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HomeMy WebLinkAboutPOOL1312-0020-ApplicationContact Person: VUo(11 rc Company Name Business Address City �Vte• City of Parkland `J Building Permit Application tdic www.citvofparkland.org it Phone#: Is4 - 7-702,+ E-mail: �tJ •h ,� �h, (� rick, (y �1 ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135 CCOI State Property Owner's Name Owner's Street Address City Ad Job Site Address Work Description: A, ave T23 State Master Permit Number Date Zip 353 Phone # q 1. _ - Construction Value Engineer's Name 'Engineer's License # 'Phone # Zip 3 5074 Phone # 154 ' 53 g k 'Architect's Name t !Architect's License # i �t �� il) woo) '.(» Illi I - TQC Lot ,t Block A 'Phone# /cAJ t rvt,f n -r (ParC /4. o5 -C 7)64 - o lC /2-/q/r3 51: -613 0.0-0 L)cl'ic4-11 Re o- 9'54 Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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 Contractor Notification E-mail: 51 1 m P i3J tD Print Name of Qualifier/Builder: License mile �,I'77;CG,c3/ Signature/6f Q lift : . / On this 613 day of /✓/t/r , 20/, Not=b1 State of Florida, personally appeared before me, the undersigned t ( f51 t Notification E-mail: I �Y afi(hose name is subscribed to and within TARY PUBLIC, TATE PRINTE she . knowledges that he/she exe WILLIE VELAZQUEZ Notary ruo"u -5 tcJut F 02016 My Comm. Exp Commission # EE 190460 Bonded Througn w; u a II" AME OF NOTARY PUB Personally known to me ❑ Oath taken NOTARY PUBLIC SEAL OF OFFICE: I 1pplication Approved By: =-rmit Officer Property Owner Prin Name of PropertyjOwner: tGilA /'l. Oise -,S Owner's Address: 0h?_Ter Signatur 0 ar k„,,v EL --)a7- On this)' day of /(// , 20 /3 , before me, th Not. Publico State of Florida, personally appear nstrument k undersigned and whose name ja subscribed to and within the , edges .t,. NOTA'Y PUBLIC, STA PRINTED NAME OF NOTARY PUBLIC 0 Personally known to me 0 Oath taken 0 Produced identification ❑�athnottaken. IYILLIE VLLNLUUtL Notary Public - State of Florida •E My Comm Expires Jun 16, 2016 Commission /y EE 190460 ` Bonded Through National Notary Assn 9 r.i 'W' as ui NOTARY PUBLIC SEAL OF OFFICE: Date: she executed it. Produced identification 0 Oath not taken WILLIE VELAZQUEZ Notary Public - State of Florida My Comm. Expires Jun 16, 2016 Commission # EE 190460 Bonded Through National Notary Assn Contact Person: Dz Company Name Business Address cltYF L tic City of Parkland Building Permit Application www.citvofoarkland.org Phone #:9 -TIT - 71-(00 Email: (W.1CCt 0-, (_GOL•(c,,h ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135 ALA.) Lln�.f j \, I: lee is L c 3065 Ai.L. 1/4-' Ave_ State L Zip 753334 Phone # 9g4 .�}(�_, 'fit, -.5 Property Owner's Name v a v' Owner's Street Address (,(;)110 fj. City Vr (a4 Job Site Address Work Description: rt;r. State Zip -s-son Phone # 954_ 353_ 53a Master Permit Number Date Construction Value Engineers Name 'Engineer's License # 'Phone # Architect's Name Architects License # (,Cil.% W A LI. r 0 ! ' 1 TZr Lot Block A 'Phone # eoec Et.i (wp AP 'FT 11c4-C3R 3 25 Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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 Contractor Notification E-mail: Print Name of Qualifier/Builder: License number: Signa\tikrzof Ltualifi On this d 1 ay of �•, iziv , 20 fo- - , beforefine, the undersigned Notary Pu. lc of the Stela f Florida, personally anp area *-.>%r.r// and whose name is s iSscribed to and within WfAhVsh owl ; at she execut-d �- - WILLIE VELAZQUEZ J NOTAR 'BLI', STIOF FLA '� ,-40. : Notary Public - State of rIunud ' My Comm. Expires Jun 16, 2016 .' _ Commission N EE 190460 PRINTED NAME OF NOTARY P ,LI("' [?onied Through National No'ary Assn a v , Personally known to me ❑ Oath taken NOTARY PUBLIC SEAL OF OFFICE: Application Approved By: Permit Officer ❑ Produced identification ❑ Oath not taken VLLhZOUtz Notary Public - State of Honda n,rn Expires Jun 16, 2016 Commission N EE 190460 - Bonded Through National Notary Assn. - Property Owner Notification E-mail: Print Name of Property Owner: P 4a1Pl Owner's Address: XGgb a/4//' / ii /'lW%P/2 55/76 On thisd S day of /1/ . 