708 Cavalla Rd 2014 bath remodel CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST efttt BY 4PM FOR NE)ff BftY iNSPEeTION. 247 58t4
JOB INFORMATION:
Job ID: 14-RAAR-21
Job Type: RESIDENTIAL ALTERATION
Description: remodel bathroom
Estimated Value: $800.00
Issue Date: 9/25/2014
Expiration Date: 3/24/2015
PROPERTY ADDRESS:
Address: 708 CAVALLA RD
RE Number: 171365-0070
PROPERTY OWNER:
Name: DE SHONE, ANGELIKE
Address: 708 CAVALLA RD
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $0.83
STATE DBPR SURCHARGE $0.83
Total Payments: $84.16
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
FILE COPY 800 Seminole Road, Atlantic Beach, FL 32233 '
Office (904) 247-5826 Fax (904)247-5845 FPS E PE 1 is; 2,!,,.,
Job Address: 709- eavcz 1�a r Permit Nu r:
Legal Description 3kad Parcel 9 —
goo 6�0 Floor Area of Sq.Ft. _Sq_.Ft_
Valuation of Work$ —Proposed Work heated/cooled non-heated/cooled Z1,9. 0-1)
Class of Work(circle one): e Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial dZeside-n—fi_QL
If an existing structure,is a fire spriWer system installed? (Circle one): --YM--Tjq N/A
Florida Product Approval#
For multiple products use product app�rova 5`rm �
Describe in detail the type of work to be perforined:
Property Owner Information:
Name: ail 0. '7-0 (fa Va
- we-tilca oe-�: otle- Address:
City VP414hv`;',- dwoc& State6�.Zipj h
E-Mail or Fax#(Optional) _P one (jimN-2
Contractor Information: CONTRACTOR EMAIEL ADDRESS:
Company Name: OualiNing�gent:
Address: --city'I - - State Zip
Office Phone Job Site/Contact Numb Fax
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
on is h re made aw a ermit to do the work and installations as indicated I certify that no work or installation has commencedprior to the
11 be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
cai e to o't ' p
y 11 work wi
Ap
c 0 a Perm t and that a
issuan e m ncd 'thin six(6)months, or if construction or work is suspended orabandonedfor aWeriod ofsbc�6)months at any time after
and void i 'ok is not com
, is co", c, . I u t t
k n d nde tand a eparate permits must be securedfor Electrical-Work,Plumbing,Signs, idls,Pools, Furnaces,Boileis,Heiriers,
Tanks andAir 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 Y014i NOTICE OF
COMMENCEMENT.
I herelh 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
work will be co�nplied with whether specified herein or not. The granting of a permit d es not iesume to give authority to violate or cancel the
ederal,state, or local law regulating construction or the peifi��mance of c 0 structi P'.
provisions ofany otherf on on
Signature of Owne Signature of Contractor
PrintName kiogjiic oki Print Name
........ ..........a
BefoT ine Before me
! c ofq
'o
this_%D of 2 0 It_y_ this Day of 20
Revised 01.26.10
011blic' tatp of Fionda
Notary Pu ic I'f: shiriey L Graham Notary Public
. My Commissicin FF 0
Of# E,pres0211412018
CITY OF ATLANTIC BEACH
OWNER/ BUILDER AFFIDAVIT I L E C 0 P Y
L L 10I
1. 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 TIRS 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(l). 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.
"tog clavo I(a "If
ADDRESS PHONE NUMBER
Awad'(WA W�Oti
PRINT P(TE<
SIGNATURE DATE
Before me this day of 20L4in the county of
or
Duval,State of rii ,.has par Ily a peared herin by himself herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
0 Personally Known
EV<uced Identification- zr 6 z z — 0
yet
N81 Ill Of Florida
Notary Signatu IM
My c8ffiffilMorl PF 066990
F/BLDG/O�er-BuilderAffadavit;REVII�D�4116 09 "4.
P-4
X�'% Ail City of Atlantic Beach
APPLICATION NUMBER
Building Department
(To be assigned by th bU1101
800 Seminole Road 'Y" -y tn Building Diepartmyent.)
-21
Atlantic Beach, Florida 32233-5445
Phone (904)247-5826 - Fax(904) 247-5845
-mail: building-dept@coab.us Date routed:
r ,j E
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 709 IIA,, F—D —art—
=_ ment review required :5��?'No
�—ZL-dzg_-)
Applicant: 74 E Planning &Zoning
Tree Administrator
Project: 7W ��&0 0(t 1, Public Works
Public Utilities
Public Safety
Fire Seivices
Review fee $_ Dept Signature
Other Agency Review or Permit Required Review or Recept. Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: W411pr-oved. nDenie-d-
(Circle one.) Comments:
(LDING)
PLANNING &ZONING Reviewed by:- Date:v—
TREE ADMIN. I nied.
Second Review: []Approved as revised
PUBLIC WORKS Comments:
Fir�-t R,, vi
a
Comm ?nt
ki e d7l
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [:]Approved as revised. nDenied.
Comments:
Reviewed by:__-.-- Date:
Revised 05/14/09
7