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• DISCLOSURE S'�'A't'F•*'�•NT .FOR OWNER CITY OF ZEPHYRHII+LS SV2I�DING DEPARTMENT _ • have read and fully understand aad agree �to the provisions of �tt�is instrum�t• The undersigned sta.tes and affirms that he or she is desirous of constructing, resiovating, adding to or reroofing his or her owri domicile, •that he or she actually occupies, or wi11 occupy by said d'omici:le, and same is n�t £or •rent, lease or sale. That he or she sha11 oc-mply with the followiing conditions: 1. That the ownar and.he or she alorie shall act�as the builder £or al1 phases of construction. 2, Ttiat the ovPSSer wi11 comply with a11 provisions of �the City of Zephyrhil'ls ordinances and codes �+*'�;nent to t-he build.iag. 3. That in the event various phases of construction are subcontracted, he will engage only properly liceased subcontractors and will personally supervise such work. 4, That in the event the Building Inspector sha11 re�T�'Te corrections to be made, -the owner will assume f'ull responsibility �to insure •they are made, and upon completion will ca13 for a reiaspection before proceecling with the building. 5. That the owner sha11 assume fu11 responsibilitY fcr the constructioa and wi11 not axpect_ supp.rvision of his work from the City of Zephyrhills Building Depas�esit. 6. That prior t� final inspect�.on aay additional fees, including reiaspection fees, must be paid ia ful1. A written rsquast £rom this of£ice sha11 constitute an offici.al riotice -to pay additioaal fees• 7. That the ovPner sha11 comply with a11 Ciiy, 5tate and Federal laws in regard to social security, workman's compensation, lien 1aws, etc. , where applicable. 8. That the owner sha11 co�ply with a11 t�e safe.ty codes issued by the Florida Industrial C��ssion. 9. State 1aw rez+,;res constxziction to be done by licensed contractors. You have applied for a �r+^;t under ari Bxemption to that law. The exemption allows you, as the owner of yovr property. to act as your own contractor with ce�+-=�*+ restrictions evea though you do not ha.ve a license. You must provide direct onsite supervision of the constructioa yovrself'. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial building, providad your costs do not exceed $25,000. The building or rssidence must be for yovr own use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a buildi.ng you bave bvilt or substantially i�proved yourself within 1 yeaz after the constructioa is complete, the law wi.11 presume .that you built or substantially improved •if for sale or laase, which is a violation of thi.s exempt3.on. You may not hire an unlicens�d person to act as yovt contractor or to supervise people working on your buildiag. It is your respoasibility to make sure that peaple P�FJloyed by you have licenses re�,;red by state law and by county or municipal liceasing ordiriances. You may not delegate the responsibility for supervising work to a licensed contractor who is not. licensed to pesform the work bei.ag dnaa. Any pgrson working on yous building who is not licensed must work uaiie= your direct supervisioa and must be employed by you, which meaas that you must deduct F.I.C.A. and withholding tax and provide workers' compensati.on for that employee, a11 as prescribed by law. Your construction must comply with all applicable laws, ord�siaaces, building codes, and zoning ragulatioris. DAr.L'E+ ' �y �� 3 OWNER'S S=C�IATURE ` ADDRESS � � PHONE W2TNE55 PERMIT #