RC-17-1004 PermitNaAC-1�11,! - 7-1064
mss" s y� Miami Shores Village Petmi'Type•Rd8kiential ConSfitiiction
10050 N.E.2nd Avenue NWtC18S5lffCalo?? AIt81rtICn
Miami Shores,FL 33138-0000 er
P rtrrl datr .� F`PROVED ,
,hFy � Phone: (305)795-2204 E '
L0R'"
IIs1� to 411112017 Expiration: 10/08/2017
Project Address Parcel Number Applicant
9413 NW 2 Place 1131010150190
GABRIEL&JOHN R PEREZ DAA '•.
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
GABRIEL&JOHN R PEREZ DANIELA& 9413 NW 2 Place (305)767-6055
- - - ----- MIAMI SHORES FL 33150-2216
1615 BAY Drive
MIAMI BEACH FL 33141-
Contractor(s) Phone Cell Phone Valuation: $ 500.00
HOME OWNER
Total Sq Feet: 190
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review
Window Door Attachment
Date Denied: Framing
Type of Construction:RE-TILE WALKWAY AND RED BRIC Occupancy:Single Family Insulation
Stories: Exterior: Drywall Screw
Front Setback: Rear Setback: Final PE Certification
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Planning
Certificate Date: Additional Info: Review Electrical
Review Building
Bond Return: Classification:Residential Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural
Review Mechanical
CCF $0.60 Invoice# RC-4-17-63661
DBPR Fee $2.00 04/11/2017 Credit Card $50.00 $64.60
DCA Fee $2.00
Education Surcharge $0.20 04/11/2017 Credit Card $64.60 $0.00
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $0.80
Total: $114.60
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certi at a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zon' g. rm re uthorize the above-named contractor to do the work stated.
April 11, 2017
Authorized S g tures Owner / AppLicW / Contractor / Agent Date
Building Department Copy
April 11,2017 1
Miami Shores Village
�
BuildingDepartment RECE,VE®p
10050 N.E.2nd Avenue, Miami Shores,Florida 33138 APR 1 1017
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 '5ill
FBC 201
BUILDING Master Permit No. CA-1 "
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
ii f n 1 CONTRACTOR DRAWINGS
JOB ADDRESS: q4-l 2) lXJ ()/.�
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: �Flood Zone: BFE: FiF_E: /��
OWNER:Name(Fee Simple Titleholder): Tiy V �Y�U Phone#c-I 0 !ov
Address: LV_4?
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email: 13 fir}U cr44 fq Eo Com
CONTRACTOR:Company Name:_. t'1�M.0 Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration �I^ `�n/ New [pair/Replace ❑ Demolition
P
Descri tion of Work: E'_ W CC4,4 ZP
® /
41�01 0
Specify color of color thru tile: `�"-E?trv-aQ0
Submittal Fee$ Permit Fee$ f ff -00 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ '
(RevisedO2/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address '
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. 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 a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature 42 oQ Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of k � ,20 t :4 , by day of ,20 ,by
n 1�2QJx% is personally known to ,who is personally known to
me or who has produced P(0 20 -(4-4(0-(4 amoer who has produced as
identification and who did take an oath.4'j(')r1dG identification and who did take an oath.
NOTARY PUBLIC: L C1 NOTARY PUBLIC:
Sign.%$;11 Sign:
Print: Print:
ri°ti ''••
Seal: t MY=AWSSiLn
602 Seal:
w a? EXPIRES'No20
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portded 1 h,v N0+^ writers
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APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305)795.2204
Fax:(305)756.8972
,,,OWNER BUILDER DISCLOSURE STATEMENT
NAME: �ODATE:
QNP
ADDRESS: 94/;3 i'U r P/ ` I I l mores �L
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,F.5 489.103(7).And I have
read and understood the following disclosure statement,which entitles me to work as my own contractor;I further understand that I as the owner
must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption
allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the
construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a
cost of$25,000.00 or less(The new form states 75,000).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 year after the construction is complete,the law will presume that you built
for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make
sure the 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
with-holdings tax and provide workers'compensation for that employee,all as prescribed by law.Your construction must comply with all
applicable laws,ordinances,buildings codes and zoning regulations.
Please read and initial each paragraph.
1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an
exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain
restrictions even though I do not have a license.
Initial
?v
2. 1 understand that building permits are not required to be signed by a property owner unless he or she is resp nsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initial
3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understand that I may protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my ownn me.I also understand that the
contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contr
Initial
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also build or improve a commercial
building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially
improved for sale or lease.If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the
construction is complete,the law will presume that I built or substantially improved it for sale or lease,whic vi a es the exemption.
