Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION/BUILDING PERMITTING
1 North University Drive, Box #302 • Plantation, Florida 33324 • 954-765-4400 • broward.org/building
OWNER/BUILDER STATEMENT/AFFIDAVIT
OWNER NAME:
SUBDIVISION: LOT: BLOCK:
STREET ADDRESS:
ATTENTION PROPERTY OWNER: If the property address is different from the address on the state-issued
identification, this form will not be accepted. (RE: Florida Driver License) If there is a change of address, Florida
Driver’s License or ID card holders have 30 days to update their address with the Florida Highway Safety and
Motor Vehicles. Please provide a copy of your state-issued driver's license.
I am applying for a Building Permit pursuant to the Owner/Builder exemption set forth in Florida Statute 489.103. Florida
law requires that I attest to the following statements.
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
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 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 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.
I understand that, as an owner/builder, I am the responsible party of record on this 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 all permit 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 this exemption. Florida State Statute 489.103(7), 489.503(6)
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 individual 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 ordinance.
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.
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.
