RC-15-498PERMIT# 12,C.--15 gct 8
CONTRACTOR: j
SUBMITTAL DATE: P (2.015
ADDRESS: I-.. 3 W I OS •S —
NAME:174 I U? IcA M
RESUBMITAL DATES:
(1NQ,ODM
PLUMBING
PROJECT TYPE: Q
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MECHANICAL
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Yanady Prieto
Subject:
Location:
Start:
End:
Recurrence:
Meeting Status:
CANCELLATION •
173 NE 105 ST
786-556-1995
PHILIP KIM
PERMIT RC-3-15-498
job site meeting
173 NE 105 ST
Thu 9/13/2018 8:30 AM
Thu 9/13/2018 9:00 AM
(none)
Meeting organizer
B '3OAM
i?4 (k
(CP- <rp
BUILDING
PERMIT APPLICATION
❑ BUILDING
PLUMBING
JOB ADDRESS:
❑ ELECTRIC
❑ MECHANICAL
173 NE 105th Stre
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. RC-3-15-498
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION
[II PUBLIC WORKS ❑ CHANGE OF x❑ CANCELLATION
CONTRACTOR
et
❑ RENEWAL
❑ SHOP
DRAWINGS
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel#: 11-2136-005-0150 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):
Address: 173 NE 105th Street
Philip and Penny Kim
Phone#: 786-556-1995
City: Miami Shores
State: Florida
Zip:
33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #:
DESIGNER: Architect/Engineer:
Address: City:
Value of Work for this Permit: $
Type of Work: ❑ Addition ❑
Description of Work:
Alteration
Certificate of Competency #:
Phone#:
State: Zip:
Square/Linear Footage of Work:
❑ New ❑ Repair/Replace Ti Demolition
Please close out Permit # RC-3-15-498. The work was never done.
Canc{c ?Trmil-
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ Co/CC $
DBPR $ Notary $
Double Fee $
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.
Signature
Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
L9t21 day of Se. irt (lva(.,2v' ,20 I0 ,by day of ,20 ,by
11A11;C k�wt
, who is personally known to , who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
JASMOSPICI
arrOXRUSION.PPISIZS
m70.202111
pgrogitsmilockbeSildni
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
******************************,N****** ******+Ica*******s*********s****s**s***s***s*******************s********
r
APPROVED BY
(f/l
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
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ELECTRIC ❑ROOFING ❑ R ION ❑ EXTENSION ❑RENEWAL
❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHI+_ 'o ❑ CANCELLATION ❑ SHOP
CONT'4,Y4:' DRAWINGS
RECEIVED
MAR 19 2015
BY:
JOB ADDRESS: 1 S �G Q�"wt & hei.a
FBC 20 (0 Master Permit No. � 49e
Sub Permit No.
t 4
City: Miami Shores County: Miami Dade Zip: 3Si38
Folio/Parcel#: I ZI b OOS -- 0 IS Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): i'v f krill ti eE Vi 4Ij 4I44 Phone#: (.3 6\SS(9 - I (i, cis
Address: 1t3 NE (Kit :Shred -
City: 1 pp aa
City: 1v11 Q,iti\ l 'jt l2II State: flu 4ctsk_ Zip: 33 I S P
Tenant/Lessee Name: Ni A Phone#: 13 A
Email: o4v,A.a ?Q_vt.S
CONTRACTOR: Company Name: 1 15 ' r�� �,., Phone#:
Address:
City:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: gai/AV . Vt.1 like, Phone#: �-v�� N�!-J ++ �3ac)8ZZ-3i41
Address: 2-106 V$JLLd .SW.ep , £ i- �I� City: th AI 1421A. State: Zip:
Squpre/Linear Footage of Work: 1'(O sr/aro cat -
Type
of Work: n Addition n Alteration ❑ New ,ryF ❑ ,Repair/Replace rX Demolition
es,
I'
Description of Work: bawtbLcI a)4S�LN SUt1 novvi QY� l,t.pILGQ ill tfil1. Attu �1�1rd 0A4
i yN 0 ik r Stk 'dl.N/4 INi\d Iw / C�.ocir. 1
Value of Work for this Permit: $ 20, OOC► , 6 0
State:
Zip:
Specify color of color
CC-) Permit
tile:
Submittal Fee $ �J ' `') 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)
r Y
Bonding Company's Name (if applicable)
Bonding Company's Address
City VP' 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 aJl, work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a.tsgpara a permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIQ,NERS ETC
OWNER'S AFFIDAVIT: I certify that all the forvgding information is accurate and that all work will be done in compliance with all
applicable laws regulating construction anf►cinir 't
"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 �' ''11�' t Signatur
OWNER or AGENT
CONTRACTOR
The foregoing instrument�"�was acknowledged before me this The foregoing instrument was acknowledged before me this
� �~ day of r V �s-vVC�"- , 20 by day of , 20 , by
IPA:X%p 1C4� , who impersonally know o , who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
OTARY PUBLIC:
NOTARY PUBLIC:
ro`µv ►°°ek, ' KIMBERLY RO! ' , r'
•
',� .. ,4 MY COMMISS,,C. , :7 ;.'
