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RC-18-706Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pei ■ n Permit NO. RC-3-18-706 Permit Type: Residential Construction Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date. 6/4/2018 Expiration: 12/0112018 Parcel Number Applicant 10611 NE 11 Avenue Miami Shores, FL 33138-2120 1122320280380 Block: Lot: Owner Information STEPHEN LENSI Address 10611 NE 11 Avenue MIAMI SHORES FL 33138- Contractor(s) CIRCA BUILDERS INC Phone (305)882-1733 Cell Phone STEPHEN LENSI Phone (860)490-6310 Cell Valuation: Total Sq Feet: $ 25,000.00 500 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INTERIOR RENOVATION KITCHEN Stories: • Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: INTERIOR RENOVATION KITCHEN Classification: Residential Fees Due Bond Type - Owners Bond CCF CO/CC Fee DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $500.00 $15.00 $50.00 $11.25 $7.50 $5.00 $5.00 $750.00 $27.00 $20.00 $1,390.75 Pay Date Pay Type Invoice # RC-3-18-66840 06/04/2018 Check #: 1344 03/19/2018 Check #: 1340 Bond #: 3786 Amt Paid Amt Due $ 1,190.75 $ 200.00 $ 200.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Drywall Miscellaneous Window Door Attachment Tie Beam Final Framing Insulation Truss Insp Columns Foundation Window and Door Buck Fill Cells Columns Wire Lathe Review Electrical Review Electrical Review Electrical Review Building Review Plumbing F. Termite Letter F. Elevation Certificate Review Planning Review Structural Review Mechanical Declaration of Use 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 ertify that -II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zo r',.a/ utherm . - I authorize the above -named contractor to do the work stated. uthorized Signature: Owner / Applicant / Contractor / Agent June 04, 2018 Date Building Department Copy June 04, 2018 1 BUILDING PERMIT APPLICATION Miami Shores Village REc Building Department UN 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC2017 Master Permit No. C., 1 — 1 Ok Sub Permit No. teht jjZ UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 GG II; /V/ 1) City: Miami Shores County: Miami Dade Zip: 321,3 E Folio/Parcel#: 1 I 123 2 ' C/-- v Sep 0 Is the Building Historically Designated: Yes NO x Occupancy Type: (e< Load: Construction Type: C 8 S Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): S Inca lrU1?. Phone#: Address: / 060 / /V. of f t., .A., c City: /Li;v.^,� Tenant/Lessee Name: State: r L Email: t—Sf'"YiTh „ /€.?L7 6is c.c.,--,nct.i. /. c,Dr7 CONTRACTOR: Company Name: ` (C� `TfZ / RC. r4 e e) 0 Z ®c S 1 . T AI - Phone#: (7% •\? 76°C Address: Sc 6, ( 0v . Ini • _LP,_LP,"E �" City: /-11/ 0 t E 6/-f- State: l L Zip: /313 0f -� Qualifier Name: V; L 'J K- Q(..) (T -I /2-- Phone#:(7 6 1� / c��-F" 7 `-7 6 CO L State Certification or Registration #: �/� ea !�' �i Certificate of Competency #: ff DESIGNER: Architect/Engineer: 1 1 ---1 AL, ec,-/ P:C.. Phone#: Address: 1 2 .`1.Zv j;,..) S3 9 City: "(it-: n,f: State: T L- Zip: 33 / 7S Value of Work for this Permit: $ 2 S , 00 0 Square/Linear Footage of Work: SO 0 Type of Work: ❑ Addition Iteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 0.1'1--Pr,,9,'" ( %•i-7 y.---+ k' rc. , -, , -+• ,bc�'`"L. Ch aW t o> CD zip: JS /33 Phone#: 2.66—f-9U 6310 Y Specify color of color thru tile: Submittal Fee $ 20° Permit Fee $ 1SO CCF $ ) CO/CC $ SO Scanning Fee $ 21 Radon Fee $ 1 • SO DBPR $ I� • 2S Notary $ 5 Technology Fee $ 2 Training/Education Fee $ S Double Fee $ Structural Reviews $ Bond $ S 0 0 {>b6i TOTAL FEE NOW DUE $ t G 0. 7 S (Revised02/24/2014) V • i J 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 herebymade 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 andreinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 4th day of l , 20 18 , by S4•ePiec�tr • A • 1,- , who is personally known to me or who has produced 114 V%-fr identificat NO ARY Sign: Print: Seal: who • d take a ath. *:.........I YANADY P'I 0 MN • aMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Thru Notary Public Underwriter i *********** _rwss***-**Irr****a*'a****s*********************** as Signature The foregoing instrum nt was acknowledged before me this 4tk day of V n`Q , 20 (2 , by v0G -0 r • U t YO , who is personally known to me or who h produced .Y. 14..r (; CktiVse as identification NOTARY PU APPROVED BY Sign: Print: Seal: Plans Examiner Structural Review YANADY PRI 0 MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 F' • r d 1 hru Nasty^rubric Underwriters * *fkif#*'**R*►�r7P************** Zoning Clerk (Revised02/24/2014) VICTOR JUL QUINTERO 8061 NW 186 TEti HIALEAH. FL 33015-0000 Doe 09-26-1958 sE3 M 09-14-2012 ! 15-0E F qr, Oir-26-202V EST btM STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 QUINTERO, VICTOR CIRCA BUILDERS INC 8061 NW 186TH TER HIALEAH FL 33015-7205 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CRC1329624 UED: 07/17/2016 CERTIFIED RESIE N4TIAL CONTRACTOR QUINTERO, VICTOR '', >' ' CIRCA BUILDERS"INC` IS CERTIFIED under the provisions of Ch.489 FS. Expiration date : AUG 31, 2018 L1607170001899 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT. OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CRC1329624 The RESIDENTIAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 QUINTERO, VICTOR CIRCA BUILDERS INC Y, 8061 NW 186TH TER HIALEAH FL 33O15-7205 ISSUED: 07/17/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607170001899 006566 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 6210322 BUSINESS NAME/LOCATION CIRCA BUILDERS INC 8061 NW 186 TER MIAMI FL 33015 OWNER CIRCA BUILDERS INC Worker(s) 2 RECEIPT NO. RENEWAL 6474928, LBT EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SUB —BUILDING CONTRACTOR CRC1329624 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/19/2017 ECHECK-17-187638 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental.regulatory laws and requirements which'apply to the.business. The RECEIPT NO. above must be displayed on all commercial t404es—Miami—Dade Code Sec 8a-276. For more information, visit wwwA{jctor �` ------"N CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDD/YYW) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS106/0412018RAFFORDEDATE HOLDER. THIS • CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER REEL INSURANCE DBA COVER ALL INSURANCE 5800 W ATLANTIC BLVD MARGATE FL 33063 INSURED CIRCA BUILDERS INC. 8061 NW 186 TER MIAMI FL 33015 CERTIFIED RESIDENTIAL CONTRACTORS LIC # CRC1329624 COVERAGES • CONTACT NAME. (ACC PHONE F:q.954-956-0006 E-MAIL ADDRFSS: INSURERISI AFFORDING COVERAGE INSURERA: WILSHIRE INSURANCE COMPANY INSURER B INSURER C : INSURER D : INSURER E : INSURER F : FAX (EUC. NoL•954-956.0555 NAIC # ER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURKtVISION ED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL _1NSn SUBR wvn POLICY NUMBER POLICY EFF (MM/DD/YYVYI POLICY EXP IMM/DD/YYYY1 LIMITS X COMMERCIAL GENERAL LIABILITY A I EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGETO RENTED DASnil $ 100,000 CL00208910 03/19/2018 03/19/2019 MED EXP (Any one person) $ 5,000 PERSONAL Si ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PRO- PER. GENERAL AGGREGATE $ 2,000,000 POLICY ECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Fa arridnnt) $ A ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per person) $ — AUTOS _ AUTOS NON -OWNED BODILY INJURY (Per accident) $ _ HIRED AUTOS AUTOS PROPERTY DAMAGE (Pnr 'dent) $ UMBRELLA LIAB i OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y / N PER STATIITF OTH- FR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ (Mandatory in NH) If yes, describe under •E.L. DISEASE - EA EMPLOYEE $ D DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFIED RESIDENTIAL CONTRACTOR nc OTICIP A VG Lino CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVE. MIAMI SHORES, FLORIDA 33138 ( I@MSVFL.GOV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TLICY PROVISIONS. tQ AUTHORIZED REPRESENTA © 198&Q]4 ACORD CO ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD TI N. All rights reserved. JIMMY PATRON'S CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 4/19/2018 PERSON: QUINTERO FEIN: 611531239 BUSINESS NAME AND ADDRESS: CIRCA BUILDERS, INC. 8061 NW 186TH TER HIALEAH FL SCOPE OF BUSINESS OR TRADE: Licensed Residential Contractor 33015 EXPIRATION DATE: 4/18/2020 VICTOR IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 /RC R /1/-//,g or FLo,o4 Cowtv-ri �r ZI. .6Er0R‘ TN (S 6 S O // =t C L �P 'i t4/ N�O) bEI N 6 b y b( 5 w o w b 6 p c_S e-S &'VV 7i-f r /4 og ooltt eE owLY pEZso& c O /< sr pr\I 114 p kv-TE c T c Or e17- A-7— �0 b de t1A✓, M;AM i S µvRtrS Co/V 02.4 e-T-0 5i 6A//9-ruAr ApP EiE0 (/ c roR QU cn/y6(2O J5t v € gn/ r© (ciq AFF; s ; 61) RNA Sue5cR/ e66 8€FO1 s l _ D A Of �cJ n1C0 r ?6Q S O4ML L'( % ivo t r' dR PPo 00c6lfJf n�rs�c� r(o,J TYp' _ or 6 12gobuceD r'Ng +Ck-ens'P . Py YANADY PRI 0 MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 oft°, Bonded 1hruNotar'Pub!icUnderwritP Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of N`f , 20 (S. By S4Cpinren 4flvQJ L-enS I Notary: SEAL: who is personally known to me or has produced as identification. YANADY PRIETO , MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Os' s' Bonded Thar Notary Public Undenmters AFL 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 ❑ ROOFING ▪ PUBLIC WORKS t O rr l 1 kr- I( Act* Miami Shores It t-ts2 ,.pip, -o3$0 • Fes,. Occupancy Type: (2-�S- Load: OWNER: Name (Fee Simple Titleholder): Address: l k City: /Vt(4M. Tenant/Lessee Name: ^ / Email:—C+501-+en. RECEIVED MAR 19 2018 0J‘k CP FBC 20 Master Permit No. elm 1 .40U Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR County: Miami Dade Zip: Is the Building Historically Designated: Yes Construction Type: t85 Flood Zone: BFE: Sr' l- r• iX-N S ( State: EA- @or-) 0.1 I Cc' Phone#: El RENEWAL ❑ SHOP DRAWINGS 33 (3 NO FFE: Zip: o Phone#:260 `f'90 6310 CONTRACTOR: Company Name: k 0J ' L Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: p Certificate of Competency #: DESIGNER: Architect/Engineer: TUrJ. f ik A / f •2 - Phone#: Address: 7. 