OWNER BUILDER DISCLOSURE STATEMENT
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931 6/3/2020
Phone # (239) 765 -0202 Permits@fmbgov.com Fax # (239) 765-0909
Page 1 of 2
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 the 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 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.
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 exemption.
5. I understand that, as the 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 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.
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 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.
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
http://myfloridalicense.comDbpr/pr/cilb/ 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 issued under this permit.
OWNER BUILDER DISCLOSURE STATEMENT
Town of Fort Myers Beach 2525 Estero Blvd. Fort Myers Beach, FL 33931 6/3/2020
Phone # (239) 765 -0202 Permits@fmbgov.com Fax # (239) 765-0909
Page 2 of 2
12. I agree to notify the Town of Fort Myers Beach Community Development 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 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, the
notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required
when the permit is issued.
I hereby acknowledge, that I have been provided with a copy of the Owner Builder Disclosure Statement pursuant to Florida
State Statute 489.103(7) in reference to permit number _____________________.
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:
________________________________________________________________
I further agree to notify the Town of Fort Myers Beach Community Development Department immediately of any additions,
deletions, or changes to the information for which I have been provided a permit under this disclosure.
I, _____ (Property Owner), hereby certify that
_______________________________________ is my authorized agent/representative of the property described herein. All
answers to the questions in this registration and any supplementary information attached to and made
part of this registration is honest and true.
Signature of Property Owner
Typed or printed name of Property Owner
STATE OF _____ _____ COUNTY OF ________________
The foregoing instrument was certified and subscribed before me
by means of __ physical presence
OR_online notarization,
this ______day of ___________________, 20___, by ______________________, ___ who is
personally known to me OR ___ who has produced ______________________ as identification.
(SEAL) Notary Public Signature
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