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EL-18-981Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 cie� � - r Sf') I�? Issue Date: 04/24/2018 Location Address Parcel Number 443 NE 94 ST, Miami Shores, FL 33138 1132060140510 Contacts Permit NO.: EL-4-18-981 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: Approved Expiration: 01/06/2020 SETH LONG Owner SETH LONG Applicant 650 W AVE 501, MIAMI BEACH, FL 33139 650 W AVE 501, MIAMI BEACH, FL 33139 Mobile: 3017853381 Mobile: 3017853381 B.L.F ELECTRICAL INC Contractor VLADIMIR A LABRADA 1750 W 46 ST APT 337, HIALEAH, FL 33012 Business: 7863802509 Description: REMODEL HOUSE ELECTRICAL WORK Valuation: $ 12,260.00 Inspection Requests: 305-762-4949 Total Scl Feet: 0.00 11 Fees Amount CCF $7.80 Change of Contractor $110.00 DBPR Fee $6.44 DCA Fee $4.29 Education Surcharge $2.60 Permit Fee - Additions/Alterations $429.10 Scanning Fee $3.00 Technology Fee $10.40 Total: $573.63 Payments Date Paid Amt Paid Total Fees $573.63 Credit Card 07/08/2019 $110.00 Cred itCard 04/24/2018 $413.63 Credit Card 04/12/2018 $50.00 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. 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 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. Futhermore, I authorize �Pq *ye named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date July 08, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING [A ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: q'1 3 AIE ` ,_ECEIVED Miami Shores Village ju os 2 19 Building Department BY: 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 20 114 Master Permit No. 1 C S— I I Sub Permit No.FF ! (7` v I ❑ ROOFING ❑ REVISION ❑PUBLIC WORKS HANGE OF / CONTRACTOR 7 ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS City: "Miami Shores County: L---IVfiami Dade Zip: 3 3 / 3 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: A OWNER: Name (Fee Simple Titleholder): -Q. Phone#: 301���33�� Address: 3 City: k-f c a-,' S S State: iL` Zip: Tenant/Lessee Name: Phone#: Email: / •� CONTRACTOR: Company Name: �IQGI�'-rG -�^�✓L Phone#: Address: -?&g ' lu 1..-> City: f'f-)/ 6z4-(� State: lore-- Zip: 3301S Qualifier Name: Vli4A/A'-J,<- 4'"4fA-f— Phone#: State Certification or Registration #: JK-e-1.300 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ J 2 1 Z60 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alterat�io/any �-,�-❑ New ❑ Repair/Replace ❑ Demolition Description of Work:. � , .:r•. �' ,�ti.,x�► yr •r,+.•1..M:4o...�.., y-.a. v »,_�.r+w. c .... _ � e . . .. P i Spef tle:tku. Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ 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 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. i — Signature i Y111 % Signature OWNER or A NT CONTRACTOR The foregoing instrument was acknowledged before me tills 2 L/ day of T 1J w e , 20 /1 , by ,S �N `L— on who is personally known to me or who has produce )/i 6A/ UPli Ztces•£ as identification and who did take an oath. NOTARY PUBLIC: Print: C0m fission N GG 286695 Seal:an My Co m. Expires Dec 20, 2022 Bonded through National Notary Assn. APPROVED BY The foregoing instrument was acknowledged before me this day of JCJ 20 / % , by v 14 �.< A who is personally known to me or who has produced MWC,#7 L f-" EPe:., as identification and who did take an oath. NOTARY P Sign: YINET Commission # GG 286095 Seal: '••.,.an? My Comm. Expires Dec 20, 2012 Bonded through National Notary Assn. Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) co m ru M C Certified Mail Fee $ $3.50 fY 1 Extra Services $ Fees (check box, add tee app te) ❑ Return Receipt Qwdcop» $ o /' ❑Return Receipt (electronic) $ h11,11 Postmarl�j r3 ❑ Certified Mail Restricted Delivery $ He •, Q ❑ Adult Signature Required $ $0 no C: `�"'� : p ❑ Adult Signature Restricted Delivery $ Postage A m $0.55 [) Y2019 Total Postage and Fees 1:01 $ $6.85 r Sent To � �j V (/ �--------------------� � S't��et jjpt:Q PtoNO B�''" � -jtt-3 Certified Mail service provides the following benefits: ■ A receipt (this portion of the Certified Mail label), for an electronic return receipt, see a retail ■ A unique Identifier for your mailpiece. associate for assistance. To receive a duplicate ■ Electronic verification of delivery or attempted return receipt for no additional fee, present this delivery. USPS®-postmarked Certified MWI receipt to the retail associate. 13 A record of delivery (including the recipient s signature) that is retained by the Postal Service - for a specified period. Important Reminders. ■ You may purchase Certified Mall service with First -Class MWI', First -Class Package Service°, or Pribrity, Mair service. ■ Certified Mail service is notavailable for International mail. ■ Insurance coverage is notava{lable for purchase with Certified Mail service. However, the purchase of Certified Mail service does not i:hange the insurapce coverage automabga!P included with certft'Prionty Mail items. � ■ Fo1'yi additional fee, and wgf(a proper endorsement on the maof'ece, you may request the fol;owing s'nfvices: - Return receipt service, which provides a record of delivery (including the recipient's signature). You can request a hardcopy return receipt or an electronic version. For a hardcopy return receipt, complete PS Form 3811, Domestic Retum Rocelpt attach PS Form 3811 to your mailpiece; Restricted delivery service, which provides dellvery to the addressee specified by name, or to the addressee's authorized agent. Adult signature service, which requires the signee to be at laast 21 years of age (not available at retai). Adult signature restricted delivery service, which requires the signee to be at least 21 yearn of age and provides deCvery to the addressee specified by name, or to the addressee's authorized agent (not available at retai,). ■ To ensure that your Certified Mail receipt is accepted as legal proof of mailing, it should bear a USPS postmark. If you would like a postmark on this Certified MWI receipt, please present your Certified Mail item at a Post Office- for postmarking. If you don't need a postmark on this Certified Mail receipt, detach the barcoded portion of this label, affix it to the mailpiece, apply appropriate postage, and deposit the mailpiece. IMPORTARII Save this receipt for your records. rb vorrrr OOV Vr APIII LUI0 (HeWSe) FUN 7500.02-oee-9047 May 24, 2019 NOVOA ELECTRICAL CONTRACTOR 1580 W 38TH PL #3 HIALEAH, FL 33012 786-287-4220 Re: Change of Contractor, 443 ne 94th St., Miami Shores, FL 33138 Dear Novoa Electrical Contractor: This certified letter serves as notice of our formal intent to change Electrical Contractor at our property, 443 ne 94th St., Miami Shores, FL 33138. i se sign and notarize this change of contractor request form at your sliest convenience and return to my address: 537 NE 96th Street, Miami Shores, Fl 33138. Sincerely, Owner Owner " USPS.com® - USPS Tracking® Results Page 1 of 4 USPS Tracking® FAQs > (https://www.usps.com/fags/uspstracking-faqs.htm) Track Another Package + Tracking Number: 70181830000030228038 Remove X Your item is out for delivery on July 6, 2019 at 9:00 am in HIALEAH, FL 33012. Out for Delivery July 6, 2019 at 9:00 am Out for Delivery - HIALEAH, FL 33012 0. Cr v Get Updates Text & Email Updates Tracking History July 6, 2019, 9:00 am Out for Delivery HIALEAH, FL 33012 Your item is out for delivery on July 6, 2019 at 9:00 am in HIALEAH, FL 33012. July 6, 2019, 8:50 am Sorting Complete HIALEAH, FL 33012 u n https://tools.usps.com/go/TrackConfirmAction?tRef=f illpage&tLc=2&text28777=&tLabels... 