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FW-18-3649Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 r� I ��i �• � I � � I �� issue Date:12/13/2018 Location Address Parcel Number 302 NE 97TH ST, Miami Shores, FL 33138 1132060135870 Contacts Permit NO.: FW-12-18-3649 Permit Type: Fence/Wall Work Classification: Wood Fence Permit Status: Approved Expiration: 06/11/2019 JAY BROWN Owner Samada Fence Inc Contractor 302 NE 97 ST, MIAMI SHORES, FL 331382406 Sergio Samada Business: 9545594355 samadal@msn.com Inspection Requests: Description: WOOD FENCE BOARD ON BOARD 6' HIGH 3 GATES Valuation: $ 3,550.00 Inspec i n Re 48" WIDE TO REPLACE PERMIT#FW18-259 49 Total Scl Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Planning and Zoning Review Fee $35.00 Scanning Fee $9.00 Technology Fee $2.85 Wire and Wood Fence Fee $64.00 Total: $168.05 Payments Date Paid Amt Paid Total Fees $168.05 Credit Card 12/13/2018 $168.05 Amount Due: $0.00 Building Department Copy 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. cce ti g this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits a requi ed or ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNER AFFID VI : I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating on�tru i n and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorize ' ature: Owner / Applicant / Contractor / Agent Date December 13, 018 Page 2 of 2 r , -4 �IAA03 �� �1 �) BUILDING PERMIT APPLICATION Miami Shores Village 112018 Building Department BY. L 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 1 FBC 20 Master Permit No7N i19 `�'{ Sub Permit No. �13UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 3 Al C 9 3r S V City: Miami Shores County: Miami Dade Zip: _� ? 136 Folio/Parcel#: // 3'"oip O I, 3 Is the Building Historically Designated: Yes NO to"' Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): (S Phone#:� D s' `/Yq' `7 o9 % Address: 3 O /V i✓ g S74 F�l t `(t.w + i City: J ��-c °u-S State: Zip: -371309 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Samada Fence, Inc Phone#: 954-559-4355 Address: 110 W 31 ST City: Hialeah State: FL Zip: 33012 Qualifier Name: Sergio M. Samada Phone#: 305-720-6344 State Certification or Registration #: Certificate of Competency #: 11 BS00347 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ �•� 0` Square/Linear Footage of Work: // 3 Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ElDemolition Description of Work: too -ad V _ate C a'''d V-1 ,%�'` ,J v-&--d G'0 1C-1,k 3 & C_itL r C( 6" &L,9 -e `.f r in A, M _�> T-:_� t-T- :$ T�W (9 - ;2 S q Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Permit Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ (Revised02/24/2014) I TOTAL FEE NOW DUE $ � & . QS Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 FZ�IJOWNER or AGENT The foregoing instrument was acknowledged beforemethis _day of PC Ce--Y bf I 20 [ V by ? a (Jf a44-J—+^- who is personally known to me or Lho has produced I(--L,0 L- as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrum t was acknowledged before me this V day of PI- C- ai-7 �P e—J 20 by Sea)) 0 Q--si- °(lam who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: — Sign:_ Print: ai' N"P. A NallPrint: WK W Seal: ap� '�ft AM �17, y�� Seal: Wyk& ��EgyftA 17, 2 W 02'l OOII ft i�encln No" APPROVED BY Plans Examiner Zoning (Revised02/24/2014) JtkI Structural Review P vJ Clerk 4 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 LV WMICI — 44uthCrti %-.ompensaiion 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 fit" � 20 I l By ��'�`�`� who is personally known to me or has produced as identification. Notary: t A* r„ mm SEAL: m # i : J* V. X2 oftsiOWded ft Atroq ft" Sheen Z-of 2 (SL-rev Related Data) - See Sheet 1 of 2 for Legal Description, Certifications, Property and other