124 W Woodland Dr - BR08-001539 (FENCE) DOCUMENTSa ry e-LII
CITY OF SANFORD PERMIT: APPLICATION
pplicanon # , Submittal Date:
Job -Address: 19-'q Lu W V`alue of Work: S if, 00
Parcel ID: Zoning: Historic District: _
6
c\ ' k L, r , •Square Footage: D'cs crtption of Work: eO acP asn p t the rt t_
Permit'l)pe: Bui,Iding` , Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool . Si_n
Electrical Ness Service - # of AMPS Addition/Alteration Change of Service Temporary Pole 0
Mechanical Residential Non -Residential Replacement New (Duct Layout & Energy Calc, Required)
Plumbing/ Ness Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/Ness Residential # of Water Closets Plumbing Repair - Residential Commercial O
Occupanc. J) pe Residential Commercial O Industrial Q Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required I
i........................................ ... ............ ........ I.....................................................
P'rroo{-'err Os_ner. JsiL L. 26,YpAes amA S siA, 22,,eaejContractor: x<c]
dresi, 12.4 11J Address: P,ine:
C1{ci 3`J 6fj E-mail: Bonding CompanN:
ddress rchitecvEngineer.
ddress.
f
x.
7, - - Phone: State
License Number: Mortgage Lender:
Address: Phone:
Fax:
Plan
Res
iess Contact Person: Phone: Fax: E-mail: appli, ation
is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced pnor to the ss.:ance
o! Ia permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate x.TrJi
must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and vIR CONDITIONERS,
etc R5 \FFID,\
VII I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable lases reek a!,ne onstrucnon and
zoning v:yRNINC)
TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR- PA -PING TWIG[ :f:Ok iNIPROVE:NIENIS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEf ORE I !, 1 1: !
IN'SPEC IION. IF YOU INTEND TO OBTAIN FFNANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOL k UIICl.01 '
0:\1NlENCEMENT. NC Cl_
I:i iddition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public record, o and !here
may be additional permits required from other governmental entities such as water management districts, state agencies, or Iederal aaene es is verification-
that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. op(e/.'rf a}cceptancf1e emit t.,., wl. Signa
f
Owneri/Agent
Date Signature
of
Contractor/Agent Date Print Us er Agent'
s N t / g \ !z / Print Contractor/Agent'
s
Name„ s S%(off Signature
of Not- le
oJ'yrida ?y .- ,, DateSignature of Notary -State of Florida Date cis . s Ossrri a
ent s %(
sonally. Contractor/Agent is _Personally Known to Me or , Produced. ID. Produced ID
y -` s S UTIL: FD: ENG:
BLDG: Pi:c) a1_S: ZQNIN'G sac. 1 C on'
ii!'Ws i c
f OWNER BUILDER STATEME T/AMDAVIT
4 y
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 orresidence must be for
your own use or occupancy. It may not be built or substantially improved for sale orlease. 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)
a1.P
UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103
AS LISTED ABOVE.
HAVE ACCESS TO THE ADOPTED CODES.
AM FAMILIAR WITH THE CODE PROVISIONS.
L
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.
h
I UNDERSTAND THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN
OWNER BUILDER STRUCTURE WITHOUT BEING INVESTIGATED.
I UNDERSTAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A.,
WITHHOLDING TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE.
Prod pertyAd"dr ess 12 4 iu ,uJ g hd v,
l_ , do hereby state that 1 am qualified and capable of
performing the requested construction involved with the permit application filed.
4
Date
Form of Identification hrzva.r L, t ey, s 2 6 3a H 3) - 62-'-103 - /0
Must be Photo ID)
A violation of this exemption is a misdemeanor of the fir-st.degree punishable bya 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)
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