HomeMy WebLinkAboutSUBMITTED PAPERS�4
QFFICE USE t3 XN1
DATE FILED:
'?LANMVIEW FEE: ;
CONCURRENCY FEE:
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2.
4.
5.
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RECEIPT NO.: PERMIT NUMBER: 17_02 — O 1 �
RECEIPTNO.: �'CERT. CAP. NO.:
ALL I FO MIDST BE COMPLETE & FILLED IN TO BE ACCEPTED
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
BUILDING & CODE REGULATIONS DIVISION
2300 Virginia Avenue to(k
Ft. Pierce, FL 34992-5652 S0
772-462-1553 �� �1/E®✓ - f �` '
APPLICATION for BUILDING PERMIT le you"tj/
CERTIFICATE of CAPACITY/ZONING COMPLIANCE
PROJECT INFORMATION
/D 867 S. 6 6,54 nl
LOCATION/SITE ADDRESS: # la-7 Gr�ihi2� rs� f��! A (YE *ALA. eAl' Ma FL soy ,0 I
PROJECT NAME: SITE PLAN NAME:
PROPERTY TAX ID #: �,�//- a'!D D dD ,5-
LEGAL DESCRIPTION (attach extra sheets if necessary):
PLAT BOOK 6. PAGE NO. 7. BLOCK NO. 8. LOT NO.
PARCEL SIZE (ACRES/SQ FT.): ! — . LOT DIMENSIONS:
i0 C�OWLETE DESCRIPTION OF CONSTRUCTION PROJECT OR WORK ACTMTY:.ZN 57-iRLL &,WdRETE
0
dN �iIIT.°e F ID%/�f 1119"7r �Fle �EIP Zn a- , 5T,/Q(r
&EARt';rEn�„�L_ d�pcn_; F;�oQE 6N� >`r�rr l D
11. SETBACKS (ACTUAL) FRONT: BACK: RIGHT SIDE: LEFT SIDE:
g TYPE OF CONSTRUCTION (Check all appropriate boxes).
NEW CONSTRUCTION [ ] EXPANSION/ADDITION [ ] INTERIOR RENOVATION
[ ] RESIDENTIAL [ ] COMMERCIAL [ ] INDUSTRIAL
OTHER (SPECIFY) C,0
D13 DESCRIPTION OF PROPOSED USE: /C �S ; r�6 �V % i'A L " M E
14: SQ. FT OF CONSTRUCTION: 0 D,6 89, I- %• 15. SF. FT 1st FLOOR:
ea
16. VALUE OF CONSTRUCTION: $ T �.-U..
The value of construction is used to determine the amount of permit fees to be assessed. St Lucie County reserves the right to question and/or modify the indicated
value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction activities. If the value is $2500 or more, a
RECORDED Notice of Commencement must be submitted with this application.
SLCCDV Form No.: 001-02
UPDATED 6/25/09
6%/05� G ® s" 477-4041,e0
OWNER INFORMATION
NAME: ,44i 1 Ed C.5 / G.
ADDRESS: 12441267Li
CITY: ' STATE: Al 1/ ZIP:
�-
PHONE (DAYTIME): 016 f h'� �<-2 — Email:
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE
FILL IN NAME AND ADDRESS BELOW.
FEE SIMPLE TITLEHOLDER:
ADDRESS:
CITY: - STATE: ZIP:
PHONE (DAYTIME): (_)
CONTRACTOR INFORMATION
ST. of FL REG.CERT #:
BUSINESS NAME:
QUALIFIERS NAME:.
ADDRESS:
CITY:
PHONE (DAYTIME): (_)
ARCHIT/ENGINEER:
STATE:
FAX NO.
ADDRESS:
CITY: STATE:
PHONE (DAYTIME): C__)
BONDING COMPANY:
ADDRESS:
CITY: STATE:
MORTGAGE LENDER:
ADDRESS:
CITY:
STATE:
ST. LUCIE COUNTY CERT #:
Email:
ZIP:
VP;
ZIP:
ZIP:
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days after notification
it wig be voided and returned to you by mail
CERTIFICATION: - --
-This ap lication is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced 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. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, FENCES, ETC., not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict_with any applicable Homeowner Association rules, bylaws or any covenants that may restrict:or prohibit such
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply. _
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE 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 JOBSITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
NOTICE TO APPLICANT: IF IT IS NOT YOUR RIGHT, TITLE, AND INTEREST THAT IS. SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT, YOU PROMISE IN
GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
M
OWNER OR CONTRACTOR SWEMMA REw
STATE OF FLORIDA
COUNTY OF �CcruG Ca�
The foregoing instrument was acknowledged before
me this 13 day of k6 20 12
by
who is personally known or has produced
0- �* Lt e- ASS g27.33gs identification.
