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. PDF formai
View image in PDF format
View image in PDF format
View image in PDF format
View image iri PDF format
View imam in PDF format
View image in PDF format
View mage in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View image In PDF format
View image in PDF format
View image in PDF format
View image in PDF format
View in -4-30e in PDF format
http./!sea�'�h.sun! is ire! ..uir, l,; 3 l-Crilesti...cin.:2dliJai:0i l..,;7'_i>J;. J' 99Ul;Lrt, 271E 10/25,17. 7.4
, 2017 FORE GN PROFIT CORPORATION ANNUAL REPORT FILED
DOCUMENT# F98000004548 Apr 24, 2017
Entity Name: PFG LOANS, INC. 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