HomeMy WebLinkAbout2821 S Magnolia Ave 18-4723CITY Of
_ C A �40RD PERMIT APPLICATION
BUILDING DIVISION
Application No:
Documented Construction Value: $ 15-0,
4&b�dress: 2-92-1art noltcc Vit Historic District: Yes❑No❑
Parcel ID: 01' 20- 30. 513- O 0 0 - d 130 Residential Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Dpi ouofWork:1nk t Ja'}ec irx.v' <C Fq)ctLe WI eA6±
Plan Review Contact Person:
Phone:
Fax.
Title:
,// Property Owner Information.
KQ
ame e' V 1 i � t til �.P_ Phone: (D + l0 2.3 �' 8 gip
t Street: 28 Z 5 • fy),a lot AvP— Resident of property? : NC5
City, State Zip: Sar`�rcA FL 32-7-7 3
(2",IL=
Street:
City, State Zip:
V
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Contractor Information
Phone:
Fax:
State License No.:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 RECORDING YOUR NOTICE OF COMMENCEMENT
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior
to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand
that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners,
etc.
PBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6t° Edition (2017) Florida Building Code
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that maybe found in the public
records of this county, and there may be additional permits required from other governmental entities such as water management districts, state
agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713
The City of Sanford requires payment of a plan review fee at the time', of permit submittal. A copy of the executed contract is required in order to
calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value
will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated
charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued.
OWNER'S AFFIDAVIT: I certify that all of the forgoing information is accurate and that all work will be
done in compliance with all applicable laws regulating construction and zoning,
----<— 12 40 l 1
Signature o Owner/Agent Date
Name
EXPIRES: F
Bonded Thw4
Owner/Agent is _ P
Produced ID Type of ID
a a U.
# FF i'Ui$$
try25, rt?
Permits Required: Building ❑ Electrical ❑
Construction Type: Occupancy
Total Sq Ft of Bldg: Min. Occupa
New Construction: Electric - # of
Fire Sprinkler Permit: Yes ❑No ❑ # of Heads
APPROVALS: ZONING:
COMMENTS:
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced ID Type of ID
❑ Plumbing ❑ Gas ❑ Roof ❑
Load:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
%A
OWNER BUILDER STATEMENTIAFFIDAVIT
Altamonte Springs, Casselberry, Lake Mary, 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
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 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 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
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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
in 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.
f
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 city 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
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homeowner's insurance may not provide coverage for those injuries. I am willfully actin as an owner -
y g
builder insurance coverage for injuries to workers builder and am aware of the limits of m 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.
Rev. 9.14.2009
Property
P10 l e a
C-c� c do hereby state that I am qualified
and capable of performing the requ
conditions specified above. I
Signature of Owner -Builder Date
Form of Identification f'� r L v e �s = �P Z (�
z -307 O
(Must be Photo ID)
A violation of this exemption is a* misdemeanor of t first degree punishable by a term of imprisonment
not exceeding 1 year and a $1000.00 fine in ad�ition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final a rov% revoke the permit, or pursue an action or remedy
P g J PP � P � P Y Y
for unlicensed activity against the owner and any p�rson performing work that requires Iicensure under
the permit issued.
construction �volved with the permit application filed and agree to the
i
Rev. 9.14.2009
I agree that, as the party legally and f nanciall 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 ith all applicable laws, ordinances, building codes, and
zoning regulations.
I am of aware of construction practices and I hale access to the Florida Building Codes.
I understand that I may obtain more informationegarding my obligations as an employer from the Internal
Revenue Service, the United States Small Busi ess Administration, the Florida Department of Financial
C
Services, and the Florida 1 Department of Rev 'nue. I also understand that I may contact the Florida
Construction Industry Licensing Board at 1-8 0-487-1395 or at www.myflorida.com/dbpr/pro/cilb/ for
more information about licensed contractors.
E,
I am aware of, and consent to, an owner-builde' 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 address
listed below.
I agree to notify the building department immediatelya of any additions, deletions, or changes to any of the
that I have provided on this disclostit el or in the permit application package.�
Cinformation
Licensed contr dors are regulated by laws desi
have
'ned to protect the public. If you contract with a person
who does not a license, the Construction I
dustry Licensing Board, the Department of Business and
Professional Regulation and the building depa
ent 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 unde
individual or firm is injured while working on y
tand that, if an unlicensed contractor or employee of an
ur property, you may be held liable for damages. If you
obtain an owner -builder permit and wish to hire i
whether the contractor` is property` licensed an4
'licensed contractor, you will be responsible for verifying
the status of the contractor's workers' compensation
coverage.
t
Property
P10 l e a
C-c� c do hereby state that I am qualified
and capable of performing the requ
conditions specified above. I
Signature of Owner -Builder Date
Form of Identification f'� r L v e �s = �P Z (�
z -307 O
(Must be Photo ID)
A violation of this exemption is a* misdemeanor of t first degree punishable by a term of imprisonment
not exceeding 1 year and a $1000.00 fine in ad�ition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final a rov% revoke the permit, or pursue an action or remedy
P g J PP � P � P Y Y
for unlicensed activity against the owner and any p�rson performing work that requires Iicensure under
the permit issued.
construction �volved with the permit application filed and agree to the
i
Rev. 9.14.2009