Signature of Notary
Commission No. (Seal)
CONTRACTOR SIGNATURE
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this day of . 20
by
who is personally known or has produced
as identification.
Signature of Notary
Commission No. (Seal)
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNERBUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
For specific instructions see appropriate permit checklist.
OFFICE USE ONLY ' Blw ••_�
SECTION
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27
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MAP NO.��
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CONST TYPE
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# OF FLRS
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STORMWATER
LOT OF REC
LOT OF REC
LOT SPLIT
LOT SPLIT
Before 111990
After 1/1990
REQUIRED
APPROVED
REPORT
HABITABLE
RADON
PERMIT
CODE
AREA
FEE
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LIBRARY
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PUBICBLD
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PLUMBING
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DATE SENT TO ADDRESSING:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
�•/ • /2
DATE
COMPLETED
'
INITIALS
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 3674996 OR BOOK 33 ?PAGE 1255,..Recorded.02/15/2012 at PM
NOTICE OF COMMENCEMENT
Permit No. Tax Folio
State of Florida County of St. Lucie
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.
!✓ill�dl i l L1/l 6' LG 7FfE .SElt�u�r�t, ro: cf �h Nc 1 UN?r 157
Legal Description of Prope : (and stree ddress if vailabl��
n� "��: fly .5"7
General description of Improvement: h'>°/ / S ?_p �Xr 5 TI A/d 6 i �)r.n/rr, AWX
owner infor atian or Lessee�forination if the Lessee contracted for the improvement:
Name AJ
Address L
Interest in property:
Name and address of fee simple titleholder (if different from Owner listed above):
ContractorsName: s A /i1('�n� i��i —A— Q [�Iy�ie
Contractor Address: Phone Number:, ,;�-_ p7�jr
Surety (if applicable, a copy of the payment bond is attached): Amount of bond: $ 4d11-- —
Name and address: Phone number:
Lender Name: Phone Phone Number:
'ender's address:
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
71r .13(1)(a)7., Florida Statutes:
Name: _ N/ �� Phone Number:
!n addition to himself or herself, Owner designates of
Lienoes Notice as provided In Section 713.13(1)(b), Florida Statutes.
Phone number of person or entity designated by owner:
to receive a copy of the
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor, but will be 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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
INSPEcriON. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my knoMedge and belief.
o
(Signature of Owner or Lessee, or Owner's or Lessee's Authorized Officer/Director/Partner/Manager
(Signatory's Title/Office)
The foregoing instrument was acknowledged before me this day of � , 20� , C
By Czorcy' as i'�1��C for
Name of P son �M Type of authority (e.g.officer,trustee) Party on behalf of whom Instrument was exxeeccutied.�--�f�
Y ' 1 Personally known_or produced Identification
(Signature o Notary Public -State ANGELA M. HUFF I _
(Print, Type, or Stamp Commissio a N�I i�Qy� 12EMIS p Type of Identification produced
Balled ThN Na1�yPu6sc UnJe�wlfen
STATE Of FLORIDA
ST. LUCIE 1iNTY
TV14S IS 10 GEATIFY THAT TH
TRUE-W-C 94ECT COPY TOE
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BUILDING & CODE SYSTEM You are logged s: Version
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857 Version 21.13A
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............ _!
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.nter.............. .............i �6
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Edit Address
DR 157 _ ........................... JENSEN BEACH................................. _. FL.... 34957............................._ Historic: NO.......
OUNTy Owner(s): CARMEN CESTA
Block: r Lot #: F,,,,,___,___,_, , Zoning:HUTCHINSON ISLAND R(
Flood Map: PANEL 313 OF 410 Flood Elevation: IB ... _ Flood Zone:
227766
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E
SYRANSE
NY 113203-1130
Owner CESTA I 2525 �
AVE
Type Name Company art # ,Phone Fax I Cell Email Street Addr City State Zip
� 641 i
Property `CARMEN SCOVILL
PERMIT INFORMATION
Add Sub Permit
Type
Permit Category;_RESIDENTIAL
Permit Type:
BUILDING (MIS
Date Applied:
2/13/2012
Date Issued:
2H5/2012
Date Finaled:
2/15/2012
Date Voided:
Date Expired:
_-
8/13/2012
Status I Contracti Compami Cert# I Status
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I_Finaled
US)
..........................................:..........................................................................
