RC-16-15091 17 .- /�,�,,,� � �. ,
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Yanady Prieto
Subject: JORGE BEROA
Location: 158 NW 94 ST
Start:
End:
Tue 12/5/2017 11:00 AM
Tue 12/5/2017 11:30 AM
Recurrence: (none)
Meeting Status: Meeting organizer
Organizer: Yanady Prieto
Required Attendees: Arlenis Silvera; Maharai Gonzalez; Sindia Alvarez; Ismael Naranjo
Categories: Purple Category
JORGE BEROA >. OWNER
TO CANCELLED PERMIT
158 NW 94 ST
305-842-0896
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
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
PLUMBING MECHANICAL
JOB ADDRESS:
/)u
City: Miami Shores
Folio/Parcel#:
Occupancy Type:
❑ ROOFING
❑ PUBLIC WORKS
g Cf . ST-
County:
FBC 20
Master Permit No.0 1 b \JO9
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF
CONTRACTOR
-CANCELLATION ❑ SHOP
DRAWINGS
Miami Dade
Zip: 3 /
Is the Building Historically Designated: Yes
Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): �/-
1d it -Ce° 2 D J
Address: /S p®low 941 3 C
city: / j S d11 -El
NO
BFE: FFE:
Phone#: 0 5 / OP, o
State:
zip: 3 5 / �' c)
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name:
Phone#:
Address:
City: State:
Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competen`ty
DESIGNER: Architect/Engineer: Phone#:
Address: City:
State: Zip:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:
D C Al)C - ®t /L-/-4 ,' I— -
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $
DBPR $
(Revised02/24/2014)
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ __
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
Signature
R or AGENT CONTRACTOR
The foregoing instrumee was acknowledged before me this The foregoing instrument was acknowledged before me this
1 day of 1 KC'Pmb'Y , 20 n, by day of , 20 , by
r lber(OQ.GfCifngc�rag is personally�known to , who is personally known to
T
e or ho has produced rrn'1G4ntPl\- 1'`-t'S;cirii s me or who has produced as
'exp ' ®a► 2.1�I?_G�'
identification and who di•, : e an o• identification and who did take an oath.
NOTARY P
NOTARY PUBLIC:
Sign:"� Sign:
I
Print: t 4 n � f ; Print:
Seal: �Y�:r:^vo. YAidADI'P 0 Seal:
M ' COMMISSION # FF 214031
ar 'i EXPIRES: March 25, MO
'444 Banded 'Mu Nalany PIPoSt, 1144040 441
*********** viii+l****************************************************************
APPROVED BY Plans Examiner
(Revised02/24/2014)
Zoning
Structural Review Clerk
QA,,AAA) 1-fr(L 61-b 11-
1 P231 -(0-6k_ kadttidy ov) 60 kA
cAtv_e4 1,_,„; (- e -i(e -/ s-Dci am) -tz,t aA)24/1
i‘CJi ScM) al4fR 9D'3/Z 111614-4
I � Citi+aC U.t4-, Mfil,A-A) ci-dvo-
to uau.ol�i
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
PLUMBING ❑ MECHANICAL
JOB ADDRESS:
City:
Folio/Parcel#:
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
Master Permit No.
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
V y�
REC r a � � �.—
�� 01 2016
BY:
J
FBC 20 (`-i
❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION
CONTRACTOR
15J Po 9ittf sr
❑ SHOP
DRAWINGS
Miami Shores County: Miami Dade Zip: 3-5 / $
Is the Building Historically Designated: Yes NO
Occupancy Type: Load:
Construction Type: Flood Zone:
BFE: FFE:
OWNER: Name (Fee Simple Titleholder): VO R -fee: 0 L4Lb%- Phone#: > S J I 2 6d 1 0
Address:
�11ls�' tU tk rr
City: f ( i SO CAE
Tenant/Lessee Name:
Email:
State: .--f/ CAI- 0i
Zip: 3-2) I S
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/EngineeCAN cELLED Phone#:
City: State: Zip:
Value of Work for this Permit: $ s 6 6
Square/Linear Footage of Work:
Type of Work: ❑ Addition n Alteration ❑ New
Description of Work: F ti (I`'1/4t i✓ VC VAle C
11
-V\ht IOT S 1 f s-16 uL 0
0oiq (Elm SuNILJ A(� ro g1)( IAA !/
t1i
Specify color of color thru tile:
1,�
Repair/Replace 11]Demolition
►
(ACtn (�i�r► - i' ! c
UA,; t TA t C O A)S (-z:t ; t1 t3 c Alt
PLvf.,S.
Submittal Fee $.� Permit Fee $ CCF $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revised02/24/2014)
DBPR $
CO/CC $
Notary $ • (ID
Double Fee $
Bond $
TOTAL FEE NOW DUE $
t•
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 attachmen o, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whi n 7) days after the building permit is issued. In the absence of such posted notice, the
inspection will no r . 1 1. 1 ction fee will be charged.
A
Signature Signature
ER or AGENT
CONTRACTOR
The foregoing instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this
1 it day of ''J U tiE , 20 1 r , by day of , 20 , by
JCS -CC.• `>E-R00e, ((ZI\M A ic-Zho is personally known to ho is personally known to
me or who has produced Tri._ 1,Q Vii_ uc.D\I es me or wh�la pi od ced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC} NOTARY PUBLIC:
Sign:
Print:
Seal:
(\7)h -fW i 2-e.,
**************
ot01r P,si Notary Pu•ilc State of Florida
2' Sindla Alvarez
of My Commission FF 156750
�Fovo� Expires 09/0312018
as
Sign:
Print:
Seal:
*************************************************************
APPROVED BY Plans Examiner
(Revised02/24/2014)
OAZoning
Structural Review Clerk
OWNER BUILDER DISCLOSURE STATEMENT
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
NAME: JOl-(e 197-6 x --A-043" DATE: 1%00
ADDRESS: 1 S o " 90 7"
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
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 m 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 ow •ancy. 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 constru. a ill presume that you built
for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as . j esponsibility to make
sure the people employed by you have licenses required by state law and by county or municipal licensing • "r! ! Any person working on
your building who is not licensed must work under your supervision and must be employed by you, which means tha 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 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
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 J
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 and contracts.
Initial lib
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 resic1
construction is complete, the law will presume
trbuilt or substantiallyroveditimproforvled myselflhihis sold or leasediltthtwithin 1 year after the
EDisaor , Initial q6
5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. -1/6
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 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. 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
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
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, ordinances, building codes, and zoning regulations.
Initial
10. I 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 may contact the Florida Construction Industry
Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilb/index.html
Initial
11. I 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:
1S8 "ow op -1 file '53/ g
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on
this disclosure. 41—
(�
Initial
Licensed contractors are regulated by laws designed to protect the public. If you contract with a perso. • . d. -s • of have a license, the
Constr4uction Industry Licensing Board and Department of Business and Professional Re _ u. I. .t, you with any financial
loss that you sustain as a result of contractor may be in civil court. It is also important for a r licensed contractor or
employee of an individual or firm is injured while working on your property, you may be he d liable for damages. 1 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
(1 day of aU IL , 20
G&f'1-P"Iv io was personally known to me or who has
Produc thre License or —Da( as identification.
OWNER
NOTARY
Notary Public State of Florida
Sindia Alvarez
My Commission FF 156750
Expires 09/03/2018