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RC-16-8561 BUILDING PERMIT APPLICATION 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 20 (' Master Permit No. Za(o� e Sub Permit No. El BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ElCHANGE OF\gl CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 165 NW 96th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3101-025-0130 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Provident Funding Associates, L.P. Address: 851 Traeger Avenue Phone#: 650-652-1300 City: San Bruno State: CA Zip: 94066 Tenant/Lessee Name: n/a Phone#: Email: rbrede@provident.com t CONTRACTOR: Company Name: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 ❑ New Description of Work: ❑ Repair/Replace ❑ Demolition Specify color of color thru 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 issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. SignatureC z4.14 OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this &.e day of , 20 n, by day of , 20 , by .n -n a , who is personally known to , who is personally known to me or who has produced 'ONPir O LACCASE as me or who has produced as Signature CONTRACTOR identification and who did take an oath. NOTARY PUBLIC: Sign. Print: J. PHILLIPS Seal: Commission #1 2095221 Notary Public - California I San Mateo County 20 M Comm. Ex fres Jan 25, 2019 ***************************.****** **:,�:****************s****************s*****s*************** identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY (Revised02/24/2014) 1 Plans Examiner Structural Review Zoning Clerk PF Property Management 851 Traeger Avenue, Suite 100 San Bruno, California 94066 Telephone: 650-652-1300 ext. 3212/Facsimile: 650-652-1348 October 26, 2017 Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 RE: 165 NW 96th Street, Miami Shores, FL Dear Sir / Madam- - (950 The purpose of this letter is to request Miami Shores Village Building Department to cancel the open shed permit for the property located at 165 NW 96`h Street, Miami Shores, FL If you have any questions, please contact me at 408-694-1735 Ext. 7157 Thank you for your assistance. Respectfully, te4 Ernie Brede, Manager PF Property Management Provident Funding Associates, L.P. Page 1 of 1 Prope Search Application - Miami -Dade County Page 1 of 1 !CE Of THF PROPERTY APPRASER Summary Report Property Information Folio: 11-3101-025-0130 Property Address: 165 NW 96 ST Miami Shores, FL 33150-1714 Owner PROVIDENT FUNDING ASSOCIATES L P Mailing Address 851 TRAEGER AVE STE 100 SAN BRUNO, CA 94066 USA PA Primary Zone 0800 SGL FAMILY - 1701-1900 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds / Baths / Half 2 / 1 / 0 Floors 1 Living Units 1 Actual Area 1,455 Sq.Ft Living Area 1,065 Sq.Ft Adjusted Area 1,285 Sq.Ft Lot Size 8,625 Sq.Ft Year Built 1946 Assessment Information Year 2017 2016 2015 Land Value $189,543 $189,543 $140,036 Building Value $89,436 $89,436 $89,436 XF Value $2,890 $2,927 $2,396 Market Value $281,869 $281,906 $231,868 Assessed Value $274,512 $249,557 $226,870 Benefits Information Benefit Type 2017 2016 2015 Non -Homestead Cap Assessment Reduction $7,357 $32,349 $4,998 Note: Not all benefits are applicable to all Taxable Values (i.e. Coun y, School Board, City, Regional). Short Legal Description RESUB OF BLK 3 OF BONMAR PARK PB 42-60 LOT 13 BLK 3 LOT SIZE 75.000 X 115 OR 18222-3007 0798 1 Generated On : 10/27/2017 Taxable Value Information 20171 2016 2015 County Exemption Value $0 $0 $0 Taxable Value $274,512 $249,557 $226,870 School Board Exemption Value $0 $0 $0 Taxable Value $281,869 $281,906 $231,868 City Exemption Value $0 $0 $0 Taxable Value $274,512 $249,557 $226,870 Regional Exemption Value $0 $0 $0 Taxable Value $274,512 $249,557' $226,870 Sales Information Previous Sale Price OR Book - Page Qualification Description 08/03/2017 $240,500 30645-2543 Federal, state or local government agency 01/01/2008 $470,000 26204-3182 Other disqualified 12/01/2007 $360,000 26199-3520 Sales