Sign: a,. •
., Sign:
Print: (k VYN dL" _-(0c2,0_ '"k-2 c
Seal: 4.6`'''.7.1•Taels KIMBERLY RODRIGUEZ w" °�*i,
T MY COMMISSION # EE 879807 MY COMMISSION # EE 879807
`' * * EXPIRES: March 3, 2017
1�IAFS: March 3, 2017 ni
Print:
APPROVED BY Plans Examiner Zoning
(Revised02/24/2014)
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: /I,l (I r DATE: _ 1,°1 I Z®l S
ADDRESS: 1 3 �i Th tk (Siva, YU ituf(,rl j1a>(ltsc 77,-/- .g 13�
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 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!be4done 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.
_9
a. .
2. I understand that building permits are not required to be signed bya'property owner unless he or she is responsible for the
construction and is not hiring a licensed contractor to assume responsibility.
Initial TK-
Initial q1L
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. 1 understand that I may build or improve a one family or two-family r
a commercial building if the costs do not exceed $75,000. The buil
not be built or substantially improved for sale or lease. If a building or
myself is sold or leased within 1 year after the construction is complete,
improved it for sale or lease, which violates the exemption.
a farm outbuilding. I may also build or improve
must be for my use or occupancy. It may
have built or substantially improved
sume that I built or substantially
. 49 Initial ' \ 1C
I 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
municipal ordinance.
cs„
• C.
Initial ��v
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 U k.._
9. I agree as the partylegally and y res onsible for this proposed Construction activity,I will abide byall applicable
9 9 Y financially P P P Pp
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 l [`
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/dbprlpro/cilb/inddex.html
Initial L'>
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:
(}5 iNE Io9 L v -, t38
12. I agree to notify Miami Shores Village immediately
have provided on this disclosure.
r
Licensed contractors are regulaed to protect the public. If you contract with a person who does not have a
license, the Constr4uction Indust i '« ;t g Board and Department of Business and Professional Regulation may be unable to
assist you with any financial loss thau 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.
Initial'
ons, deletions, or changes to any of the information that I
Initial Aj K---
Was acknowledged before me4this-, :y' 1k — day of KWL01n , 20 ("c
11,
B�0 U(,.(
y ��.. w� who was personally known to me or who has
f-L-fjY-I U-Cx NSA
Produced there License or`' 5CO -- - CY04'd identification.
OWNER
NOTARY
gy+Po Notary Public State of Florida
4Sindia Alvarez
. � My Commission FF 156750 .
�1� Expires 09/03/2018
September 7, 2018
Miami Shores Building Department
10050 NE 2 Ave
Miami Shores Village FL 33138
Telephone: 305-795-2204
Facsimile: 305-756-8972
Re: 173 NE 105`' Street, Miami Shores, Florida, 33138
Request to Close Building Permit # RC-3-15-498
To Whom It May Concern,
r....._
AF.
SEp
Hello, my name is Philip Kim, and I am the owner of the above -referenced property. A few years ago, I
submitted a building permit (Permit # RC-3-15-498) for a sunroom renovation project. The work was
never done. We were not satisfied with our architect/engineer and decided to postpone the project.
I have some new plans in the works. However, I would like to close out the above -referenced building
permit before submitting any new plans.
Thank you for your time and consideration in this matter.
Best regards,
Philip Kim
Owner of 173 NE 105th Street
Cell: 786-556-1995
Email: pkim@penskykim.com
Miami Shores Village
Building Department
10050 N.E. 2nd Avenue
Miami Shores, FI 33138
Tel: 305-795-2204
Fax: 305-756-8972
11/24/2015
173 NE 105 Street
Miami Shores FL 33138
RE: Process No.RC-3-15-498
Address: 173 NE 105 Street
Dear Owner,
Our records indicate that the above referenced permit has expired without obtaining the
proper permit approval. In order to serve you better, we need to keep our files up to date.
As per section 105.3.2 of the Florida Building Code, "An application for a permit for any
proposed work shall be deemed to have been abandoned 180 days after the date of filling, unless
such application has been pursued in good faith or a permit has been issued."
Please be advised that open permits will hinder your ability to refinance or sell this. property.
Please contact the Building Department, within 15 days of receipt of this letter in order to
take care of this matter.
Sincerely,
l/Z3/ '—
Ismael Naranjo, CBO
Building Department Official
305-795-2204