20/7 , before me, the undersigned Not bli 4the§tate fFlorida,personallyap.--red J� d and whose na . • is subscribed to and within the ackn s f Jst egiecuted it. • WILLIE VELA7ni ir_ 7 rvotary Public - State o1 Florida My Comm Expires Jun 16, 2016 Commission ix Fr 19n1s0 fronded Through Vional N,,'3 v Assn PVoduced identification NOTARY PUBLIC PRINTED NAME OF NOTARY PUBLI ❑ Personally known to me ❑ Oath taken NOTARY PUBLIC SEAL OF OFFICE: Date: ❑ Oath not taken ""''` WILLIE VEL,n?QUEZ Notar •!•y Pub is - Sate of Honda '''c My Comm. Expires Jun 16, 2016 Commissio- N EE 190,160 t,' 0 Contact Person: U(1 i t- Ito, f f1✓� City of Parkland Building Permit Application www.citvofDarkland.org Phone#: 's 4 E-mail:7-7061 W, (-1 cit ('(� (t) Ol ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135 Company Name Business Address CityDgV±� State Property Owner's Name Owner's Street Address city Pyr )q4t NC)C- P (At! (c ''S r L. L ! 0 \ S. . 4-C'-`' Master Permit Number Date zip -5'n 14 Construction Value 'Engineer's Name 'Engineer's License # 'Phone # State CL Zip ?,3 r 1f Phone # c 54_ ' 3 - c-'96 1 'Architect's Name 0 'Architect's License # Phone 4154 _-1-0/ Al ave ci»Se— MoiScl C COW iiJ 1@1st "reA- Job Site Address 6Q1/G) Thj I [ Te f. Lot G Block Work Description: 12o0L Ippin�i V 'Phone # W y lel@„ P, re.`C'c 954--IL-7'-5 Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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 Contractor Notification E-mail: Print Name of Qualifier/Builder: Kf,t fi In D r License nu��� , C s (cs 3 /, SignaturQualifier: ( On this day of /4;P v , 20 (3 , before me, the undersigned Nota w/P;JOtttN e State of Florida, personally appeared (6071"' A- 0 and whose name is subscribed to and within ted it. the insttm t, d h /she acknowle NOTA P LIC, ST/)tE O PRINT NAME OF NOTARY PUBLIC,..`' l3 Personally known to me 0 Oath taken NOTARY PUBLIC SEAL OF OFFICE: Application Approved By: Permit Officer t he/s WILLIE VELAZOUEZ Notary Public - State of Florida • _ My Comm. Expires Jun 1 b, 'L U1 b Commission 11 EE 190460 0 Produced identtficat9cittd, ,1' 6 :' iry Assn ❑ Oath not taken , WILLIE VELAZOUEZ (C-77:\:.--, Notary Public - State of Florida 1 `• \)') • _ My Comm. Expires Jun 16. 2016 Commission # E6 190460 6d)n:'ed Through i;afu)^al "j -.'dry Assn Property Owner Notification E-mail: Print Name of Property Owner: A Owner's Address: r �,, oZ L . I�� TQC rK t t -3302-c Signature of Pr On this dZ ( day of V 0f/ . 20/Y , before me, the undersigned Notary Pu lic of the State of Florida, personally appeared /1' and whose name is subscribed to and within the instr . , . -d he/she acknowledges b she executed it. OT RY PUBbt, STATE PRINTED NAME OF NOTARY P BLIG•'', ID Personally known to me , ❑ Oath taken NOTARY PUBLIC SEA OF OFFICE: WILLIE VELAZOUEZ roddiaNiel3nti{ {Lcafic%ale 01 Florida My Comm. Expires Jun 16, 2016 _ hnonAkdifission #E 1•i4 iVl4 ei� 1anjI`f oo(ary Ass Notary Public My Comm. Explrer .:,.n 16, 201f Commisslcr. -- 00460 f Bonded ihr., .o` Date: Contact Person: Company Name Business Address City City of Parkland Building Permit Application www.citvofparkland.org Phone #: E-mail: ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135 State Zip Phone # Property Owner's Name Al Mods Owner's Street Address C(tZ( i Ise Tei Cite. r1aWJ State %t., Zip I 7c. Phone # Tc Job Site Address Work Description: (coaok b t) Iii,Lot f'7 L) 4 - Block fa ri? I S 'Master Permit Number !Date Construction Value Engineer's Name Engineer's License # Phone # 'Architect's Name !Architect's License # 'Phone # 1 (v, 1111 i rept Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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 Contractor Notification E-mail: Print Name of Qualifier/Builder: License number: Signature of Qualifier:\ On this day of i/ , 20 , before me, the undersigned