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. DISCLOSL7RE S'f'A'►'a•*'tF-'Z.1T .FOR OW1�R CI.TY OF ZEPHYRFi27�+S SIIII.DING DEPARTt�NT _ � „ I� ��,�_ have read and fully understand and , S.i. agree •t o t h e p r e v s.s i o n s o f �t Y us instrument• The undersigned states and affirms that he or she is desirous of const=ucting, renovatiag, addin4 to or seroofing his or her own domi.cile, •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 tY,e owrier aad_he or she alone sha11 act as t-he builder for al1 phases of' constsuction. 2. That the owner will co�ply with a11 provisions of the City of Zephyrhills ord.inances and codes pEL�tissent to the 1�uildiag. 3. That in the event various phases of construction are subcantracted, he will engage only properly licensed subcontsactors and will personally s�spervise such wark. q, That iz� the event the Euilding Znspector shall rei,;*-e correctioas to be made, the owner will assume full responsibilitY to insure �they are made, and upon co�pletion will ca11 for a rp�n-�ctioa before proeeeding with the building. 5. That the owner sha11 assume fu11 responss.bility for the construction and wi11 not �cpect_ supervision of his work from the City of Zephyrhills Building Dapas�ent. 6. That prior to final inspection aay additi-ona-1 fees� �zscluding reinspection faes, must be paid ia �full. A writtan requgst from this office sha11 constitute an official notice -to pay add�-�io� f�s. - 7. That the owner sha11 comply with al1 City, State and Federal laws in regard to social security, workman's comperisaticn, lien 1aws, etc. , where applicable. 8. That the owner sha11 comply with al1 the safety codes issued by the Florida Iadustsial Commission. 9. State 1aw rec�,;�-es constrtiction to be done by licensed contractors. You have applied for a pP�^�t under an axemptioa to t�sat law. The exP.mPtion allows you, as the owner of your property, to act as your owa contsactor with ce =� restrictions enen though you do not ha.ve 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 fatm outbuildiag. You may also build or improve a commercial bvilding, provided yovr costs do not eaceed $25,000. The building or residence must be for yovr ov�n use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or substaatially improved yourself wit�in 1 year after the constructioa is complete, the laoa wi11 pres�e �that you .built or substaritially improved •if for sale or lease, which is a violation of thi.s exemption. You may not hire aa vnla.oensad �E=son to act as yovr contsactor or to supervise people working on your building. It is yovs responsibility to make sure that people employed by you have licenses rec�,;red by state law and by county or muni.cipal licensing ordinaaces. You may not delegate the responsibility for supervising work to a licensed contractor who is not liceased to perform the �vork being doaa. Any pesson wor3cing on your building who is not liceased must work uncler youz' di='@ct superPisioa azid must be employed by you, which maaas that you must deduct F.I.C.A. and vrithholdi.ng t== and provide workers' compensation for that smployee, al.l as prescribed by law. Your construction must comply with a11 applicable laws, ordinances, building codes, and zoning regulations.., OWNER' S S2 � DATE V ' 4`� � ADDRESS ��- PHONE W=TNESS \ PERM2T #