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• DISCLOSURE S'►'a'r'F'�•NT .FOR OWNER CZTY OF ZEPHYRFiII+ZS SVII+DING DEPARTb�NT = have read and f'ully understand and agrae •to the provisions of �this instrument• The uxzdersigned states and affirms that he or she is desirous of constructing, re�ovating, adding to or seroofing his or her own domicile, •that he or she actually occupies, or wi11 occupy by said domicile, and same is not for •rent, lease or sale. That he or she shall comply wit� the following conditions: 1. That the ovmer and_he or she alone sha11 act as the bvilder for a11 phases of construction. 2. That the owner wi:ll comply with a11 provisions of �the City of Zephyrhills ordinances and codes pertineat to the building• 3. That in the event various phases of construction are subcantracted, he wi11 engage only �properly licansed subcontractors and will personally supervise such work. 4, That i.n the event the Building Inspector shall re?"re corrections to be made, the owner v�i11 assume full responsibility to insure •they are made, and upon co�pletion will ca11 for a reinspectioa before proceeding with the building. 5. That the owner sha11 ass�e �fu11 responsibility far the constrisction and wi11 not expect_ supervision of his work from the City .of Zephyrhills Building Department. 6. That prior to £inal iaspection any additi.onal £ees, including reirispection fass, must be paid in full. A written request from this office sha11 constz.tute an official notice -to pay additional fees. . 7. That the owner sha11 co�ply with a11 City, State and Federal laws in regard to social security, workman's compansation, liea laws, etc. , where applicable. 8. That the owner shal.l comply with a11 t�se safety codes issued by the Florida Industsial Commission. 9. State 1aw re?�ires construct�.on to be done by licensed contractors. You have applied for a permi.t under aa ex�mptioa to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certain restrictions enen though you do not have a license. �You must provide direct onsite supervision o� the coastruction yourself. You may build or improve a one-family or two-family resid�ce or a farm outbuilding. You may also build or improve a commerci.al building, provided yovr costs do not exceed $25,000. The building or residence must be for yovr own use or occupancy. It may not be built or substaati.ally improved for sale or lease. 2f you se1:l or lease a building you have built or substantially improved yourself within 1 year after the constsuction is complete, the law will presume �that you .built or substantially improved �if for sale or lease, which is a violation of this ax�ption. You may not hire aa unlicansed pErson to act as your contsactor or to supervise people working on yovs build.iiag. It is your responsibility to make sure that people employed by you have licenses required by state lavr and by county or municipal licensing ordinances. You may not delegate the responsibility for supervising v�ork to a licensed coatractor who is not. licensed to perform the work being dona. Any person workiag on your building who is not licensed must work undes your diract supervision azid must be P�Ployed by you, which meaas that you must deduct F.I.C.A. and withholdiag taz and provide workers' compensation fos that employee, a11 as prescribed by law. Your coastruction must comply with a11 applicable laws, ordinances, building codes, and zoniag ations. owr�R�s sz� f ` n� 9 " ADDRESS PHONE W2TNESS PERMIT #