Notary Public of the `ate of Florida, personally appeared and whose name is subscribed to and within the instrumentAind he/she acknowledges that he/she executed it. NOTARY PUB C, STATE OF FLORIDA PRINTED NAME OF NOTARY PUBLIC ❑ Personally known to me ❑ Produced identification ❑ Oath taken NOTARY PUBLIC SEAL OF OFFICE: Application Approved By: Permit Officer ❑ Oath not taken Property Owner Notification E-mail: Print Name of Property Owner: Attain .,107Scc,C, IOwner's Address: ail)0k Tet. Signature of ne On this Y1 day of sir/fr./ .2 , before me, the undersigned Nota Public of,ijie,S',atR of Florida, perso • . Ily appeared /i/ /"I (/.J'� and wh•.e name is subscribed to and within the • she acknowledg: that he/she executed it. N¢�ARY PUB. C, STA 0 LORIDA PRINTED NAME OF NOTARY PUBLIC ❑ Personally known to me ❑ Oath taken NOTARY PUBLIC SEAL OF OFFICE: Date: U Produced identification WILLIE VELAZQUEZ Notary Public - Slate of Florida _ •_ My Comm. Expires Jun 16, 2016 ss Commission # EE 190460 Bonded Through National Notary Assn Contact Person: \)e ✓t1 h e !1'G r (LA Company Name Business Address City 904,1 City of Parkland Building Permit Application www.cityofoarkland.org 11 Phone#: �]4 ' Email: SL .Mat(S� ti) fl0�.fo�.h ALL OF THE FOLLOWING MUST BE FILLED IN BY APPLICANT, ACCORDING TO F.S. 713.135 Poo( k,,,kd ors LAC - 56 i S . w. 51-re,,d State FL Zip 3.14- Phone # 064:4-17--7q00 Property Owner's Name A\ 6,0 M,S,s 60).0 Al W . I" - Owner's Street Address City fjor l�{ Job Site Address Work Description: State ,L, Zip 3 (j Phone # 954 . 580) 02.0 !J Master Permit Number Date Construction Value Engineer's Name Engineer's License # Phone # Architect's Name Architect's License # O lc . Tc P Lot (7 Block Phone # 6,Alo azo SF 154- ulg-3$ZS Application is hereby made to obtain a permit to do the work and installation as indicated. I certify that no work or installation has commenced prior to the issuance of permit and that all work will be performed to meet the standards of all laws regulating construction in the City of Parkland, Florida. I understand that a separate permit may be secured for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, BOILERS, TANKS, AIR CONDITIONERS, ROOFING, SHUTTERS, ETC. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCMENT 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 Contractor Notification E-mail: 5u.)1 Vy` Print Name of Qualifier/Builder: 14A) -) License number: C_PC. SSI' r 3 Signature of Qu/Iifier: - - / «� On this al- day of MG'S , 20 r, , before me, the undersigned Notary Public the State of Florida, personally appeared KIX/h1 Pt3T_Q Property Owner /-ek. Notification E-mail: Print Name of Property Owner: / NG MAc,P ,S and whose name is subscribed to and within the strume•t; - d he/she acknowle TARY PUBLIC, %TE OF IDA PRINTED NAME OF NOTARY PUBLIC l7 Personally known to me ❑ Oath taken NOTARY PUBLIC SEAL OF OFFICE: Application Approved By: Permit Officer fi'e•eNtvinedit+ ` - — WILLIE VELAZQUEZ My Comm. Expires Jun 16, 201 Commission # EE 190460 ' Rnn'ina T ()CYO Address: lI: C) '�'iLw. l „t�+�( / St Signature of 72 i . 1'.I„d - \ 4 On this d day of N U`/ , 20 /) , before me, the undersigned Notary Public of the State of Florida, personally appeared L/a✓ A (5)e f and whose name is subscribed to and within the instrument, and he/she acknowledges that he/she executed it. NOTARY PUBLIC, S RINTED NAME OF VVILLIC VCLHLUULL 2lDA Notary Public - State of Florida - (� (- . My Comm. Expires Jun 16, 2016 6Tpic uommisslon # EE 190460 Pond Through N3honal No'ary Assn ifr'tsrodaced-ident eaiiefkip—, ❑ r dentificatien IL L Z ❑ Personally known to me ❑ ath not taken WILLIE. VESAZe ' l ❑ Oath taken Mary Public - State o1 Florida + My Comm. ExoliCS Jun 16, Zu) Ccm nisslor i) EE 1 4,°F,;; Bonded Through National Notary AsS NOTARY PUBLIC SEAL ma MP OP OF OFFICE: Date: ❑ Oath not taken WILLIE VELAZQUEZ Notary Public - State o1 Florida • My Comm. Expires Jun 16, 2016 ,�' Commission # EE 190460 City of Parkland Building Permit Application Contact Person: LI ) , ( ( G dp www.citvofDarkland.or _ Phone*:qSq-43Lf -4so Email: 46 A cat 01 a) SC (C �,i S �r a. j . C&."'1 ALL OF THE FOLLOWING MUST BE FILLED IN BY APPUCANT, ACCORDING TO F.S. 713.135 Company Name / 7 1- m cry, 9fSc yee-rl e Business Address Ca ?