150 Walnut Crest Run - P18-004695 - SEWER LINE LAUNDRY TO GARAGEI
Name R I C-41P- b o 41A R O- u e2- Phone:
Street: 1 5-0 W A (-,) u- L IZ,;-:7 5 t R u N
City, State Zip: 5 A N irnP-o F-L 3 Z 7 7 t
Name
Street:
City, State Zip:
CITY OF
S DECK PERMIT APPLICATION
BUILDINGILDING DIVISION
116 Application No: w I
z0F Documented Construction Value: $ cL-O CDC C>
Job Address: i' 5-0 w/I C ti L,-r G tZ F-ST P- V 0 Historic District: Yes No
Parcel ID: 2 Z-- l q- 3 0-'S O Z- 000 p- J 7 80 Residential Commercial
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Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: Rt-cdc-ATE I-Au D-J r-r, GARAG,Q , P,12PC ctZ SewCA Litt;
l'"' (-tA5i4-E2 DRA,Q r 0wi-3 OF 674?-"rr- tT/E .,ro I RCN7 Y020, RemvDC-
lc ram atN
Plan Review Contact Person: C jr, z' 0 )
A
A 2 O V z- Title: 0 w N E2
Phone: L/07—Ll6/ Llcl1S Fax: Email:. (ZIt'ARQ-7L. AI L,c0),rr--
Property Owner Information
y61=yqts'
Resident of property? :
Contractor Information -
Phone:
Fax: -
State License No.:
Architect/Engineer Information
Name: K E E 5 E e %155 vc-I I+i05
Street: clg s S • 0. 13 , .. city,
st, zip: A a o P kP r- 3 z 7 0 Bonding
Company: Address:
Phone:
4 o 7- S S o- Z 3 33 Fax:
E-
mail: R ic: k . A4-A P.Qu t<z () 6.voKEE s r- e. cc r Mortgage
Lender_: r_ R+zEPof-" 14402 Address:
P.O: 13 o k (o l Y 063 dta-"
A-5 Tk- 7SZ(C1-70(03 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 apermit 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: 6°i 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, stae
agencies, or federal agencies.
Acceptance ofpermit is verification that I will notify the owner of the property of the requirements ofFlorida Lien Law, FS 713. i
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, inaccordance with local ordinance. 'Should calculated
charges figured offthe executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued.
ti•
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 of Owner/Agent Date
t C
Print Ow.
Signature ofContractor/Agent Date
Print Contractor/Agent's Name
Signature ofNotary -State of Florida - _ - -Date
Owner/Agent is ZPersonally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
ELIZABETH AUSTIN
r°.; < `; Notary Public - State ofFlorida
Commlssxpires ay8,2 BELOW IS FOR OFFICE USE ONLY
r ;' My Comm: Expires May 6, 2021
s•° bondedthroughNational Notary Assn.
Permits Required: ' Buildi_. Electrical "MechanicalF1 Plumbing - Gas Roof Eln
Construction Type: Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
F1oddIone:
of'Sttiries•
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No. #. of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING: 9F 2-C-19
Grant Malo t, Clerk Of The Circuit Court & Comptroller Seminole County, FL
Inst#2018f38385 Book:9262 Pac,i:1309; (1 PAGES) RCD: 12/7/2018 4:17:35 PM
REC FEE $10.00
THIS INSTRUMENT PREPARED BY:
Name: 1/ 2 rJ QJs=Z
Address: v • L sy vT r _
NOTICE OF COMMENCEMENT
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A" } r,
v S ei;
State of Florida
County of Seminole
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Permit Number: Parcel ID Number: Z / O. O 7- ' fX- , d
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.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
LoT /71
Rk0,5EAvF AL7- LA•11 F /% O-X) k-O t`
PR G Z P&5- /2--!
GENERAL DESCRIPTION OF IMPROVEMENT:
i rGc OL0C-IG r.2 C/biA 7 cEGa .-re wn 5I-Ar2 4
C2 to 6n0-A.l L 2rvnonr5e mr/ r il&r.1
OWNER IN ORMATION:
Name: 1CAR 2 d /f !' Q U L
Address: / TO 1-U A 51^ %Z V tJ 7Zz
Fee Simple Title Holder (if other than owner) Name:
CONTRACTOR:
Name:(_7 Cy
Address:
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served
as provided by Section 713.13(1)(b), Florida Statutes.
Name: F P-C E po rn /W 0 a %" 4
nfi —. PO '80 X Cn / 1 L? o-3
In addition to himself, Owner Designates
Section 713.13(1)(b), Florida Statutes.
Z Co
To receive a copy of the Lienor's Notice as Provided in
Expiration Date of Notice of Commencement (The expiration date is 1 year from 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.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true
to the best of my knowledge and belief.
IGA ALP d f `/ q /e 0. J 1-
Owner's Signature ,% " - Owner's Printed Name
Florida Statute 713.13(i)(g):' The owner must sign the notice ofcommencement and no one else may be permitted to sign In his or her stead'
State of ) Countyof ,
1,,
The foregoing Instrument was acknowledged before me this ( day of ` ! - lY"l r._JC.i 20
by , ' a o Z Who is personally known to me
Name ofperson making slate -
OR who has produced Identification type of Identification produced:
KARIMA AMELIA NURSE
MY COMMISSION # GG 179265 ary Signature
t ';'r EXPIRES: January 25, 2022
14,
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
n„ the property listed, may act as my own contractor with certain restrictions even though I do not have aV" 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 beV 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 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
n persons working on my building or residence. It is my responsibility to ensure that the persons whom I
C 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
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
ZA
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/dbpr/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: z"" / 50 W A LN 0fi C d2 E S )' U IJ , 5 A N Fco;2 D FL 3 2 77 /
I, tc r :2 n p /VII14 ' Ct rz z , 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.
Signature of Owner -Builder
Form of Identification
Must be Photo ID)
Date
Z - 5--%9
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
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