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RC-15-2795Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 8701 NE 4 Avenue Road Miami Shores, FL 33138-0000 Owner Information Address Parcel Number 11-3206-046-0660 Block: Lot: Phone us: APPRO Expiration: 01/22/2017 Applicant CYNTHIA LAM CeII CYNTHIA LAM 8701 NE 4 Avenue Road MIAMI SHORES FL 33138- Contractor(s) CAIBAI CONSTRUCTION LLC Phone CeII Phone (786)229-2770 (786)470-4207 Valuation: Total Sq Feet: $ 4,400.00 0 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: REMOVE Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Return : AND REPLACE VANITY A Occupancy: Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.00 $2.00 $2.00 $1.00 $132.00 $9.00 $4.00 $153.00 Pay Date Pay Type Invoice # RC -11-15-57642 07/26/2016 Credit Card 11/02/2015 Credit Card Amt Paid Amt Due $ 103.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Fill Cells Columns Review Electrical Review Electrical Review Electrical Review Electrical Review Building Review Building Review Building Review Building Review Mechanical Review Plumbing Review Planning Review Plumbing Review Plumbing Review Structural Review Mechanical 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 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. Futhermore, I authoriz al'i above-named contractor to do the work stated. July 26, 2016 Authorizes Sig<imature: Owner / Applicant / Contractor / Agent Building Department Copy Date July 26, 2016 1 BUILDING PERMIT APPLICATION • BUILDING ❑ ELECTRIC ❑ PLUMBING ❑ MECHANICAL Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ▪ ROOFING ❑ PUBLIC WORKS JOB ADDRESS: 8701 NE 4th Ave Road, Unit 8701 city: Miami Shores county: Miami Dade Folio/Parcel#: 11-3206-046-0660 Is the Building Historically Designated: Yes NO RECEIVED OCT 242017 FBC 20N Master Permit No. 47 1 S—alc(5- Sub Permit No. El REVISION EXTENSION El RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Zip: 33138 Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Cynthia K. Lam X Flood Zone: BFE: FFE: Phone#: (305) 333-2177 Address: 8701 NE 4th Ave Road, Unit 8701 City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: Lamsync2@gmail.com CONTRACTOR: Company Name: C fl 1 84 I C'.OtS j (2..L1 C.T1 O� Address: I 05-geoO&7SL^-) —rn 2 City: rol j & I ry State: FL_ Zip:: 3! 7 0 ( S Qualifier Name: 10,6 S� • Phone#:l r o) 22-61 Zi7 0 State Certification or Registration #: 6.-6C. 0 5-9' Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Phone#6907-26\2:17 0 Value of Work for this Permit: $ al Al a Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition 2 Description of Work: .,trn-/ 0Oa%-1 `GL 1�%%f��. r 12-S4•IrintiA l 0 Specify color of c ! for hru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 issuer. In the absence o h posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this a ( Ll day of CO , 20 l , by Cynthia K. Lam ,,//�� who is personally known to me or who has produced I�(---Ic-3"-'lval-' as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: �yy ************************* APPROVED BY (Revised02/24/2014) 17- Signature ►-W CONTICTOR The foregoing instrument was acknowledged beforree me this �Li day of ^, ) (�l`CZ , 20 C ` by l ' Z -who is personally known to me or who has produced EL --as identification and who did take an oath. `ON1110I11i bl �len�byO NOTARY PUBLIC: Sign: _ ®Q' Print: Seal: Plans Examiner %)7' a ya.ae %� •• ....... $��a ��illl11:1111111` e `- Zoning Structural Review Clerk Arlenis Silvera From: Ismael Naranjo Sent: Thursday, October 12, 2017 3:13 PM To: Arlenis Silvera Subject: Fwd: 8701 NE 4 Ave Rd Can you provide Mr. Losa with the info Sent from my iPhone Begin forwarded message: From: Jose A Losa Sr <joelosasr(cbellsouth.net> Date: October 12, 2017 at 2:41:26 PM EDT To: "Naranjoi(&miamishoresvillage.com" <Naranjoi(&miamishoresvillage.com> Subject: 8701 NE 4 Ave Rd Reply -To: Jose A Losa Sr <joelosasr cx bellsouth.net> Mr. Naranjo Building Director Miami Shores Village Please We would like to obtain a copy of the permit application done by Mr. Marcos Leon for the above referenced address to proceed with our legal action against him and the Notary Sincerely yours Mr. Jose A Losa Jr. General Contractor i