PERMIT APPLICATION CHECK LIST
_____________1) PROPERTY CARD - OBTAINED FROM PROPERTY APPRAISER’S OFFICE OR
THEIR WEBSITE: WWW.DESOTOPA.COM.
_____________2) APPLICATION FULLY COMPLETED WITH NOTARIZED SIGNATURE(S). ALL
SIGNATURES MUST BE NOTARIZED WHERE INDICATED-ORIGINAL SIGNATURES ONLY (NO COPIES
OR FAXES ACCEPTED FOR PERMIT ISSUANCE).
_____________3) OWNER/BUILDER DISCLOSURE STATEMENT IS REQUIRED IF THE OWNER IS ACTING
AS THEIR OWN CONTRACTOR. CERTAIN RESTRICTIONS APPLY AND THESE ARE LISTED ON THE
OWNER BUILDER DISCLOSURE SHEET.
_____________4) NOTICE OF COMMENCEMENT (REQUIRED ONLY IF CONTRACT COST EXCEEDS
$2,500.00). THE NOTICE OF COMMENCEMENT MUST BE COMPLETED, SIGNATURE NOTARIZED, AND
FILED IN THE CLERK OF COURT’S OFFICE AND THEN A COPY OF THE FILED NOTICE MUST BE
RETURNED TO THIS OFFICE WITH THE APPLICATION. A SECOND COPY OF THE FILED NOTICE MUST
BE POSTED AT THE JOB SITE.
_____________5) AN APPROVED ZONING REQUEST AND SITE PLAN FROM THE PLANNING
DEPARTMENT. BEGINNING OCTOBER 1, 2006, ANY LOCATION INSIDE THE CITY LIMITS MUST HAVE
A COMPLETED AND APPROVED CITY APPLICATION FROM THE CITY BEFORE SUBMITTING THIS
_____________6) RESIDENTIAL SWIMMING POOL, SPA, AND HOT TUB SAFETY ACT-NOTICE OF
_____________7) CONSTRUCTION AND DEMOLITION DEBRIS DISPOSAL METHOD FORM.
DESOTO COUNTY BUILDING DEPARTMENT
126 N. Hillsborough Ave * Arcadia, Florida 34266 * Phone: (863) 993-4811 * Fax (863) 993-4815
* Lester Hornbake, Jr., Building Official
Owner Phone Contractor Phone
Mailing Address_____________________________ Address_____________________________________________
Project Street Address________________________________________________________________________________
Directions to Project_________________________________________________________________________________
Description of Project________________________________________________________________________________
Intended Use________________________________________________________Contract Cost $__________________
Fee Simple Titleholder’s Name and Address (If other than the Owner) _________________________________________
Bonding Company’s Name and Address_________________________________________________________________
Architect/Engineer’s Name and Address_________________________________________________________________
Mortgage Lender’s Name and Address__________________________________________________________________
Warning to Owner:
Your failure to record a notice of commencement may result in paying twice for improvements to your property. If you
intend to obtain financing, consult with your lender or attorney before recording your notice of commencement.
Owner & Contractor Must Read Before Signing: This application is hereby made for permit(s) for the project
indicated above. To the best of our knowledge, the information contained herein and on all submitted documents is
correct and complete. We declare that a work requiring permit has not yet begun at the work location and understand that
work may not begin until permits are issued. We understand that permits or approvals may be revoked if there has been
any false statement or misrepresentation as to the facts made on this application or on any of the submitted documents.
We certify that any wetlands on this property will not be disturbed before, during or after Building of this property as part
of this permit.
Owner’s Affidavit: I have read the Warning To Owner statement. If I am an owner acting as my own contractor, I
certify I am the property owner and I have read and signed the Owner-Builder Disclosure Statement and meet the
exemption requirements for an owner-builder permit.
Owner and Contractor must both sign below if the contract amount exceeds $2,500 unless the
contract is for the replacement of A/C equipment at a cost of $7,500 or less. If Notice of
Commencement has been signed by owner and submitted prior to, or with, this application,
owner’s signature is not required on this application form.
