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� DIS�LOSIIRE STATEI�•u'►' .FOR OWl�R C2TY OF ZEPxT�'�RTT�T - SVILD=NG DEPAR'�'�•NT _� � have read and fully uriderstand and agree -to the provisions of �this insts+��t. .The undersigned.states and affirms tha he or she is desirous o£ constructing, rer,ovating, add:ing to or seroofing his or her o�n domicile, that he or she actually occupies, or xi11 occupy by said domic�:le, and same is not for •rent, lease or sale. That he or she shall comply with the following conditions: 1. That the owaer and.he or she aloae sha11 act as the bvilder for al1 phases of constructz.on . 2. That -the owner wa:11 comply with al1 provisians o£ �the City of Zephyrhills ordinances and codes pertineat to the buildiug. 3. That in the event various phases of constnicti.on are sul�contracted, he vrill Ell gage only •properly licensed subcontsactors and will pErsorial.ly supervise such work. 4. That in the event the Buildiag Inspactor sha11 require corrections to be made, the owrier will assume full responsibility to insure•they are made, and upon completion wi11 ca13 for a rei.aspectioa before proceeditig with the build3ng. 5. That the owner sha11 assume fu11 responsibility for the construction aad �i11 not expect_ supervision of his �vork from the City o£ Zephyrhills Buildixig Depast�exzt . 6. That prior to final inspection any additional fees, including reiaspection fees , must be paid in fu11. A�vritten request from this office shall constitute an official notice to pay add.i.tional fees. 7_ That the oarner sha11 comply with a11 City, State asid Fedezal laws ia regard to SOC121 8eCL7S1'�� WO=�Cme3II�5 Cn�oncg�,OA� 11PS1 12SV5� E'tC. � where applicable. B. That the owner sha11 comply with all the safety codes issued by the Florida 2ndustsial Commission. 9. State 1aw requires construction to be doae by liceased contractors. You have applied for a per�t under an exemptioa to that law. The exP�ption allows you, as the owner of your property, to act as your own contractor with cert=;*+ restrictions even though you do not have a licersse. You must_provide direct onsite supervision of the coastruction yourself. You may build or improne a oae-family or two-family resideuce or a farm outbuildiag. You may also build or improve a commercial building, provicled your costs do aot exceed $25,000. The buildi.ng or residsace must be for your own use or occupaacy. It may not be built or substantially i.mproved for sale or lease. If you se1:l or lease a building you have built or subst�sitially improved yourself within 1 yaar after the constrssctioa is complete, the la�v wi.11 pres�e •that you built or substaatially improved •if for sale or laase, which is a violation of this EX emption. You may not hire an unlicensad person to act as your coatsactor or to supervise people working on your builrling. It is your responsibility to make sure that people employed by you bave licenses rern by state law and by county or munica.pal licensing ordinanees. You may not delegate the responsibility for supervisa.ng mork to a liceased contractor who is not. licensed to perform the ovork beiag done_ Ax�.y pnrson working oA your bv.ildiag who is aot licensed must work uniier your direct supervision and must be employed by you, which meaas that you must deduct F.I.C.A. and v�ithholding ta.x and provide workers' compeasati.on for that employae, a11 as prescri.bed by law. Your construction must eomply with al1 applicable 1aws, ord,i.siances, building codes, and zoniag regulations. OWNER' S SIGNATL7RE , D p,� ADDRESS PHONE � �- W22NESS p'F'R*�'T #