oyi\A-0;-\\k- i1(+C° BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2011 Master Permit No. RC15-2795 PERMIT APPLICATION Sub Permit No. OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0RENEWAL PLUMBING MECHANICAL EIPUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 8701 NE 4th Ave Road City: Miami Shores County: Folio/Parcel#: 11-3206-046-0660 Occupancy Type: Load: Construction Type: Miami Dade Zip: 33138 Is the Building Historically Designated: Yes NO X Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Cynthia K. Lam Phone#: 305-333-2177 Address: 8701 NE 4 Ave Road City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: N/A Phone#: Email: Lamsync2@gmail.com CONTRACTOR: Company Name: Caibai Construction Address: 10876 SW 24 Terrace Phone#: 954-822-1832 or 786-229-2770 City: Miami Qualifier Name: Jose Losa State: Florida Zip: 33165 Phone#: 954-822-1832 or 786-229-2770 State Certification or Registration #: CGC 058065 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: N/A Value of Work for this Permit: $ 4,300.00 Type of Work: ❑ Addition ❑■ Alteration Square/Linear Footage of Work: n New 130 sq. ft. approximately ❑ Repair/Replace ❑ Demolition Description of Work: Replace kitchen cabinets and install new set. Open and install new door leading from kitchen to laundry room. Remove and replace vanity and replace tub with shower. Install new faucet, and new tile in the shower area. Specify color of color thru tile: Submittal Fee $ Permit Fee $ ‘ 32-. O CCF $ 3 03 colas Scanning Fee $ Radon Fee $ 2 -° DBPR $ 2 ' Notary $ Technology Fee $ 9-- Training/Education Fee $ i - GO Double Fee $ Structural Reviews $ — ( R evi sed02/24/ 20 14) Bond $ TOTAL FEE NOW DUE $ (5'3 . Q3 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip NOWE 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 J 4^-1, Signat OWNER or AGENT The foregoing instrument was acknowledged before me this 2 day of 1LC.ne , 20 , by t l//t lGi l� &in who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC:. Sign: Print: as CONTRACTOR The foregoing instrument was acknowledged before me this Z day of -114-na- 20 1 , by 1.)S. E/ . ii , who js personally knowr\to me or who has produced identification and who did to NOTARY PUBLIC: th. RAULNAVARRO MY COMMISSION #FF972714 EXPIRES: MAR 20, 2020 Bonded through 1st State Insurance Seal a 4444**** AMIL --- lb- -Mk_ • ,N! ODISA CARVAJAL /Notary Public - State of Florida My Comm. Expires Oct 16, 2018 Commsssionm*F *14411,40* Ir.-. ii' g onal Notary Assn. tet /Pt; APPROVED BY (Revised02/24/2014) Print: r?-x.3.� Seal: ***************************************************************** Plans Examiner Zoning Structural Review Clerk CAIBAI CONSTRUCTION 10876 SW 24 Terrace Miami, FI 33165 786-229-2770 e/ ry mm -mi s2J0S RE: d 7®l Vg qi'/i ,4f aip PerfrorA I, Jose Losa, as a qualifier and contractor of record for above referenced address, request to be removed or a hold to be placed on all Permits in my company name for this address. I did not sign permit application or authorize anyone to work at this job under my license. I do not want any restrictions, violations or possible lawsuits to be placed on my license due to circumstances beyond my control. I urge you to grant my request and I would hope that the city takes actions to "stop an additional work" at jobsite. Thank you in advance for your prompt attention to this matter. Should you need to contact me for any questions or concerns, please contact me at (786) 229- 2770. Th .`•u,1, J•se osa ° ai Constru tion C C058065 73 - C,41- 10 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-290472 Permit Number: RC -11-15-2795 Scheduled Inspection Date: October 26, 2017 Inspector: Riveron, Alexis Owner. LAM, CYNTHIA Job Address: 8701 NE 4 Avenue Road Miami Shores, FL 33138-0000 Project <NONE> Contractor. CAIBAI CONSTRUCTION LLC Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 11-3206-046-0660 Phone: (786)229-2770 Building Department Comments REMOVE AND REPLACE VANITY AND TOILET. REMOVE TUB AND CONVERT WITH SHOWER. REMOVE EXISTING KITCHEN CABINETS AND INSTALL NEW CABINETS. expiration warning sent out 1/3/16 Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP-286649. CREATED AS REINSPECTION FOR INSP-286312. BY CINTHIA LAM Need to provide new