which are qualified 07/01/2003 $245,000 21423-4143 Sales which are qualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 10/27/2017 w/ � �f_p»r!n~r,r.mn�� � DIVISION,/ - C ORPORATIONS an official Slate al Florida .1.e1)%ite- Detail bwEntityNaNNe ° Foreign Profit Corporation PFG LOANS, INC. Cross Reference Nam PROVIDENT FUNDING GROUP, INC. Filing Information Document Number F98000004548 FEI/EIN Number Date Filed 07/301998 State CA Status ACTIVE Last Event CANCEL ADM DISS/REV Event Date FiIed 10/27/2008 Event Effectve Date NONE Principal Address 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 Changed: 02/21/2012 Kgihng Address 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 Changed: 02/21/2012 Registered Agent Name uAddress CORFORATION SERVICE COMPANY 1201 HAYS STREET TALLAHASSEE, FL 32301-2525 Offioe,J]reumrDetaU Name & Address Title PDVC 7 - PICA, R. CRAIG 851 TRAEGER AVENUE, SUITE 100 SAN BRUNO, CA 94066 Title DSVP PICA, DOUGLAS 851 TRAEGER AVENUE, SUITE 100 SAN BRUNO, CA 94066 Title DSVS BLAKE, MICHELLE 851 TRAEGER AVENUE, SUITE 100 SAN BRUNO, CA 94066 Annual Reports Report Year 2015 2016 2017 Document Image, Flied Date 04/13/2015 04/29/2016 04/24/2017 04/:24f72017 -- ANN 0A,_ REPORT 04/29/2015 -- ANNUAL REPCR C4.1312015 -- A NUAL REPORT 05!01%4014DUAL REPORT 04/16/2013 -- ANNUAL R=PORT 02J21 /2012 -- ANNUAL. REPORT 04/O4i2Oi1 -- ANNUAL REPORT C4121%2010 -- ANNUAL REPORT 01412412.O09 -- ANNUAL R;rPORT 10/27/2006 -- R,EiNSTATFMENT 04;30120,J; -• A',INUAL REPORT 0.4242305 - At !NUAL REPORT 04/i)ri;riGj -- A.NR' JAL REPORT REPORT 02/17i2003 -- ANNUAL REPORT 05/29:2032 - ATINL)AL REPORT O:3!0612001 -- ANNUAL REPORT 05/0$/7000 -- ANNUAL REPORT 07r°p1199g Af..JNUAL REPORT Foret9n Profit Nie, linage ir. 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Secretary of State CC5588344593 Current Principal Place of Business: 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 Current Mailing Address: 851 TRAEGER AVENUE SUITE 100 SAN BRUNO, CA 94066 FEI Number: 77-0293745 Name and Address of Current Registered Agent: CORPORATION SERVICE COMPANY 1201 HAYS STREET TALLAHASSEE, FL 32301-2525 US Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Officer/Director Detail : Title PDVC Title DSVP Name PICA, R. CRAIG Name PICA, DOUGLAS Address 851 TRAEGER AVENUE, SUITE 100 Address 851 TRAEGER AVENUE, SUITE 100 City -State -Zip: SAN BRUNO CA 94066 City -State -Zip: SAN BRUNO CA 94068 Title DSVS Name BLAKE, MICHELLE Address 851 TRAEGER AVENUE, SUITE 100 City -State -Zip: SAN BRUNO CA 94066 Date I hereby Wm)/ mer me information lnakrated on this report or supplemental report /s true and accurate and that my eteczronlc signature shat have the same legal effect as it made under oath; that t em an officer or dtrectorol the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Florida Statutes; end that my name appears above, or on an attachment wrm all other Like empowered. SIGNATURE: MICHELLE C. BLAKE SECRETARY 04/24/2017 Electronic Signature of Signing Officer/Director Detail Date Corporate Resolution 1, Michelle C. Blake, Secretary of Provident Funding Group, Inc., a corporation duly organized and existing under the laws of the State of California, and General Partner of Provident Funding Associates, L.P., do hereby certify that the following is a true and correct copy of a resolution of the Board of Directors of said corporation, adopted at a special meeting held on the 6th day of January in the year 2016: RESOLVED, that any one of the following: • Ernest Brede, Assistant Vice President • Rebecca Brede, Assistant Vice President • Milin Patel, Assistant Vice President is authorized and directed to cause the Company to take all steps necessary to effect the sale of any real property pursuant to a notice of time and place of a foreclosure sale; to bargain, sell, transfer, assign, set over and deliver the real property; and to sign the name of Provident Funding Associates, L.P., to all deeds, contracts of sale or other instruments