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1100 W 13 St - BC08-001554 - FENCECITY OF SANFORD PERMIT APPLICATION I Apt licatior'' Job Address: /pp 14 ' /_:JJ 74 Parcel ID: I F= A Zoning: Submittal Date: Value of Work: S Historic District: Description of Work: r C k 17 Square Footage: fA ............................ ...............................................I......... Permit Type: Building 0 Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Sian Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required) Plumbing/ NeNN Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/N'eNy Residential: # of Water Closets Plumbing Repair— Residential Commercial Occupancy Type: Residential Commercial Industrial Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required f.C'e"ZI,... •Ol ••,• •!l !/• •Contractor: i 11, Property Owner address: D© Ll/ / Address:14 Phone:c3'?` E-mail: 'Phone: State License Number: Bonding Company: Address: Architect/Engineer: Address. Mortgage Lender: Address: Phone: Fax: Plan Review Contact Person: Phone: Fax: E-mail: pph,c3uon is hereby t'nmadetoobtainapermittodotheworkandinstallationsasindicated. I certify that no work or installation has commenced prior to c ance o1 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 reeuiatu,a construction and zoning. V,\RNING -1-0 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING I \VICE i'OR 9PROVE`91_NIS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE lHil FIRS i INSPI-CI ION. IF YOU INTEND TO OBTAIN FfNANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING l Ol: R NOIICt:: OF C'O!M!VIENCEMENT. U I i : In addition to the requirements of this permit, e may be additional restrictions applicable to this property that may be found in the public records of thrs count, and there may be additional permits requir fr m other governmental entities such as water management districts, state agencies, or federal aeencie; Accpqtance of permit is e tca ' tr at I will notify the owner of the property of the requirements of Florida Lien Law, FS 713 Signature of Ownr/Agent Date Signature of Contractor/Agent Date Print Contractor/Agent's Nam@, Signature of Notary -State of Florida Date Contractor/Agent is _ Personally Known to Me or Produced ID s-/71A8 PPRO\';\I_S ZO\ UTIL: FD: NCrc— BLDG: Special Condiu Pnl •r gent' , lame S gnature of Notary -State of Florida Date MY COMMISSION # DD629096 EXPIRES: February 25, 2011OFF F0.`I-3- WARY FI. NotaryDiscount Assoc. Co. 0;ner -\gent r;"""Pd`isana'41 Ktr94P6 vi8 0rsaa+k; Produced ID Re\ 0.07 A 1-2-TH--ST-R-EET--------------------- -- N (— U1 C i SDI & N1' DISK (#33 4" OAK TREE 3OUTH R; W LINE R woeG' QO \GP LCONCREfE I EAST 6 1,4;; t z 5 ESC 5 GAL LIGUSTRUM--, 4' ON CENTER \' O l p1<4 lbGJ4t n t• C/ r\old v 1 7r..`.,....r JN E rC_: , S ..`J Act. 1 con ruction must meet all City Codes and Land evelop ent Regulations. 10. her permits required for this project must be obtained. I An Notice of Intent(NOI) for Stormwater Discharge t7 D I Cy associated with industrial nrr;vity OWNER BUILDER STATEMENT/AMDAVIT 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) I UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103 AS LISTED ABOVE. I HAVE ACCESS TO THE ADOPTED CODES. I AM FAMILIAR WITH THE CODE PROVISIONS. J G' 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 UNDERSTAND. THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN OWNER BUILDER STRUCTURE WITHOUT BEING INVESTIGATED. 1 UNDERSTAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A., WITHHOLDING TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE. Property Address: / / p P _5 I, _72 .77%A , do hereby state that I am qualified and capable of performing the requeste6 construction with the permit application filed. 5 0 7 - oY Date 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. 4/20/07)