HomeMy WebLinkAbout03-2383
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
2383
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
2383
ADDITION/ALTERATION
434-ADD/AL T RESIDENTIAL
MOBILE HOME SUBDIVISION
Address: 37541 NEUKOM AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: GRAND HORIZONS
Parcel Number:
6,375.00
9/23/2003
132.50
132.50
9/23/2003 Phone:
SCREEN ROOM TO GLASS ROOM ADD PATIO COVERS
Name: GONZALEZ MANUEL
Address: 37451 NEUKOM AVE
ZEPHYRHILLS, FL. 33542
'J !~/1f}
,/ '/ t?L 1 JII'JO
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1 B
CONSTRUCTION POLE 2ND ROUGH PLUMB DUCTS INSULATED
I LINTEL PRE-METER WATER FINAL MECHANICAL
FRAME MISC SEWER MISC
I INSULATION WALL MISC . MISC. MISC.
INSULATION CEILING MISC. MISC. MISC.
. DRIVEWAY MISC. MISC. FIRE DEPT. FINAL
- -- -
REINSPECTlON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Thirty-Five Dollars ($35.00) shall be made for each trip for each trade:
(a) Wrong address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when
inspection called (d) Work not ready for inspection when called
(e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible
nJhe paym~I1~c:>f inspectiol1 fees shall be made before any further permits will be issued to the person owning same
"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,"
---------- Complete Plans, Specifications and Fee ~Must Accom~pany Applicatlon.--
____ _~__n____ __~'-""'c:>rk shall b_E::!. performed in accordance with City Codes and ~ Ordinance~_
NO OCCUPANCY BEFORE C.O.
----_.._~~_.. ~_..- ~~-
~Sl~ ~MITOFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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GRAND HORIZotJS - PHASL- Orv(
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CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8th Street, Zephyrhills, FL 33542
813-780-0020 FAX:813-780-0021
DATE RECEIVED
PLANS REVIEW FEE
OWNER' S NAME~a.t'lIA.e.1 Gonz.a..l ~-z......
JOB ADDRESS .3 746/ rJ etA-koY\1 Ave..
PASCO PERMIT SERVICE
PHONE 813-788-5314
LEGAL DESCRIPTION: LOT(S)
SUBDIVISIONGrGtnJ [-for 17 Dn s
BLOCK
PARCEL ID # ~ - a.5" -~l- ooqo- 0??oo- l ~ 00
DSIGN
PROPOSED USE: ~L FAMILY DWELLING
o COMMERCIAL
~DDITION
o MOVE
(OBTAIN FROM PROPERTY TAX NOTICE)
~LTERATION 0 REPAIR 0 INSTALL
WORK PROPSED: 0 NEW CONSTRUCTION
o DEMOLISH
DMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
BUILDING SIZE
c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL
D Glttss ~
liv;l'I~ ~::LO
FOOTAGE P.::l.+-io ~ ~5"
PCLtlO Covers
DESCRIPTION OF WORK
SQUARE
I4-dd
R'
HEIGHT 5l!:~ p/~s
,
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
~UILDING
IlYELECTRICAL
PERMITS REQUESTED
$
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o PLUMBING
o MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES
o NO
BUILDER
~ COMPANY Kt-n t.<.1'1i Lb"Srrkc/to;'"
STATE CERT OR REGIST
SIGNATURE ~ ~ CITY PROCESSING i
/ .
