Permit Roof 1045 Hibiscus 2011 t
` s CITY OF ATLANTIC BEACH
ff A. � 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Ji�I>
Application Number 11- 00002239 Date 6/21/11
Property Address 1045 HIBISCUS ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 3500
Application desc
reroof
Owner Contractor
BORRERO OWNER
1045 HIBISCUS STREET
ATLANTIC BEACH FL 32233
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 70.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 3500
Expiration Date . 12/18/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 70.00 70.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 74.00 74.00 .00 .00
I f
f
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
•
Job Address: _L b 44S 1 btr.us M. Aticu -h c ' vl 1 a a 33 Permit Number:
Legal Description La. 1 Q Beach 4A, Q- A sVsCEd dl i1 I .1 P - 10 •' ' area #
Floor Area of Sq.F Sq.r't
Valuation of Work $ 0 / 0 0 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: - . - k P001
Property Owner Information:
Name:1 T5O 1O & Address: I GAS 141 t sCu S S
City tc-k- VWkt1C, b r State ft-Zip 3,x.33 Phone Ci(}Li co ilic ,26/. l
E -Mail or Fax # (Optional) + C&C / • icj 6 C jCY1ai 1 • C - 6I->7
Contractor Information:
Company Name: Qualifying Agent.
Address: City S . Zip
Office Phone Job Site/ Co Tr't Number F.
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a per to do the work and installations as indicated. 1 certify that no work or installation has co menced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners, etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions o f a n y other f e d e r a l , state, or local 1 • • regulating construction or the performance of construction.
ignature of Owne MA, AA • ----" �‘,. Signature of Contr.. or
Print Name � �j 4 ` . f Print Name
Swo • o -nd subscribed before me Sworn to and subscribed b= `. i. e
this ..4 P . of t :� • . 1. _� . 20 this Day of 20
� — S HH LEY l.. GRAHAM
9� _—� . r. Y C. u u ' Ilk : .. • .,
Notary , q, s;.5... " :- ..`= EXPIRES: February 14, 2014 Notary Pu. •
- ••Fo°.•' Bonded Thru Notary Public Underwriters
:.. ,:',.—,;„,-- ,7.-- .,:,„;.-- zsier Revised 01.26.10
�:. " " .�
t - CITY OF ATLANTIC BEACH
, i:-= ':.'*ii 41..
k r ®WNER / BUILDER AFFIDAVIT
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 REOUIRED 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. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) 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.
/o V5 17/,6s 5 cc/
ADDR S / fJ h PHONE NUMBER
r a- i /y O ff Z d 0
PRINT '
X 1 i /A A. -A. 4/2 `///
I • • UR .. DATE
Before me this i day of ' 20/ in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations are tru and accurate.
Notary Public at Large, State of , County ofi�A L
PersonallyKn• n' / f l� O y ?3 7 g4v
6
Produce• •entifcation // ,(, 4 y � J ,. a
Si •ature: l� I 7
Notary t . : : -•-'� .: 'llJ.e :.
..
-./ ! _ �' ' ES: February ,4, 2014
[ Notary Public Underwrite •
F:BLDG /Owner - Builder Affadavi, .
JUN - 21 -2011 11:02 FROM: CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
Doc # 2(0136'100, OR tak 15634 Nags z i um.,
Number Pages.1
Recorded 05/21/2011 at 11:14 AM.
1VO�ICE OI' CONDVR:1yCEN�E ,ltM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00
Permit No. -
Tax Folio No.
THE TJNDERSI(INED hereby gives notice that improvements will made to certain real property, and in accordance with Scclion
713J 3 of the Florida Statutes, the following information is provid -' in this NOTICE OF COMMENCEMENT.
_` (legal of property (� dgerr�pfion):. i ; ' lb. i��4 ,$ t � • , L o ' . , �. in f i• � M-t �, 42 , '`"
a) Street Yob) Address: J 4 r '... `.mod +� - -. " " .'.1' Mi. - - .'41 • r
2.Gcncxal desesiption of improvements: �----
:l ��.
3, 0 ,er Infottnation '" ,ter ( 1 F
a) Name and address; tM �` `" r� L , $1
b) Name and address of f ee simpt = ;deb 4 der Of other t -.i,� owner) 3003
c) Interest in property _
4.Contracior Information r
a) Namc and address: f.
b) Telephone No.: , 1I Fax No. (Opt.)
5,Surnty information II
a) Name and address: _ -
b) Amount of Bond:
Telephone No_: _ 11----m No. (Opt.) _ —
6.l.endcr
a) Name and address: ,
Phone No.
7. Identity of person within the State of Florida designated by owed, ' upon whom notices or. other documents may be served:
a) Naive and address: .. _
b) Telephone No.: _ Fax No. (Opt.)
8.In addition to himself, owner designates the following person 've a copy of the Lienor's Notice as provided iil Section
713.13(1)(b). Florida Statutes:
a) Name and address:
b) Telephone No.: _ Fax No. (Opt.)
9.Expisation date of Notice of Contmenecntent (the expiration ' e is one year from the date of recording unless a different date
Is specified): —
• WARNING TO OWNER: ANY PAYMENTS MADE BY OWNER AFTER TJJL EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PA NTS UNDER CHAPTER 713, PART T, SEC'T'ION 713.t3,
,FLORIDA STATUTES,. AND CAN RESULT IN YOUR PA G TWICE FOR IMPROVEMENIS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORD AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCIN CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR. NOTIC OF COMMENCEMENT. •
STATE Op ?LOMA ) ;+ ►
COUNTY OF PINELLAS
igpam[e'd Owner or , 'a Au t'.cd UfficeeDi •,: 'antler/Manager
• _4 _ ' I . _.J • )
' nt Name j '
The f o r e g o i n g instrument w a s acknowledged b e f o r e r o c this 1 d a y of `"71 f , 2(1/ / , by
as _ 1 _ (type of authority, e.g. officer, trustee,
attorney to fact) for (name ape • on' . . If i I w , ore , ,train , -`t was executed).
Personally Known OR. Produced Identification 1V 1 otary Sigua " /,�{i `°
Type of Identification Produced t al= (imm) _ 1f ;€ l f' t / � —4S--...--
0 •, l
Verification pursuant to Section 92.525, Florida Statutes. 'Lind II. allies of perjury, l declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and . cf.
.4, '•` : ( 7f, ine (s line # 10.) Above
'vl T h u g Nay February U raters
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