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� DISCI.OSVRE S'r��'F•*�'NT .FOR OW2�R C OF ZEPHYRFi=I�I+S BiTILDING DEPARTMENT /� � . _ � � d have sead and fully understand and , agre •to the provi ions of � � s instrument• The undessigned states and affirms that he or she is desirous of constructing, r�ovating, adding to or seroofing his or her owsi domicile, •that he or she actually occupies, or wi11 occupy by said domici:le, and same is not for �rent, lease or sale. That he or she shall co-mply with the following conditioas: 1_ That the owner aad.he or she alone sha11 act as the bvilder for all phases of constsuction. 2. That th@ owner wi11 comply with a11 provisions of �the City of Zephyrhil�ls ordinances and codes pErtinent to the buildiag. 3, That in the event various phases of constructian are subcontraated, he wi11 engage only �properly liceased subcontsactors and will personal:Ly supervise such work. 4, That in the event the Building Znspector sha11 ra?"re corrections to be made, the owner will assume full responsibility to insure •they ase made, and upon completion will call for a rBinSpection before proaeecling with the building. 5. Tha.t the owner sha11 assume fu11 responsibility for the construction aad wi11 not axnect_ supervision of his work from the City of Zephyrhills Building Department. 6. That prior to final inspecti.on aay additi.onal fees, including reinspection fses, must be paid i.a �full. A written request from this office sha11 constitute an official notice to pay addi.tional fees. 7. That the owner sha11 comply with a11 City, State and Federal laws in regard to social security, workman's compensation, lien laws, etc. , where applicable. B. That the ownF+s shall comply with a11 the sa£ety codes issued by the Florida =adustrial C�+�ssion. 9. State law reC3l�ires constrtiction to be done by licensed contractors. You have applied for a ppT*^�t under an exemptioa to that law. The exe�ption allows you, as the owner of yovr property, to act as your owa contractor with cert==a restsictions even though you do not have a license. You must provide direct onsite supervision of the construction yourself. You may build or i�prove a one-family or two-f'amily residence or a farm outbuilding. You may also build or improve a commercial buildiag, provided yovs costs do not e�ceed $25,000. The building or resideace must be for yovr own use or occupancy. It may not be built or substantially improved for sale or lease. If you se]:l or lease a bvilding you have built or su2�starttially improved yourself within 1 year after the constsuction is complete, the laW wi11 prest�e •that you .built or subst�ntially improved if for sale or lease, which is a violation of this exemption. You may not hire an vnliceasad person to act as your contractor or to supervise people working on your buildisig. 2t is your responsibility to make sure that people employed by you have licenses rei,;red by sta.te law and by county or muriicipal licensiag ordinances. You may not delegate the responsibility for supervising work to a licensed coatractor raho is ziot licens@d to perform the work being doaa. Any person working ��n your building who is aot liceased must work uniies your direct super�risioa and must be P�ployed by you, which maaas that you must dgduct E.I.C.A. and withholdi.ng tax and provide workers' compensatioa for that e�ployee, a11 as prescribed by law. Yovr construction must comply �aith a11 applicable 1aws, ordinances, building codes, and zoning regulatioris. OWNER'S S2QTATLTRE��( DATE _ 75'�C� �/� ADDREBS PHONE s . W=TI1F�6S PERL�IIT #