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�nel __
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anpla
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1777
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... ...... ..... ... ._..._._........_..__.......__..........._........
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._............._......_...�...._._........ ... ...._....... ........_._...................
_..... ._.
Tenant Phone I Job_ Date
Q Filed By
EDIT Construction, Zoning, and Temnorary Snecial Permit Information
Permit #: 1202-0136 Confirmation
0
;i
# New Units: 1 # New Floors: ' 1 # New Buildin s # New Bedrooms: � # New Bathrooms:
L:_::::........ g i._.._...... ;---1 h......._.._
';Exterior Type: L.,._......._........._...........__..........................-....._...__......! NOC Required: C i NOC Received Date:' .' ....... ) NOC Expire Dater
CertCAP Required: F1 Setbacks: Front: ! Back: T.eft Side: �� Rieht Side:
Status M j; ;n
http://code/(S(41ckcfdps5tzymyi2zniecc3))/Add EditPennit.aspx 3/11/2014
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Fence Permit Number: LO---
Pool Ladder Description: Fy I
i
PERMIT RECORDS REQUEST
Employee Requesting File I Date Requested I Date Returned I Notes
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http://code/(S(41ckcfdps5tzymyi2zniecc3))/Add EditPennit.aspx 3/11/2014
FLE COPY
1
FROM: STEVENS. WOOD, P.E. FEBRUARY 7, 2012
FL PE No. 34398
950 SULTAN DR
PSL, FL 34953
(772-878-7324)
TO: ST LUCIE COUNTY BUILDING DEPT
SUBJECT: CERTIFICATION FOR 'AS BUILT' CONCRETE SKIRTING AND
MASONRY VENEER CONSTRUCTION
REFERENCE: CASE #, 65743 & 68093
CARMEN CESTA RESIDENCE @
10851 S OCEAN DR
LOT #157 (WINDMILL VILLAGE MHP)
JENSEN BEACH, FL 34957 a. /7 X
BACKGROUND:
THE PURPOSE OF THIS LETTER IS TO CERTIFY THE 'AS BUILT CONCRETE SKIRTING
AND STONE VENEER CONSTRUCTION AT THE ABOVE REFERENCED MOBILE HOME
ADDRESS.
• THE SUBJECT MOBILE HOME IS A 1989 CHARIOT EAGLE DOULBE WIDE UNIT
APPROX 40 FT LONG BY 24 FT WIDE ANCHORED TO A CONCRETE SLAB.
• STORM SURGE FROM HURRICANES FRANCIS AND JEANE IN THE FALL OF 2004
CAUSED SIGNIFICANT DAMAGE TO THE UNDERSIDE OF THE MOBILE HOME
DESTROYING THE SKIRTING, THE AIR CONDITIONING UNIT, PLUMBING,
DUCTING, AND OTHER MECHANICAL EQUIPMENT UNDER THE MOBILE.
• SOON AFTER THE HURRICANES (WHEN PERMITS WERE NOT REQIURED FOR
CERTAIN REPAIRS), THE CESTAS BEGAN REPAIRING THE SKIRTING BY
INSTALLING 4"X8"X16" CMU BLOCK ANCHORED TO THE CONCRETE PAD WITH
REINFORCING BARS AT 36" O.C. IN FILLED CELLS. (SEE ATTACHED SKETCH)
• IN AN EFFORT TO FURTHER FORTIFY THE HOME, SHEETS OF 2" DUROCK CEMENT
BOARD WERE ATTACHED TO THE EXTERIOR WALLS UPON WHICH 1" THICK
MASONRY VENEER (PAVERS) WERE ANCHORED ON THE EAST, WEST AND NORTH
WALLS. (SEE ATTACHED SKETCH).
• BASED ON A RESIDENT COMPLAINT, THE ST LUCIE COUNTY BUILDING DEPT
ISSUED A NOTICE TO STOP WORK UNTIL A PERMIT WAS OBTAINED. TWO
CASE NUMBERS HAVE BEEN ISSUED. CASE # 65743 FOR THE SKIRTING ISSUE
AND CASE # 68093 FOR THE PAVERS.
• THIS ENGINEER PERFORMED AN INSPECTION OF THE SUBJECT MOBILE HOME
ON 1/28/12.
Steven G. Wood, P.E.
