Fillable Form 20: Community Development Department (Charlotte County BCC)

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Form 20: Community Development Department (Charlotte County BCC)

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BROWSE CHARLOTTE COUNTY BCC (FL) FORMS

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Community Development Department
Building Construction Division
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingConstruction@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
Permit Number:
For Office Use Only
Application date:
20
CSR Initials
OWNER-BUILDER DISCLOSURE STATEMENT
(Per Florida Statute F-S 489.103.7.b)
PLEASE READ THE STATEMENT BELOW CAREFULLY. FAILURE TO COMPLY WITH THIS STATEMENT SHALL RESULT IN
YOUR PERMIT BEING REVOKED BY THE BUILDING OFFICIAL AND MAY RESULT IN FINES UP TO $10,000.
I understand that State law requires construction to be done by licensed contractor and have applied for an owner/builder
permit under an exemption to that law. The exemption specifies that I, as the owner of the property listed, may act as my
own contractor with certain restrictions even though I do not have a license.
I understand that, as an owner-builder, I am the responsible party of record on a permit. I understand that I may protect
myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my
own name. I also understand that a contractor is required by law to be licensed in Florida and to list his or her license
numbers on permits and contracts.
I understand that I may build or improve a one-family or two-family residence or a farm outbuilding. I may also build or
improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my own use or
occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or
substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I
built or substantially improved it for sale or lease, which violates the exemption.
I understand that, as the owner-builder, I must provide direct, onsite supervision of the construction.
I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building
or residence. It is my responsibility to ensure that the persons whom I employ have the licenses required by law and by
county or municipal ordinance.
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I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the
construction and is not hiring a licensed contractor to assume responsibility.
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I understand that it is a frequent practice of unlicensed persons to have the property owner obtain an owner-builder permit
that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner-builder, may
be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or her
employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am
willfully acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my
property.
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I understand that I may not delegate the responsibility for supervising work to a licensed contractor who is not licensed to
perform the work being done. Any person working on my building who is not licensed must work under my direct
supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal
income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers'
compensation for the employee. I understand that my failure to follow these laws may subject me to serious financial risk.
I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,
the United States Small Business Administration, the Florida Department of Financial Services, and the Florida Department of
Revenue. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or www.
myfloridalicense.com/dbpr/pro/cilb/index.html for more information about licensed contractors.
I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable
laws and requirements that govern owner-builders as well as employers. I also understand that the construction must comply
with all applicable laws, ordinances, building codes, and zoning regulations.
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05/2011
A recorded Notice of Commencement is required in the Permitting Office prior to the first inspection.
(Page 1 of 2)
Community Development Department
Building Construction Division
18400 Murdock Circle | Port Charlotte FL 33948
Building Phone: 941.743.1201 | Building Fax: 941.764.4907
Zoning Phone: 941.743.1964 | Zoning Fax: 941.743.1598
BuildingConstruction@CharlotteCountyFL.gov
www.CharlotteCountyFL.gov
Permit Number:
For Office Use Only
Application date:
20
CSR Initials
Plumbing
Roofing
Solar Systems
Spa /Swimming Pools
Insulation
Carpentry
Drywall
Cement, Concrete, Masonary
Ceramic/Marble/Terrazzo
Plaster/Stucco/Spraycrete
Painting and Wallcovering
Other (Detail Below)
Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who
does not have a license, the Construction Industry Licensing Board and Department of Business and
Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of a
complaint. Your only remedy against an unlicensed contractor may be in civil court. It is also important for you to
understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your
property, you may be held liable for damages. If you obtain an owner-builder permit and wish to hire a licensed
contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the
contractor's workers' compensation coverage.
I am aware of, and consent to, an owner-builder building permit applied for in my name and understand that I am the party
legally and financially responsible for the proposed construction activity at the following address:
Number and Street City Zipcode
I agree to notify Charlotte County Community Development, Building Division, immediately of any additions, deletions, or
changes to any of the information that I have provided on this disclosure.
OWNER-BUILDER DISCLOSURE STATEMENT
(Per Florida Statute F.S. 489.103.7.b)
10/2020 jg
A/C & Heat
Electric
Aluminum
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CHECK THOSE CONTRACTOR CATEGORIES BELOW WHICH WILL BE DONE BY THE OWNER
The undersigned applicant agrees to comply with the provisions as outlined herein and with all Federal, State, and Local codes. It is further understood that a violation of
any applicable code may result in a stop work order being issued and a cessation of all work until such violation has been remedied. The undersigned applicant for this
building permit does hereby certify that Applicant has or will, prior to the performance of any work in connection with the authorization granted under this permit,
comply with the provisions of the: Florida Workman's Compensation Act; Social Security Act; Florida Child Labor Laws; Contractor's/Employer's Liability Insurance
Requirements; and all other applicable Federal, State, and Local laws, a violation of which may invoke penalties.
Under penalties of perjury I declare that I have read the foregoing document and that facts stated are true, correct and in compliance
with the applicable regulations. F.S.92.525
NOTICE: All subcontractors must have a Charlotte County Certificate of Competency. Permit is void if construction is not started within
180 days or does not receive an approved inspection within 180 days from date of issue. An approved inspection will extend the permit
for an additional 180 days. Starting work prior to issuance of a permit may result in a penalty fee of up to four times the permit fee.
Gas Piping
Fence
Landscape Irrigation
A recorded Notice of Commencement is required in the Permitting Office prior to the first inspection.
(Page 2 of 2)
Owner Builder Signature:
Date:
Printed name:
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Form 20: Community Development Department (Charlotte County BCC)

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Completed 13 February 2021

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