1920 S Park Ave - BR18-004763 - REROOFCITY OF
ORD Building & Fire Prevention Division
FIRE DEPARTMENT DEC 17 2018
RESIDENTIAL SHED AFFIDAVIT':
vPERMITft: L-n (/-A
I D
120 SQUARE FEET OR LESS)
ADDRESS:
t
1 0 S P-1 ` /4vl
A 4,, 7 7/
HEREBY AFFIRM THAT ALL OF THE FOREGOING
INFORMATION IS TRUE AND ACCURATE. THE SHED TO BE INSTALLED ON THE PROPERTY LISTED ABOVE WILL BE REQUIRED TO MEET THE
FOLLOWING: INSTALLED TO MEET ALL MANUFACTURER REQUIREMENTS, PROPERLY TIED DOWN PER MANUFACTURER
RECOMMENDATIONS, AND LOCATED ON THE PROPERTY IN ACCORDANCE WITH THE APPROVED SITE PLAN. SITE BUILT SHEDS MUST
ADHERE TO COMMON CONSTRUCTION PRACTICES. I UNDERSTAND THAT FAILURE TO PROPERLY LOCATE THE SHED IN THE APPROVED
LOCATION WILL BE VIOLATION OF CITY CODES AND COULD RESULT IN THE SUED HAVING TO BE RELOCATED OR TAKEN DOWN AT THE
OWNER'S EXPENSE.
r-1 LICENSED CONTRACTOR
LICENSE ff:
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE:
HOMEOWNER (OWNER/BUILDER)
OWNER/BUILDER NAME:
OWNER / BUILDER SIGNA
PLEASE NOTE"
DATE:
DATE:
THE BUILDING DEPARTMENT WILL NOT CONDUCT ANY INSPECTIONS ON SHEDS SIZED 120 SQUARE FEET OR
LESS. THIS AFFIDAVIT MUST BE PROVIDED, SIGNED AND NOTARIZED, AT THE TIME OF PERMIT SUBMITTAL AND
WILL SUFFICE AS THE FINAL INSPECTION APPROVAL FOR THE SHED.
STATE OF FLORIDA COUNTY OF> r tj
Sworn to and Subscribed before me this -day of LL-A 20 e by:
S- Q- k i 1A Who is Personally Known to me or has 1 Produced (type of
idea lification) IJi as identification.
Signature of Notary Public
State of Florida
A A odh.Wb..Aw oa lit
ANNETTE BLANDPrint/Type/Stamp Name e, , _
e fAsNotaryPublic -State of FloridaofNotaryPublic0 # 0 0nGG662 3Commission # GG 060623
xMyComm. Expires Jan 16 2018
0
I'M
17
CITY OF
ac PERMIT APFLICATI4NSNFORD
BUILDING DIVISION
Application No: -
Documented Construction Value: $ C)
Job Address: r d Historic District: Yes No
Parcel ID: Residential,E' Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
r
Description of Work:
Plan Review Contact Person:
Phone: Fax: Email:
Title:
Property Owner Information
Name 1., n 1,./ t, . ., Phone: f r 7
Street: t ,I A Resident of property? :`
City, State Zip: ('
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 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.
FBC 105.3 Shall be inscribed with the date ofapplication and the code in effect as of that date: Wh Edition (2017) Florida Building Code
NQTIC;E: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the Publics
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 ofpermit 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 `fable 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 foregoing information is accurate and that all work will be
done in compliance with all applicable laws regulating construction and zoning.
r
Signature ofOwner/Agent Date Signature of Contractor/Agent Date
Priin t Owner/Agent's Name ._ Print Contractor/Agent's Name
W
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of Ill Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps Plumbing - # of Fixt
Fire Sprinkler Permit: Yes No # of Heads
ml
APPROVALS: ZONING: , '7'• UTILITIES:
COMMENTS:
ENGINEERING: FIRE:
Ok to install approx. 4A-
sgft) stied as shown on plan. Nleets area and
dimension regulations for the ztiuing
district. Shed rust be a minimum of 's, ft
from the side property title and a tninitoutn of
Alf ft from the rear property tine.
Flood Zone:
of Stories:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
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install approx. -01 x_p/ sqft)
shed as shown on plan. Meets area and dimension
regulations for the S)2-1 zoning district.
Shed must be a minimum If 7 S, ft from
the side property line and a minimum of ft
from the rear property line. J
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lMUIRJ4
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.
k Cam 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
i Construction Industry Licensing Board at 1-850-487-1395 or at www.myflorida.com/dbpr/pro/cilb/ for
more information about licensed contractors.
f 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.
f 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
1 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.
and capable of perfo
conditions,ispecified
do hereby state that I am qualified
ng the requested construction involved with the permit application filed and agree to the
Owner -Builder
Form of Identification
Must be Photo ID)
Date
C.zr-7bc11
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
OWNER BUILDER STATEMENT/AFFIDAVIT
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)
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.
f I understand that, as an owner -builder, I am the responsible party of record on a permit. I understand that I
fmay 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
1 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 it
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. 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