Florida P.E. No. 34398
950 Sultan Dr
PSL, FL 34953
FILE C'Omh'PY
FINDINGS:
BASED ON THE INSPECTION, REVIEW OF THE MATERIAL'S/PROCESS, PHOTOS,
PAPERWORK AND DISCUSSIONS WITH THE OWNER/BUILDER (CARMEN CESTA), THE
FOLLOWING FINDINGS WERE MADE IN REGARD TO THE 'AS BUILT SKIRTING AND
MASONRY VENEER:
• THE CONCRETE SKIRTING IS INSTALLED AROUND THE ENTIRE PERIMENTER
AND CONSISTS OF 4"X8"X16" CMU BLOCK ANCHORED TO THE CONCRETE PAD
WITH VERTICAL REINFORCING BARS DRILLED AND EPDXYED AT 36" O.C. IN
FILLED CELLS. THERE WERE AT LEAST (6) ACCESS PANELS THRU THE
SKIRTING FOR ENTRY UNDER THE MOBILE. IMPACT TESTS ON THE
SKIRTING WALLS DID NOT RESULT IN ANY DEFLECTION, MOVEMENT OR
SHIFTING OF THE CMU'5. THE SKIRTING IS SOLID. SEE SKETCH.
• ON 100% OF THE EAST AND WEST WALLS, 2" DUROCK CEMENT BOARD WAS
ATTACHED THRU THE VINYL SIDING INTO THE STUDS OF THE MOBILE
HOME USING STAINLESS STEEL SCREWS AT 12" O.C. ALONG EACH STUD.
ANCHORS WERE PRE -DRILLED TO VERIFY ADHEREMENT TO WOOD STUDS.
• OVER THE DUROCK IS A THIN -SET MORTAR USED TO SECURE THE 1" THICK
PAVERS. LIFT TESTS ON THE PAVERS COULD NOT DEFLECT, SHIFT OR
REMOVE THE PAVERS. THE PAVERS ARE FIRMLY SECURED. SEE SKETCH.
• THE BACK (SOUTH) WALL DID NOT HAVE ANY DUROCK OR PAVERS INSTALLED
AT THE TIME OF THE INSPECTION.
• ON APPROX 50% OF THE FRONT (NORTH) WALL Z" DUROCK CEMENT BOARD
AND/OR WIRE MESH HAD BEEN ANCHORED TO THE STUDS WITH SST
SCREWS AT 12" CENTERS. PAVERS WERE INSTALLED OVER THE WIRE MESH
(AND DUROCK) WITH THIN SET MORTAR. LIFT TESTS FOUND THESE PAVERS
FIRMLY ANCHORED TO THE WIRE MESH AND DUROCK.
CONCLUSIONS:
• BASED ON THE ABOVE FINDINGS, THE 'AS BUILT CONCRETE SKIRTING AND
PAVER VENEER WILL NOT ADVERSELY IMPACT THE MOBILE HOME'S ABILITY
TO WEATHER FUTURE HURRICANES. IN FACT, IT MAY PROVIDE ADDED
PROTECTION.
• THEREFORE THE'AS BUILT CONCRETE SKIRTING AND PAVER VENEER
CONSTRUCTION IS ACCEPTABLE AS I5.
• CONTINUED PAVER VENEER CONSTRUCTION (PER ABOVE DOCUMENTED
PROCESS) MAY PROCEED ONCE THE PROPER PERMITS ARE OBTAINED.
• DUE TO THE FIRM ATTACHMENT OF THE PAVERS TO THE DUROCK/WIREr
MESH, ANY ATTEMPT TO REMOVE THE PAVERS WOULD LIKELY RENDERJHE'
MOBILE HOME COMPROMISED AND IRREPARABLE.
a 1-711
1;11-V,; C i1 ii<:111,
ST LUCIE COUNTY
DUILDING DIVIWR
REVIEWED BY V
DATE ' 80
PLAN AND PERMIT
MUST B KEPT ON JOB OR
NO INSPECTION WILL BE MADE
„t� �Swnm a emmm
CARMN CMA RESIDENCE
foj3�t 5. ocaw DR, - ;71577
E)3SnKG ROOF CONSIRUCWL
r D0FRIOR SfOIE PA1 M
SEE IN THH -SEf UtJRTAR
m Z 1i31 X CMQ&X
SILL aTV010 TO cmu
SKZtdWG
4 a8 jc46" HRX CIO
AT900 TO 10P OF 1W
47 CM
NM 4 OM SKffff iG
{ AT HAM OF DOS=
TRAILER• CORE MU"
SOLE) AT FEW LOCAMN
REMFOR(RG BAR t?RM0 AND
GROUT tHrO DUSI-M OOtiE UE'
PAD AT @ 36' o c ..