���.t J _:?An g��c City State DP Phone * Property Owner's Name ,9 an I ' ) % e Jc Owner's Street Address . b 0 0 A)_0. /0 / 7`� i r City State Zip Phone* • PPi td ond, f=L 33O71 qs 75:3- .5g0 / 60 cO ,u.w /oi .Te(Ot Work Description: ../L n c Job Site Address Block ,� Master Permit Number Date Construction Value Engineer's Name Engineer's Ucense * • Phone* Ardutect's Name Atchltect'S license Phone* eGL) .-U Application is hereby made to obtain a permit to do the work and Installation as Indicated. I certify that no work or installation has commenced prior to the Issuance of pennit and that all work will be performed to meet the standards of all laws regulating construction In the City of Parldand, Florida. I understand that a separate permit may be secured for ELECTRICAL, PLUMBING. SIGNS, WELLS, POOLS, BOILERS, TANKS, AIRCONOMONERS, ROOFING, SHUTTERS, ETC. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE Of COMMENCMENT 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 Contractor Notification E-mail: Print Name of Qualiflgr/,BuUder. ) Ucense number Signature Ilfler: At,H. On this 14 day of , 20 13 , before me, the undersigned Notary Public�oj the State q� Florida, personally appeared 11a t 11 ttoa»anc and the instru r nd he/she adalww NOT Y PUBUC, ST FLORIDA C.� k G o 146-5 PRINTED E OF NOTARY PUBUC cte . ,.u+auy known to me 0 Oath taken NOTARY PUBLIC SEAL 0 OFFICE: Application Approved By: Permit Officer O Produced Identification 0 Oath not taken ALYSE L GOLDBERG Y r MY COMMISSION if DD 967022 4 Bonded EXPIRES: March 2, 2014 4, Thru Notary Public Underwriters n l� Property Owner Notification E -mai: Print Name of Property Owner Owner's Address: N - L)• Iid' f Property r. EA/ -k 171/1/9 4n this day of J)t. Nota Ic of the State of F , before me, the undersigned appeared Is subscribed to and within the he executed Instrxn s/ste��a fik/11 ARY PUBLIC, STATE OF FkORIDA NTEDDAME OF NOTARY PUBLIC PRl 0 Personally known to me O Oath taken NOTARY PUBLIC OF OFFICE: Date: 1 qu L.i cssn�s" tp..cecictj d Identification O Oath not taken ALYSE L GOLDBERG MY COMMISSION* DD 967022 EXPIRES: March 2, 2014 Bonded Thru Notary Public Underwriters CITY OF PARKLAND BUILDING DEPARTMENT OWNER/BUILDER AFFIDAVIT Disclosure Statement Florida Statute 489.103(7) March 1995 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 -family or two-family residence or a farm outbuilding. You may also build or improve a commercial building at a cost of $25,000 or less. The building must be for your own 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 (1) year after the construction is complete, the law will presume that you built it for sale 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 worker's compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. The Florida Department of Professional Regulation (DPR) can request the Circuit Court to impose a civil penalty of up to $5,000 per incident and also be entitled to the collection of fees and cost incurred. For your information, the Owner/Builder may become liable and responsible for the employees he hires to assist in the construction project. The responsibility may include the following where required by law: 1. Worker's Compensation (for workers injured on the job). 2. Social Security Tax (must be deducted from the employee's wages and matched with the owner's funds). 3. Unemployment Compensation (may or may not be required). 4. Liability Coverage. 