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DISCI,OSURE S'r'�'r'F*'�'NT .FOR OW1�R CITY OE ZEPFiYRHII+I+S BIIII.DSNG DEPARTMENT 2 �� have read and fully understand and agree �to the provision of �this inst=ument• The undersigned states and affirms that he or she is desirous of constructing, res,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 s2kzl.l comply vrith the following conditions: 1, That the owner and_he or she alone sha11 act as the builder for a11 phasas of construction. 2. That the ovrner will comply with aZl provisions of the City of Zephyrhil'ls ordinances and codes pertineat to the buildixiJ• 3. That in the event vasious phases of construction are subcontracted, he wi11 engage only prop�rly licensad subcontsactors and will personally supervise such work. q. That in the event the Building =nspector sha11 rac�,;re corrections to be made, the owner will assume full respoasibility to insure •they are made, asid upon campletion will ca11 for a rei*+-�ction be£ore proceeding with the building. 5. That the ownes sha11 assume fu11 responsibility for the constsuction and wi11 not expect_ supervision of his work from the City of Zephyrhills Building Depar��t. 6. That prior to final inspection aay additional fees, inclndin4 reinspection fees, must be paid in ful1. A written raquest from this office shall constitute an official notice -to pay additiorial faes. . 7. That the owner sha11 comply with a11 City, Sta.te and Federal laws ia reC3aSd to social security, workman's c�+�p*+�ation, lien 1aws, etc. , where applicable. B. That the owner sha11 comply with a11 the safety codes issued by the Florida Industrial C��ssion. 9. 5tate 1aw re�T�Tes construction to be done by licensed contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as the oavner of your propErty, to act as yovr owa contractor with certain restricti.ons even though you do not have a license. You must provide direct onsite supesvision o� the cosistructi.on yovrself. You may build or improve a one-family or two-family residence or a fazm outbuilding. You may also build or improve a eommescial building, provided yovr costs do aot exceed $25,000. The building or resideACe must be for your own use or occupancy. It may not be built or substantially improved for sale or lease. If you se]:l or lease a building you have bvilt or su2�stasitially improved yourself within 1 year after the constniction is complete, the la�v wi11 prest�e •that you built or substantialZy improved •if for sale or lease, which is a violation of this exempt�.on. You may not hire an unlicansad person to act as your coatractor or to supervise people working on yovr building. 2t is your responsibility to make sure that people e�ployed by you have licenses rez,;red by state law and by county or municipal licensing ordinaaces. You may not delegate the responsibility for supervising work to a licensed contractor who is not licensgd to perform the work beirig dnae. Any person working on yovr building who is not licensed must wor3c under yovs dirsct supervision and must be P�ployed by you, which means tha.t you must deduct F.I.C.A. and vrithholding tax and provide workers' comperisatioa for that employee, a11 as prescribed by law. Your construction must comply with a11 applicahle 1aws, ordinances, bua.lding codes, and zoning r� s. ) � OWNER'S S2GDIATURE �L Z DATE ' a - ADDRE 5 S ��.�/B ✓ PHONE - S WZTNE S � PERMIT #