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DEMO-10-1839� 1 °I 1 t.z BUILDING PERMIT APPLICATION FBC 20 Address: Z(z) /Jt /01, 5 i ,A"L(i-r- ( City: /44,4 5 / S State: JOB ADDRESS: Z l® A to 5 t City: Miami Shores Folio/Parcel #: /l - 3 z ®eo oz ' Is the Building Historically Designated: Yes Value of Work for this Permit: $ Type of Work: Address Description of Work: 1 a, County: Alteration COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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 7 , — .7 Permit No 0 0 1l 31 Master Permit No. Permit Type: BUILDING OWNER: Name ee Simple Titleholder): / p / ��'' ©» - PC -1 /€ 91 C � P ) �' Phone #: � Zip: 33(3e Tenant/Lessee Name: Phone #: Email. //L /./.."- 57 Miami Dade Zip: NO / Flood Zone: Z`' / CONTRACTOR: Company Name: Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Square/Linear Footage of Work: 37 #' ONew URepair/Replace )emolition ******** * * * * * * * * * * * * * * * * * * * ******* ***** Fees*** ******* ** * * **a * * *** * *rsri ***** *** * *** **** CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ (re ° 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 A FFIDAVIT: 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 moved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ) S j "1 , 20 1LL, by 1("CH who is personally know to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: MIE RIVERA I •+MISSION # DD62599 Sl A �i ► xPIRES January 02. ?^9 AA.) ) Flondallofa Sari„ Print: -- My Commission * * * * * * * * * * * * * * * * * * * * ** APPROVED BY _RA X0625991 . ernce.ce,n Z fplA Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)(rev6/4/10) Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 by 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: ******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk Inspection Number: INSP - 153249 Scheduled Inspection Date: November 29, 2010 Inspector: Bruhn, Norman Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project: <NONE> Contractor: HOME OWNER Building Department Comments DEMOLITION OF ILLEGAL PORCH ENCLOSURE Passe A Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 152395. Repairs for demo work must be approved. NB PLEASE CALL. TODD HENDRICKS 305.915.4899 November 24, 2010 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 Permit Number: DEMO -10 -10 -1839 Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number (305)915 -4899 Parcel Number 1132060480010 Page 14 of 21 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. ft.FtD iL -'-" 11 TAX FOUO NO. i I 3ZcIG - Cqg - 6 it) STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement escription of improvement: P d4 L`( /'0 /( rte{' ) 4? jp wner(s) name and address: ontractor's name and address: 5. Surety: (Payment bond required by owner from contractor, if Name and address: Amount of bond $ 6. Lender's name and address: different e is s Sign ure of Owner P t Owner's Name Sworn to and subscribed before me this Notary Public Print Notary's Name My commission expires: 123.01 -52 PAGE 4 8/02 yr h— 601(...17 ,nginal filed nyy) VITNESS 1ARVEY Y \■d NOTARY PUBLIC Commission g l9 • D0765901. 4 o F of F.V ®9 "OF 1 1111 1111111111111111111111111111111111111111 CF14 20 i 10R075425 1 OR Qk 27480 Ps 40091 (1Ps' RECORDED 11/05/2010 09 :58820 HARVEY RIJVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA LAST PAGE egal description of property and street/address: f L A i - - 1 i3 j ' " - S -r 51 - I (3f/ Interest in property: Name and address of fee simple titleholder. on , AD 20 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a cifled) Iz-ti by /' -lc- ` (U' 1 96L-A— Rdayof 1 ,2fl`U ok� %iuimfin∎o� /1) ) Z I��� Sl/ f 'si Address: •'... " / c . ?' , / 5A 5 '55(3F 1310612012 NAME: le.- . /PL2- ADDRESS: Zit' Ai b 411 OWNER BUILDER DISCLOSURE STATEMENT DATE: / 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 $,,414.1 s /iDges 5313 ' 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 - s ilder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may a as my own contractor with certain restrictions even though I do not have a license. India 2. I understand that building permits are not required to be signed by a property owner unless he or she is respo ble for the construction and is not hiring a licensed contractor to assume responsibility. Initia 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 my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license umbers 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 substantial / improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built o substantially improved it for sale or lease, which violates the exemption. Initial Initi Initia 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 b 'M.unty or municipal ordinance. 