5. Federal Withholding Tax. I acknowledge that as an Owner/Builder, I am obligated to actually, physically, build the structure or do the work whi I have permitted. I understand if I am not physically doing the work or physically supervising free labor from friends or relatives, that I must hire licensed contractors, i.e., electrician, plumber, mechanical (heating & air conditioning), etc. I further understand that the violation of not physically doing the work, and the use of unlicensed contractors at the construction site, will cause the project to be shut down by the Inspection Staff of the City of Parkland. Additionally, state statute allows for additional penalties. I also understand that if this violation does occur, that in order for the job to proceed, I will have a licensed contractor come in and obtain a new permit as taking over the job. I understand that if I hire subcontractors under a contract price, they must be licensed to work in Broward County, i.e., masonry, drywall, carpentry. Contractors licensed by the Broward County Central Examining Board or the State of Florida are required to have worker's compensation and liabilitx insurance coverage. I will assume full responsibility as an Owner/Builder Contractor and will personally supervise or do all work allowed by law on the permitted structure. Property Owner Address: b IC l I .z/, c 'A K 1 et L ' Permit Address: Telephone: fl 51 7 5 5 i50 1 1 1 Drivers License #: ' m 2:10 - a t 6 - 5 1 - 3K 2. - 0 I hereby acknowledge that I have read and an�d the abov fidavit. Owner/Builder Signature: Date: I i', P. � '2. The foregoing instrument was acknowledged before me this I Z day of TV J L `'+� , ?.08-, by (Name of Person Accknnow1gdging) who is personally known to me, or who has produai..a ll 44. t of ID) as identification and wh 417./ did not take an oath. Notary Public Signature: My conunission Expires: Rev. 2/04 °'` RICHARD J PACCA • MY COMMISSION #FF024334 EXPIRES August 7. 2017 (407) ;II- 1 FIoridallotarySorvIce corn FROM :PARKLAND BUILDING DEPT FAX NO. :9547538838 Jul. 31 2008 12:10PM P1 CITY OF PARKLAND BUILDING DEPARTMENT OWNE ;/BUILDER QUESTIONNAIRE Notice: Florida Statute 489 requiring const nation to be done only by licensed contractors provides an exemption from licensing for a property owner who acts as ti s/her own contractor ytnder soecific conditions, Answers to the following questions are essential to determine if those tate qualifications are satisfied by an Owner/Builder applicant. Notc: It is not the intent of FS 489, nor the policy of the Parkland Building Department to issue an Owner / Builder Permit under this exemption for work which a Permit is required but which work .as been commenced without the I Iumeowner having first obtained said Permit, AFTER COMPLETING TI•IE C WNERBUILDER APPLICATION AND QUESTIONNAIRE, PLEASE CALL FOR AN APP( OINTMENT WiTH THE BUILDING OFFICIAL OR CHIEF STRUCTURAL INSPECTOR FO R. ]REVIEW AND APPROVAL OF THIS DOCUMENTATION. Owner/Builder Applicant Name: a t a Mos <-_c Site address of the proposed building wort : _ '., w cc: t J�tr20 l'0,1:..1; Name of legal title owner of the address al eve: ivt osis Describe the scope of work for the propos( d new construction: RLgf4.0, , t''foz Name of Architect of Record: M c s r 5 /1 /A Structural Engineer of Record: t'I c s 4 v How is the building or space going to be u ed? ree_s r d ezi 4—us. L Who will do the actual labor in each major t.a4de area? Trade: Owner sio if!, Owner with Hired Hein. or By Licensed Contractor (Name): Structural: Ai �_ ._ ?SLS Electrical: Plumbing: A/C - Mechanical: Hurricane Itupact Protection: ( ( ( Engineering; i icy MOS r Other: Other:..... --- Other: Other: Who will supervise the trade work to meet lie applicable code? ,a /h ,, /341DS. s What provisions have you made for Liabili y and Property Damage Insurance? ►-1.41< •.