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RF-10-1346Project Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Fees Due CCF Education Surcharge Notary Fee Permit Fee - Repairs Scanning Fee Technology Fee Total: Amount $1.20 $0.40 $5.00 $100.00 $3.00 $1.60 $111.20 Building Department Copy Address Expiration: 01/01/2999 Parcel Number 10626 NE 10 Place Miami Shores, FL 1122320280840 Block: Lot: PARANDEH ALASHTI 1 Contractor(s) HOME OWNER Phone Cell Phone Authorized Signature: Owner / Applicant / Contractor / Agent Phone Type of Work: Gutters Additional Info: Classification: Residential Scanning: 1 Pay Date Pay Type Amt Paid Amt Due Invoice # RF -7 -10 -38504 07/23/2010 Credit Card $ 111.20 $ 0.00 Applicant July 23, 2010 Date Cell PARANDEH ALASHTI 10666 NE 11 AVE MIAMI SHORES FL 33138 (305)891 -0378 (305)962 -5330 1 Valuation: Total Sq Feet: $ 1,150.00 280 1 Available Inspections: Inspection Type: Final 1 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. July 23, 2010 1 BUILDING PERMIT APPLICATION C 20 Permit Type: BUILDIN • ROOFING Owner's Name: (Fee Simple. Titleholder) y 7 t •; 1 1 1 \ / ; Phone # 2 ` ! Owner's Address' P • City M tn wl S 't state Tenant/Lessee Name Phone # Email Contractor's Company Nano Contractor's Address _1124 LEI !� ~ t 1. e ) City 1/ A4 Architect/Engineer'sNames (if .applicable) Value of Work' For this Permit .$ Type of Work: CDAdditioti [;Alteration Describe Work: 1:11 i 1 3X : (A) ) /N-0 — e: State ** ** **k * * * * *** * *' * * * * * * * * *: * * * * * ** *Fees *** * * * ** /0 cv o. Permit No: ' ' \? i C Master Permit No. 715° 1t / vb.o 313 Zip 33J. Phone # A J JUL 2 3 7010 Flood Zone CCF $ CO /CC•:$ Technology Fee $ Bond '$ io Job Address (where the work is being done) \ City - MTZmi Shores V.i11 e County . ". ' Miami -Dade FOLIO / PARCEL # £) ? 10 is Bulidi ng tf istorically Designated YES . NO Zip._) Qualifier Name Phone # gi State Certificate or Registration No Certificate of Competency No Contact Phone * ** Submittal Fee $ Permit Fee $ Miami Shores Village Building Department 1000 D N.E.2nd Avenue, Miami. Shores, Florida 33138 Tel: (305) 75,2204 Fax: (305) 756.5972 . INSPECTION'S PRONE NUMBER; (305) 762.4949 N CZ- Email„ Phone # - 9 402,-,s 30 Sq uare / L Footage Of Work: .1�• ew 0 Repair/Replace ❑ Demolition **** * * ** ** Notary $ Trainin ducation.Fee $ Scanning $ Radon DPBR Amble Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 1 See Reverse side NOTARY PUBLIC: .. % I� ✓ �i day of ,20 ,by who is personally known to me or who has produced as identification and who did take an oath NOTARY PUBLIC: 03/ z cn omm lIC ; ... 04'''''' rtrlr r t l" ' \ ' Sign: Print: My Commission Expires: APPROVED BY (Revised 07/10 /O7)(Revised 06/]0/200.9) Plans Examiner Engineer Sign: Print: My Commission Expires: Zoning :Clerk. checked Bonding Company's Name if a . p lieabie) Bonding Pte' �:' ZAP Bonding Company's Address City State Zip IVIortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation his 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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. Owner or Agent The foregoing instrument was acknowledged before me this 3 day of Z�"�.`� , 20 10 by TaamiDal Aufsgri, who is personally known to me or who has produced ft -- 1 As identification:and who did take an oath. \\\ `` i jl.f l l l r f ii,, Signature Contractor The foregoing instrument was acknowledged before me this 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: eG1,ra IA 5 DATE: Dli 9 -3) k ADDRESS: (062-6 A) • E I 0 v co M I an' i cAa .r 3 3 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 an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 01- 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I 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. 