7/8/2019 USPS.com® - USPS Tracking® Results Page 2 of 4 July 6, 2019, 8:47 am Arrived at Unit HIALEAH, FL 33012 July 6, 2019, 1:25 am Departed USPS Regional Facility MIAMI FL DISTRIBUTION CENTER June 30, 2019 In Transit to Next Facility June 22, 2019, 7:20 am Unclaimed/Being Returned to Sender HIALEAH, FL 33012 Reminder to Schedule Redelivery of your item m Q m n X May 28, 2019, 1:65 pm Notice Left (No Authorized Recipient Available) HIALEAH, FL 33012 May 28, 2019, 10:21 am Out for Delivery HIALEAH, FL 33012 May 28, 2019, 10:11 am Sorting Complete HIALEAH, FL 33012 May 28, 2019, 8:30 am Arrived at Unit HIALEAH, FL 33012 https://tools.usps.com/golTrackConfirmAction?tRef=fullpage&tLc=2&text28777=&tLabels... 7/8/2019 USPS.com® - USPS Tracking® Results Page 3 of 4 May 24, 2019, 8:49 pm Arrived at USPS Regional Facility MIAMI FL DISTRIBUTION CENTER May 24, 2019, 6:12 pm Departed Post Office MIAMI, FL 33153 May 24, 2019, 4:24 pm USPS in possession of item MIAMI, FL 33153 Product Information m co See Less o. v n 77 Can't find what you're looking for? Go to our FAQs section to find answers to your tracking questions. FAQs (https://www.usps.com/fags/uspstracking-fags.htm) https://tools.usps. com/go/TrackConfirmAction?tRef--fiillpage&tLc=2&text28777=&tLabels... 7/8/2019 USPS.com® - USPS Tracking® Results Page 4 of 4 The easiest tracking number is the one you don't have to know. With Informed Delivery°, you never have to type in another tracking number. Sign up to: • See images* of incoming mail. • Automatically track the packages you're expecting. • Set up email and text alerts so you don't need to enter tracking numbers. • Enter LISPS Delivery InstructionsTM for your mail carrier. Sign Up m m 0- Cr (https://reg.usps.com/entreg/RegistrationAction_input? *NOTE: Black and white (grayscale) images show the outside, front of letter -sized envelopes and mailpieces tI Y T %@ Atomated equipment. https://tools.usps. com/go/TrackConfirmAction?tRef'--fullpage&tLc=2&text28777=&tLabels... 7/8/2019 RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY dbpr, a STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL :CONTRACTORStICENSING BOARD THE ELECTRICAL .CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA_STATUTES LABRADA, VLAD! M I R- A B.L.F ELECTRIC. -INC 7897 NW 173 ST HIALEAH FL 33015 LICENSE NUMBER: EC13004858 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com 4., Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. 008486 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL -DO NOTPAY 6253082 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BLF ELECTRIC INC RENEWAL SEPTEMBER 30, 2019 1750 W 46TH ST 337 6517644 Must be displayed at place of business HIALEAH FL 33012 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECfiIVED BLF ELECTRIC INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR EC13004858 Worker(s) 1 $45.00 07/12/2018 CREDITCARD-18-053635 This Local Business Tax Receipt only confirms payment of the Local Business Tax...The.Receipt is note license, permit, or a certification of the holdar:a 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 vehicles - Miami -Dade Code Sec 6a-276. For more Information, visit www.miamidade.gov/laxcollector A o JIMMY PATRONIS 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: 2/14/2018 PERSON: LABRADA FEIN: 261720283 BUSINESS NAME AND ADDRESS: B L F ELECTRIC INC 7897 NW 173 ST HIALEAH FL 33015 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor Electrical Wiring Within Buildings and Drivers EXPIRATION DATE: 2/14/2020 A 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 _�� 3 4 �" �� v o Z,� BLF Electric Inc. Date: DC - ZY— Stare of 14- County of /-LtejP4 ha L- Before me this day personally appeared V r'oc �il�li �e ZCt4t R dg who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: l/y qS/5 1 Sworn to (or affirmed) and subscribed before me this U day of TUV-Q 20 /Q . by I/ I& d c'x-- L R 6&.4 Personally known OR Produced Identification Type of Identification Produced Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation 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: l . 