Survey related data. SURVEY IS NOT COMPLETE WITHOUT BOTH SHEETS ... SCALE: I "=30' .. .. ...... . .. ...... .... . N.E. 9 7 t h STREET I & A5PHALT ROADWAY - (75' RIGHT-OF-WAY) I • • • • • • • • • • • • • w • • • • rl � 233APKWAY i•••�• •••••• ' Q : • • • • • I • • • • • • ) • • • • 90'00'00'E 7 .CQ(PW) 5' CONC. WALK — PIP 112- NO I.D. IN N J a Q rnCOVERED 20.39 < CONC. 0.4' W.C73i' 19.09 J " w o m C Q200 .Z C 41 20 L - m �2.00' O Q O !, Z 4•00 ONE STORY I - o rn C - w RE51DENCE k302 cnUn o 11.30 2590Lj 3.9d Q PAVER5 10.40 _ V a l ^W i 5PA 8.4' CE C7 1 �n Z tOi PAVER5 POOL 21.80 _ - t E. 0.2' N. _ PIP 112' ? N90°00'00V z NO I.D. co`L g NO I.D. 10.5' A MALT ACCE55 ROAD - (I 5' PLATTED AL Fence; Good9 m- _ — — — suPpOnin Side Out. The per ,cat a, LOT 13 lntericr embers of of the p of on a' ' ATE RE�Y[tE�IEN $: and the finisheq V' ni h the fence is e l / l 7 lot or ri- fail face the adjoin from gates the t spool area,pen any abutting wdy. self •closing/self-locking, ated on pool side of the gate and located no less than 54" from bottom of gate. PLEASENOTE: Adverse Conditions • Please note the fotlawJng; FW 424.2.17.1.8SUBJECT PROPERTYIS SERVICED BYPUBUC U11MES. - THIS SURVEY IS APPROVED FOR CONSTRUCTION BY LANOTECH SURVEYING. - Asphak crosses Sod Prokne. -Fence crosses East Property line. Lantech Surveying offers services throughout the State of Florida. Haase refer to our website at Invoice Number: 01.57612 www.L.ardtechSurvey.com for up to date information about our locations and coverage area. OB�RslUr� This survey has been issued by the fo8rnvng Landtech Surveying office: Drawn By: C. Ferrara ,. 1500 N.W. 62nd Street, Suite 511 DaleofFedWork: 10105I2011 LAN w Fort Lauderdale, Florida 33309 Revision: Survey Update -7124I12.CF Sy >Ry E Y I N G Office: (954) 776-6766 Fax: (954) 776-4660 Revision: Pad ilea added - 8114112 - CF Providing Fast& Accurate Land Surveying Services throughout Florida www.LandtechSurvey.com Revision: .. measura6Cy:6etter! ► Sheet 1 of 2 (Survey Related Data) - See Sheet 2 of 2 for Sketch of Survey. SURVEY IS NOT COMPLETE WITHOUT ALL SHEETS LEGAL DESCRIPTION THE WEST 1/2 OF LOT 11 AND ALL OF LOT 12, BLOCK 43, MIAMI SHORES SECTION ONE AMENDED, ACLQWUNG TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10, PAGE(S) 70, OF THE PUBLIC RECORDS OF WI RI-DADE COUNTY,•.'- FLORIDA. •••••• . •.. •..... . PROPERTY ADDRESS 302 NE 97TH STREET MIAMI SHORES, FL 33138 INVOICE NUMBER 01-57612 DATE OF FIELD WORK 07/25/2012 CERTIFIED TO JAY BROWN FLOOD ZONE X - 120652 - 0302 - L • .... • ..'..' AesG , R QU } tzs must ► �+ rk away from the °pen °�fwarc� device a self, closing/sel�o are;,.. located on pools eking, and located ode of the gate �Om bottomless than 54. FBC 424.2.17 lgate. Fences Good S � Ou The vErt;ca hor_ -Zo suppO �' g Me of a f: nce `erlor of the p' sha'I face the rt on van ch t'1e fence Is located ana the fir sr d c:y,c sha,! face the adjoining lot or any abutting right of Way. General Notes: 1. THIS SURVEY IS BASED UPON RECORD INFORMATION PROVIDED BY CLIENT. NO SPECIFIC SEARCH OF THE PUBLIC RECORD HAS BEEN MADE BY THIS OFFICE UNLESS OTHERWISE NOTED. 2. IF THIS SURVEY HAS BEEN PREPARED FOR THE PURPOSES OF A MORTGAGE TRANSACTION, ITS SCOPE IS LIMITED TO THE DETERMINATION OF TITLE DEFICIENCIES. NO FUTURE CONSTRUCTION SHALL BE BASED UPON THIS SURVEY WITHOUT FIRST OBTAINING APPROVAL AND/OR UPDATES FROM LANDTECH SURVEYING. LANDTECH SURVEYING ASSUMES NO RESPONSIBILITY FOR ERRORS RESULTING FROM FAILURE TO ADHERE TO THIS CLAUSE. 3. ANY FENCES SHOWN HEREON ARE ILLUSTRATIVE OF THEIR GENERAL POSITION ONLY. FENCE TIES SHOWN ARE TO GENERAL CENTERLINE OF FENCE. THIS OFFICE WILL NOT BE RESPONSIBLE FOR DAMAGES RESULTING FROM THE REMOVAL OF, OR CHANGES MADE TO, ANY FENCES UNLESS WE HAVE PROVIDED A SURVEY SPECIFICALLY LOCATING SAID FENCES FOR SUCH PURPOSES. DETERMINATION OF FENCE POSITIONS SHOULD BE BASED SOLELY ON THEIR PHYSICAL RELATIONSHIP TO THE MONUMENTED BOUNDARY LINES. 