The URL can be used to link to this page

RC-10-384r Inspection Number: INSP - 137590 Permit Number: RC -3 -10 -384 Scheduled Inspection Date: February 28, 2011 Inspector: Bruhn, Norman Owner: THORNE, OLIVE Job Address: 573 NE 106 Street Miami Shores, FL 33138- Project: Contractor: HOME OWNER Building Department Comments February 28, 2011 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 Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122310140150 BATHROOM REMODEL Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments ec--- Page 4 of 33 BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING ROOFING Owner's Name Fee Simple Titleholder) p ) �l /��- r�vG Phone # 7 3 Owner's Address City/ Z___ S tate frG7 Zip s - l Tenant/Lessee Name Phone # Job Address (where the work is being done) S Lr , / :: 01/' City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Contact Phone ■rOarn 1e Submittal Fee $ �' Permit Fee $ 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 No.Vc) Master Permit No. Oa t% � EGEIIY3 MAR 1 0 2010 BY: Is Building Historically Designated YES NO /✓ Flood Zone Contractor's Company Name`' Contractor's Address City State Zip Qualifier Name Phone # E -mail Phone # State Certificate or Registration No. Certificate of Competency No. Architect /Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ❑ Repair /Replace Describe Work: /soe'° CCF $ Structural Review. $ Total Fee Now Due $ . U..Q sak0 See Reverse side - ❑ Demolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *** Fees************: r * ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** CO /CC $ Notary $. Training /Education Fee $ �` � Technology Fee $ '40 Scanning $ Radon $ ( ) DPBR $ Q .� Bond $ Double Fee $ Violation date: . / 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. Signature.- ; Owner or Agent The foreg 'ng instrument was acknpwledged b fore me this 10 day of Z- ,Y\ 2010, by0)UV 1J )lC1 who is NOTA Sign: Print: My Commission Expires: ****** * * * * * * * * * * * * * * * * * * * * * * * * * *** *k* ** t: F*9t9t*9t*: F**** k****** kk: F**** 9t9c**** :P*** * * ** **** *:F:F9t9t9:*:p9t** ***** APPROVED BY rsonally known to me or who has producedl identification and who did take an oath. (Revised 07 /10 /07)(Revised 06/10/2009) F Plans Examiner 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 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: -'- f DATE: � < <� Ito ADDRESS: - 1 i/ 0 __11 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 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. 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. 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 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. 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. 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 .com /dbpdpro /cilb /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 .,1 ally and financially responsible for the proposed construction activity at the following address: i7 r - , - t S' .s 3313 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. 