Owner Signature Date Contractor Signature Date
Signed and sworn before me on this ___day of______________, 20__ Signed and sworn before me on this ___day of __________________, 20___
By ____________________________.He/She is personally known to me or by ____________________________.He/She is personally known to me or
Has produced _________________________ as identification. Has produced _________________________ as identification.
Notary as to Owner_____________________________ Notary as to Contractor_________________________________
FOR OFFICE USE ONLY
RECEIVED BY: __________________DATE RECEIVED: _______________________ TRACKING: _____________________
Permit #: ________________________TOT. SQ.FT________@$.04/SQ.FT=$:________
CIRCLE ITEMS RECEIVED: 1 2 3 4 5 6 7 8 9 10
R-O-W PERMIT #:__________________SEPTIC PERMIT #:_____________________
Contractor Assignment and Authorization
Each contractor must sign this form prior to permits being issued for that trade. By signing this form, the contractor accepts responsibility for work
performed by authorization of the permit issued for this project and agrees to comply with all applicable laws, codes, ordinances, and regulations that
govern the work. An owner may sign only if eligible by law to perform such work.
PROJECT STREET ADDRESS__________________________________________________________________
Permit Type Required Contractor License Contractor’s Signature Date
Building 1,2,3,4,5,7 &10
Electrical 1, 6 &10
Plumbing 1,3,7 & 10
Mechanical 5,7 & 10
Aluminum 1,2,7,9 & 10
Gas 1,7 & 10
Roofing 7 & 10
Drywall 7 & 10
Carpentry 7 & 10
Masonry 7 & 10
Concrete 7 & 10
7 & 10
7 & 10
 Three sets of plans showing specific details of the work. (One set will be returned)
 Site plan with legal description, showing septic system location, distances between proposed and existing structures and setbacks from all
 Septic tank permit or system verification from Health Department (non-sewer areas). Where sewer is available, provide name of utility
providing service & letter verifying availability of service for this project
 Right-of-way permits if any construction is going to take place in the County/public right of way or an original notarized
letter stating that there is an existing right-of-way with no changes being made.
 Completed, signed Florida energy code form (central zone 5) for buildings and additions subject to energy code. Include one complete
form & two cover sheets. Provide equipment load sizing calculation for heating/cooling equipment. (Manual J, Manual N or equivalent)
 In comments below, provide a general description of electrical work. If a new service or service change is involved, include intended use
of service and service rating in amps, volts and number of phases.
 In comments below, provide any additional details necessary to describe work to be done.
 For mobile home installations include the mobile home supplementary information sheet with this application. If mobile home is new, a
blocking diagram from the manufacturer must be provided. If the mobile home is used a pre-inspection must be performed.
 Authorized aluminum engineering details showing connections, foundations, spans, material specifications and design of the aluminum
 Property card and/or proof of ownership.
OWNER-BUILDER DISCLOSURE STATEMENT
If you are an owner acting as your own contractor, it is required that you read each section of the
following and sign the acknowledgement on the bottom in the presence of a notary public.
State law requires construction to be done by licensed 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 contractor with certain restrictions
even though you do not have a license. You must provide direct, onsite supervision of the construction yourself. You may
build or improve a one-family or two-family residence or a farm outbuilding. You may also build or improve a
commercial building, provided your costs do not exceed $75,000. The building or residence must be for your own use or
occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a building you have built or
substantially improved your self within 1 year after the construction is complete, the law will presume that you built or
substantially improved it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person
to act as your contractor or to supervise people working on your building. 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. You 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 your building who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' compensation for
that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building
codes, and zoning regulations.
1. You may not hire an unlicensed person to act as you contractor or to supervise people working on your
building. 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.
2. You may not delegate the responsibility for supervising work to a licensed contractor who is not
licensed to perform the work being done.
3. Any person working on your building who is not licensed must work under your direct supervision and
must be employed by you, which means that you must deduct F.I.C.A. and Withholding Tax and provide
Workers’ Compensation Insurance for that employee, all as prescribed by law.