** ***************************************************************
ELECTRICIAN
SIGNATURE'I-'=;~ f~ 2_
COMPANY OW/I'l/er
STATE CERT OR REGIST #
CITY PROCESSING #
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
******************************************************************
MECHANICAL
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
**********************************"*******************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
**********************************************************'*******
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
compliance with ~ny applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may be required
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owper has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions of the "Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs as the contractor, you are indicating that
you, rather than the contractor, are responsible for the work. If the contractor wishes
you to sign as contractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "owner" prior to commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will
be done in compliance with all applicable laws regulating construction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and installation as indicated. I
certify that no work or installation has commenced prior to issuance of a permit and that
all work will be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I Inust take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone "A" or "A,etc.", it is
understood that a drainage plan addressing a "compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
A permit issued shall be construed to be a license to proceed with the work and not as
authority to violate, cancel, alter, or set aside any provisions of the technical codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is conwenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
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. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
s,d;~-;;;E~ OR ~ SIGN~~ tdd
STATE OF FLORIDA 01 ',,"
COUNTY OF ~SCO
The foregoing instrument was
Before me this _ day of
by
acknowledged
2Q_
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _day of
by
fbsc...o
a cknowl e,%ed
,
(name of person acknowledged)
Dwho is personally known to me, or
(name of person acknowledged)
C1ho is personally known to me, or
of identification)
take an oath.
Dwho has produced
(type of identification)
and who Ddid DUd not take an oath
o who has produced
(type
and whoD did 0 did not
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
PASCO COUNTY BUILDING PERMIT APPLlCAnON
CENTRAL PERMrmNG OFFICES: SHADED AREAs FOR OFFICE USE ONLY
· Dade City: (352) 521-5144 FAX (352) 521-5149 0CCllPANc'I: SECt: . a '19 f3.;)
'3852 17th St., Dade City
· New Port Richey: (727) 847-8126 FAX (727) 847-8901 NO. OF UNITS:
7530 Uttle Rd.. Rm. 210 New Port Richey RRE DISTRICT: PERMIT#:
· Land Q'Lm<es: (813) 929-1266 FAX (813) 929-1307 1YPE C<lNSTRUCTloN' I II III r>I V VI
4111 Land O'Lakes Blvd. (US 41), Land O'Lakes . ft=
THIS APPLICATION MUST BE TYPED OR PRINTED IN INK DATE RECEIVED: 8-- ~ BY:
AND IS VOID IF NOT PERMlffiD WITHIN 6 MONTHS
-------------------------------------------------------------------------------------------- --- ---------
IS THIS APPLICATION THE RESULT OF A STOP WORK ORDER OR NOTICE OF VIOLATION? y _ N-=::..
G OWNER'S NAME: -.t1 an /.\.e.l ~ ut Ie z. PHONE # (_)
9 JOB lOCATION: 374 S I tV ~ IY) A vt-. SUBDIVISION: Gro.nd 1+0 r iZ-b", S
~ PARCEllD#: S ~ T ~ 5" R ~ SUB Qf&2 BU< ~ LOT 11./00 PROJECT # TAZ _ LOT SIZE 79' x lQi:..
~ OWNER'S PRESENT ADDRESS: St1~ CI1Y: Zephyr"'.. ,,~ STATE: fl. ZIP: 33~C/ /
;:
o FEE SIMPLE TITLEHOLDER'S NAME Of other than owner):
address (if applicable): CI1Y: STATE: ZIP:
----------------------------------------------------------------------------------------------------------
DESCRJPllONOFWORK: G\.n ~ 5cr~~ 12M -Tv ClAss Po..t- Covo-- a../l ~ l'st. ahs
G UVING AREA: ..< ~O t:/J PATIO: ~ 35" GARAGE: ENTRY: TOTAL UNDER ROOF: 'f S-.s- ttJ
9 # BEDROOMS - # BATHROOMS -- _ TYPE CONSTRUCTION: 0 BLOCK 0 FRAME ,QtOTHER: tAl /.uf;t.(;"u............
ca FILL Y _N_
~ IF MOBILE HOME OR RV: MAKE
t=
a..
