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RC-19-2160Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 D F -f I-Afl.j Issue Date:10/11/2019 Location Address Parcel Number 10400 NE 4TH AVE, Miami Shores, FL 33138 1121360130150 Contacts Permit No.: RC-09-19-2160 Permit Type: Building (Residential) Work Classification: Alteration Permit status: Approved Expiration: 03/16/2020 Edelman Lopez 1R Owner HOME OWNER Contractor 104004 HOME OWNER ct Description: NEW STEPS AND LANDING AT FRONT DOOR Valuation: $ 3,000.00 on Requests: Ins 30secti 4949 TotalSq Feet: 100.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $18.00 Structural Review ($90) $90.00 Technology Fee $2.50 Total: $216.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $216.90 Credit Card 09/18/2019 $50.00 Credit Card 10/11/2019 $166.90 Amount Due: $0.00 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 the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date October 16, 2019 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 10400 NE 4TH AVE, Miami Shores, FL 33138 rnntartc Issue Date:10/11/2019 Parcel Number 1121360130150 Permit NO.: RC-09-19-2169 Permit Type: Building (Residential) Work Classification: Alteration Permit Status: Approved Expiration: 03/16/2020 Edelman Lopez JR Owner 104004 HOME OWNER Contractor HOME OWNER Description: NEW STEPS AND LANDING AT FRONT DOOR Valuation: $ 3,000.00 Inspection Requests: 305-762-4949 TotalSq Feet: 100.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $18.00 Structural Review ($90) $90.00 Technology Fee $2.50 Total: $216.90 Payments Date Paid Amt Paid Total Fees $216.90 Credit Card 09/18/2019 $50.00 Credit Card 10/11/2019 $166.90 Amount Due: $0.00 Applicant Copy r For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that maybe found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. October 11, 2019 Page 1 of 2 C EIVF,D Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION `BUILDING ❑ ELECTRIC ❑ ROOFING SEY 1 8/2019 M. 7(U C 2� 11 a Master Permit No. ��—I I 1W Sub Permit No ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10400 NE 4th avenue City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2136-013-0150 Is the Building Historically Designated: Yes NO X Occupancy Type: smgiefam"y Load: Construction Type: Flood Zone: NO BFE: FFE: OWNER: Name (Fee Simple Titleholder): Edeman Lopez Phone#: 7864618854 Address: 10400 NE 4th ave city: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: edelmanlopez@mac.com CONTRACTOR: Company Name: Aows.A QW ls.r Phone#: Address: City: Qualifier Name: e#: p: State Certification o gistration #: Certificate of Competency #: DESIGN : Archite ngineer: INli1�✓Uk- �°�Lir✓Ul.i� �l•L Phone#:�� Addres . 3-73 v q 2 City: V'11Aa4j 15 LSState: FL- Zip: 3 3 13 0 Value of Work for this Permit: $ �; ODO Square/Linear Footage of Work: '1O"d S f Type of Work: ❑ Addition ❑ Alteration El New Repair/Replace ❑ Demolition Description of Work: ' '1 e—P S A- f „V G % fit' /q-V 041� Specify color of color thru tile: Submittal Fee $ * C Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ 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) Chase Mortgage Mortgage Lender's Address PO BOX 78420 City Phoenix State AZ Zip Zip 85062-8420 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 reinspegtion fee will be charged. Signatu ENT The foregoing instrument 'w� as acknowledged before me this 8" day of e i- 20 1 a by d'A -t�) fz'.- r who is personally known to me or wWY*4.ps produced U as identifi tion a d w o di WOTAR PUBLIC Print: an oath. � pH 25, 7.�. A !- y 1lGG 25720 Signature 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: Sign: Print: Seal V *zj jOUBU.....��� Seal: as s::ssssssssssssssssssssssssssss *sss sss*:**ssssssssssss*sssssssssssssssss*s*:*****ss:s*rss***s*r****ss* 1 � APPROVED BY Plans Examiner b d-�' "� Zoning t f Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: fde,1MAA1 �.DE Z DATE:IF ADDRESS: IOZOO AIC �14 & , 3313P Do hereby petition the Wlage cf 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 wi:l 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 applied for nnwner-builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as wn 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 is sponsible for the construction 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 myAwn 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 an o tracts. 