334 Lusitano Way - BR18-004703 - DECKCITY OF
S,NFOX%X-r
BUILDING DIVISION
PERMIT APPLICATION
Application No: ? 1 -S
Documented Construction Valuers'L-70-50—
ebb Address:3 3Xf 73
LUTA) )AY SAMVp Historic District: Yes[Non
Parcel ID: 1 p2(),31 -6r Residential El CommercialEl
Type of Work: New 4 AdditionEl AlterationEl RepairEl Demo[--] Change of UseEl Move F1 Description of Work' r-
7 12(0) LIP, LIaZEz- "Da 11`( viii—H aP- EKIA4110(2 N0q7ZXjqL
CZ-6400,4W(w Plate Review Contact Person:'
VSD LOPICZ Fax: mail v\,v
Property Owner Information Name
Lopez Phone: Cqol)
E60 -0A01 Street: L(2!&iT-
AJVQ 0,U Residentof property?: City, State Zip: SAA;,
WRD r/ 1311 Name Street: City, State
Zip:
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 cornincriced 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.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6"' Edition (2017) Florida Building Code
NO I;(LF.: 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 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 tees when the permit is issued.
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.
Signature ofOwner/Age w
Date Signature of Contractor/Agent
4 x lv L o c
Print Owner/Agent's e
r Ir
Signature of Notar - tate of Florida Date
24tta`Y "Ug SHARON J. WHTE
4,3,
My COMMISSION Ai GG 005761
0yEXPIRES: Juiy 9, 202o Owner/
Agent is 1 Personally2XnEflv*U*hfts,W*tNotatyse,viats Produced
ID Type of ID Print
Contractor/Agent's Name Signature
of Notary -State of Florida Date
Date
Contractor/
Agent is Personally Known to Me or Produced
ID Type of ID BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas Roof Construction
Occupancy Use: Total
Sq Ft of Bldg: Min. Occupancy Load: Flood
Zone: of
Stories: New
Construction: Electric - # of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: Yes No # of Heads i1oK,
f4coo' Po APPROVALS:
ZONING: /;,. " 4q , UTILITIES: ENGINEERING:
Fire
Alarm Permit: Yes []No WASTE
WATER: FIRE:
BUILDING: COMMENTS:
0 ep is e
OWNER BUILDER STATEMENT/AFFIDAVIT
Altamonte Springs, Gasselberry, 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)
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 1, as the owner of
the property listed, may act as my own contractor with certain restrictions even though I do not have a
Alicense.
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 narne 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 I 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.
1 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.
AL
1 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. 1, 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
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
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.cotn/dbpr/pro/cilb/ for
AL
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 1 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: r .
l_ " ZQ, do hereby state that I am qualified
and capable of performing the requested construction involved with the permit application filed and agree to the
conditions specified above.
jztk,
Signature of Owner-Bui
Form of Identification
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 activity against the owner and any person performing work that requires licensure under
the permit issued.
Rev. 9.14.2009
4WCITY OF Building & Fire Prevention Division
ORD DECK PERMIT GUIDELINES
F RF, M PART NIE N I
All permit application packages must be complete prior to acceptance. You must check each box to the
left or indicate n/a on this submittal. A complete application package shall include the following:
wilding Permit Application completed, signed and notarized. Application must include correct address
and complete parcel I.D. number.
rpled 'y I! -actor MM-me—property owner, indicating th"e"37MMMed
construction value
IIPPIIMIJU MI'M a"Lut 15 1IM115C 155m%;;;d lly the Some 0 Rol ide i
applicant).
A sjLV 0_. iped rtq j, el tq 9@tj"jjje7 9hojil @ p@q*jWA-1r'-QW th- !jrgU-qgd &QUjrgCjgl; if
he/she appoints an employee of his/her company to sign the permit application as the contractor.
and naming the City of
Sanford as certificate h ldcx QL a r.Qpo Ql'a --m ma Q*Aaafau
Florid must be submitted with each application if contractor is the applicant).
POwner Builder Statement / Affidavit (if owner is applicant) 000
Must be signed in person at the Building Department)
LoP000" Wood decks elevated 12" or less from finished floor to grade:
No engineering required.
0 Commonly accepted construction practices.
0 (2) Two copies of a legible drawing showing all framing details, foundation details, and meet all
applicable code requirements.
0 Wood
2) sets signed
m - ect 129 mph ultimate design wind speed for risk category I buildings
VOOOO* Two (2) site plans indicating proposed location and distances to property line(s).
These guidelines were compiled to assist the applicant in preparing a deck permit application and may not be
complete. The applicant is required to meet all City ofSanford, state, andfederal code requirements.
Effective: August 1, 2017
I
REVIEWED FOR CODE COMPLIANGi-
PLANS EXAMINER
DATF
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Legal Description:
Lot 94, Bakers Crossing Phase 2, according to the Plat thereof as
recorded in Plat Book 62, Page(s) 97-99, Public Records of Seminole
County, Florida.
Flood Zone: X Panel: 0070F
Community Number: 12117C Date: 9/28/2007
CERTIFIED TO:
Chicago Title Insurance Company
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