Initial
5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction.
Initial
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence.It
is my responsibility to ensure that the persons whom I employ have the license required by law and by county or n ipal ordinance.
Initial
7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that erroneously
implies that the property owner is providing his or her own labor and materials.I,as an owner-builder,may be held liable and subjected to
serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property.My homeowner's
insurance may not provide coverage for those injuries.I am willfully acting as an owner-builder and am aware of the limits of my insurance
coverage for injuries to workers on my property.
Initial op
B. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the
work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by
me,which means that I must comply with laws requiring the withholding of federal income tax and social securJ-V contributions under the
Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employee.I unde to d that my failure to follow
these may subject to serious financial risk.
Initial
9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide all applicable laws and
requirement that govern owner-builders as well as employers.I also understand that the
Construction must comply with all applicable laws,ordinances,building codes, and zoning regulation
Initial
10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States
Small Business Administration,and the Florida Department of Revenues.I also understand that I maycontact Florida Construction Industry
Licensing Board at 850.487.1395 or http://www.mvfloridalicense.com/dbor/pro/cilb/index.html
Initial
11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the party
legally and financially responsible for the proposed construction activity at the following address:
/V o) ar"ilp PZ N , S ),=L,
Initial_9f
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the infor i n hat I have provided on
this disclosure.
Initial
Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who does not have a license,the
Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial
loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or
employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder
permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of
the contractor's workers compensation coverage.
Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local
permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property
owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued.
Was acknowledged before me this_0 day of 20
By.7Vbf) Io'!„111 ) PPfre,-'-.-who was personally known to me or who has
Produced th r License r (0 - �(n��— 1-2gas identification.
,i?ti'�•�?;t;=. MAHARAI K GON7A,�7
MY COMMISSION#GG 044602
114 1 �,+ ;a ` EXPIRES:November 2,202o
k° Banded Thru Notary public Undervvdters
OWNER hOTARY --
INSoREs
Miami shores Village
®1 .11101" Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
IORIUA Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
STATE OF(FLORIDA)
COUNTY OF(DADE)
h
The undersigned Affiant, 10 ,does hereby attest that
(Property owner) R1
The attached survey, performed by L }4) ® ��V"'A)G+ d'
(Name of surveyor's company) 4
For address: CIA l � O LO ` P r- f"�lt ckrn/ 1® treS �
Performed on (date of surrey) is an accurate representation of the existing conditions and
locations of all structures on the property as of this date.
The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property
without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to
remove or obtain permits for any structures which now may exist on the property which are not permitted or which
may violate zoning or building code regulations. The Affiant further understands that the existence of any such
structures may affe t final inspections as applicable to this or other permits,
Further,Affia th
Property wner Si ature ProperjX Owner Print Name
SWORN TO A SUBSCRIBED before me this d day of L 201
Affiant is personally known to me, produced as ident' cation.
;btary
r'a�d P'ub1ic Staie of Florida '
;;omm
Revised(6/25/12)Revised on 5/22/20091 Revised on 6/12109 ssi�'"N ` F ?
o
� 1
MIGUEL EOFIN®SA
LAND SURVEYING, INC.
LAND PLANNERS — 5URVEYOR5
6494 CORAL WAY
MIAMI, FLORIDA 33155
•••••• • • ••• •
•• •• • ••• ••
•
Phone: (305) 740-3319 Fi�•�5) C36%-319Q•. ••
740-3320 %••••' •
• • • ••• ••
RECEIVED
APR 1 2017
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LEGAL DESCRIPTION: CUTIFICATION : so. see:
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LOT OF 7 Pl�l X 103tERY.CER IF T THAT THIS SKETCH OF SURVEY
ACCORDING TO THE PLAT REPRESEIWTS A TRUE AND CORRECT SURVEY RECENTLY
THERE OF ASRECORDED IN PLAT BOOK MADE UNDER MY DIRECTION AND THAT rr IS IN
Z�- COMPLIANCE WITH THE MINIMUM TECHNICAL STANDARDS
AT PAGE OF THE PUBLIC RECORDS OF SET FORTH BY THE FLORIDA BOARD OF LAND SURVEYORS
DADE COUNTY, FLORIDA. PEftUANT TO SECTION 472.02'7 FLORIDA STATUES.
WaT YAL
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NOTES: - ELEVATIONS SHOWN ARE BASED 'ON N-G-V-0-
- PROPERTY DESCRIFT)ON SHOWN MMEON 15
AS FURNISHED AND =0 'LAMS HAVE NOT •
BEEN ABSTRACTED FOR ROM-OF-WAY
AND/OR EASEWE= OF RECORDS.