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 mysel Id or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lea ch violates the exemption. Initial 5. I 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 wo i 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 c 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 worki on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and a ware 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 curity contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. er1tand that my failure to follow these may subject to serious financial risk. Initial 411 f 9. 1 agree that, as the party legally and financially responsible for this proposed Construction activity, I will abid 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 venue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may cont 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 th I am the party legally and financially responsible for the proposed construction activity at the following address: ro yoo ,le Y4 kJ4_9 Initial 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the0A, ation 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 1 67tt day of 20 1 By Z�J\-d"vi ) r who was personally known to me or who has Produced there Licen Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) The undersigned Affiant, 4fe-1e,&,4A1 49e L , does hereby attest that (Property owner) The attached survey, performed by PVw ( t ,ram !Gj,1 61 aij Uv� (Name of surveyor's company) For address: / 0 y 0 0 — Al 4C. y�� ,4yG', /� &-6on-C4 rL Performed on 7 1 `L I 70tq) (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final in ections as applicable to this or other permits. Furt ff nt sa nau ht. Property Owner re Property Owner Print Name SWORN TO AND SUBSCRIBED before a this J day of�� Affiant is personally known to me,7 produced I L ,:s identificay'o?r-.\ Revised on 5/22/2009/ Revised on 6/12/09 Y P!�Fr "Zl" ``�� y • .... O :* 2• ti 000 297215A � � SKETCH OF BOUNDARY SURVEY 111 LEGAL DECK I PT I ON: Lot 24 and the East 112 of Lot 23, Block 117, AMENDED PLAT OF SECTION NO. 5 OF MIAMI SHORES, according to the plat thereof, as recorded in Plat Book 10, Page 47 of the Public Records of Miami - Dade County, Florida. Property address: 10400 NE 4th Avenue Miami Shores, FL 33138 15' ALLEY — 1.2' pavement 77 01 Fnd 5AP 6' wood Iron Rod fence No ID 10 LUMPS M N N J -� C" C C-j v CV � _ m . v a 0 Ln LEGEND: A - CENTRAL ANGLE (DELTA) A - ARC LENGTH A/C • AIR CONDITIONER BCR - BRONARD COUNTY RECORDS BM - BENCHMARK t - CENTERLINE (0) - DEEDULATED FIN) - FOUND FPL - FLORIDA POWER 6 LIGHT H - HANDICAP PARKING SPACE O/S - OFFSET ) - PLAT PB - PLAT BOOK .0 POINTOFCURVATURE PG AINT - PAGE- POB - POINT OF BEGINNING C OFCOMMENCEMENT R - PAINTS R/W - RIGHT -OF -MAY SF - SQUARE FEET N +' m m L N Vr C 1�p �I 14 3' I to- V os ONSTY I RES I DENNCCE 1 •10400 — — 35' Fnd 5/8, Iron Rod No ID I ••••I•• •••• • ••• • • •••••• ••••• • .1 .• • LU 46900 o•• • • • • • • Qy • • 00900* co • �' • • acn C Y . Uj D' o Z m •, m o I Cj Fnd Nall Hole Fnd 5/8' Lot 23 I I Iron Rod I No ID_ i 25.00' Lot 24 �9•a 5' concrete walk Fnd Na l l �` a~ Hale 18' pavement NE 104th STREET THIS SURVEY MEETS THE MINIMUM TECHNICAL STANDARDS AS SET FORTH BY THE FLORIDA BOARD OF PROFESSIONAL SURVEYORS AND MAPPERS IN CHAPTER 61617-6. FLORIDA ADMIN- ISTRATIVE CODE. PURSUANT TO SECT 1 ON 472. 027. FLOR 1 DA STATUTES. �.�--------- --- a!�g------- M/KKI H. ULAICH PROFESSIONAL SURVEYOR MAPPER •5853 STATE OF FLORIDA HOW 11124-117 SCALE: i = 20' NOTES: I. THIS SURVEY REFLECTS ALL EASEMENTS AND RIGHTS -OF -NAY AS SHOWN ON THE ABOVE RECORDED PLAT. THE SUBJECT PROPERTY HAS NOT BEEN ABSTRACTED BY THE UNDERSIGNED FOR OTHER EASEMENTS OR RIGHT -OF -NAY. 2. ANGLES SHOWN HEREON ARE BASED ON PB i0. PG 47. NDCR. 3. ELEVATION SHOWN HEREON ARE BASED ON NORTH AMERICAN VERTICAL DATUM OF 1988 (NAND 1988). 4. SUBSURFACE FEATURES NOT LOCATED. 5. OWNERSHIP F FENCES/WALLS NOT DETERMINED. Not.lilid without the signature and -the orlginal rat5�l seal -of _ a Ftarida licensed surveyor -and Nipper., REVISIONS I DATE FOR: EDELMAN DATE: 7/2/2018 IND. 1806033 IF. B. 120-62 DEN I LAND SURVEYORS, INC. LB #72Bi 1991 NW 35th AVENUE, COCONUT CREEK, FL 33066 (954)973-7966 FAX (954)979-0343 LAND SURVEYS 0 SUBDIVISIONS 0 CONSTRUCTION SURVEYS