4. GRAPHIC REPRESENTATIONS MAY HAVE BEEN EXAGGERATED TO MORE CLEARLY ILLUSTRATE MEASURED RELATIONSHIPS - DIMENSIONS SHALL HAVE PRECEDENCE OVER SCALED POSITIONS. 5. UNDERGROUND IMPROVEMENTS HAVE NOT BEEN LOCATED EXCEPT AS SPECIFICALLY SHOWN. 6. ELEVATIONS ARE BASED UPON NATIONAL GEODETIC VERTICAL DATUM (N.G.V.D.1929) OR NORTH AMERICAN VERTICAL DATUM (N.A.V.D.1988) AS SHOWN ABOVE. 7. ALL BOUNDARY AND CONTROL DIMENSIONS SHOWN ARE FIELD MEASURED AND CORRESPOND TO RECORD INFORMATION UNLESS SPECIFICALLY NOTED OTHERWISE. 8. CORNERS SHOWN AS "SET" ARE IDENTIFIED WITH A CAP MARKED LB (LICENSED BUSINESS) # 6799. HEREBY CERTIFY THAT THIS BOUNDARY SURVEY MEETS THE MINIMUM TECHNICAL STANDARDS FOR SURVEYS, AS SET FORTH BY THE FLORIDA BOARD OF SURVEYORS AND MAPPERS IN CHAPTER 61G17.6 OF THE FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 472.027, FLORIDA STATUTES. Pik Digitally signed by Andrew Snyder, PSM • DN: cn=Andrew Snyder, PSM, o=LandTech Surveying, Inc., ou, OtpTC pr email=asnyder@landtechsury ey.com, c=US Date: 2012.08.14 09:55:18 ' + 7/25/2012 DATE: &DREW S YDE - PROfESSIONAL SURVEYORAND MAPPER FLORIDA REGISTRATION No. 5639 (NOT VALID WITHOUT THE SIGNATUREAND THE ORIGINAL RAISED SEAL OR ELECTRONIC SEAL OF THE FLORIDA LICENSED SURVEYOR AND MAPPER SHOWNABOVE) Legend/Abbreviations: EOW = Edge of Water A = Arc Length FF = Finished Floor CA = Central Angle FIP = Found Iron Pipe C/L = Centerline FIR = Found Iron Rod CF - Computed from Field Measure FN = Found Nail CR = Computed from Record data L = Per Legal Description CAN = Cable TV Riser M = Measured DE - Drainage Easement OHC = Overhead Cable Ease = Easement ORB = Official Records Book P = Per Plat RAN = Right -of -Way P/L - Property Line TR = Telephone Riser PC = Point of Curvature UE = Utility Easement PCC = Point of Compound WM = Water Meter Curvature UP = Utility Pole PK = Parker Kalon Nail CATV = Cable TV Riser POB = Point of Beginning DE = Drainage Easement POC = Point of Commencement Ease = Easement PRC = Point of Reverse Curvature �� J�IIWUN111 AL Z S U R V E Y I N G Providing Fast & Accurate Land Surveying Services throughout Florida ... measurably better? •....• ... .. MiamiShor03*9'--_ViIIagq ...... :....: • • .00000 Building De';", mint, :::::• 10050 N.E 2nd Avbnue Fences Gccd Side Out. The \,ertical and horiMitih i Shore6;XiO0fida 331A "":' �0 s suppon61g memb6rof a fence b` all face the Tel; (305) 795.E #• ,,,, interior cf the p' )t on vvh --h t-r tanc- is located Fax' 4305; 756.8972 , , •' • • • • and the finished s do shah +ace the adjo,ning lot or any abuttog right-of-way WOOD FENCE DETAILPGC,, GATE REq :,t;.•.;1;1��,s: ❑ Shadow Box Access gates must c. 3rd ❑ Vertical Picket away from the G • • ; .a be self • closing/se . trip.,, Board on Board device located on pool sr : . • ie gate and located no les,. 64" Fences < = 6' high posts spaced at 4' on center maximum from bottom o !ate. Fences < = 5' high posts spaced at 5' on center maximum FgC 424.2.1i 1. . Fences < = 4' high posts spaced at 6' on center maximum Fence must not exceed 6' in height Fence Good Side Out. The vertical 1x pickets fastened and horizontal with two corrosion supporting members of a resistant fasteners per connection fence shall face the interior of the plot on which the fence is located 2x4 horizontal and the finished side shall face the pressure treated wood members Xwith two corrosion adjoining lot or resistant fasteners any abutting right- per connection of -way. 4x4 pressure treated ,, posts embedded 2'into concrete footing 10' diameter x 2' deep ALL wood must be pressure treated I All fasteners must be corrosion resistant L No less than two fasteners in any connection