a: WORK CODE
u
en
w
C
PASCO PERMIT SERViCE
PHONE # ( _ ) 813-788-5314
CITY: STATE: _ ZIP:
PASCO CO COMPUTER 10#: '14 70
YEAR
SIZE
PRE-PAID PLANS FEES: $
CITY:
STATE: _ ZIP:
CITY:
STATE: _ ZIP:
CITY:
STATE: ~ ZIP:
-----------------------------------------------
MECHANICAL CONTRACTOR:
SIGNATURE:
ADDRESS:
STATE UC # Qf applicable)
o NEW 0 ALTERATION VALUATION: $
PHONE# (_)
CITY: STATE: _ ZIP:
PASCO CO COMPUTER 10#:
(Required)
PLUMBING CONTRACTOR:
SIGNATURE:
ADDRESS:
STATE UC # Of applicable)
# FIXTURES: SEPTIC PER #
PHONE # (_)
CITY: STATE: _ ZIP:
PASCO CO COMPUTER 10#:
SEWER: WATER: WEll:
OTHER CONTRACTOR:
SIGNATURE:
ADDRESS:
STATE UC # (if applicable)
TYPE CONTRACTOR:
PHONE# (_)
CITY: STATE: _ ZIP:
PASCO CO COMPUTER 10#:
VALUATION: $
---------------------------------------------------------------------------------
OTHER FEE TYPE:
AMOUNT: $
RECEIPT#:
---------------------------------------------------------------------------------
JOBS UNDER $2,500 IN VALUE DO NOT NEED TO
RECORD AND POST A "NOTICE OF COMMENCEMENT"
TOTAL BUILDING PERMIT FEE:
· · · · NOTICE. . . .
BOTH THE OWNER AND CONTRACTOR OF RECORD (License Holder) MUST READ AND
SIGN THE REVERSE SIDE OF THIS APPUCATION
FEES BlOCK
PlANS FEE: $
BUILDING:
$
B.ECTRICAL
FEE:
s
MECHANICAL
. FEE: $..
PLUMBING
FEE: $
....._, . ....-.........
'. ....... .......
RADON
FEE:
S'.
.....$ .
(pennit form 101911
EDITIONS OF THIS FOAM RElEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF
PC930430321G (~
'\. 'jOTICE OF DEED RESTRICTIONS
The undersigned understand that this oermlt may be subject to "deed restrictions.' which may oe more restrictive than County regulations. The
underSigned assumes responsibility for compliance with any applicable deed restnctlons.
S. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work. they may be required to be licensed in accordance with state and local regu-
lations. If the contractor is not licensed as reqUired by law. both the owner and contractor may be Cited for a misdemeanor violation under state
law. If the owner or Intended contractor are uncertain as to what licensing requirements may apply for tI1e Intended work. they are advised to
contact the Pasco County Building Division - Licensing Section at (727) 847-8009.
Furthermore. If the owner has hired a contractor or contractors. ne IS advlsea to have the contractons) sign portions aT the .contractor Block" of
this aOPllcatlon tor wnlcn they Will be responslole. iT YOU. as tn\:! owner sign as the contractor. you are Inaicatlng that vou. rather than the contrac-
tor. are resoonslOle tor the work. if the contractor wlsnes you to sign as contractor. that may oe an Inalcation that he IS not properly licenSed and
IS not entitled to permitting pnvlleges In Pasco County.
C. TRANSPORTATION IMPACT/UTILlTIES IMPACT AND RESOURCE RECOVERY FEES
The underSigned understand that Transportation Impact Fees ana Resource Recovery Fees may apply TC) the construction of new buildings.
change of use In existing buildings, or exoanslon of existing buildings, as specified in Pasco County ' lance numbers 89-07 and 90-07, as
amended. The undersigned also understands, that such fees, as may be due, will be Identified at the time of permitting. It is further understood
that Transportation Impact Fees and Resource Recovery Fees must be paid pnor to recelvmg a "certificate of occupancy" or final power release.
If the project does not involve a certificate of occupancy or final power release, the fees must be paid pnor to permit issuance. Furthermore. If
Pasco County Water/Sewer Impact fees are due, they must De paid prior to permit issuance. In accordance with applicable Pasco County ordi-
nances.
D. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended)
If valuation of work is $2500.00 or more. I certify that I, the applicant. have been provided with a copy of "Florida Construction Lien Law _
Homeowner's Protection gUide" prepared by the Florida Department of Agnculture and Consumer Affairs. if the applicant is someone other than
the .owner," I certify that I have obtained a copy of the above deSCribed document and promise in good faith to deliver It to the "owner" prior to
commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information In this application IS accurate and that all work will be done In compliance with all applicable laws regulating con-
struction. zoning and land development.
