HomeMy WebLinkAbout1602 Forest DrCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Q v°
Application No: ( V Documented Construction Value: $ , 00
Job Address: i 6v a DA'V'C-. S nv,qif J 1=4- Historic. District: Yes No;
Parcel ID: Zoning:
Description of Work: KooT Q PlRc M en'
Plan Review Contact Person: /.iy C/L Title: OW Iag_ '<-
Phone: 3ai 'a 'i'6 pro 61 Fax: qc -7-6O0`7 / 77-5f E-mail: 2 T A-Z fn 4P,40 t ,Gan-1 Property
Owner Information Name.
J a FfA Zl F Phone: - 0.N 3 a Street:
1001ot'4c CRcck- c i Resident of property? City, State
Zip: 01Z(a.vc;o ,cL 3 P Y 3 Contractor Information
Name Phone:
Street: Fax:
City, State
Zip: State License No.: Architect/Engineer
Information Name: Phone:
Street: Fax:
City, St,
Zip: E-mail: Bonding Company:
Address: Building
Permit
Mortgage Lender:
Address: PERMIT
INFORMATION
Square Footage:
Construction Type: No. ,of Stories: No. of
Dwelling Units: Flood Zone: Electrical Plumbing
New Service -
No. of AMPS: New Construction - No. of Fixtures: Mechanical 0 (
Duct layout required for new systems) Fire Sprinkler/Alarm No. of heads:
p
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.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this
property that may be 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 I 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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Si r O /Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
w LQ"" /.
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
otovr v ge DEBB1E BEAM UIN
yly ,()N4i,11SSION r DD629096
rJ E l tiFS: February?5, 2011
FI. Nor2ry Disca•:nt Assoc. Co.
Owner/Agent is Personally Known to Me o
Produced ID Type of IDVl L-C 4- APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
UTILITIES:
Contractor/
Agent is Personally Known to Me or Produced
ID Type of ID WASTE
WATER: BUILDIN
Rev
11.08
R
I.
102
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Cassel berry,, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Minter 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)
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
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 ity
for sale or lease, which violates this exemption.
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
Myinjuriessustainedbyanunlicensedpersonorhis'or'her employees while working on my property.
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.. „
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
r
POP
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.
I am of aware of construction practices and I have access to the Florida Building Codes.
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 1-850-487-1395 or at www.myflorida.com/dbpK/pro/cilb/ for
more information about licensed contractors.
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 address
listed below.
I agree to notify the building department immediately of any additions, deletions, or changes to any of the
information that I have provided on this disclosure or in the permit application package.
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, the Department of Business and
Professional Regulation and the building department 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 property licensed and the status of the contractor's workers' compensation
coverage.
Property Address: 1600 -);teS f f_4 3077
z / , do hereby state that I am qualified
and capable df performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
i ll i/lo
nature of er Date
Form of Identificatio
Must be Photo ID)
A violation of this exemption is a misdemeanor of the first degree punishable by a term of imprisonment
not exceeding 1 year and a $1,000.00 fine in addition to any civil penalties. In addition, the local
permitting jurisdiction shall withhold final approval, revoke the permit, or pursue any action or remedy
for unlicensed
1;
activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev.9.14.2009
1 1 I Ne p a01 I i d lid li N lf> h N i q' I IBM
Permit No.
Tax Folio No.
NOTICE OF COMMENCEMENT
State of Florida
County of Seminole
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.
MARYMNE MORSE, CLERK OF CIRCUIT CART
SEMINOLE COUNTY
BK 07496 Rg 0731; Upg)
CLERK'S 21010143474
RECORDED 1Eh4/2+010 03i32:50 Rio
RECORDINS FEES 10.00
RECORDED BY T Smith
1. Description of property: (legal description of the property, and street address if available)
C70 Lre4•% Dr,i,)c- dA-vryr-,'`,(, fL 3a 'T
General description of improvement: Woo 102e J(ttPr tl "
3 Owner information: Name: JAI f AZielz
Address: 34D6 l9e k('ng` Ckee-K- c'T - 6;Z'>aru;A,tL 3L9£3.s 1A
b. Interest in property: 0 w,v E Z
c. Name and address of fee simple titleholder (if other than Owner): Name:
Address:
4. Contractor Name: Phone number: 9 $ 9
c. Address: AAA A-e ,,
5. Surety Name
Address:
b. Amount of bond: $ YANNE MO 5E
6. Lender: Name: ICIRCUIT U
Address:
b. Lender's phone number:
Ta. Persons within the State of Florida designated by Owner upon whom notices or other docu
provided by Section 713.13(1)(a)7., Florida Statutes: Name:
Address:
6 8.a. In addition to himself or herself, Owner designates of
Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. V 11
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)
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 Au't cer erector/Partner/Manager Signatory's Title/Office
The foregoing instrument was acknowledged before me this day of - , (year) , by (name of person) as (type of
authority, ... e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrument was executed) .
SEAL)
Signature of Notary Public
Personally Known OR Produced Identification Type of; Identification Produced L- D
Verification pursuant to Section 92.525, Florida Statutes: Under penalties of perjury, I declare that I have read the foregoing and that
the facts sta it ar o the LA ny knowledge and belief.
Py
S e co erson Signing Above _
a
ev. date 3/2008
i'.,j i"!'u L Y-..... ^
Q
rt yvG Po h,ri IK coned <f