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• DISCLOSVRE S'�'n�*�•NT .FOR OWNER C2TY OF ZEPHYRH22:LS BUII.D2NG DEPARTA�NT _ � have read and fully understand and , - agree •to the provisions of �this instrument. The undersigned states and affirms that he or she is desirous o£ constructing, rsnovating, adding to or reroofing his or her ovrn 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 sha11 comply v,rith the followin.g conditions: 1. That the owner and_he or she alone sha11 act as the bvilder fos� a11 phases of construction. 2. That the owner wi11 comply with a11 provisions of the City of Zephyrhills ordinances and codes pertinent to the building. 3. That in the enent various phases of constsziction are subcontraated, he will engage only •properly licensed subcontsactors and will personall.y supervise such work. 4. TYiat in the event the Huilding Inspector shall rac�,;re correcta.ons to be made, the owner will assume full responsibility to iasure •they are made, and upon cc�mpletion will ca13 for a reinspection before proceeding with the building. 5. That the owner shall assume �full responsibility for the constxzictioa and wi11 not expect_ suppsvision of his mork from the City of Zephyrhills Building Depastment. 6. That prior to firial inspection any additional fees, includizig reinspection feas, must be paid in full. A v�rittan requast from this office shall constitute an official notice -to pay additioxial fees. 7_ Tizat the owner sha11 comply v�rith all City, State and Federal laws isi regard to social security, workman's compexisation, liea laws, atc. , where applicable. B. That the owner sha11 comply wit� a11 the safety codes issued b•t the Florida Industrial C��ssion. 9. State 1aw rez+,;res constsuction to be done by licensed contracl�ors. You have applied for a �*�+++;t under an exemptioa to that law. The exemption allows you, as the owner of your property, to act as your cwn contractor with ce�-=;n restsictions even though you do not have a license. You must provide direct onsite supervision of the coastruction yourself. You may bvild or improve a one-family or two-family residence or a farm outbuilding. You may also build or ;+�+r*-ove a commercial bvilding, provided your costs do not exceed $25,000. The building or residsxice must be for yovs own use or occupancy. Zt may not be built or substantially i�proved for sale or lease. If you ,se.l:l or lease a bvilding you have built or suUst�ntially improved yourself wittiin 1 year after the construction is complete, the laW �i.11 pres�e that you built or substanti.ally improved •if for sale or lease, which is a viclation of this ax�ption. You may not hire an unlicaased pErson to act as yovr contsactor or to supervise people �vorking on your buildiag. It is your responsibility to make sure that people employed by you have licesises rez,;red b,y state law and by county or municipal licensing ordinaaces. You may not delegate the responsibility for supervising work to a licensed coatractor who is not. licensed to perform the �vork being dona. Any parson working o,n your building who is not licensed must work uader Zrour direct supervision and must be employed by you, which means that you must deduct F.I.C.A. and Frithholding tax and provide workers' compeasation for that e�ployee, a11 as prescribed by law. Your construction must comply with a11 applicable laws, orclisiances, building codes, and zoning regulatioas. OWNER'S S=Q�;TLTRE -�.,- .;LL.( � - , DATE T` t{; , ��( � ADDRESS J �j .r�� . �� r" \ - � � .J L�(` PHONE -�,C`� �i, "� f 1.% i T '� W=TNESS PERMIT #