necessary to carry out this resolution, all of the acts in the premises undertaken by each of these individuals being ratified as the act and deed of this corporation. FURTHER RESOLVED, that any and all actions taken these individuals in connection with the matters contemplated by this resolution be, and are hereby, approved, ratified and confirmed in all respects as full as if such actions had been presented to the Board of Directors for its approval prior to such actions being taken. Dated: 1/28/16 ThiefALM-Felo-c Michelle C. Blake, Secretary BUILDING PERMIT APPLICATION BUILDING ❑PLUMBING Il ELECTRIC 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 FRF7f t_ MAR 3 0 2016 BY: - 5J FBC 20 r4 Master Permit No. Sub Permit No. ROOFING REVISION ❑ EXTENSION II PUBLIC WORKS CHANGE OFC CANCELLATION CONTRACTO JOB ADDRESS: V\ rt ( Q c 1) AL City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): – V_t •/'--(=>\1 Address: \ d V\u.) RENEWAL SHOP DRAWINGS NO BFE: FFE: 13 10 Phone#: City: SkryrP� State: – Zip: 33 l c Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: � e v—* Address: P:I)Phone City: State: Zip: Qualifier Name: Phone#: State Certification or Registration 44: DESIGNER: Architect/Engineer: r „ Certificate of Competency #: Phone#: State: Address: " ' City: �,r Value of Work for this Permit: $ yth Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration Description of Work: (..1'\7e--& 1 O 1-1-Z- View 11�e�i ❑ Repair/Replace Zip: n Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (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 OWNER or AGENT The foregoing i trument was acknowledged before me this day of 1,-4- el (6 k , 20 by /lc rr\D'e , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: ...•� '• Print:iV/, Seal: a;•• �_ yo•" 07, Zoning Signature CONTRACTOR The foregoing inst ument was acknowledged before me this day of , 20 , by who is personally known to as me ordGh e4 tsit iden catioand who did take an oath. 4PliBLIC: as Sign: Print: Seal: APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review Clerk 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: ¶\&vkb \kO\ DATE: tAfkitelk. 'tel 16 ADDRESS: \b'c VW) *b IAo0-2-0 PC 33 15-0 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 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 co • -, he 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 c ' responsibility to make sure the people employed by you have licenses required by state law and by county or municipal lic• - •n working on your building who is not licensed must work under your supervision and must be employed by you, which means thuct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must com ' 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 responsibili 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 and contracts. Initial 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'f\1'\ 5. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 1 iA 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 p-'1 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 VA. 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.mvfloridalicense.com/dbpr/pro/cilb/index.html Initial �V 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: Initial V \ 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. Initial Licensed contractors are regulated by laws designed to protect the pu . . u Contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business a I.tion 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 . i7 : ,� f `. erstand that, if an unlicensed contractor or employee of an individual or firm is while workingonyour ro ert , you m► or damages. If you obtain an owner -builder injured P P Y,,�' g permit and wish to hire a licensed contractor, you will be responsible for verii:yingwhether the ractor 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 O day of IA k , 20 \-b By Ftl c� ' " lvt Produced there License or who was personally known to me or who has Or2AJrz OWNER