431 Camelia St RERF19-0071 Shingle REROOF SHINGLE PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RERF19-0071
800 SEMINOLE ROAD ISSUED: 5/1712019
ATLANTIC BEACH. FL 32233 EXPIRES: 11/13/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PIM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT ISTH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPIMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this p=tthere may be additional restrictions applicable to this property
that may befound in the public records of this county,and there may be additional permits required I
governmental entities such as water management districts,state agencies,orfederal agencies.
JOBADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
431 CAM ELIA ST REROOF SHINGLE SHINGLE ROOF $6999.00
TYPE OF REALESTATE BUILDING USE
CONSTRUCTION: NUMBER: ZONING: GROUP: SUBDIVISION:
1708741500 ATLANTIC BEACH SEC H
-COMPANY: ADDRESS: CITY: STATE: ZIP:
PEREZ JAVIER V 1015 ATLANTIC BLVD#453 ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
�Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTLON ACCO — I QUANTITY PAID AMOUNT
BU�'�No PERM T 45�0000 3U2�2LT10W 0 $95,00
�TATT.s' 0 $2,W
STATE D( 0 $2.x
7 TOTAL:$89.00
issued Date:5/17/2019 1 of 1
-,�Lk Building Permit Application Upda[ed 1019118
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FIL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
JobAddress: 43) 1?4111�11� 0- f.6 t�� 32-7-13 —Permit Number: Rc-�Rr iq - (Do 71
Legal Description —RE# l70?-)74 - lz51`30
Valuation of Work(Replacement Cost) 0,11- Heated/Cooled SF Non-Heated/Cooled
• ClassofWork: Mew DAddition OAlteration DRepair DMove DDerno ElPool OWindow/Door
• Use of existing/proposed structure(s): ElCommercial *esidential
• If an existing structure,is a fire sprinkler system installed?: OYes RNo
• Will tree(s)be removed in association with�raaa:
Describe In detail the type of work to be performed tttb��rate Tree Re
Florida Product Approval# F1, 10-JA4�- Ra/ Fj M.:46- RIzf-for multiple products use product approval form
1=rtV�w.lrl Information
V e e- Address 14-31 COM
Y� 1��TcTk St:�atte;,,f�� Zip 2>-2�2,33 Phone('OL
City u,t I jl`Xrjk�, e 9 o,4 - 't �,5 - 0,'�
E4 COI M333 it 1201l ez��
Owner or Agent(If Agent,Power of Attorney or Agency LetterRequired)
Contractor Information
Name of Company Qualifying Agent
Address City State_Zip
Office Phone Job Site Contact Nu r
State Certification/Registration#_E-Mail_
Architect:Name&Phone# Z-
Engineers Name&Phone# 1-�
Workers Compensation Insurer OR Exempt 0 Expiration Date
Application is hereby made to obtain a permit to d e��k ad installations as indicated.I certify that no work or installation has
commenced prior to the issuance of a permit that all work will be performed to meet the standards of all the laws regulating
out at. t
construction in this jurisdiction.I underst�t�hata sep'arate perm it must be secured for ELECTRICAL WORK,PLU MIRING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements ofthis
permit,there may be additional restrictions applicable to this property that may be found In the public records of this 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 YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDIN
OF COMMENCEMENT.
<��pr Agent) (Signature of Contr If
-Signed and fill b f 4 day of Signed and sworn to ffi )=before me this
sw to or a mn e ore me V4_L _day of
I Oly
;:Z7
a r a �("=, .ture of Notary)
Personally Known OR
.duc;d 4.-mificaton I P duced Identification
Type of Identification C,?,-0C,3'Lr=Identification;
"ALL INFORMATION
Owner Builder Affidavit HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY 15 REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Build i ng-Dept@coa b.us PERMITM
1. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART I"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 ORA FARM OUTBUILDING. YOUMAY
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
1�IN VIULAI IUN UE I M]b 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. I
IL INJURY LIABILITY,SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKERS COMPENSATION INSURANCE BE PURCHASED. .
Ill. 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$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(l). AN-OCCUPATIONAL UCENSE- IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPTC&COAB.US) IF IN DOUBT.
V. ACKNOWLEDGEMENT, I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
JobAddress: �131 O.A�4,,i 15�± PL- 3&�--33
Owner Name: JA- vier Pe,e,?_ Phone Number:goa- 4&6_-657�;-
Mailing Address: J�� Citv: 4-�An.�2 64-4 state: f& zip: 7 ��I. J3
Notarized Signature of Owner
The Moinjg instrjuent was 9ce;k;7n=wIedge before me this AL—day of 01 inthe tateofFlorida, County
Signature of Notary Public Z
[ ] Personally Known OR[ ] Produced Identification
Type of Identification: 6L. P (oZ043SA206 - D&3
M1111"! — Updated 10124118
TOM 131
EA
7 IMYCOM,
MYCOMM�=10N#FF`9Ml
E E� PIR
XPIRES;
NOTICE OF COMMENCEMENT
Stateof County Of —Z:,IKV0L Tax Folio No. 1 -7 C)a7 4 — 1 ED 0 0
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordaruz with Section 713 of
the Florida Statutes,the following information is shd�d,;gsNOX�E FCO=ICE
Legal Description of property being improved: DYv,e,
o7
Address of property being improved:
General description of improvements: Now
Owner: ��Vle�r pore,?= Address: &,))-h� A- 9 )q-
Owner's interest in site of the improvement:
Fee Simple Titleholdff(if other than owner):
Name:
Contractor: 6,atng- Uc- (JLj)fLe-,Y-
Address:
Telephone No.: Fax No:
Surety(if my)
Address: Amount of Bond$
Telephone No: Tax No:
Name and address of my person making a low for the construction of the improvements
Name:
Address:
Phone No: Fax:No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be
served: Narne;
Address:
Telephone No: I=No:
In addition to himself, owner designates the following person to receive a copy of the Meant's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is me(1)year from the date of recording unless a different date is
specified):
TMS SPACE FOR RECORDER'S USE ONLY OWNER
Y;�
#i;d th 0
Signed: Date:05
Befom me this day of in the Cow o Duval,Sone
4
�ax
-f Florida,has personally appeared
�#2[ngll�,ORBK18m)5 Pa9e1O1O, or
NumW Pages:1 Irsonally Known:
Recorded 0�170)19 08:14 AM, Loduced Identification:
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL otary Public:
COUNTY y commission expires-
RECORDING $10.00
TONI
% WGOMMSSION#FF92�1
EXPIRES,�WeT6�2019