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 emplo,ees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully ;cling as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 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 incom tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers co nsation 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 ap licable 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 Se ice, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I ma ntact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvfloridalicense.com /dbpr /pro /cilb/iind .html Was acknowledged before me this I 411 day of C)C4oxbet._ , 20 10 OWNER ► NOTARY Initia Initial Initial Infia Initial Initial By - ZrJd it X x, ho was personally know to me or who has Produced there License or as i ; ntification. KATtizillaz R& i °: MY COMMISSION # QGr EXPIRES January 02,,: It?11 SOP 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: z iv /tea— Yr , ,t / 5 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatio ' 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. The folbwing pages were originally attached to plans with the following permit # ) K69 N. E. 2 AVENUE •1.70' r.I.Pe/a' --Io Iv ^t 03 ro O$ A C !:'Ll 11-- w U.. Eg til o uP.,tr _ �� < Y _ E s01 03'00 1 81.68'(P)C U --1 1 5.00' LL � li ASPHALT PAVEMENT CC M Z 1 =20 i= 0 0 LU L O ® LL H 0 c t— a C w L. H I H@RE•Y CERTITY THAT THIS 7OYNOTRY SURVEY IS A TRUE AND CORRECTREFRF.EFNIXIION OSA SURVEY PREPARED UNDER MN OBtEC110N. 7,US CO•PUES YATA THE IRNYUY TECHNICAL S AS SET FORM ST THE EIRE OT FLORIDA IMMO OF PROFESSIONAL WIO: ,..,�.<•:•• - S,G17$ ELOROAAD►RNISTRRME CODE PURSUANT 70 472.017, E LRMSE SIGNED MIGUEL ESA! STATE OF FL FOR THE FIRM P.S.A. HO. 510f MT MO MIMI, ANAUrNBYIC a.ECWAs ESIPAfA ANOAVtNBttMATISO At c Mt AMOR 11.16 NAPE NOT WIIOYIRNOIRTNB AROIRRNRJNOIMF ORCSYXRA CoeI.or A MOOED MYMOR AM WAFER Notes: NO NOTES •• •0• • • • • • •• • • • • • • • • • •• __.. ••• •• • • • •• • SFJR*E G ,.. H ' •• ••• 1466551440 '�' StP€ E i LJ i i :• Suite -3119 • • • M40{{1,.1 PIHONtt (305) 740 -3319 Ffr4C+Ih(80*'56 90141144:470 ;'• • Accegeil 14,;' Survey: A - 18161 PAGE 1 OF 2 SAVE TIME THE TRIPOD HELP SAVE YOU TIME AND LABOR WHEN SHORING. With only 2 laborers, you can cover a large amount of square feet in little time. THE Post shores, with the use of the Tripod, mantains itself more vertical receiving the load at its maximun capacity. Aluminum Beams and Joist are available in a wide range of lengths l ifith section heights of 7 1/4" and 6 1/2 ". •BYMDNS A Dayton Superior Company li Aluminum Beam Symons Aluminum Joists have a 6 112 165 mm) section height and are very economical for applications involving higher slabs and Narrower bays. They are available in lengths ranging from 5' (1.5 m) to 21' (6.4m) in 2' (0.6 m) Increments. Odd lengths are the most ►pular sizes for handset shoring as well as narrow ay flying tables. They weigh only 3.6 lbs. /ft. (5.4 Kgm) including the 2" x 2" (51 x 51 mm) nailing strip. As a result, they are very easy to erect. Strip and move. Their unique computer optimized design makes these beams unusually strong for their weight. In fact, they can support 233 Lbs. per lineal ft. (347 Kgm) on a 10' (3 gym) span al U360. Thick 4" (1 02 m) wide top and bottom flanges provide outstanding safety and resistance to tipping. SHORING HEIGHT 5' 6' 7' ' 8' 8' 10' 11' 12' 13' 14' 15' Ps -1 R 6'200 2,812 6,200 2,812 5,500 2 5 4,800 2,177 4,100 1,880 - _ _ - _ _ Ps -2R - 6 5,500 4,800 2,177 4,100 1,860 3,400 1,542 2,700 1,225 - - _ _ Ps -3R • - - _ 4,800 2,177 4,100 1,860 3,400 1,542 2,700 1,225 2,350 1,068 2,050 930 - - Ps -4R - - - - - _ 3,400 1,542 2,700 1,225 2,350 1,066 2,050 930 1.775 805 1.675 714 Ps -1 R ' Length: Internal rnal tube: Weight: 1,900/20' CONT. 5'1" to 9'0" " 1.90" x .079" x 5'1 . 18.7 lbs. 1.55m to 2.74m 48 x 2 x 1550mm 8.5 kgs. lo Length: External tube: 6'0" to 11 2.20" x .079" x 511" 1.83m to 3.35m 56 x 2 x 1800mm Ps-2R Internal tube: 1.90" x .079" x 5 48 x 2 x 1800mm Weight: 24.3 lbs. 11.0 kgs. 1,700/20' CONT. Length: 8'0" to 13'0" 2.44m to 3.96m External tube: 2.20" x .079" x 67" 56 x 2 x 2000mm Ps -3 Internal tube: 1.90" x .079" x 7'10" 48 x 2 x 2400mm Weight: 28.7 lbs. 13.0 kgs. 1,200/20' CONT. Length: 10'0" to 15'0" 3.05m to 4.57m Ps External tube: 2.20" x .098" x 7'10" 56 x 2.5 x 2400mm -4 R Internal tube: 1.90" x .098 "'x 8'6" 48 x 2.5 x 2600mm Weight: 35.9 lbs. 16.3 kgs. 1,150/20' CONT. ALLOWABLE LOADS IN LBS: KGS. AMERICAN SYSTEM . METRIC SYSTEM SAFETY FACTOR = 3:1 Inspection Number: INSP - 153338 Scheduled Inspection Date: November 