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Certificate of Completion�
Mv,j` Miami Shores Village's
�.:
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
1, Tel: 305-795-2204 Fax: 305-756-8972
' Building Inspection Department
Description: Addition and reno vation. -,
46
Descri p P Y+.
REPLACING PERMIT RC-10-16-2935 r� r
4 r +yt Permit Type Building (Residential) Bldg. Permit No. RC-03-20-493.�
r Owner JORGE LUIS RIOS Contractor HOME OWNER rx
' Subdivision/Project Date Issued 09/30/2020
r Construction Type V-B Occupancy Single Family , U
L, Type ►�
Square Footage 2,496.00 Flood Zone X `
`-' Location If the building is located in a special flood hazard area documentation of the as -built lowest flood
' 10555 NE 2ND CT elevation or lowest horizontal structural member has been provided and is retained in the records of
�T
Miami Shores, FL 33138 Miami Shores Village.
is4 This certificate issued pursuant to the requirements of the Florida Building Code certifying that at the
MORES time of issuance this structure was in compliance with the various ordinances of the jurisdiction
c `S �Nc.1932 L� P , r
<< regulating building construction or use.lift
! :,'•
�* Building Officials Approval Ismael Naranjo, CBO >
FEOR►OP' Not Transferable
` ;-*'; POST IN A CONSPICUOUS PLACE
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Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Lf Uvi U
�
Issue Date: 03/17/2020
Parcel Number
10555 NE 2ND CT, Miami Shores, FL 33138 1122310130600
Contacts
Permit NO.: RC-03-20-493
Permit Type: Building (Residential)
Work Classification: Alteration
Permit Status: Approved
Expiration: 09/ 14/ 2 0 20
JORGE LUIS RIOS Owner
Other:7862026660
HOME OWNER Contractor
HOME OWNER
Description: REPAIR BACK AND INSTALL THE SLIDING GLASS Valuation: Inspection Requests:
p $ 42,890.00
DOOR ADD POWDER ROOM 305-762-4949
REPLACING PERMIT RC-10-16-2935 Total Sq Feet: 93.00
Fees Amount
Payments
Date Paid Amt Paid
100% Permit Renewal Fee $1,286.70
Total Fees
$1,286.70
Total: $1,286.70
Credit Card
03/17/2020 $1,286.70
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 AFFIDA fy that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constructs n . Futhermore, I authorize the above named contractor to do the work stated.
Authorized
March 17, 2020
/ Contractor / Agent
Date
Page 2 of 2
Miami Shores Village
Building Department MAR 05 2020
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 B�2
FBC 201---:�
BUILDING Master Permit No.�?,C-03"20- �
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: V
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): "mil S Phone#:"a--7 Alo 2 02
Address -a tz3
City: State: r— Zip: r //''
Tenant/L ss a Name: Phone#: �� 202 4(,
Email: (% �sUd,��V�U�
CONTRACTOR: Company Name: Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: �) City: State: Zip:
Value of Work for this Permit: $ �C-I� 0- C) C) Square/Linear Footage of Work:
Type of Work: ❑t�ratio�New;,,,,/ ❑ �ir/ra cW�R&'r/5,
f Wnrk. Ci�/'/
racrrin d��r%%��V�
color of color thru the:
Submittal Fee $
Scanning Fee $
Technology Fee $_
Structural Reviews $
Permit Fee $
Radon Fee $
_ Training/Education Fee $
CCF $_
DBPR $
CO/Cc $
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
Zi
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 YOU PROPERTY. IF YOU INTEND
TO OBTAIN FINAN CONSULT WITH YOUR LENDER OR A ORNEY BEFORE RECORDING
YOUR NOTICE COM ENCEMENT."
Notiftcant: As a conditio to the issuance of a building permit w' h an estimated v lue exceeding $2500, the applicant must
profaith that a cop of the notice of commencement and nstruct" n lien la brochure will be delivered to the person
whoy subje to atta hment. Also, a certified copy of the r orded n tic of mencement must be posted at the job site
for sp ction which o curs seven (7) days after the buildi g permit iss e . 1 the absence of such posted notice, the
inspnot e a rove nd a reinspection fee will be charged \ ��
EMT
The fo in in a tl ash n e ged before me this
day of 20 by
,who is
t personally ' known to
me or who has produced r��y` as
identification and who did take an oath.
NOTARY PUB
Sign:
Print:
Se R P SINDIA ALVAREZ
' MY COMMISSION # GG 238273
EXPIRES: September 3. 2022
Bonded Thru Notary 11
�ublk e e
APPROVED BY
The foregoing instrum was ykr wleclgecl before me this
day of 20, by
who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
IIIYYY Plans Examiner
Structural Review
Zoning
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
OWNER BUILDER DISCLOSURE STATEMENT
NAME: DATE:
ADDRESS:
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. 1 understand that state law requires construction to be done by a licensed contractor and have app ied for an owner -builder permit under an
exemption from the law. The exemption specifies that I, as the owner of the property listed, may a as my own contractor 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 r ponsible for the construction and
is not hiring a licensed contractor to assume responsibility.
3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understandVhatmay protect myself from potential
financial risk by hiring a licensed contractor and having the permit filed in his or her name instead ofname. I also understand that the
contractor is required by law to be licensed in Florida and to list his or license numbers on permits ants.
Initial
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. o build or improve a commercial
building if the costs do not exceed $75,000. The building or residence must be for my use or occu ncy. It may not be built or substantially
improved for sale or lease. If a building or residence that I have built or substantially improved mys I 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 leas vfich violates the exemption.
5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction.
6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons ing gin my building or residence. It
is my responsibility to ensure that the persons whom I employ have the license required by law and by ty r municipal ordinance.
.. .
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 w rking on my property. My homeowner's
insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder an 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 w is not licenses to perform the
work being done. Any person working on my building who is not licensed must work under my direct upervision and must be employed by
me, which means that I must comply with laws requiring the withholding of federal income tax and s ial security contributions under the
Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employe nderstand 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
—v
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 con act 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 Yt% party
legally and financially responsible for the proposed construction activity at the following address: 1
Initia
12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of theijm�tion that I have provided on
this disclosure. I
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 proper owner's driver license, the notarized signature of the property
owner, or other type of verification acceptable to the local permitting age cy is required when the permit is issued.
Was acknowledged before me this day of��t , 20
io�
P—' , who was personally known to me or who has
ced th�eJ- WnsO or t'� as identification.
t" SINDIA ALVAREZ
,. My COMMISSION # GG 238273
EXPIRES: September 3, 2022
• ,�F F�,..` NOTARY Bonded 7hru Notary Public Underwriters