- BWARIMS ARE BASED ON THE PLAT OF
DADE COUNTY,FLORIDA. _4j
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THE FIRM pREpArm FOR:
PtiplosAi 6494 S.W. 24 STRF-F-T
No.5 lot
MI MIAMI, FLORIDA 33155
DATE :
OF FLORI A Joe No. PHONE: (305) 740-3319
T lEmMOMM SEAL. SCALE: BEEPER: (305) 859-1503
LEGEND OF SURVEY ABBREVIATIONS
A ARC LENGTH M MEASURED
A/C AIR CONDITIONER MAINT MAINTENANCE
ADD ADDITION MH MANHOLE
AOJ ADJACENT OR ADJOINING NO. NUMBER
AE ANCHOR EASEMENT N.T.5. NOT TO SCALE
ALUM. ALUMINUM 0/H OVERHANG
A5PH ASPHALT O.P. OPEN PORCH
B/G BUILDING CORNER O.R.B. OFFICIAL RECOR05 BOOK
BCR BROWARD COUNTY RECORDS 0/5 OFFSET
BLDG BUILDING OM/ OVERHEAD WIRES
BLK. BLOCK P PLAT
BM BENCHMARK PAR PARCEL
BNOY BOUNDARY PB PLAT BOOK
B/W BACK OF WALK PC POINT OF CURVATURE
C CALCULATED PCG POINT OF COMPOUND CURVATURE
CB CATCH BASIN PCP PERMANENT CONTROL POINT
C135 CONCRETE BLOCK STRUCTURE PG PAGE
GO CHORD DIRECTION PI POINT OF INTERSECTION
CJB CABLE JUNCTION BOX PK PARKER KALON
CLF CHAIN LINK FENCE POB POINT OF BEGINNING
CM CONCRETE MONUMENT POG POINT OF COMMENCEMENT
CMP CORRUGATED METAL PIPE PP POWER POLE
GONG. CONCRETE PRM PERMANENT REFERENCE MONUMENT
COR. CORNER PRC POINT OR REVERSE CURVE
COV. COVERED PT POINT OF TANGENCY
D DEED P1/MT PAVEMENT
DB DEED BOOK R RADIUS OR RECORD
OCR DADE COUNTY RECORDS REG RECORD
D.E. DRAINAGE EASEMENT RCP REINFORCED CONCRETE PIPE
DOT DEPARTMENT OF TRANSPORTATION RES RESIDENCE
E/F END OF FENCE RET RETENTION/RETAINING
E/P EDGE OF PAVEMENT RNG RANGE
EM/ EDGE OF WATER RM RIGHT-OF-WAY
ELEC. ELECTRIC SAN SANITARY
ELEV. ELEVATION 513T SOUTHERN BELL TELEPHONE
ENCL. ENCLOSURE 5CN SCREEN
EM ELECTRIC METER 5E SOUTHEAST
E5MT EASEMENT SEC SECTION
F/C FENCE CORNER SEW SEWER
F/L FENCE LINE 5N&D SET NAIL&P15C LB#6463
FF FIN15HED FLOOR 5P SCREEN PORCH
FH FIRE HYDRANT 5P&G SET 1/2"PIN&CAP LB#6463
FIP FOUND IRON PIPE 5K STATE ROAD
FIR FOUND IRON ROD 5RC SET REFERENCE CORNER
FN FOUND NAIL 5TA STATION
FND FOUND 5TM STORM
FN&D FOUND NAIL&0I5C STY STORY
FN&T FOUND NAIL&TAB SUED SUBDIVISION
FP&L FLORIDA POWER&LIGHT T TANGENT 006*
GAR GARAGE TB TOP OF BAW, • °**so* °° °••
GAW GUY WIRE TBM TEMPORART P�RCJ MARK •
....••
HW HEAD WALL TRANS TRANSFORMER ••
ID IDENTIFY,IDENTITY 5TWP TOWNSHIP
INV INVERT TYP TYPICAL •••••• • • •
IR IRON ROD UE UTILITY EA50~ • • • •
IF IRON PIPE UGD UNDERGROL►ID••• i••••° •• ••
L LENGTH WD WOOD 000000 •
LB LICENSED 13U51NE55 WM WATER METER* • ••••••
•• • •• •••
LC CHORD DISTANCE WV WATER VAL •
LD LEGAL DESCRIPTION :Go:*: • • •
LFF LOWEST FINISHED FLOOR 0 i • • •° •i•
LP LIGHT POLE • • :06006
••°•• • •
L5 LAND SURVEYOR • • • •• •••
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