DUS111+iG CONCREIE PAD •�•
ERR SUPPaRr pC
Steven G. Wood, P.E.'.
Florida P.E. No. 34398 Aml
950 Sultan. Dr ,
eD NS /' )qcLCTi'e.A C`�D�
6s
,��C�
/D1-6
200
aN
Sp
•r f r
& AJ,4-L v C� (2�—
D� � a
BOARD OF
COUNTY
COMMISSIONERS
Manufacturer:
Model #:
Serial #:
Year Built:
Subject: Stucco applied to manufactured housing
To: St Lucie County, Building & Code Regulations Division
PLANNING & DEVELOPMENT
SERVICES DEPARTMENT
Building & Code
Regulation Division
This letter has been requested for us to acknowledge the exterior renovation of our
manufactured home by adding stucco over dense glass panels and applied without
permitting by the contractor. It has been brought to our attention that the application
utilized in the remodel process is not approved for manufactured homes and requires
additional engineering for extra weight and support on the framework. It is our
understanding that cracking may occur to the exterior due to the prior application and
method used, and therefore will not hold St Lucie County, Building & Code
Regulations Division responsible.
With this letter we also recognize that our manufactured home is not considered a site
built residential dwelling and that any subsequent removal of the manufactured home
from the existing site may be compromised during transport on highways and may
require other means of removal or demolition.
We understand that professional plans and engineering maybe required for the
additional support and foundation attachments needed under the manufactured home to
accommodate the extra weight and will require a final inspection report by a licensed
engineer or architect.
If you have any questions, please contact the Building and Code Regulations Division,
Permitting Department at 772-462-1553
Owne��
333-.7-33L
Notary Seal:
HR1S DZADOVSKY, District No. I • TOD MOWERY. District No. 2 • PAULA A. LEWIS, District No. ; • FRANNIE HUTCHINSON, District No. 4 . CHRIS CRAFT. District No. 5
County Administrator— Faye W. Outlaw, MPA Website: www.stlucieco.oro
2300 Virginia Avenue • Fort Pierce, FL. 34982-5652
PERMITTING AND ZONING: Phone (772) 462-1553 FAX (772) 462-1735
CONTRACTOR LICENSING: (772) 462-1672 • CODE ENFORCEMENT: (772) 462-1571 • INSPECTIONS: (772) 462-2165
FAX: (772) 462-1148
St. Lucie County
Building & Zoning Department
2300 Virginia Avenue
Fort Pierce, Florida 34982
(772)462-1553
OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMENT
F.S. 489.103 (7) EXEMPTIONS
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 provide direct, on -site supervision of the construction yourself. You
may build or improve farm outbuildings, a one -family or two-family residence or a commercial building at a cost of
under $75,000.00. The building or residence must be for your own occupancy. It may not be built or substantially
improved for sale or lease. If you sell or lease a building you have built or substantially improved your self within
one year after the construction is complete, the law will presume that you built or substantially improved it for sale
or lease, which is a violation of this exemption. You may not hire an unlicensed person to act as your contractor or
to supervise people working on your building; 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. You may not delegate the
responsibility for supervising work to a licensed contractor who is not licensed to perform the work being done.
Any person working on your building who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide workers'
compensation for that employee, all as prescribed by law. Your construction must comply with all applic ble w
ordinances, building codes, and zoning regulations. Initial
I understand that the building official and inspectors are not there to design or give advice.on h t e
the minimum code. Initial
I understand that as an owner -builder that any contract disputes with sub -contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license, I may be responsible and li
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction project -
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and relat �'
cost, which could include loss of wages during recovery from their injury. Initial
To qualify for this exemption under this subsection, an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
Zoning Department to the Florida State Department of Professional Regulation. Signed and acknowledged on this
day of of 20
Owner/Build r Sign�aQre
STATE OF FLORIDA
COUNTY OF !(�/�_�
The foregoing instrument was acknowledged before me this 49 day of f'� , 20 4(2. ,
by who is personally known to me, or who has
produced i L!G as identification.
Signature of Notary
Title: Notary Public
Type or Print Name of Notary
Commission Number
(Seal)
Planning & Development Services
Building & Code Regulation Division
Permitting Department Receipt
2300 Virginia Avenue
Fort Pierce, FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Date: 13 February 2012
Receipt #: 0000083786
Permit Number: 1202-0136
Job Address: 10851 OCEAN DR 157
amount: $50.00
Paid With: CA
Check Number:
Paid By: CARMEN CESTA -
Received By: eileenn
Online address: http://www.stlucieco.org/planning/permitting.htm
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