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 V P 20_ej . By 5�-Q �` �y who is personally known to me or has produced 1 s• s „ as,identification. Notary: n m�ssio►t k GG 186095 SEAL: Bonded Comm. Expires Dec 20, 2022 lhrou3h Natlorial Notary Assn. Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit No. EL-4-18-981 Permit Type: Electrical - Residential rlI I' Work Classification: Alteration Permit Status: APPROVED Parcel Number Issue hate: 4t2412018 l Expiration: 10/21/2018 Applicant 443 NE 94 Street 1132060140510 Miami Shores, FL 33138- Block: Lot: SETH LONG Owner Information Address Phone Cell SETH LONG 650 W Avenue MIAMI BEACH FL 33139- 650 W Avenue MIAMI BEACH FL 33139- Contractor(s) Phone Cell Phone NOVOA ELECTRICAL CONTRACTOR (786)287-4220 (305)824-2858 ype of Work: REMODEL HOUSE ELECTRICAL WORK dditional Info: REMODEL HOUSE ELECTRICAL WORK lassification: Residential canning: 1 Fees Due Amount CCF $7.80 DBPR Fee $6.44 DCA Fee $4.29 Education Surcharge $2.60 Permit Fee - Additions/Alterations $429.10 Scanning Fee $3.00 Technology Fee $10.40 Total: $463.63 Valuation: $ 12,260.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-4-18-67153 04/12/2018 Credit Card $ 50.00 $ 413.63 04/24/2018 Credit Card $ 413.63 $ 0.00 Available Inspections: Inspection Type: Review Electrical 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 AFFIDA I : I certify th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constr io z ing. therm e, I authori he above med c tractor to do the work stated. Se'�' N Lam April 24, 2018 Autho z Sin ur ner / Ap icant / Contractor / Agent Date Buil ' g Department Copy April 24, 2018 1 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 F-IBUILDING 0 ELECTRIC ❑ ROOFING PR 2018 l FBC 20) Master Permit No. RC-5-17-1209 Sub Permit No. CL � <� — `G 81 ❑ REVISION ❑ EXTENSION RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 443 NE 94th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11 -3206-014--0510 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Seth Long Phone#: 954.410.4695 Address: 537 NE 96th Street City: Miami Shores State: FL. Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: MI/Oa Fk6j �� �iR�rQCT�o 1 Phone#: Address: 81311, Nj �) 91te 11 Q-lioiAcA Arr4 �e�L' CuSfnM�1Sc1VICG�/► ij' j(�(�j� City: Ii�;� d Q �{ State: T Zip: 33 /,/1 Qualifier Name: foskiQUIls Ro i of Phone#: M 7S(0' S 33.38 State Certification or Registration #: EC13 0A fir.- ^i, Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State Value of Work for this Permit: $ 12260.0 Square/Linear Footage of Work: Type of Work: ❑ Addition N Alteration ❑ New ❑ Repair/Replace Description of Work: Remodel house. Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ SoPOLI d Permit Fee $ /b CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 45 ' 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 IF I 11— Signature OWNER or YGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this I'J day of __, 20 by , D day of .sQa•-# If 20 10 by k who is personally known to 0 V A 4 iI r ` 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: u Print: e-%J `.emu' identification and who did take an oath. NOTARY Sign: U—L"(j/G V Print: Lek Uvcn Seal: ��"r0�e Seal: Q . , g LAURAFARLEY �' •"••. `'� LAURA PARLEY * * MY COMMISSION i FF 188027 * * MY COMMISSION # FF 188027 EXPIRES: March 16, 2019 EXPIRES: March 16, 2019 N! "rrov i�oa`O Banded ThN Budget Notary Servkes of Bonded Thru Budget NoFar *Sr� ********************************** ******************************************************************** APPROVED BY y J ! A7'�A�P—/�S Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)