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DISCLOSURE STATEMENT FOR OWNER CITY OF ZEPHYRHILLS BUILDING DEPARTMENT I, have read andfu~~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 domicile, that he or she actua~ly occupies, or wi~l occupy by said domicile, and same is not for rent, ~ease or sale. That he or she sha~~ comply with the following conditions: 1. 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 Zephyrhil~s ordinances and codes pertinent to the building. That in the event various phases of construction are subcontracted, he wi~l engage on~y proper~y ~icensed subcontractors and wi~~ persona~ly supervise such work. That in the event the Bui~ding Inspector sha~~ require corrections to be made, the owner wi~l assume fu~~ responsibi~ity to insure they are made, and upon comp~etion wi~l ca~~ for a reinspection before proceeding with the bui~ding. That the owner sha~~ assume ful~ responsibi~ity 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, including reinspection fees, must be paid in fu~l. A written request from this office shall constitute an official notice to pay additiona~ fees. That the owner sha~~ comp~y with a~~ City, State and Federal ~aws in regard to socia~ security, workman's compensation, ~ien ~aws, etc., where app~icable. That the owner shall comply wi th a~l the safety codes issued by the F~orida Industrial Commission. State ~aw requires construction to be done by ~icensed contractors. You have app~ied for a permit under an exemption to that law. The exemption a~lows 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-fami~y or two-fami~y residence or a farm outbui~ding. You may also build or improve a commercial 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 built or substantial~y improved for sa~e or ~ease. If you sel~ or ~ease a bui~ding you have built or substantia~~y improved yourse~f within 1 year after the construction is comp~ete, the ~aw wi~~ presume that you built or substantia~ly improved if for sa~e or ~ease, which is a vio~ation of this exemption. You may not hire an unlicensed person to act as your contractor or to supervise people working on your building. It is your responsibility to make sure that peop~e employed by you have ~icenses required by state law and by county or municipa~ ~icensing ordinances. You may not de~egate the responsibility for supervising work to a ~icensed contractor who is not ~icensed to perform the work being done. Any person working on your building who is not ~icensed must work under your direct supervision and must be employed by you, which means that you must deduct F.LC.A. and withho~ding tax and provide workers' compensation for that employee, al~ as prescribed by law. Your construction must comp~y with a~l applicable ~aws, ordinances, building codes, and zoning regulations. OWNER'S SIGNATURE ~ /j/~ ADDRESS ~ SO'A !f'Th T 2epl......t" J... "-~ f- /. PHONE 813 -3J.2- /5"11 2. 3. 4. 5. 6. 7. 8. 9. DATE cJ~1 11/07 WITNESS PERMJ:T #