permit application. According to Mr. Losa the qualifier for CAIBA Construction he was not aware of this permit. The signature on the permit application is not his signature and he did not authorized this work. October 25, 2017 For Inspections please call: (305)7624949 Page 15 of 27 BUILDING PERMIT APPLICATION BUILDING 1j1 ELECTRIC ■ PLUMBING n MECHANICAL Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 n ROOFING NOV Master Permit No. Sub Permit No. 2015 FBC 20N n REVISION n EXTENSION RENEWAL CANCELLATION 1 SHOP DRAWINGS (PUBLIC WORKS I 1 CHANGE OF ., CONTRACTOR JOB ADDRESS: 8701 NE 4th Ave Road City: Miami Shores CANCEL, tit ty Coun : Miami Dade Zip: 33138 Folio/Parcel#: 11-3206-046-0660 Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Address: 8701 NE 4 Ave Road Cynthia K. Lam Is the Building Historically Designated: Yes Flood Zone: BFE: NO X FFE: Phone#: 305-333-2177 City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: N/p` Phone#: Email: Lamsync@aol.com CONTRACTOR: Company Name: Address: City: Phone#: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: N/A Phone#: Address: City: State: Zip: Value of Work for this Permit: $ #- `f, 440o. a) Square/Linear Footage of Work: Type of Work: E Addition ■ Alteration n New Repair/Replace ri Demolition Description of Work: RefiO4e C-cmcQ_ yepiCtL12., \l Gin t \'L( Ct.n 1ak . Rernc e -1100 co,a CorweYor u -)0-f). &-cxc -r. i�ili�1u�l t'sCt43Ati'YA 1C�CI'lE�'1 it et (Ina i ry5.1 I (19(0Cath I J Specify color of color thru tile: Submittal Fee $ Com' `' V Permit Fee $ CCF $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ co/CC $ OZ (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Zip N/A 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, fit esti ated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and c ctiof law brochure will be delivered to the person whose property is to attachment. Also, a certified copyo the recorde notice o ommencement must beposted at the job site P P Y subjectf f 1 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 4A -t.•• Signature / !L6'k g `-� OWNER or AGENT The foregoing instrument was acknowledged before me this dayof November Zo 15 by Cynthia K. Lam , who is personally known to me or who has produced C. identification and who d NOTARY PUBLIC: Print: b'Z,.79,t, g /eire.4 6 __rc•�an oat . EMMANUELREGIS w • ' MY COMMISSION # EE 877007 = EXPIRES: Apr 14, 2017 �''r••••••'Bonded Thru Notary Public Underwriters Seal: *********************-- APPROVED BY (Revised02/24/2014) I 1/ CONTRACTOR The foregoing instrument was acknowledged before me this r day of November 20 15 by Cynthia K. Lam , who is personally known to me or who has produced identification and who NOTARY PUBLIC: Sign: Print: 6/27,' i -P / , f. . i Seal: EMMANUEL REGIS MY COMMISSION # EE B77007 EXPIRES: April 14, 2017 Bonded Thru Notary Public Underwriters ......_....,,**>k********** ***R***s«s***** *** **lc*ss*s«s***** s***s*** Plans Examiner Zoning Structural Review Clerk 0 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: q%IIcz apnDATE: CCU/S ADDRESS: ell D/ i-/ AYE 2CL C 1 E-1 (Cr n/ ! Shor6- FL Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 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 allowsyou, as the owner ofyourproperty, to act asyour own contractor even th ot+gl�>�otAdgnot have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence.' .i.mayal5o 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 ale 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. I understand that state law requires construction to be done by a lic exemption from the law. The exemption specifies that I, as the own restrictions even though I do not have a license. e ifi o"r"g11t4 taye applied for an owner -builder permit under an t,y act as my own contractor with certain Initial 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I 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 own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits andco tracts. Initial �w 4. I 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, which violates the exemption. Initial 5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 1, 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 municipal ordinance. Initial 7. I 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. 