705 Bonita Rd RESO23-0117 Application BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach Building Department
PERMIT# �t5�73 -O[l7
800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process
tnt Phone: (904) 247-5826 E ail: Buuilding-Dept@coab.us
Job Address 705 tv/� a-
RE# / 71/ 0270
-
Legal Description // / / e42,1/(1--- P4Ugg tafii an—/6 4/441_,
Valuation of Work(Replacement Cost) Iry Heated/Cooled SF /5i , Non-Heated/Cooled SF
•Class of Work: ❑ New ❑Addition 17, 'Iteration' ['Repair ['Move ['Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial [residential •If existing structure, is a fire sprinkler system installed?:❑Yes[f'1'Vo
•Will tree(s)be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) 0-114-d-
Describe in detail the type of work to be performed:
VeGkt.GiL.e -1-Wo um-13, /- /r-iTJCe#1, / - 1.4"0/41 / 41, ge-k fic o eiofre S, 6wi
ty / ox e �� ; enc Gr;.ce Poa4,4 a S. opk' prj'&C .
Florida Product Approval# (For multiple products use Product Approval Information Sheet)
Property Owner Information Name /.� ALS ��J'7�q?1.�i2Phone( o5) T�cZ - 4Cj-7/
Address "7055 0 a City /�f F`�e. 4I State Zip 37Z ,
Email t/ __ 2f7 AJ! ner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information Name of ompany Phone
Address City State Zip
Qualifying Agent State Certification/Registration#
Email Job Site Contact Number
Worker's Compensation Insurer OR Exempt El Expiration Date
Architect's Name Email Phone
Engineer's Name Email Phone
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 the standards of all the 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.
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 city/county,and there may be additional permits required from other governmental entities such as water
management districts,state agencies,or federal agencies.
OWNER'S AFFIDAVIT:I certify that all 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN Fl ANCING, CONSULT WITH YOUR LENDER OR AN
ATTORN : EFORE R e ' D G YOUR NOTICE OF COMMENCEMENT.
iir'
(Signat, •wn' ' r Agent) (Signature of Contractor)
Signed and sworn to(or a irmed)before me this 1 5� day of Signed and sworn to(or affirmed)before me this day of
, 202g by Ic(o Vaz9 ticz by
Signature of Notary Signature of Notary
[ ] Personally Knofnrpnl,,�-'OR [ Produced Identification [ ] Personally Known OR [ ] Produced Identification
Type of Identification:F v1 AAD vOO2y Q 2_ Type of Identification:
- . .
Via`* VANESSA ANGERS
:*= MY COMMISSION#HH 244118
7r P EXPIRES:March 23,2026
FOi f��.:
Owner Builder Affidavit **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
/� 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: VI(-1
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
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 EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
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.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
Job Address: 705 1t7t I'C / / 47 7 JLj�QQ-/f t
Owner Name: AIN& VA Z 2 Phone Number:
Mailing Address: 7S 'inti City: I4-1144m6 State: L Zip: /Z
Notarized Signature of Owner
The foregoing instrument was acknowledged before me this Si
. day of iZ:Ewib€.( , 20 Z 3, in the State of Florida, County
of
Signature of Notary Public
[ ] Personally Known OR [ roduced Identification
Type of Identification: -f( ;y - -r''C1N1a c1DI/QZG� �-Z
VANESSA ANGERS Updated 10/24/18
s*i MY COMMISSION#HH 244118
472
+:' c•• EXPIRES:March 23,2026
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MAP SHOWING BOUNDARY SURVEY OF:
LOT 16, BLOCK 2, ROYAL PALMS UNIT ONE, AS RECORDED IN PLAT BOOK 30, PAGES
60 THROUGH 60A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
8025'r - N
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EACH MSWIREDo
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NOTES. '•a""'IAM'MCA IRON PIPE NO N
TMS PROPERTY UES IN FLOoo ZONE X'PER 8000 INSURANCE p5. CATE • (DEN AFICAlION
RATE MAP(FIRM),DUVAL COUNTY,COMMUNITY No. 110075. N 8 20'02" .. Or 0.3'
MAP/PANEL No. 1203TC-orOB-L RENSED NOVEMBER 2 1016 N 85.20,0'. 1 1 9 48 'LAT '
BEARRIGs BASED ON THE NORTH RIGHT-OF-WAY UNE OF BONITA
W 1 •0.29'(M UI'ED
ROAD AS BONG N 85'20.43'W
25'BUMINO RESTRICTION UNE BY PUT
N.T.S.DENOTES NOT TO SCALE /4.~-
ROAD/
♦ �'-
061E DENOTES OVERHEAD ELECTRIC e� B O N IT �'
(P)DENOTES PAID MEASURED BEARING/DISTANCE �♦ 6 ROAD �♦�,\
(P)DENOTES PLAT BEARING/DISTANCE
#$44,
, nc �, _
ALL LOTS HEREON!K BLOCK EXCEPT AS NOTED ��\ , OF�_ A,'4)+#V,
♦
-x- DENOTES 4'CHAIN LAW FENCE 2I AS NOTED �CERTIFlED TO:
-i'-DENOTES 6'WOOD FENCE EXCEPT AS NOTED
THERE MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT SHOWN 4S,\..., PATRICIA COLEMAN
ON THIS SURVEY SLAT MAY BE FOUND IN THE PUBLIC RECORDS
OF OWN.COUNTY.FLORIDA
I hereby certify that this survey meets the
A standards of practice as set forth by
DURDEN i the Florida Board of Land Surveyors, pursuant to
I
SURVEYING Section 472.027 Florida Statutes and Chapter
I
N5J17 Florida Administrative C
985 11TH AND AVENUEMAPPISOUTH
G, INC.
JACKSONVILLE BEACH, FLORIDA 32250
I � 4 (904) 853-6822 FAX(904) 853-6825
DURDENSURVEYING®GMAIL.COM I —
LICENSED BUSINESS NO. 6696 FLORIDA REGISTERED SURVEYOR Na 170
K BRUCE DURDEN,.P.
SUPVEYOYS NM
THE SURVEY HEREON WAS MADE B1nIOUT THE BENEFIT OE ABSTRACT OR SEARCH OF TITLE AND FIELD: NOVEMBER 03 2023
THEREFORE REGARDING ORIMOR OWN HEREON PERTAINING.
TO ASEMENT'S..CIAOIS or CAD FILE NO. L-16.B-2(705 BONITA ROADI.OWG
RESERVATIONS OR TIER SaLLARLWTTTTE WHICH MAY OVERLAPS,
INR THE ABSTRACT UNE R SEARCH OF TITLE.
SCALE: '� 0 20' B-10375
TMS SURVEY NOT VAUD UNLESS INS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE saws. WORK ORDER NUMBER: 23387