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Home My WebLink About2021 S Summerlin Ave[7 7- CITY OF SANFORD PERMIT APPLICATION _ a _ Permit Date: _ Job Address -3 L /, S S t. xs �� /itJ Jr G i � 3, ;Z71 _ 36 .Descrip'tio`n of Work: /RZ .CA640,4) ilr Historic District: Zoning: 1: alue-of_Work:=$- i Permit Type: 'Building- 1 Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixttrres # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair Residential or Commercial Occupancy Type: Residential Commercial Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: _ / (Attach Proof of Ownership & Legal Description) s' O.wnersaName & Address::a _ G / t%! i�/��i ,1� .�1� 2 s , cel L.14 2.7 71 - 4/,4 3Z> Phone -.&14 7% 2-0-3 — [� `9 3 (4 — Contractor Nam' e & Address: ^. State License Number. _ ^ Phone & Fax: Contact Person: Phone: Bonding Company: _. Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax. 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. d.xt 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 Eau s regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT TH T MTR. PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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 oftheproperty of the requirements of Florida Lien Law, FS 713. Signature of Owner/Agen ate Signature of Contractor/Agent 4PrniOwner/Agent�'s Name � nPrint Contractor/Agent's Name ure of Notary -State of Florida Date / Signature of Notary -State of Florida DEBBIE BLANTON n sMYC(P�litt�al4lCdito9lit,t®gggpr Pr ID EXPIRES Februa I-a00-3N07ARY . N^otary iscountAssoc.Co. APPLICATION APPROVED BY: Bld 01AVg: (Initial &Date) Special Conditions: Contractor/Agent is _ Produced ID _ Date Date Personally Known to Me or Utilities: FD: (Initial & Date) (Initial & Date) (Initial -& Date) �Y3130 4k.�'h ��"�nrrt"Fi R a s e a F��n� �x CITY OF SANFORD BUILDING DIVISION OWNER/BUILDER AFFIDAVIT CONSTRUCTION CONTRACTING Owners of property when acting as their own contractor and providing direct, onsite supervision themselves of all work not performed by licensed contractors, when building or improving farm outbuildings or one -family or two-family residences on such property for the occupancy or use of such owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to exceed $25,000, on such property for the occupancy or use of such owners and not offered for sale or lease. In an action brought under this part, proof of sale or lease, or offering for sale or lease, of any such structure by the owner -builder within 1 year after completion of same creates a presumption that the construction was undertaken for purposes of sale or lease. This subsection does not exempt any person who is employed by or has a contract with such owner and who acts in the capacity of a contractor. The owner may not delegate the owner's responsibility to directly supervise all work to any other person unless that person is registered or certified under this part and the work being performed is within the scope of that person's license. For the purposes of this subsection, the term "owners of property" includes the owner of a mobile home situated on a leased lot. To qualify for exemption under this subsection, an owner must personally appear and sign the building permit application. 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 $25,000. The building or residence must be for your own use or occupar cy. It may - not be built or substantially improved for sale or lease. If you sell or lease a building you ha3 ire built or substantially improved yourself 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' Qompensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. I,'�� /► l`J.�',L: , do hereby state that I am qualified and capable of performing the requested construction involved with the permit application filed. I will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work allowed by law on the permitted structure. Owner/Builder Si ature D to Print Owner/Builder Name MY COMMISSION # DD 188491 EXPIRES: February 25, 2007 Owner is L_ Produced ID