Application IS hereby made to obtain a permit to do work and installation as indicated. I certify that no work or Installation has commended
pnor to Issuance of a permit and that all WOrK Will be performeo to meet standards of all laws regulating constnctlOn. County codes, zoning reg-
ulations, and land development regulations In the lunsdiction. I also certify that I understand that the regulations of other government agencies
may apply to the Intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include
but are not limited to:
· Department of Environmental Protection - Cypress Bayheads, Wetland Areas and Envirtmmentally Sensitive Lands, WatertWastewater Treatment.
· Southwest Florida Water Manaaement District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercources.
· Armv COrDS of Enaineers - Seawalls. Docks, Navigable Waterways.
· Department of Health & Rehabilitative Services Environmental Health Unit - Wells, Wastewater Treatment, Septic Tanks.
· US Environmental Protection Aaency - Asbestos abatement.
· Federal Aviation Authoritv - Runways.
I unaerstand that the following restrictions apply to the use of fill:
· Use of fill is not allowed in FlOOd Zone "V" unless expressly permitted.
· If fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at
time of permitting which is prepared by a profeSSional enQlneer licensed by the State of Florida.
· If fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used
only to fill the area within the stem wall.
· If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to
adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit
application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to
commencing construction.
I understand that a separate permit may be required for electncal work, plumbing, signs, wells, pools, air conditioning, gas, or other installations
not specifically included in the application.
A permit issued shall be construed to be a license to proceed with the work and not as authority to vialate, cancel, alter, or set aside any provi-
sions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans.
construction, or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced
within six months of permit issuance. or if work authorized by the permit is suspended or abandoned for a period of six months after the time
the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and
wiN demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the jab is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPE . IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AlTORNEY
BEFORE RECORDING Y UR NOTIC OF C MMENCEMENT.
SIGNATURE
DATE
MY COMMISSION
EXPIRES
",'" Suzanne Bahr
~~""~..~~;;;'-_ Commission #00157131
~*:~~:i Exoires: Nov 15,2006
-:. :-,~ . . . 'o~ ,,' Bonded Thru
"",~~,~,;", Atlantic Bonding Co., Inc
DATE
NOTARY AS TO y~
CONTRACTOR .>LJ,..,b
,~Y;;~'" Suzanne Bahr
/"~~~<f'---- Com!llission #00157131
MY COMMISSION ~;:. '~J.::~ Expires: Nov 15,2006
EXPIRES > ~ .. t;,~,1 5""d...<ll'lnu
;"/I~~tl~\\' Atlantic Bonding Co., Inc.
NOTARY AS TO
OWNER OR AGENT
.~
NOTICE OF COMMENCEMENT
1111I111111111I1111I1111111111111111111111111111111111111111
2003156955
. State of LI Dr" j d..CL. County of PeA-50
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,
and in accordance with Chapter 713, Florida Statutes, the following information is provided in
this Notice of Commencement:
1. Description of Property: Parcel No. 3Y-db-,;t1-00'10-00000-ILfOO
GY"'and. H-orizons - Pha..se One.
(Legal description of the property and street address if available)
2. General Description of Improvement r_ h a.Y\~ e.. e.x.t'S T t ~ 6C-re.:e.1'\..
room +0 ~ l~s.s lA-J i Vldow ~.. odd. o..-l t.t.VV\ l~ l.A.~
p&'-+LD ('.A) I/ef
3. OwnerInformation: Name ~ CLV1 lA. e..l
Address ,~7 451
Net-tkorn Ave.