4. I 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. Initial 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial Initial II 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working 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 county or municipal ordinance. Initial 1)' 7. I 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 114 8. I 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. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 10. I 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. mvtioridalicense .com/dbpr /prolcilb /index.html 11. I 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: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. 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 retumed 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 YafI OWNER day of ` SLX-X , 201 Initial Initial Initial By N DC t1 H wi was personally known to me or who has Produced there License or r` ' iTh a s identification. L` ,,Imisaiurt / y ,� ,,�\��� t; ien /1, , -// n OR I o t � � . �\`. l /'rll111II%' ��� Initial Initial 69 PROPOSAL/e7;rvitiTR,A,CT Ri *WHITE El CAMEO ALMOND o SANDTONE CL CREAM 0 R BROWN 0 M BROWN 0 OTHER o RED o E GREEN 0 V GREEN D S GREY o V GREY O COPPER 0 BRONZE 1570 W 35 Pia PROPOSAL SUBMI City, State Phone : TOTAL FOOTAGE 1 TOTAL DEPOSIT $ BALANCE $ TERMS OF and must b or the max unless a A . , _mieriicarim7T°3 77- ' 7 777 _ rift 2414a 2007 j Time ' rirve Customer #: LJ APPROVED ZONING DEPT- www.american4uttertech.com BY • ''i-1 : ' , A ..--:: < f ..,...-•, .i . , = . ; . ; :, , „ •-• . , • ; .; ' • . .,t4e - • - h. ,•• ;, CI .11 ,J13; ° TOTAL DOWNSPOUT L 13 1 u u ivliam: Shores mei. I-ASH C-HE2k CLIENT SIGNATURE: A I DATE: Ph: 305-825-5152 1-800-935-1644 Fax: 305-825-5132 Date: e ' e • ' -- • I "i I• — L H' TtE I5 CAMFO 0 ALMOND o SANDTONE O CL CREAM o R BP(\A/N OM BROWN Nift3X4 04X5 L H HEAD 03" ROUND 04"ROUND 0 OTHER . cs ALUMINUM O COPPER O GALVANIZED o STAINLESS STEEL BLDG DEPT5 ¥ )1,‘„e3d. NTE R / 20 YEAR GUARANTEE ON MATERIAL ., amage su t g from accident, misuse, abuse, nemgCt, or from other than normal and ordinary use of the product. PffitEntiaarorbl WhicMetate a draw cut off date and payment release date are the only exceptions signecrby representatives both parties. FINANCE CHARGE': Fiilance charge in amount of the lesser of 1.5% per month (18% per annum), law„wn tte giddel ast due. APPROVAL: No alterations or additional work shall be performed rattaalkICAITGUTTER in wrilin . W are not responsible for damage to roof tiles, shingles or fascia boards. o REJ 0 E GREEN 0 V ( o S GREY D GREY 0 CGFPEri O BRONZE AUTHORIZED SIGNATURE: Seamless Rain Gutter INSTALL 3 X 4 WHITE SEAMLESS GUTTER AROUND THE HOUSE Passed Inspector Comments M1 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until nspection Number: INSP - 149322 Permit Number: RF -7 -10 -1346 I Inspection Date: July 26, 2010 Inspector: Rodriguez, Jorge Owner: ALASHTI, PARANDEH Job Address: 10626 NE 10 Place Project: <NONE> July 23, 2010 Miami Shores, FL Contractor: HOME OWNER Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 cs� Permit Type: Roof Inspection Type: Final Work Classification: Gutters Phone Number (305)891 -0378 Parcel Number 1122320280840 Page 1 of 1