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DISCLOSURE S'�'A'�'�•�'NT .FOR OWI�R CITY OF ZEPHYRHII�LS SLTII�DING DEPARTMENT _� � � Z��- have read and fully understand arid agr •to e 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 actually occupies, or wi11 occupy by said domicile, and same is not for •rent, lease or sale. That he or she shall comply Frith the following conditions: 1. That the owner and_he or she alone sha11 act as the builder for all phases of constsuction. 2. That the owner will comply with a11 provisions of �the City of Zephyrhills ordinances and codes �*�+-;nent to tbe buildiag. 3. That in the event various pha.ses of constructioa are subcontracted, he will engage only •properly licensed subcontractors and will personally supervise such work. 4. That in the event the Building Inspector shaZl rec�'�re corrections to be made, the ovtner will assume full responsibility -to insure •they are made, and upon campletion will ca13. for a reinspectioxi before proceeding with the building. 5. That the owner shall assume fu11 responsi.bility for the construction aad wi11 not axpect_ supervision of his work from the City of Zephyrhills Building Depast�ent. 6. That prior to final inspection aay additional fees, including reinspection fses, must be paid in ful1. A writtan request from this office sha11 constitute an official notice to pay addi.tiorlal fees.. 7. That the owner sha11 camply with a11 City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc. , where a7�plicable. B. �hat the owne= sha11 comply with a11 the safety codes issued by the Florida Industrial Commi.ssion. 9. State law rern�ires construction to be done by licensed contractors. You have applied for a pexmit under an exemption to that law. The exemption allows you, as the owner of' your propPSty, to act as your own contractor with eertain restrictions even though you do not have a license. You must provide direct onsite supervision of' the construction yourself. You may build or improve a one-family or two-family residence or a fas.� outbuildiag. You may also build or improve a commercial building, provided your costs do not exceed $25,000. The building or residence must be for your own use or oc.c^..�.xpancy. It may not be built or substantially improved for sale or lease. If you se]:l or lease a building you bave built or substantially improved yourself within 1 year aftPS the construction is complete, the law will presvme •that you built or substantially improved •if for sale or lease, which is a violation of this EXemption. You may aot hire an ualicensed person to act as your contractor or to supervise people working on yovr building. It is your responsibility to make sure that people employed by you have licenses rernTired by state law and by county or munica,pal licensing ordinaaces. You may not delegate the responsibility for supervisi.ng work to a licensed contractor who is not licensed to perform the ovork being doae. Any person working on your building who is not licensed must work under yovs direct supervision and must be P�ployed by you, which meaas that you must deduct E.2.C.A. and withholcling taz and �provide workers' compensation for that employee, a11 as prescribed by law. Your construction must comply with a11 applicable 1aws, ord.isiances, building codes, and zoning regulatioas. 7 ' �,./ / OWNER'S S GTTATLTRE � DATE �/7��/..�G/� ADDRESS v PHONE - W2TNESS � - PERL�T #