• ,e,t_c /.Q nt b e, /14 What provisions exist for withholding Soc al Security and Federal income Taxes, as required by Federal Law, from wages paid to people you hire who are not i,,E;nsed? :� ..ed fi+, n5 I.» 4 f 'fr. o',9/2 After improvements, who will use the spac ;? M t . What previous Owner/Builder improvemer t:; nave you done in Florida? t Location: Scope of Work Done: Year Done: Location: Scope of Work Done: Year Done: What Code honks do you own for referenc' ? Building: Electric: I' lurnbing: HVAC: Other: Do you realize that as the perinit holder ye 1 are liable for following all Local, County, Slate and Federal codes, laws and requirements, and you are also Iiable ft r anyone injured on the construction site? Have you consulted with your Homeowners Insurance Agent? i Lender? n Attorney? n In order to assure your success in this p eject, please signify your awareness that the function of the I3uilding Department is to verify code compliarr c, and that stall' may not offer design or instructional advice. have read and understand a pertti m Owner/Builder Construction and agree to comply. Owner/Builder Signature:L�� ` / ` Date: i '_' 2041 Review and Accepted by: _ Date: 14„ 1_, 200 Rev. 2/04 PERMIT NO SUB -PERMIT SUB -PERMIT SUB -PERMIT -POOL1312-002_9) PERMIT TREE 1,4 V V�IiIV idu STATUS FEES CHARGED JOBVALUE POOLS/SPA/REMODEL/WF APPROVED $1,955.20 $54,300.00 FEES PAID BALANCE DUE TOTAL"of ALL, FEES` PERMITS FEES CHARGED FEES PAID 1 $1,955.20 $90.00 OWNER DEMO POOL & REPLACE - FENCE/ALARMS 12/04/2013 $90.00 $1,865.20 MOSES,ALAN R & SUSAN H BALANCE DUE $1,865.20 Drintori• Lririnv fl ',miory ')MA 1 of 1 4- • Permit #: 1 / — v ad Contra 'tor: Submittal Date: /3 Lot: Lot: Bioc'h: Subdiwai n: oCa s Project 1 Model Type:,. Zoning Mechanica Landscapin Fire Product Approvals Structural Plumbing Electrical Engineerin Truss Plans Permit #: E 4 c. C Contractor: r'c, , «U + r__ Submittal Date: .4 4, Lot: c.- Block: h Subdivision: Project / Model Type: f 1 Zoning Structural Mechanical Landscapin Fire ) Electrical Plumbing Engineerik Product Truss Approvals Plans Perrnit# ! .Fo110 # 443 0) 1 0Pl 4 t .NQTICE• oF'Co'NMmENCtM•ENT The undersigned hereby glv.ei notice that improvement vial be certain r41 property and In acooritano,swith Chapter 71W, Florida 8tatutes;*he fo..c...ng In,ctn atdon is providedto this Notice of commencement : . • ,• •••+ ihISt'Ps•itnf�rv�dr0►r400rder • Lot Block Untt;ft Dldg;lf _, _ Lengthy legal attached _d/ 7_ VI IL1s.. '? rY ISG INSTR # /11985015 OR BK 50404 Pages 753 - 753 RECORDED 12/13;13 01'33 14 PM BROWARD COUNTY COMMISSION DEPUTY CLERK 1012 #4, 1 Pages • 1. Legal Description of Property: Street Address if available: . Subdivision/ Condoominium: • ,1; Ar, S 0 • Fb, !' i 1 And( t 3* - t i,wr 2. .04.. nand description of improvement: • • cL.1. M rM i v\ e.)* P,o,,( 4 t% 1,_, • . 3.a. Owner nameand address: (uv1 11as;:.s CO2Q ))LJ 101'4- Te.r •Qc..klel„,) -L- `-3e b. interest In property: • • • ' p, Name and address of fee slmpie titleholder of other than Owner): 4. a. Contractor name and address: • b. Contractor's phone number: !Pod T: i_3t�,,, � �L l� SL) . 4-S r”. S e e,�- 4 31 m(/ c z � 'z z t • 6. a.' Suretyname and address: "b. Surety's phone number. i $ • , c. Ainount of bond 6. a. Lender name and address:. • b. Lender's phone number: • Persons within the State of Flop Fhtsdestfinatsd by Owhet upo • by Section 713.93(1)(a)7., Florida'tutes:• N,.; • :14 Name: Address: 1 b. Phone number. 8. a. In addition to htmaD\ or herself, the Owner. designates ' • b. Phofie number of parson or entity designated by owner 9` Expiration date of notice of commencement : • om notices dr other documents may be served as provided • tp Mori 1 (the expiration data is 1 yearfrwn the data of reoorciing unless 1 different date is spect:led) •• WARNING TO!QWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE"NOTICE OF . •COMMENCEMENT• ARE CONSIDEI &D IMPROPER PAYMENTS UNDER CHAP'T'ER 7'(3,.PART 1, SECTION. 713.13, FLORIbA STATUTES, AND' OAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR.PROPERTY. • A NOTICE OF COMMENCEMENT MUST BE RECORDED MID POSTED ON THE JOB SITE BEFORE THE FiRST INSPECTION.• IF YOU INTEND TO.0 TAiN FINANCING, CON&ULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORG YOUR NOTICE OF COMMENCEMENT. . •Signature(s) of Owner(s) or. By •Name TltlelOffice ir(s)' Authorized Oftmer/Dlrector1FartnsrjManager By. • • • . Nam`s • Title/Office ' (-; l Gam • STATE' OF FLORIDA COUbir( OF BROWARD The foregoing instrument was acknowledged before By . me this �,,, >n, �, ,� 4 o s �. S• . q day of • 0. • ❑ lndlvtdual{y, 4r u for '8 soiiallyknown, or❑producedthatoUvwtngbrpeofIdent1Qaddoq: Signature of NOW/ Valk.; • Print Narita: MEAL) • Under perialtles of:perjury,.t deelarattiat 1 havi read the foregoing and that the facts stated Infterstius,t0 tint ofmyknowte4tgeand ballet* •Slgnature(s) os By / prised OfflcarlD 4.. L tot!""`eL, RICHARD J PACCA (407) 34-0153 MY COMMISSiON #FF024334 EXPIRES August 7. 2017 • F l o rid aN of aryS a ry i c e. c o m er(Manager who signed above: By . • yiroccrdeltrormslnx r.cdceetca nmencanentrevised 7.3A7.doc PARKLAND RESERVE COMMUNITYASSOC., INC. C/O GRS MANAGEMENT ASSOC INC 3900 WOODLAKE BLVD STE 309 LAKE WORTH, FL 33463 NOTICE OF ACC APPROVAL December 16, 2013 KENDALL & ROBIN DAY 7388 NW 111 WAY PARKLAND FL 33076 RE: 7388 NW 111 WAY Dear Owner: Your Request for Architectural Change has been approved. Specifically, you have approval to proceed with the following: Install a 21' x 35' pool, travertine deck and additional landscaping per provided drawings. The playground will move forward about 10' and the fence on the north side will move to in front of the air conditioner. Approval stipulations if any are listed below: We reserve the right to make a final inspection of the change to make sure it matches the Request you submitted for Approval. Please follow the plan you submitted or submit an additional Request form if you cannot follow the original plan. You must follow all local building codes and setback requirements when making this change. A Building Permit may be needed. This can be applied for at the County offices. Our approval here is only based on the aesthetics of your proposed change. This approval should not be taken as any certification as to the construction worthiness or or structural integrity of the change you propose. Be aware that you are responsible for contacting the appropriate Utility Companies before digging. We appreciate your cooperation in submitting this Request for Approval. An attractive Community helps all of us get the full value from our homes when we decide to se1L Sincerely, PARKLAND RESERVE COMMUNITY ASSOC., INC. Bob Zulli, LCAM bzulli@grsmgt.com Ext. 115 Cc: Homeowner File 046L TABLE R4408.11 CHAIN LINK FENCE MINIMUM REQUIREMENTS Terminal Post Dimensions (in inches) Fence Height (ft) (o.d. x wall thickness) Up to 4 23/8 x 0.042 Over 4 to 5 23/8 x 0.042 Over 5 to 6 23/8 x 0.042 Over 6 to 8 23/8 x 0.110 Over 8 to 10 27/8 x 0.110 Over 10 to 12 27/8 x 0.160 Line Post Dimensions (in inches) (o.d. x wall thickness) 15/8 x 0.047 1'/8 x 0.055 17/8 x 0.065 23/8 x 0.095 23/8 x 0.130 27/8 x 0.120 Terminal Post Concrete Foundation Size (diameter x depth) (in inches) 10 x 24 10 x 24 10x24 10 x 36 12 x 40 12 x 42 Line Post Concrete Foundation Size (diameter x depth) (in inches) 8 x 24 8 x 24 8 x 24 10x36 10x40 12 x 42 For SI: 1 inch = 25.4 mm. Notes: 1. This Table is applicable only to fences with unrestricted airflow. 2. Fabric: 121/2 gauge minimum. 3. Tension Bands: Use one less than the height of the fence in feet evenly spaced. 4. Fabric Ties: Must be minimum the same gauge of the fabric. 5. Fabric Tie Spacing on the Top Rail: Five ties between posts, evenly spaced. 6. Fabric Tie Spacing on Line Posts: One less than height of the fence in feet, evenly spaced. 7. Either top rail or top tension wire shall be used. 8. Braces must be used at Terminal Posts if top tension wire is used instead of Top Rail. 9. Post Spacing: 10 foot (3 m) on center maximum. 10. Posts shall be embedded to within 6 inch (152 mm) from the bottom of the foundation. 11. In order to follow the contour of the land, the bottom of the fence may clear the contour of the ground by up to 5 inch (127 mm) without increasing table values to the next higher limit. 2010 FLORIDA BUILDING CODE — RESIDENTIAL 44.71 FROM = > (Pi PO Add ree.5 FLOOD ZONE! Alt BASE ELEVATION! 12.0' COMM /: 120051 rANEL 1, 0105 F PATE OF MAP: 6/18/97 641 PC -P. �A) El_ 11.73 (rfM) CPp �' 80.91' Sa. , hthoi.�sg -r grace bb me FAX NO. 602o.�-.v f. l01 rl tizt�. p,a rx,-cL Awr o, FL. L.qura • `I Lot (II8) Fire 14 On Prop. Cor. •I.R-wl Cap '/o E.) E .gervlce�� 6. tae -// 11.7 9 c iso PI w) 2A' Asp- iW. FiV Ficue. Nov. 11 21713 06: 38PM P1 • suRVEY Norssr I. REPRODUCTIONS OF THIS SKETCH ARE NOT VALID UN! FCS SEALED WITH AN EMBOSSED 5t1RVEYOR'S SEAL. 2. *. L EX1% Alto 21.1f15-01tiwwr e 1 ER ARE BA -5/02 Ow rrnz Car4cMa,r: 1G4-+�¢8rj EREPREED Dr ATTORNEYS 1lT.L nisDstA E TEM., Inc. Z. ELEVATIONS SHOWN HEREON ARE BASED LAN lilt NATIONAL GEODETIC VLR11CA.L DATUM Cr 1929. 4. BEARINGS SHOWN H REON ARE RELATIVE TO "T LOrtd Irtgs of i -hidnd ; ea,. 137, P'9.22 22 C etcR,) p 5 ur11¢96. Other►vt5edr-i eProperty CortZerS G. Lot corttoirt913110.5.F. 7. T�er¢ re no tTe s ort trli9 propert-y other t an,houtn hereon - 62t eat,. 6 ,l.x - p' ioi- PropoBed E1.12.05 t_at GrdOCIa 9. (x x-)- pchoteg A5 -Built lrlforrrtdtlor . . $2' Utility (72.07 .R.w/Cap nc. FFL.Rid (4.ri' x S') Elec_SerVice V.ox- E250x g fa ri.7 COL"- (t3. 1-r:CS5 C.e W; 4iNytcf (tbj.o Car „l � GaroC¢d yd Ufa 63) l3. (4'x Cori c. re' ae7- .8.5. (ftQs. it4s El.14.4-0 -Fon Mus - 35 co tr.- Cs.-1 N 01.57 A,50. ( vr• �) Cc•nc . Yatio s c..l 0 -e tr I(". Coit• Foal 1 Loi(.12.1/ •,1,/ - /, <0 L1 70.00' �==83.58' 7.1619'7:3" w Fnd-_I.K.W /Cap (P.E.S.) LAND yssc �z� A . 'LOC 6 lLAHDYttGS OF MARYLAND", according to the plot thereof •s recorded • Sn•Plat Book 137. Page 22. of the Public Records of Bro�ard County, Florida.: cERTI FICATE I WE HEREBY CERTIFY THAT -mai "$ <E1CH OF SURVEY"OF THE HEREON CESCRI13ED PROFERTY Zs' AND. RF -CT rp THE BEST ' OF OUR ICNowLEDGE AND BELIEF AS SURVEYED IN THE FIELD UNDER OUR DIRECT3C*l IN JU l2 10$12 WE FZZft l ER CERTIFY THAT THIS SURVEY MEETS THE MINIMUM TEOHNICALSTANbARDS FOR SURVEYING IN THE STATE OF F1 'iP A AOCELROJNOTO.._ CHAPTER 2t i iFi-6 CF THE FLORIDA At)1 A1Nti7 rivE E. THERE ARE NO ABOVE GROUND ENCROACHS E^+,"`S- R THAtt`THQSE SHOWN HEREON, SUBJECT TOME QUALIFICATIONS NOTED NEREON . .' - PREPARm FOR : Merl 1 rl ¢d y Group = ='v : i-1 -caxcnao TIT= rAtOmANCE coN2.ANY :FOR' T1 PSRM. BY: ' " �'--`�' �`-1 -� = .,..- tri SCOTT J = ' •• '>` PROFPSSitli L- 1Z0^SEUri It FLORS11A RECO.- O id .-'L532 �Fild.1.11- / Cap R.ICap -174 141 Fnd.l.R.w ? Cap CP_E.E5 6 23"33'92W 8.74' ‘.-er 2 Suia4J�/TYIM tLOCIDA YA: _ rr'S /110,./Olt- wnDr-'+a: ux X2 -x oxzrn• ••- dA0 5372 r .rZG4 129.. K.2ia 3C.1Y3 FOICC G1 011P.. 1ee SluoeWueer r.d/er .V."iQ'� TITLE Or i.e.- TA2tN. nc_: - 'J.n ,.. room. artaci SIS• =11Z resarNIC8 FWD. INC- SOSAN 11. li>;FS • . w15lDNS. • :n.+"°. ..• WALE David C Krntlse.aAssaclafes, Inc. Vacant 6urvey 6-29-92 303 /4,2 Professloncll Lpnd Surveyors Plot Pl do (,- 30- q2_ \1" 1. ; 30, -7914 Wiles Road '5j0-1pt. tr. vo)1 12-4-012 •2141 /4 ' JOB No. Ccral Springs, Plorldd 33067 F;nai Sur1)14�► 4-2o -c>3 34i 14 92006 d (305)344-7994 dittAdE(er-1 i-ticQ'\L1Ort1 4-23.9`3 - ` 2e.ia' Add le.9 .4-2G.-99 w/�� F, Chainlink Fence Detail 4' - 6' Chain Link with toprail Line Post Loop Cap -- Top Rail --Tie Wire • V,/ •VV V'v. vvvvV AF 40400 American Fence Association Project: Site Location: Submitted by: Date: Dome Cap Brace Band -- End/Corner Post - Tension Band ---- Tension Bar Drawing # CL -©1 -a CITY OF PARKLAND BUILDING DEPARTMENT 954-753-5447 j Date Received: 12/5/13 , Permit Number: POOL1312-0020 Lot: 6 Block: A Subdivision: THE LANDINGS OF PARKLAND I Job Address: 6020 NW 101 TER Work Description: DEMO POOL & REPLACE - FENCE/ALARMS 1 Contractor: POOL BUILDERS INC Phone: 9547977700 DEPARTMENT Date Denied Date Approved ZONING P • - 13 LANDSCAPING ENGINEERING FIRE STRUCTURAL \a\LA ELECTRICAL PLUMBING MECHANICAL Initials Date Received: Engineering Approval: Building Approval: Zoning Approval: ��✓ Survey Route Sheet Permit No.: / 3/2-002:0 Date: 91i jii Date: 2 2 - f Lj Date: - 3A 7 )