Gonz~..-L~z-
City~hlrhi lis
State Fl. :33S-t/ /
Interest in Property:
Name of Fee Simple Titleholder:
(If other than owner)
Rcpl: 709781
OS: 0. 00
08/26/03
Rec:: 6.00
IT: 0. 00
Dpty Clerk
Address City
F~contractor: Name_Ken. Wi I ej c.on~T(,lALtl-ol'"'\
Address 37&3t.tJ CaribbetV1 -:Dr. City Zephyr-hi 115
State
State FI. 33 -S-L/ I
5. Surety: Name
Address
Amount of Bond: $
6. Lender: Name
Address
City
State
~~~2~~~5MA~g: r~:~o fOUNTJf C~ERK
OR BK 5507 PG 1966
City
State
7. Persons within tbe State of Florida designated by Owner upon whom notices or other
documents may be served as provided by Section 713.13 (1) (a) (7), Florida Statutes:
Name
Address
City
State
8. In addition to bimself, Owner designates
. '
of to receive a copy of the Lienor's Notice as
provided in Section 713.13 (1) (b), Florida Statutes.
9. Expiration date of Notice of Commencement (the expiration date is I year from the date
of recording unless a different date is specified.)
Signalure orowner:./I7~ P~-ie
t?
Sworn to and subscri before me this d~ NL day of ;::;"6u.~ r-
Notary Public:
,2003.
My Commission Expires:
PC93053048/A
",~v Pu",
=;:'~<f\ COffi!TIission#DDI57131
~.,:. . :.r= EJl.plll;~. Nuv 15, 2666
'J',,;f; OF f\.o~ ,..... ~onded .Thru
'11"'\\ Atlantic BondmgCo., Inc.
OWNER-BUII.DER AFFIDAVIT
ST~ JF FLORIDA )
COUNTY OF PASCO )
BEFORE me, the undersigned authority, personally appeared Ma.Y1t<.d 0onZa../ec:...
, who being by me first duly sworn, under oath, deposes and states
as follows:
I do hereby swear/affirm:
That r own the property described IlS 3tI-;]!i - ~/- OO'tO-oocrx;J - I4:W
Gra.V'ld /ton 7-Dvl5 - p~sc- On e....
Disclosure Statement
Stllt~ 1m.: rN!uires con~truction to lJ... don~ hy licensed contnictors. Yon hllvc IlpplJed
for a permit under an exemption to the 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
mus t supervise the construction yourse I [.
family residence or 11 farm outbuilding.
You may build or improve a one-family or two-
You may also build or improve a commercial
building l't I] cost of $25,000.00 or l~ss. Thf> building must be for your own use find
occupancy. It may not be built for sale or lease. If you sell or lease a building you
have built yourself tdthin onp. year after the construction is complete, the lall1 will pre-
sume that you built it for sal~ or lease, which is a violation of this exemption. You may
not hire an unlicensed person as your contractor.
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. Any person working on your building who is not licensed must work
under your supervision and must be employed by you, which means that you must deduct
F.I.C.A. and withholding tax and provide Workers' CC11pensation for that employee, all as
prescribed by law. Your construction must comply with all applicable lAWS, ordinances,
bu i1 (Jj ng codes. llnd :>:cning ,l:egu loti <,.11:3.
That I havl'! read the foregoing, and am awnr~ of my responsibilities and liabilities
for construction work on the above-described property And do hereby agree to each of th~
aforesaid stipulations.
FURTHER AFFIANT SAYETH NOT.
?JJ~~
Owner' Sig ture
37t/-!J/ N~m live.
Address
2'o/~Th;{/~ ROo 33~cfl
~ / :l;;L/ 03
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Date
SWORN to and subscriPf-d before
this ~Jd.ay of H~/A.a,.r-
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Ni:~b~
Stat~y~~~~ida at Large
0/1 7.1lY'l () e &tv-
Print, Type, or Stamp Commissioned
Name of Notary Public
me
"\\111,, Suzanne Bahr
"~t>P!YPlJ~
/;~/:~ Com!l1ission #DD157131
:;.~. ~:..~ ExpIres: Nov 15,2006
"/~~OFf~O~" Bonded Thru
'1,,,,,\,, Atlantic Bonding Co., Inc.
My Commission Expires:
Personally Known _____ or Produced Identification
Type of Identification Y. ( ~.
/"
,
PC93053047