HomeMy WebLinkAbout1011 Sanford Ave 12-1506i ( r
APR 2 3 2012 CITY OF SANFORD
&FIRE PREVENTION
BUILDING
__—
- PERMIT APPLICATION
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Application l o t_a Documented
Construction Value: $
Job Address: /'Nz
Historic District: Yes ❑ No ❑
Parcel ID:
R-2/
Zoning: /� 1
Description of Work:
-'
Title: SAD
Plan Review Contract Person:
Phone: (41 V .� 1.13 S'� Fax:
E -mail:
Property Ow Der Information
LL
Name i� p ��u! 3 '
rIlQ Phone:
Street• 11991S ST A.41 TyJr
Resident of property?
City, State Zip: _Vd- -4, f l 3 2 1171
Contractor Information
Name
Phone:
Street: Fax:
City, State Zip: State License No.:
Architect /Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip:
Bonding Company:
Address
Building Permit ❑
Square Footage:
No. of Dwelling Units:
Electrical ❑
New Service — No. of AMPS:
E -mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
Mechanical ❑ (Duct layout required for new systems)
No. of Stories:
Plumbing ❑
New Construction - No. of Fixtures:
Fire Sprinkl / rm ❑ No. of heads:
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OWNER BUILDER 5 -IAI LMtN 11AMUAVII V
Altamonte Springs, Casselberry, LakeNary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for
homeowners from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
Rev. 9.14.2009
)y a licensed contractor and have applied for
he exemption specifies that I, as the owner of
ain restrictions even though I do not have a
ped by a property owner unless he or she is
)ntractor to assume responsibility.
)arty of record on a permit. I understand that I
icensed contractor and having the permit filed
ind that a contractor is required by law to be
R permit and contracts.
wo- family residence or a farm outbuilding. I
osts do not exceed $75,000. The building or
t be built or substantially improved for sale or
ially improved myself is sold or leased within
esume that I built or substantially improved it
onsite supervision of the construction.
person to act as my contractor or to supervise
ponsibility to ensure that the persons whom I
nce.
)ersons to have the property owner obtain an
perry owner is providing his or her own labor
and subjected to serious financial risk for any
;mployees while working on my property. My
se injuries. I am willfully acting as an owner-
e for injuries to workers on my property.
upervising work to a licensed contractor who is
working on my building who Is not licensed
employed by me, which means that I must
income tax and social security contributions
i) and must provide workers' compensation
these laws may subject me to serious financial
I understand that state law requires construction to be done t
/
an owner- builder permit under an exemption from the law. T
f
the property listed, may act as my own contractor with cert
license.
ll
J •
I understand that building permits are not required to be sib
responsible for the construction and is not hiring a licensed cc
I understand that, as an owner- builder, I am the responsible I
may protect myself from potential financial risk by hiring a I
in his or her name instead of my own name. I also underst,
licensed in Florida and to list his or her license numbers on a
I understand that I may build or improve a one - family or 1
may also build or improve a commercial building if the c
residence must be for my own use or occupancy. It may nol
'
lease. If a building or residence that I have built or substant
in 1 year after the construction is complete, the law will pr
for sale or lease, which violates this exemption.
I understand that, as the owner - builder, I must provide direc'
I understand that I may not hire an unlicensed individual
persons working on my building or residence. It is my reE
employ have the licenses required by law and by city ordina
I understand that it is a frequent practice of unlicensed I
owner- builder permit that erroneously implies that the pro
and materials. I, as an owner- builder, may be held liable
U"
injuries sustained by an unlicensed person or his or her e
homeowner's insurance may not provide coverage for the
builder and am aware of the limits of my insurance coverag
I understand that I may not delegate the responsibility for s
.not licensed to perform the work-being done. Any person
must work under my direct supervision and must be
comply with laws requiring the withholding of federal
under the Federal Insurance Contributions Act (FICA
for the employee. I understand that my failure to follow
risk.
Rev. 9.14.2009
)y a licensed contractor and have applied for
he exemption specifies that I, as the owner of
ain restrictions even though I do not have a
ped by a property owner unless he or she is
)ntractor to assume responsibility.
)arty of record on a permit. I understand that I
icensed contractor and having the permit filed
ind that a contractor is required by law to be
R permit and contracts.
wo- family residence or a farm outbuilding. I
osts do not exceed $75,000. The building or
t be built or substantially improved for sale or
ially improved myself is sold or leased within
esume that I built or substantially improved it
onsite supervision of the construction.
person to act as my contractor or to supervise
ponsibility to ensure that the persons whom I
nce.
)ersons to have the property owner obtain an
perry owner is providing his or her own labor
and subjected to serious financial risk for any
;mployees while working on my property. My
se injuries. I am willfully acting as an owner-
e for injuries to workers on my property.
upervising work to a licensed contractor who is
working on my building who Is not licensed
employed by me, which means that I must
income tax and social security contributions
i) and must provide workers' compensation
these laws may subject me to serious financial
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