16, 2010 Inspector: Devaney, Michael Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project: <NONE> Contractor: HOME OWNER Building Department Comments November 15, 2010 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 Lo - �3GI Permit Number: DEMO -10 -10 -1901 Permit Type: Demolition Inspection Type: Final Work Classification: Electric Phone Number (305)915 -4899 Parcel Number 1132060480010 REMOVE 3 ELECTRICAL OUTLETS FROM ILLEGAL PORCH ENCLOSURE TO BE DEMOLISHED Passed D Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /G Page 21 of 23 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) /c tP 4 Phone # — Owner's Address 7 /® Pe /DZ. 51 City €/ / 5/40eS State 47-- Zip 33 /3 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) Z /tom ,t-L- /0Z_ 5T City Miami Shores Villa • e County Miami-Dade_ Zip / 3� FOLIO / PARCEL # Is Building Historically Designated YES NO / Flood Zone z›./-e X Contractor's Company Name Contractor's Address Miami Shores Village Building D artment ill g p � 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 No. L t9 Master Permit No.70 10 b — t 3" Phone # 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 # Value of Work For this Permit $° - 0 • Square / Linear Footage Of Work: Type of Work: ❑Addition ['Alteration ['New ❑ Repair/Replace ❑ Demolition Describe Work: * * * * * * **** * * * * * ** * * * * * * * * * * * * * * * * * ** ** F * * * * * * * * * * * * * * * * * * * * * * *** * * * * ** * * * * * ** Submittal Fee $___1 Permit Fee $ /419 CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: 5 Structural Review. $ Total Fee Now Due $ cir 40 See Reverse side -4 BY:__ 1 2 7 2R0 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 ap i roved an a re- inspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this Z 1 day of ! , 20 /?y, by 1( )1D 1-1 C A " i '& w s personal! e or who has produced rt. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * * * * * * * * * * * * * * * * * * ** APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by 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: \�� ���111u1rrn Iiiii, A Ne �� ,, jb a' G ? i ,sply<k ***:*** Ibv** �i�tr**** �e�r�e�lr�YaYdr�tr�tr3e�: �1r�r�e�r�ct aY�i�lr**** de�r�te�k�F* sY�Y�e�tea 'eatr�Y�r *ar�Tr�e�Y�e�ele*** /I 1 lIllllll� \ 3''lans Examiner Engineer Zoning Clerk checked NAME: f' i 9- • /ca OWN U ILDER DISCLOSURE STATEMENT J> E���� D ATE: /v - Z ADDRESS: Zr / 16: /� �— Please read and initial each paragraph. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 f2b414 / S /�f?& 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. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner -bu' der permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act .s 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. 2. I understand that building permits are not required to be signed by a property owner unless he or she construction and is not hiring a licensed contractor to assume responsibility. Initial Initial Initial 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 my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licens umbers 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 oc cupanc, . It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantiall improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or ubstantially improved it for sale or lease, which violates the exemption. 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my . uilding or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law an. .y county or municipal ordinance. 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 empl ees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willful) 'cling as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Was acknowledged before me this day of ° � f , 20 OWNER 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 incom - tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers corn : nsation 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 Serv: « -, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may h''tact the Florida Construction Industry Licensing Board at 850.487.1395 or htt .: /lwww.m oridalicense .com /db•r /.ro /cilb/iindex. Initial 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that am the p legally and financially responsible for the proposed construction activity at the following address: Initial Initial rtY 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatio 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. By ` c5 K Pi t < who was pe : a y nown o who has Produced ere License or _ as identific }}�� ,�� is S� %, w, ,r, , 03 r, 2012 ' _ NOT ARV PUU11C s — 7: cn . Co mmission* .-_,;A''...0 j 0785901, `,? / /rrr/ r I I l I l I1