1..o J 33 S`Cige1 Value of Work for this Permit: $ 2S, oo 0 ,M j#M ( State: -R Zip: 33 (IS Square/Linear Footage of Work: 0 City: Type of Work: ❑ Addition Iteration ❑ New ❑ Repair/Replace I-1 Demolition Description of Work: tvi o(Z geNU'J'-'ti6 j- 1.3 M k' - 6-AfN Specify color of color thru tile: //..-� CCF $ W CJCO/CC $ Q DBPR $ i ( ' 2C Notary $ 5. O Submittal Fee $ D-00 . 00 Permit Fee $.`�`N Scanning Fee $ • CO Radon Fee $ Technology Fee $ Gala Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) • c Double Fee $ Bond $ 6-3 ' 03 TOTAL FEE NOW DUE $ (oqO • 1,190•�S Bondi+rtg 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 _Zip__Zip_day of/P-C 7 , 20 4 , by day of , 20 , by 0v0 A 4 V,,- S I , who is personally known to , who is personally known to me or who has produced - / 5-AA-- t J ..\HA ik(-4'1--- me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY Pl}81.I,C: Sign: Print: Seal: ************ APPROVED BY (Revised02/24/2014) °ft Notary Public State of Florida Paul F Gallagher oQ My Commission FF 899674 or c-cExpires 08/22/2019 NOTARY PUBLIC: Sign: Print: Seal: ******************************************************** Plans Examiner Zoning Structural Review Clerk NAME: S ADDRESS: 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 f7 DATE: 3/ I g I/ 3 1 obi I /V Atee_ / ice,,, (4K-cc PL 33 )3 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 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 S�n 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 and contracts. Initial s-5Z___ 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. ; , Iunder'stand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 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 �Z 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. 1 understand that 1 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..) understand that my failure to follow these may subject to serious financial risk. i •Ii` Initial 1J 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 J� 10. I understand that 1 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: /0601 Are /f LA /; ,; rji .23)Tp 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. 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 ) day of 420 r 120 BY e.p \ XS\ Produced th who was personally known to me or who has as identification: NOTARY 3/19/2018 Property Search Application - Miami -Dade County Summary Report Property Information Folio: 11-2232-028-0380 Property Address: 10611 NE 11 AVE Miami Shores, FL 33138-2120 Owner STEPHEN A LENSI Mailing Address 10611 NE 11 AVE MIAMI SHORES, FL 33138 USA PA Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds / Baths / Half 3/2 / 0 Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft Adjusted Area 1,960 Sq.Ft Lot Size 10,400 Sq.Ft Year Built 1949 Assessment Information Year 2017 2016 2015 Land Value $255,024 $189,446 $150,586 Building Value $144,452 $145,530 $146,608 XF Value $0 $0 $0 Market Value $399,476 $334,976 $297,194 Assessed Value $305,558 $299,274 $297,194 Benefits Information Benefit Type 2017 2016 2015 Save Our Homes Cap Assessment Reduction $93,918 $35,702 Homestead Exemption $25,000 $25,000 $25,000 Second Homestead Exemption $25,000 $25,000 $25,000 Note: Not all benefits are applicable to all Taxable Values (Le. County, School Board, City, Regional). Short Legal Description MIAMI SHORES ESTATES PB 47-58 LOT 10 BLK 3 LOT SIZE 80.00 X 130.00 OR 19750-3241 0601 5 Generated On : 3/19/2018 Taxable Value Information 2017 20161 2015 County Exemption Value $50,000 $50,000 $50,000 Taxable Value $255,558 $249,274 $247,194 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $280,558 $274,274 $272,194 City Exemption Value $50,000 $50,000 $50,000 Taxable Value $255,558 $249,274 $247,194 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $255,558 $249,274 $247,194 Sales Information Previous Sale Price OR Book -Page Qualification Description 06/05/2017 $529,000 30570-1273 Qual by exam of deed 08/19/2013 $465,000 28781-3264 Qual by exam of deed 06/01/2001 $235,500 19750-3242 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: