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"
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:*
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
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LEGEND:
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- CENTRAL ANGLE (DELTA)
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- ARC LENGTH
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• AIR CONDITIONER
BCR
- BRONARD COUNTY RECORDS
BM
- BENCHMARK
t
- CENTERLINE
(0)
- DEEDULATED
FIN)
- FOUND
FPL
- FLORIDA POWER 6 LIGHT
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- HANDICAP PARKING SPACE
O/S
- OFFSET
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- PLAT
PB
- PLAT BOOK
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POINTOFCURVATURE
PG
AINT
- PAGE-
POB
- POINT OF BEGINNING
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- PAINTS
R/W
- RIGHT -OF -MAY
SF
- SQUARE FEET
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14 3'
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os
ONSTY
I RES I DENNCCE
1 •10400
— —
35'
Fnd 5/8,
Iron Rod
No ID
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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