1. I understand that state law requires construction to be done by a licensed contractor and have applied for an
owner-builder permit under an exemption from the law. The exemption specifies that I, as owner of the
property listed, may act as my own contractor with certain restrictions even though I do not have a license.
2. 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.
3. 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. 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.
4. 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
5. I understand that, as owner-builder, I must provide direct, onsite supervision of the construction.
6. 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.
7. I understand that it is a frequent practice of unlicensed persons to have a 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 to workers on my property.
8. 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.
9. I agree that, as the party legally and finically 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.
10. 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/construction-industry/
for more information
about licensed contractors.
11. 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:
12. I agree to notify City of Groveland Building Department immediately of any additions, deletions, or changes to
any of the information that I have provided on this disclosure.
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 the 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.
Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner
and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner’s driver
license, notarized signature of the property owner, or other type of verification acceptable to the local permitting
agency is required when the permit is issued.
Signature:________________________________________ Date:__________________________
STATE OF ____________________COUNTY OF ________________________
Sworn to and subscribed and acknowledged before me this___________ day of _____________20_____
by ________________________________, who is personally known to me or who has produced
_______________________________as identification and who did ___ or did not ___ take an oath.
___________________________________(signature of NOTARY PUBLIC)
___________________________________(Printed name of NOTARY PUBLIC)
State of _____________________ at Large My commission expires:________________________
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