Revised 10/14/2016AS - - Tb BUILDING PERMIT APPLICATION fi?IBUILDING ❑ ELECTRIC Miami Shores Village BuildingDepartment RECEIVE[) p FEB 012018 10050 N.E.2nd Avenue, Miami Shores,.Florida 33138 Tel: (305) 795-2204 Fax: (305) 76-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20n Master Permit No.4=rV I r" 2��5 Sub Permit No. ❑ ROOFING ❑ REVISION ❑,EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP � �CONTRACTOR DRAWINGS JOB ADDRESS: 3 o2 '&3-I � City: -7-5139 �� Miami Shores County: ( Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: \� Flood Zone: BFE�:�/ q FFE: OWNER: Name (Fee Simple Titleholder): �'� ��!-l1�^' Phone#: Address: -P,,o Z N 2 ►�.ltkAk( S(-161�5 - State: _ Zip:7���� City: c Tenant/Lessee Name: t% i P Email: -� P'uC) 0 0 tj CIM , C"k CONTRACTOR: Company Name: Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration# Certificate of Competency #: DESIGNER: Architect/Engineer: I Phone#: Address: L!!�City: State: Zip: Value of Work for this Per � C7 Square/Linear Footage of Work: 1 © 0 Type of Work: ❑ A,dditio ❑ Alte Lion ❑ New Repair/Replace El Demolition Description of Work: V i ►Lj k3 (L NGE u� �> T�ewc-ju— Specify color of color thru tile: Submittal Fee $-5V . e6Permit Fee $ CCF $ CO/CC $ Scanning Fee $ vaki Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) 4 _, Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 copyfof. 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 whichd&curs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approvja and a reinspection fee will be charged. Signatu NER or AGENT The foregoing instrument was acknowledged before me this day ofn - , 20 �y by 7%) ,,, who is personally known to me or who has produced �`�' 1 9 �-N,� as identification and who did take an oath. NOTARY PUBLIC: �Hlildlf � � Signatu CONTRACTOR The foregoing instrument was acknowledged before me this day of me or who has produced 20, by who is personally known to identification and who did take an oath. NOTARY PUBLIC: as Print: �� oti•u�% Print: Seal: �Z A j Seal: 0 y RC1�s.**�****..***.*s*s.*s*ss:�s**ss* APPROVED BY L { Plans Examiner Zoning Structural Review,2 Clerk (Revised02/24/2014) &it tv�P06L1G -4I>hq> 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: J ai :912 wm DATE: ADDRESS: An aA% ' 1- mto^k pt- 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 aI builder permit under an exemption from the law. The exemption specifies that 1, as the owner of the property listed, may act as my oractor with certain restrictions even though I do not have a license. Initial_ 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible foronstruction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 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 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. IWI-ME 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial__ 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. 1 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 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. 1 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. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilb/`index.html Initial 11. 1 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 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information t�aye provided on this disclosure. s Initial 1' Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a lice s� e Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you witwAffpwancial 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 unlicensedNAer 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 o Ider permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the atus 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 By i� Z04- ' Produced there License or OWNER day of 20 who was personally known to me or who has v