163 Clear Lake Cir - BR08-001089 (2008) FENCECITY OF SANFORD PERMIT APPLICATION
Application # : / v I _ / Submittal Date: *
7
Job Adress: I3 GIC r c-Iz.t; fG(Q Valtie of Work:
Parcel ID: Zoning: Historic District:
Decri tion of Work: n G/ /iP Ac I_ tp C, F# Square Footage:
1...................................................................................................................
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Sign
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole El
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial Industrial
of Gas Lines
Plumbing Repair —Residential Commercial
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Property -Ow, r. / 4Z1 /'/1 80S& K r /d'r!y%42 Contractor:
Ad O sG.(" Lc3 ec: Address:
Phne 3 - BODE -mail
Bonding Company:
Address
Architect/Engineer:
Address:
Plan Review Contact Person:
Phone:
Mortgage Lender:
Address:
Phone: Fax:
State License Number:
Phone:
Fax:
E-mail:
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 verific 'on that I will notify the owner ofthe property of the requirements of Florida Lien Law, FS 713.
Signatu wnt Agent Date Signature of Contractor/Agent Date
Owner/Agent is _ ovally Known to Me or
Produced ID r-'6 L_ e ygo, 41 4' i
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL
Print Contractor/Agent's Name
Signature ofNotary -State of Florida Date
Contractor/Agent is _
Produced ID _
FD: ENG:
Personally Known to Me or
BLDG:
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
FSS 489.103 Disclosure Statement
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 $75,000. The building or residence must be for
your own use or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a
building you have 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 supervision 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' compensation for that employee, all as prescribed by law.
Your construction must comply with all applicable laws, ordinances, building codes, and zoning regulations.
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
r 1 UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103
AS LISTED ABOVE.
th R 1 HAVE ACCESS TO THE ADOPTED CODES.
I AM FAMILIAR WITH THE CODE PROVISIONS.
I HAVE ADEQUATE KNOWLEDGE AND QUALIFICATIONS TO SAFELY PERFORM AND DIRECTLY
SUPERVISE THE WORK.
THIS PROPERTY IS NOT AN APARTMENT, CONDOMINIUM OR RENTAL PROPERTY.
THIS STRUCTURE IS NOT BEING BUILT WITH MY INTENTION TO SELL, RENT, OR LEASE.
I l T3
I UNDERSTAND THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN
OWNER BUILDER STRUCTURE WITHOUT BEING INVESTIGATED.
r` A_
I UNDERSTAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A.,
WITHHOLDING TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE.
F?ro1p !Ac! Tess: p- G% r- /_c3 ( w., -cll
4t-0010:s -&VSV6 do hereby state that I am qualified and capable of
performing the requested construction involved with the permit application filed.
Ag A-V
F
Signature Date,,
DEBBIE'BAI7N
MY COMMISSION # DD629096 .:
Form of Identification o EXPIRES: February 25, 2011
Must be Photo ID) i.aoo--sNOTARY Fi. Notary DiscountAssoc. C:
r1.
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. 4/20/07)
I
Seminole County Property Appraiser Get Information by Parcel Number
f
Page 1 of 2
DAVID JOHHSOM;.:CFA. ABA
2008 WORKING VALUE SUMMARY
Amendment 1 impact not reflected.
GENERAL Value Method: Market
Parcel Id: 02-20-30-5GJ-0000-0870 Number of Buildings: 1
Owner: BUSTOS MARTIN & Depreciated Bldg Value: 107,674
Own/Addr: DIAZ ANDREY Depreciated EXFT Value: 823
Mailing Address: 163 CLEAR LAKE CIR Land Value (Market): 24,000
City,State,ZipCode: SANFORD FL 32773 Land Value Ag: 0
Property Address: 163 CLEAR LAKE CIR SANFORD 32773 Just/Market Value: 132,497
Subdivision Name: HIDDEN LAKE VILLAS PH 3 Assessed Value (SOH): 132,497
Tax District: S1-SANFORD Exempt Value: 0
Exemptions: Taxable Value: 132,497
Dor: 0103-TOWNHOME Tax Estimator
Portability Calculator
Deed
WARRANTY DEED
CERTIFICATE OF
TITLE
WARRANTY DEED
SPECIAL WARRANTY
DEED
WARRANTY DEED
WARRANTY DEED
CERTIFICATE OF
TITLE
QUIT CLAIM DEED
WARRANTY DEED
Fi
SALES
Date . Book Page Amount Vac/Imp Qualified
05/2007 06737 1772 $179,900 Improved Yes
12/1997 03336 1759 $100 Improved
05/1994 03105 0601 $53,500 Improved
05/1990 02180 1032 $62,500 Improved
02/1989 02038 0352 $100 Improved
01/1989 02038 0279 $47,000 Improved
05/1988 01961 0117 $45,600 Improved
12/1986 01814 0065 $100 Improved
01/1984 01518 1124 $51,200 Improved
ioarable Sales within this Subdivision
No
Yes 2007 VALUE SUMMARY
Yes 2007 Tax Bill Amount: $2,637
2007 Taxable Value: $141,354
No DOES NOT INCLUDE NON -AD VALOREM
No I ASSESSMENTS
No
No
Yes
LEGAL DESCRIPTION
LAND
Land Assess Method Frontage Depth Land Units Unit Price Land Value PLATS: Pick_,
LOT 0 0 1.000 24,000.00 $24,000 LEG LOT 87 HIDDEN LAKE VILLAS PH 3 PB 28
PGS 3 TO 6
re_web.seminole_county_title?parcel=0220305GJ00000870&cpad=clear%203/7/2008
NHF.-5-2008 10:50H FROM: TOE 3AIdFILIPP0 401E90E3576
FEES=27-ROO 10:33A FROM:JOE SANFILIPPO 4072908576
TLi : 4Fj T 3. 3G 410 G P . 1
T0:18663466016 P.2/4
Sanford Hidden Lake Villa Homeowners Association, Inc
Approval Form
Architectural Control Committee (ACC) approval for improvements to exterior of Hidden Lake Villas and
Carlton Homes. (SHEDS WILL REQUIRE A SIGNED SHED REQUIREMENT FORM ATTACHED)
Instructions: Please complete the following informntion and mail or fax form to the address below. Upon
approval, a signed copy will be forward to you. Visual inspection by ACC member or Managing Agent
may be necessary, Some improvements may require a permit from the City of Sanford and application
would be made after receipt of approval. All approvals will be made at the monthly board meeting held
the second Tuesday of each month, if you need approval sooner put date needed by
and reason
Please P
Name:
Address were improvements will be made
Telephone: 'Q Date:
Description ofImprovements: (If you need more space attach a 8x I I sheet of paper.)
For Fences and additions; Applicant roust submit drawing on a plat or survey showing that fence ar
addition is not blocking the required 10 (Ten) foot easement behind all villas. -
For painting: Villas — Applica "10t provide color selection package
Homes — App can must provide paint color samples(s),
Mail to: Sanford Hidden Lake Was HOA, Iiie
PO box 180004
Casselberry, Fl, 32718.10004
Fax: 407-290.8576 - Any questions call the Managing agent on 407-340-0006.
Approved by Representative of ACC or Association Board Member.
Signature tDate: S c
Date: o Signature2Signature
3 Date: FINAL
BOARD APPROVAL and verification that enhancement was completed as stated above. Verified
by ACC or board member Signature
Date: