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DEMO-10-945Inspection Number: INSP - 144415 Permit Number: DEMO -5 -10 -945 Scheduled Inspection Date: June 15, 2010 Inspector: Bruhn, Norman Owner: CANNATA, SEBASTIAN Job Address: 622 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Building Department Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 demolition of existing kitchen and loft in garage June 14, 2010 For Inspections please call: (305)762 -4949 Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1132060171830 Page 13 of 25 Protect Address Fees Due CCF Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $5.00 $100.00 $3.00 $0.80 $109.60 622 NE 98 Street Miami Shores, FL 33138- 1132060171830 Block: Lot: CRAIG DOURA 1 Owner Information Building Department Copy June 03, 2010 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Parcel Number Authorized Signature: Owner / Applicant / Contractor / Agent Phone CRAIG DOURA 622 NE 98 Street MIAMI SHORES FL 33138 -2522 1 Contractor(s) HOME OWNER Phone Cell Phone Type of Demo: Building Additional Info: KITCHEN AND LOFT Classification: Residential Scanning: 1 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -5 -10 -37998 06/03/2010 Check #: 1369 $ 59.60 $ 50.00 05/26/2010 Check #: 1364 $ 50.00 $ 0.00 Valuation: Total Sq Feet: $ 1 ,000. 0 0 0 1 Date Applicant CeII Available Inspections: Inspection Type: Final 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. June 03, 2010 1 Cofr,IP sul O 4 BUILDING PERMIT APPLICATION Master Permit No. FBC 2 Permit e: B �;�� -� Owner's Name (Fee Simple Titleholder) te.10aStian r t Phone # 7 S6. 2 (3. 3 q Owner's Address (p 22- N Q 6 Sttrer City MOM, ShOV S State E__ Zip Tenant/Lessee Name Email J ) li h rcitc tD@r a 1 . co Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Value of Work For this Permit $(9 Type of Work: DAddition DAlteration Describe Work: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 � Permit N O lO4 5 County Miami -Dade Phone # (02,2 !■E. ct S Strecr' Is Building Historically Designated YES V NO Flood Zone Contractor's Company Name Do hone # Contractor's Address City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Total Fee Now Due Zip Square / Linear Footage Of Work: :New ❑ Repair/Replace 'r+ A See Reverse side - pricsnwsi MAC" 262QU � h-- . . e /Oil * * * * * * * * * * * * * * *** * * * * * * *** * * * * ** Fees************* * * * * * *** * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ o. 0 Permit Fee $ ./te 6 CCF $ 0' OD CO /CC $ Notary $ S-- ,, i' � Training/Education Fee $ 0610 Technology Fee $ O" OV Scanning $ t ' { O Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage 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 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. Sign: Print: Signature Signature Owner or Agent nn Contractor The foreg . i g instrument was ac ' . wldged befor me • 's OG The foregoing instrument was acknowledged before me this by I � befor da day o , 20 I l �q, of , 20 , by � y who is . ersonall known to me or who has produced who is personally known to me or who has produced identification and who did take an oath4�°�. as identification and who did take an oath. c NOT i' PUBLIC: My Commission Expires: (Revised 07 /10 /07)(Revised 06/10/2009) ' • ` 'y NOTARY PUBLIC: aNs as' t F f36 SP Sign: Print: My Commission Expires: APPROVED BY e:i/L�J Plans Examiner Zoning Engineer Clerk checked 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. 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. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 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 t Z, 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. Initia 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 r substantially improved it for sale or lease, which violates the exemption. Initial Initial a.. 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. Initiak l ' 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 � 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 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. 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.mvfloridalicense.comldbpr /pro /cilb /index.html Initial cC 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: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informa 'on at I have provided on this disclosure. Initial Was acknowledged before me this day of 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 owners 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. Produced there License or OWNER , 20 G0 who was personally known to me or who has 900 1 • ow� •._ . s identification. Initial Initial NOTARY iti� t IFS •. I Lf� " 1 i 1C8 11 OS �U A • • • • • • • •4 • • • I•••• • • • • • • • . • • • •• • • — REMOVE EXISTING NC I I) L_ \ — �l — J - r T - - r — T — — I I I I I I I I I I I / 111111' — I___L — I— Lj-/ \ REMOVE EXISTING STAIR / r — \ / \ / —REMOVE ABOVE LOFT. / \ / \ / \ / \ / \ / \ / \ / \/ REMOVE KIT APPROVED DATE TONING DEPT PLDG DEPT SUBJECT 1 CCMPIJANCE WITH ALL FEDISOAL STATE AND C ,y T'ULES AND D hEGULA InP ?S, L EXISTING DOORS WITH WINDOWS TO 13E R EMo %EO � E 1 EPLAGE wl µ t 1 AN E Dvo ��a REMOVE EXISTING NC Ka262U Y � DEMOLITION PLAN JAMES M. HOWNGSWORTH. P.A. A R C H I T E C T 2208 NE 28TH STREET, FT. LAUDERDALE, FL 33305 VOICE 856.030.1388 FAX E4.830.1350 Project Name: CANNATA RESIDENCE DEMOLITION PLAN Project Number. 10- CANNATA PHASE: S.D. DATE: 5.14.10 SCALE: 1/4" =1' -0" SHEET: SK-1 4 Inspection Number: INSP- 144416 Permit Number: DEMO -5 -10 -946 Scheduled Inspection Date: June 14, 2010 Inspector: Hernandez, Rafael Owner: CANNATA, SEBASTIAN Job Address: 622 NE 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Building Department Comments Passed sK1 Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 COPPING PLUMBING IN GARAGE June 11, 2010 For Inspections please call: (305)762 -4949 Permit Type: Demolition Inspection Type: Final Work Classification: Plumbing Phone Number \io Parcel Number 1132060171830 Page 13 of 29 622 NE 98 Street Miami Shores, FL 33138- 1132060171830 Block: Lot: CRAIG DOURA Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address CRAIG DOURA 622 NE 98 Street MIAMI SHORES FL 33138 -2522 1 Contractor(s) HOME OWNER Phone Cell Phone Type of Demo: Plumbing Additional Info: KITCHEN & LOFT Classification: Residential Scanning: 1 Fees Due CCF Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $0.20 $100.00 $3.00 $0.80 $104.60 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 June 03, 2010 Pay Date Pay Type Amt Paid Amt Due Invoice # DEMO -5-10 -37999 05/26/2010 Check #: 1364 $ 50.00 $ 54.60 06/03/2010 Check #: 1470 $ 54.60 $ 0.00 Expiration: 11/29 /2010 Phone CeII Valuation: Total Sq Feet: $ 1,00 0 1 Available Inspections: Inspection Type: Final June 03, 2010 Date 1 BUILDING Permit No. PERMIT APPLICATION FBC 20c97 Permit Ty Q��, Owner's Name (Fee unp e Titleholder) ��� a phone # 780 213 ,9 Owner's Address -- 22. e;15 Cit Mi o trnt 5 V) 08S State P Zip 33 3' Tenant/Lessee Name Email not . con-1 Job Address (where the work is being done) Contractor's Company Name Contractor's Address City State Qualifier Name State Certificate or Registration No, Contact Phone E -mail Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Phone # (022 13E aS 5fir_1 City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES Master Permit No. Q ) 0 — C 145 NAY 2 6 200 VI BY: '35 NO NO Flood Zone JO- 0 1 44(p Phone # Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ 100 Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace Describe Work: Cc 7P j f3 "7 I (a) I9) tn Jara9e, Zip Phone # ******** * * * * * * * * * ** * * * * * * * * * * * * * * * * * * ** F *** * * * * * * * * * * * *** * * * * * * * * * * **** Submittal Fee T Permit Fee $ /66 4/4 .P CCF $ O ' • CO /CC $ Notary $ Training/Education Fee $ 0-90 Scanning $ 500 Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ ''IVIJ Technology Fee $ Q• Bond $ See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage 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 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. Signatur- Signature The fore in instrument was ac 41 , iwle ged befo 1 1pe day o , 20 10, by 0 /, who is personall known to me or who has produced ` 4 09 NOT Sign: a Print: r . p • 1 ; 'al My Commission Expires: APPROVED BY Owner or Agent (Revised 07 /10 /07)(Revised 06/10/2009) Ong identification and who did take an oath. 65— ` Plans Examiner Contractor The foregoing instrument was acknowledged before me this d of , 20 _ , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: • ': C. Sign: Print: My Commission Expires: ******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ************ Zoning Engineer Clerk checked M iami 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. 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 5 ( 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. Initial___ 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 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 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 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. Initial 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. Initial 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.myfloridalicense.com /dbpdpro /cilb /index.html Initial 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: Initial 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 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 o" l(J day of 20.K B 0(10 -34 , who was ersonall known to me or who has Y `Y p Y Produced there License or 11 1 —e OWNER 1 • RV as ident(fication. Initial �L-- NOTARY OTAR°s°TP'1 ''4 V. Ct 'I D71752 23 2011 ,,. 1x1. . UOrtogi ��J1+ U N`L7ANY1C bONDII1G CO., INC.