4. Your construction must comply with all applicable laws, ordinances, building codes, and zoning
5. Florida Law requires an owner acting as their own contractor to personally appear and sign the permit
application at the Building Department Office. A notarized signature will not be accepted.
6. Florida Statute 455.228 provides for a penalty of up to $5,000 for anyone obtaining permits in order to
evade contractor licensing laws.
I acknowledge that I have read and understand the information on this page and that I agree to abide these
Owner-Builder Signature Project Address
Signed and sworn to before me on this _____day of _____________________________20__
By_____________________________________________________. He/She is personally known to
me or has produced_______________________________________________________as identification.
Notary Public State of Florida at Large reference: Florida Statute: FS 489.103 (7) and 455.228
DESOTO COUNTY BUILDING
RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT
NOTICE OF REQUIREMENTS
I (We) acknowledge that a new swimming pool, spa, or hot tub will be constructed or installed at
____________________________________________________, and hereby affirm that one of the following
methods will be used to meet the requirements of Chapter 515, Florida Statutes.
(Please initial the method(s) to be used at the addressed referenced above)
_______________ the pool will be isolated from access to the home by an enclosure that meets the pool barrier
requirements of Florida Statute 515.29.
_______________ The pool will be equipped with an approved safety pool cover that complies with ASTM
F1346-91 (Standard Performance Specifications for Safety Covers for Swimming Pools, Spas and Hot Tubs).
_______________ All door and windows providing direct access from the home to the pool will be equipped
with an exit alarm that has a minimum sound pressure rating of 85 decibels at 10 feet.
_______________ All doors providing direct access from the home to the pool will be equipped with self-
closing, self-latching devices with release mechanisms placed no lower than 54” above the floor or deck.
I (We) acknowledge that not having one of the above installed at the time of final inspection, or when the pool
is completed for contract purposes, will constitute a violation of Chapter 515, Florida Statutes and will be
considered as committing a misdemeanor of the second degree, punishable by fines up to $ 500.00 and/ or up to
60 days in jail as established in Chapter 775 of the Florida Statutes.
Print Owners Name Date Owners Signature
Print Contractor’s Name Date Contractor’s Signature
Construction and Demolition Debris Disposal Method Form
Desoto County Ordinance number 2006-35 dictates that prior to a building permit being issued for the construction or renovation of any structure, the applicant shall
provide for the collection and disposal of any construction and demolition debris. No permit will be issued until one of the two following methods is chosen.
1. The applicant may choose to enter into a contract with the franchisee of the county. (Womack Sanitation Inc.)
2. The applicant may self haul their own waste to an authorized landfill using the applicants equipment and bona fide staff personnel of the applicant.
I choose to:
_________ 1. Use County Franchisee – attach contract with Womack Sanitation Inc.
_________2. I will self haul – I will dispose of all construction and demolition debris at a licensed disposal facility. You will be required to show evidence of proper
disposal upon request of code enforcement or any other county department.
Self Haulers Equipment List
Make______________________ Model_______________________ Color________________________
Tag Number(s) ___________________________ Serial Number(s) ____________________________
Attach additional numbers the reverse side of this form if needed.
THIS IS TO CERTIFY THAT I AM THE OWNER, OR THE OWNER’S DULY AUTHORIZED AGENT, OF THE PROPERTY IDENTIFIED HEREIN AND ALL
INFORMATION FILED HEREWITH IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT
FAILURE TO SUBMIT A COMPLETED APPLICATION WILL BE CAUSE FOR NOT ACCEPTING THE APPLICATION. (NOTE: THE ATTACHED
AFFIDAVIT OF OWNERSHIP AND AGENT AUTHORIZATION MUST BE COMPLETED IF AN AGENT IS USED).
(OWNER/APPLICANT SIGNATURE) (DATE)
THE FOREGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS _________
DAY OF ___________________, 20_____ BY _______________________________ WHO
IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED _____________________
AS IDENTIFICATION AND WHO DID NOT TAKE AN OATH.
NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXPIRES
EXHIBIT B – AFFIDAVIT OF OWNERSHIP AND AGENT AUTHORIZATION
(TO BE COMPLETED ONLY IF AN AGENT IS USED)
(NAMES OF PROPERTY OWNER(S))
BEING FIRST DULY SWORN, DEPOSE(S) AND SAY(S)
1. THAT (I AM/WE ARE) THE OWNER(S) AND RECORD TITLE HOLDER(S) OF THE FOLLOWING DESCRIBED PROPERTY, TO WIT:
The following is an excerpt from Desoto County Ordinance number 2006-35.
Section 7. Construction and demolition debris.
Section 7.1 Prior to the issuance of a building permit for the construction or renovation of any structure, the applicant shall provide for the collection and disposal of any construction and
demolition debris which may result from the construction. In order to obtain a building permit for the construction of any structure, the applicant shall indicate in writing on forms provided by
the county which of the following methods of collection and disposal shall be used:
Section 7.1.1 The applicant will contract with the franchisee to collect and properly dispose of all construction and demolition debris generated; or
Section 7.1.2 The applicant will self-haul, that is, provide for the collection, recycling, or disposal of construction and demolition debris at an authorized landfill using bona fide
staff personnel of the applicant and equipment for such collection and disposal that is acceptable to the county.
Section 7.2 No building permit shall be issued by the county until one of the above alternatives has been selected by the applicant.
The billing and collection of fees for collection and disposal of construction and demolition debris shall be the sole responsibility of the franchisee collector. The county may by
separate ordinance or resolution provide for standard rates and fees for collection of construction and demolition debris. All such collection and disposal shall be the responsibility of the
applicant for the building permit. All construction and demolition debris collected shall be recycled or disposed of at an authorized landfill.
ARTICLE IV. MISCELLANEOUS: PENALTIES; REMEDIES
Section 1. Penalties. Any person found guilty of violating any provisions of this ordinance shall be punished by a fine not exceeding $500.00 or by imprisonment in the county jail for not
more than 60 days, or by both such fine and imprisonment.
. Remedies. In addition to the penalties as provided herein, the county may have recourse to such remedies as provided in law and equity to ensure compliance with the provisions of this
ordinance, to include temporary and permanent injunctive relief and recovery of damages, or actions before the Special Master to achieve compliance by corrective orders and fines enforceable
by liens upon the realty of the offender. Each day a violation of this ordinance continues unabated shall be deemed a separate violation of same for penalty purposes. Administrative fines, as
provided in §381.0061, F.S., or in a franchise agreement, may be imposed by the health authority should conditions necessitate.
NOTICE OF COMMENCEMENT
State of Florida
County of Desoto
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following
information is provided in this Notice of Commencement.
1. Description of property: .
2. General description of improvement: _____ ____.
3. Owner information:
a. Name and address:
b. Interest in property: _____________________________ __.
c. Name and address of fee simple titleholder (if other than Owner):_ _____________ ____.
a. Name and address: ________________________________________________________________________________.
b. Contractor’s phone number: _________________________________________________________________________.
a. Name and address: ____ __ ______.
b. Phone number: _ __ ___.
c. Amount of bond: $_ ____ __ ____.
a. Name and address: ________________________________________________________________________________.
b. Lender’s phone number: _____ ___.
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1) (a) 7. Florida
a. Name and address: ____ __ ______.
b. Phone numbers of designated persons: ____ _.
8. a. In addition to himself or herself, Owner designates _____ __________ of _____ __________ to receive
a copy of the Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes.
b. Phone number of person or entity designated by owner: _____ ____.
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) ____ _.
The foregoing instrument was acknowledged before me this ______day of , _20___, by
____________________________________________as ____________________________________________ for
_______________________________________________________________________. (WARNING TO OWNER: ANY PAYMENTS MADE
BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS
UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE
BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
_________________________________________ ______________________ (Signature of Owner )
(Signature of Notary Public - State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known _____ OR Produced Identification ______
Type of Identification Produced:
Verification pursuant to Section 92.525, Florida Statutes.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief.