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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 )