se~J. or l.ease a buiJ.ding you have buiJ. t or substantiaJ.J.y improved yoursel.f wi thin 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 ~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 peop~e working on your bui~d:ing. It is your responsibi~i ty to make sure that peop~e emp~oyed by you have licenses required by state ~aw and by county or municipaJ. ~icensing ordinances. You may not delegate the responsibi~ity for supervising work to a l.icensed contractor who is not ~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 empJ.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, aJ.1. as prescribed by J.aw. Your construction must compJ.y with aJ.1. appl.icabl.e l.aws, ordinances, buil.ding codes, and zoning re ations. OWNER'S ADDRESS PHONE DATE /0' 03 -D7. 5<tD WITNESS PERMIT #