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528 Royal Palms Dr - Durarock/Cement Brd for Bath CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J 7 ATLANTIC BEACH, FL 32233 / INSPECTION PHONE LINE 247 -5814 RESIDENTIAL ALT /OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814 JOB INFORMATION: Job ID: 16- RAAR -24 Job Type: RESIDENTIAL ALTERATION Description: durarock /cement brd for bath Estimated Value: $500.00 Issue Date: 1/6/2016 Expiration Date: 7/4/2016 PROPERTY ADDRESS: Address: 528 ROYAL PALMS DR RE Number: 171515 -0000 PROPERTY OWNER: Name: OGIN JR, EVAN F Address: 528 ROYAL PALMS DR PERMIT INFORMATION: FEES: STATE DCA SURCHARGE $2. 00 STATE DBPR SURCHARGE $2.00 BUILDING PERMIT FEE $55.00 Total Payments: $59.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. s �.tL% /J- •J ± t� CITY OF ATLANTIC BEACH V 0 WNER / BUILDER AFFIDAVIT L 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. 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. -S� f /e o vA .‘‘ Pf 4 (Y) S 4002 C9 02 e6 G ADDRESS h/�i/YJ PHONE NUMBER !V r/ ©c , ,-✓ PRINT SIGNATURE / '-- ‘ /6 DATE Before me this II day of 2 &in the county of Duval, State of Florida, has person Ily appeared herin by himself/ herself a affirms that all statements and declarations are true r:d accurate. Notary Public at Large, State of , County of ❑ P sonall Known �" / duced Identi ' _ • - Ada 1 / ' / //` P Notary Public State of Florida Notary ::,ire: S7 +: a raham AP — - t . • MOW 0;0: My Commission FF 086990 of c',cpiree 02/14/2018 F:/ BLDG /Owner - Builder Affadavit REVISED: 4/16 X009 Il lei • BUILDING PERMIT APPLICATION TION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: fag e O Y A P/ .k M&' D R. • v /� P ermit Number: f (o" 11, g c -' Legal Description Parcel # or Area of S.Ft. Valuation of Work $ cod • OD Proposed Work he ted /cooled s Ft 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: - .4^r5 T/Q I. (, c e m Iry 'j QoAR0 Property Owner Information: Name: Fir n (s1 O G' i 1'V Address: So? 8 A 0 YA City iR?Lp,. (C Q Eric / State Zi P/� �5 �R 1 ilk 1 E -Mail or Fax # (Optional) P Phone C9 a�� a6 ��o �� Q Contractor Information: CONTRACTOR EMAIL ADDRESS: Company Name: Qualifying • : -nt: IP i Address: City I St t ' Office Phone Job Site/ Contact Number ' Zip 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 permit to do the w k and installations as indicated. 1 certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed o 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) mont s, 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 per its 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. I hereby certify that I have read and examined this a plication 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 of any other federal, state, or local law regulating construction or the performance of construction. Signature of Owner ' ��,U_ 1 Signature of Contractor 'Tint Name r V f /J O , / n/ Print Name 3efo =fir - Before me li'AU Day .f 1oiljh/ i / _ KM r e``� a . � . f 20 o.,rAY a Notary Public State of Florida =�� . � - _� , Shirley L Graham To 1 w . My Commis i' P ' us l]C • ''os,: Expires 02/1 f • y ti Revised 01.26.10