DEMO-09-314Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Project Address Parcel Number Applicant
100 96 Street 1132060132700
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
AMANI JADALLAH 100 96 Street
MIAMI SHORES FL 33138 -2726
Contractor(s)
HOME OWNER
Phone Cell Phone
Type of Demo: Walls & Signs
Additional Info:
Classification: Residential
Fees Due
CCF
Education Surcharge
Notary Fee
Permit Fee
Scanning Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$5.00
$100.00
$3.00
$50.00
($
$2.50
$112.10
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
Building Department Copy
March 09, 2009
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Peon
Expiration: 09/0512009
Valuation:
Total Sq Feet:
Invoice # Total Amt Paid Amt Due
DEMO -3-09 -34107 $ 112.10 $ 62.10;
.......................:.
DEMO -3-09 -34107 $ 112.10 $ 112.10 $ 0.00
AMANI JADALLAH
$ 2,000.00
0
Available Inspections:
March 09, 2009
Date
1
Inspection Type:
Final
'\
IvitaYA
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type (circle): Cui dull g
Owner's Name (Fee Simple Titleholder) C; Owner's Address l0V■xe
City rn t Ct!^ai State
Value of Work For this Permit $ > > UD R5.
Type of Work: ['Addition ❑Alteration
Describe Work: ' Gl
Notary $ .00
Scanning $ �•
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
Tenant/Lessee Name Phone #
Job Address (where the work is being done) .Ot) Ct 1pmil,'
City Miami Shores Village County Miami -Dade Zip 3.3(ot
FOLIO / PARCEL #
Is Building Historically Designated YES NO x+
Contractor's Company Name k--\C r% CAZnt AIL. Phone # — Tao'
Contractor's Address 1ek:) \\\. e. Clio
City irTM.CA State Zip 3E 3c6
Qualifier Name Phone #
State Certificate or Registration No. Certificate of Competency No.
Architect/Engineer's Name (if applicable) ose_. pc lQkpp
Roofing
Square / Linear Footage Of Work:
['New
Zip :7 L3$
Permit No. DEM O- �14
ter Permit No.
Phone # 1S1. - 21;6 -- t
b
Phone # �b "I, fib" 5 rn
❑ Repair/Replace Jig Demolition
* *****:****: ** ** * ******* *x: x: x:*********** F ******* *****: x** ***** ***** ******* **** * *****
Submittal
Fee $ '" Permit Fee $ �L745 CCF $ i • 5 CO /CC
Training/Education Fee $ 0 . Technology Fee $ Z. St)
Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $
Double Fee $
Structural Review. $ Total Fee Now Due $ • . 0
See Reverse side -4
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable) -
Mortgage Lender's Addre
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 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 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.
Signatureti Al j .v
Owwor Agent
The foregoing instrument was acknowledged before me this 3
day of Nitrttl , 20 O , by A 441 1 01 1 UglA (IdA 4l . ,
who is personally known to me or who has produced j1.7)/lll'lt3
Lt WI li 0 As identification and who did take a r . ath.
NOTARY PUBLIC:
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 07 /10/07)
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of ,20
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * ** ; . ;. < * * * * * * * * * * * * * * * * * * *** * * * *** * * ** x** **** * ******* ***** **** ****** ** :****
Plans Examiner
Engineer
Zoning
I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code — only if the structure meets the
minimum code.
Initial
5. I understand that as an owner- builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate any contract disputes.
Initial
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company or person.
By Alldirtt (
MONICA LISSETH DIAZ
470", MONICA
MY D
EXPIRES: October 20, 2009 5
' b?•` Bonded Thru Notary Public Underwriter°
Izs/
7. I understand that if any person gets injured on my construction project—they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Initial
8. I understand that under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my property with out first obtaining
the proper permits by licensed contractors.
Initial's
Was acknowledged before me this 3 day of tiler d4 , 20 VT
who was personally known to me or who has
Produced there License or /1 wd/5LIG /qq 17 D as identification.
, ; NAME:
OWNER BUILDER DISCLOSURE STATEMENT
•
VILLAGE OF MIAMI SHORES
ADDRESS: \OO O earjr Q le:1514
DATE:
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 building must be
for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a
Wilding 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 hold title to the above property and I am planning on doing this construction
Myself.
Initial
2. I understand that as an owner- builder I must abide by all zoning ordinances and
building regulations in effect at the time of permit application. Inactive
permits for a period of over 180 days will become null and void (expired)
and a new permit will be required to be issued for reinstatement of the
permit.
Initial 4
3. I have an understanding of the 2004 FBC & FRC and understand that this
department and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initial k
LEGEND
EXISTING PARTITION
TO BE REMOVED
existing partition
$ D E -E existing switch, light or receptacle
$ N QN new switch, light or receptacle
® existing 220 receptacle
E
® new 220 receptacle
N
existing relocated rece
ER
S ER existing relocated light
Q new J 190X
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