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� �ISCLOSVRE S'�'a'rF•*�N'►' .FOR OW1�R CITY OF ZEPHYRF327+'LS BLTIS,DING DEP1�1F�'�'►�'NT _ • have read and fully understand and , agree 'to the provisions o£ 'this instrument. The undersigned states and affirms that he or she is desirous o£ constnicting, renovating, adding to or seroofing his or her o�an damicile, •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 with the f'ollowiing conditions: 1. That the owzier aad_he or she alone sha11 act as the builder for a.11 phases o£ constructi.on. 2, That the owner wi11 comply with a11 provisions of the City of Zephyrhills ordinances and codes �*'*;nent to the building. 3. That in the event various phases of construction are subcontracted, he will engage only �properly licensed subcontsactors and will pPSSOna11y supervise such viork. 4. That in the event the Huilding Inspector sha11 rei,;re correcti.ons to be made, the owner will assume full responsibility to insvre •they are made, and upon cc�pletion will cal'1 for a reinspection before proceecling with the building. 5. That the owner sha11 assume fu11 respoasibility for the consi-suctioa aad v�i11 not expect_ suppsvision of his work from the City of Zephyrhills Building Department. 6. T2iat prior to final inspection aay additional fees. including reinspection fees, must be paid ia full. A written raquest £rom this office sha11 constitute an official notice -to pay additional faes. . 7. That the ownes sha11 comply with a11 City, State and Federal laws in regard to social security, workman's compesisation, lien 1aws, etc. , where applicable. 8. That the owner sha11 comply with a11 the safety codes issued by the Floric3a Industrial Commissioa. 9. State 1aw rec�,;res coastniction to be done by licensed contractors. You have applied for a permit under axi exempt3.on to that law. The exemption allows you, as the own@r of your prope.rty, to act as your owa contsactor with certain restrictions even though you do not ha.ve a licease. You must provide direct onsite supervision of the coxistruction yourself. You may build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a commercial buildin4, provided your costs do not exceed $25,000. The building or residassce 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 bvildiag you have built or substanti.ally improved yourself withia 1 y�ar after the construction is complete, the la�v wi.11 pres�e that you built or subst�ntially improved •if for sale or laase, which is a violation of t�is eaemption. You may not hire aa ualicaasad person to act as your contsactor or to supervise people �vorking on your building. It is your responsibility to make sure that people employed by you have licenses rei,;red by state law and by covnty or municipal liceasing ordinances. You may not delegate the responsibility for supervising work to a licensed contractor who is not. licensad to pgrform the work beissg doaa. Any parson working on your building who is not licensed must wor3c under your direct supervision and must be amployed by you, which meaas that you must deduct E.I.C.A. and withholding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with a11 applicable 1aws, ordinances, building codes, and zoning regulatioas. OWNER'S SIQ�TLTRE 7'° � _ �� J��r-e�✓'b ` DATE ADDRESS PHONE W2TNESS PEFIM2T #