Hernando County Building Division, 789 Providence Blvd., Brooksville, FL, 34601 - (352)-754-4050 -Fax:(352)754-4416
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/dbpr/consumers.html for more information about licensed contractors. I also may
contact Hernando County Building Division at 352-754-4050.
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 Hernando County Building Division 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 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.
Disclosure Statement-(Electric)-Statement Required by Florida Statute 489.503(6)State law requires electrical contracting to be
done by licensed electrical contractors. You have applied for a permit under an exemption to that law. The exemption allows you, as
the owner of your property, to act as your own electrical contractor even though you do not have a license. You may install electrical
wiring for a farm outbuilding or a single-family or duplex residence. You may install electrical wiring in a commercial building the
aggregate construction costs of which are under $75,000. The home or building must be for your own use and occupancy. It may
not be built for sale or lease, unless you are completing the requirements of a building permit where the contractor listed on the
permit substantially completed the project. If you sell or lease more than one building you have wired yourself within 1 year after the
construction is complete, the law will presume that you built it for sale or lease, which is a violation of this exemption. You may not
hire an unlicensed person as your electrical contractor. Your construction shall be done according to building codes and zoning
regulations. It is your responsibility to make sure that people employed by you have licenses required by state law and by county or
municipal licensing ordinances.
FLORIDA STATUTE 92.525 VERIFICATION OF DOCUMENTS; PERJURY BY FALSE WRITTEN DECLARATION, PENALTY. -
(3)A PERSON WHO KNOWINGLY MAKES A FALSE DECLARATION UNDER SUBSECTION (2) IS GUILTY OF THE CRIME OF
PERJURY BY FALSE WRITTEN DECLARTION, A FELONY OF THE THIRD DEGREE, PUNISHABLE AS PROVIDED IN S.
775.082, S. 775.083, OR S 775.084.
UNDER PENALTIES OF PERJURY I DECLARE THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE
DISCLOSURE STATEMENT AND AGREE TO ABIDE BY THE PROVISIONS REGULATING OWNER/BUILDER
PERMITS SET FORTH ABOVE AND IN HERNANDO COUNTY CODE OF ORDINANCES & FLORIDA STATUTES.
Property Owner's Signature
State of:_______________________________ County of:_________________________________
The foregoing instrument was acknowledged before me this____________day of ____________________, 20_____ by
___________________________________________,who is (___) personally known to me or who (___) has produced
________________________________ as identification.
Signature of Notary Public (SEAL)