1, 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 8. 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 security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial C.%' 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by 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, or . nces, building codes, and zoning regulations. 10. I understand that 1 may ob Small Business Administrati Licensing Board at 850.487.139 Initial on regarding my obligations as an employer from the Internal Revenue Service, the United States lorida Department of Revenues. I also understand that I may contact the Florida Construction Industry 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: 7O/ /V1- 4 4-ve � � Niel Initial Cg 12. I agree to notify Miami ShoresWilage rpealtat y, ditions, deletions, or changes to any of the information that I have provided on this disclosure. a7L. aiP/M (Q 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 U day of NSM S -F�-, 20 I g By DYNt v4114 KO Lk -0 Lam who was personally known to me or who has Produced there License or F UCk as identification. OWNER NOTARY o�aAr °ut. Notary Public State of Florida Sindia Alvarez yaG _ 4, My Commission FF 156750 OF FOOD Expires 09!03/2018 4 PREP/41E03 ly Law Office of Zachary Zurich, PA. 9600 NW 25th Street, 2A Doral, FL 33172 Tel: 305-852-2569 Email: zaczurich@gmallcom Fax: 954-337-2907 111111111111111111111111111111111111111111111 CFM 2015R0036291 OR Bk 29470 Pas 0232 - 2331 (toss) RECORDED 01/20/2015 14:45:21 DEED DOC TAX 750.00 HARVEY RUVIN, CLERK OF COURT MIAl9I-DADE COUNTY, FLORIDA WARRANTY DEED THIS INDENTURE, made this 8th day of January, 2015 by and between, Linton Reo, LLC, a Florida Limited Liability Company whose address is 9600 NW 25th Street, 2A, Doral, FL 33172, Grantor, and Cynthia K, Lam, a single womam whose address is 8701 NE 4th Ave Road, Mami Shores, FL 33138, Grantee: WITNESSETI{: THAT, the Party of the Grantor, for and in consideration of the sum of One Hundred Twenty Five Thousand Dollars AND NO/100 ($125,000.00) DOLLARS and other good and valuable considerations, to it in hand paid by the Grantee, the receipt whereof is hereby acknowledged, hereby assigns, transfers, corweys, grants, bargains and sells to the said Grantee, their heirs, successors and assigns the following described property, located and situate in the County of Miami -Dade, State of Florida, to -wit Condominium NO. 8701.of the Shores Villas Condomin€um, a Condominium Bullring D, according to the Declaration of Condominium thereof as recorded in official records book 8751, Pg. 1715 of the Public Records of Miami -Dade County, Florida. Patio: 11-3206-046-0660 Address: 8701 NE 4th Ave Road, Mami Shores, FL 33138 This sale is subject to the following: 1. Real Estate Taxes for the year 2015 and subsequent years. 2. Conditions, restrictions, limitations, agreements and easements of record, if any, but this provision shall not operate to re -impose the same. 3. Zoning and other governmental regulations. 4. Section B-2 of the owners tide insurance policy issued in connection with this closing to party of the Grantee and without re -imposing same. And the Grantor does hereby fully warrant the tide to said land, and will defend the same against the lawful claims of aU persons whomsoever. IN WITNESS WHEREOF, The said party of the first part has hereunto set lis hand and seal the day and year first above written Book29470/Page232 CFN#20150036291 Page 1 of 2 OR BK 29470 PG 0233 -� LAST PAGE Witnesses (as to Grantor): ifedieli Arlo, d*' &rick STATE OF FLORIDA ) COUNTY OF MIAMI-DADE) Linton Reo, LLC BEFORE ME personally appeared, Zachary Zurich as Managing Member of Linton Rea, LLC and known to me to be the person described in and who executed the foregoing instrument, and acknowledged to and before me that he executed said instrument for the purposes therein expressed. He is personally known to me. WITNESS my hand and official seal, this 8 day of January, 2015. My Commission Expires: Javier, Plneiro NOTARY PUBLIC, STATE OF FLORIDA AT LARGE 074 3004153 JAVIER PRIEMRO HERNANDEZ MY COMMISSION MFF000703 EXPIRES March.* 2011 Rawomaisgra.,v+ecoom Book29470/Page233 CFN#20150036291 Page 2 of 2