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. frd Was acknowledged before me this day of 20 Byatt T-P) Produced there License or i 2U as identification. OWNER who was personally known to me or who has Oh( Q )(L \d� Initial Z3- Initial Initial NOTARY Ai r2 -,`: 41; S".! E *Y T ORIDA C.leil.t•); V. Ot ill.GS :oua:ria ta1D f 2011 , pn T BI) ATLANTIC. BONDING co., INC. PERMIT #: P-C1Q- -3 Shores Village Miami APPROVED BY DATE ZONING DEPT BLDG DEPT 4;74 j ,17,83 FEDERAL SUBJECT 10 CCMPIJANCE WITH ALL STATE AND CCUN'N RULES AND REGULATIONS 4 It 11 iV Dat ; �I At.N" 113 I W oti O W 604 YOOvn reNOICF oP \Am c av� lo�lA,t Sink- �+cI S�o'� -r k�nry rxrl Wlia, qaGYNceeArn . El2,c}caJ � Ok )1116/ 1 NNOW • • • • • • • • • • • • •. .. • • Y� L o rk. • • • • • ••••••e • •• ••• •• • • • •• ••• • • • •• • ••. • • • •. • •• FuwY• Do, a. °' ' v; e ui Inspection Number: INSP - 156297 Permit Number: EL- 3- 10-496 Scheduled Inspection Date: February 24, 2011 Inspector: Devaney, Michael Owner: THORNE, OLIVE Job Address: 573 NE 106 Street Project: <NONE> Miami Shores, FL 33138- Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Contractor: SUNSHINE ELECTRICAL CONTRACTORS CORP Building Department Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments February 23, 2011 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection. Type: Final Work Classification: Alteration Phone Number Parcel Number 1122310140150 Phone: (305)265 -4958 Page 17 of 17 : ^.T• j .::jt''�'u'.i`i�{�I9i o .iw§k 9..Y.•;Y,:; , r +?lR i < ?�/ •f, :}.-... - R.�. •.a•:f•�i ::3tr r4^ i�f: .j4m. S '%; ..i, ; 1�' "'i iY• '.,j h.�. .: ,,. n . •,. , ^'mi . " >•. i:r � y i ,r �. . 1'� • . f� y .. 'r r ^k'i'41ti••4.'\',. { i +. {•'r /nx g s ?•'• 's ; >. • :,«:• 4 n. : ' :�:•�;f: ": i re:1•;i,i k ;: ?i:�v:` TM a i 'a '' °L: � ,, II { ... y y ' y ■r !: ; a ' ^ ^3.: ;%{ •M DATE (MM/00/YY) _ ; S ; • q as 04/16/10 +}� .2: 3;,9'.:;: x . }s / . : d:• 'tii:r ti n r `¢s• " k. , i•e r ,�.•Rl4 {• 4< .:S..S.»:P71:f. Cdr:/ nti:•. :J:Lr•.tLT fat..: 5 SCffT✓ i:.:' �i�•:: w. w3¢ s.'4^'i.�^' ''` rf , :: + •f\ i:{•: i' YS•: iY,t• Y c.^' w:. ,+ 4.. ' r,{ y ' 1• i^? ji.'?; 1. C ,�i.4,.y+::iutit{ > TCA:'ry PRODUCER DISCOVERY ENTR INS AGENCY, INC 10733 NW 58TH STREET DORAL, FL 33178 (305) 718 -8919 FAX: 718 -3584 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A PENN AMERICA INSURANCE COMPANY INSURED SUNSHINE ELECTRICAL CONT. CORP. 7 512 N. W. 55 STREET MIAMI, FLORIDA 33166 COMPANY 13 COMPANY C COMPANY D � { v :..� Y• e K • . :C '•:K ivF�'`C r. ^'` { p � r: r. , 1,.. • ' • . { p }.9 . r 3i r�9jx{•"r'i i o • � r' 1' }i •1: ti) :• 'f'i`'•r •r•.3 n- . . M 'x. •�4 T ��'3��"�•y .� 1 :st ....i:i ^i•i1 }<i'i•..i.'. :; Y:{ •. • v: x.•. v:{ v. Fvn{• x n{ Yxw } <.•.4,SSiKV %V,S.x,• 30.' LC•:{ i, W.'' fv''. d)}' r` M. xYi%• �'Q:�:a(•:♦ <.'L::L)�•�KSa.,y +• :+.Ln, • BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BEEN REDUCED BY PAID CLAIMS. � •\� { � • . M . : SS "r,{'+SF.•ii' r • i 4 . •.pSC•); M' r ,r{}<.f •:'{• 7 :. C ��•, , +� •. v`.. >. : { fa • .y. : • : f? ' .6. :.:Ja�: ,: '#, .ti .. >,aW,{. /..i^,�q'aa 'aa'w'6i 3X1 }Y7"h'' .p'�.S, . " .. _ {. ,. i ,r,. ,iJ'{i ; . • k.. i.} .C., :}:: Rb' :RH$:. � :3fi •n. +t'Y•ci`i'I. : '�. • �FIJA ''A).Q`AJ.µZai.NY'i}.T THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE P, TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMSe /DD/YY) POLICY EXPIRATION DATE IMNI/PD/YYI LIMITS A GENERAL LIABILITY 010389 04/07/10 0 4/ 07/11 GENERAL AGGREGATE 8 500,000. X COMMERCIAL GENERAL LIABILITY PRODUCTS • COMP /OP AGO 8 500,000 . 8 500,000 . ` ..T.1 • cw I CLAIMS MADE X OCCUR PERSONAL & ADV INJURY X OWNER'S & CONTRACTOR'S PROT B.I. & P.D. EACH OCCURRENCE 0 500,000. FIRE DAMAGE (Arty one fire) 9 100,000 . $500 DED { M6D SXP (Any arm person/ 0 5,000 . AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNEO AUTOS COMBINED SINGLE LIMIT 8 BODILY INJURY (Per person 8 BODILY INJURY Wet 0001tleral 8 PROPERTY OAMAGE 8 ° GARAGE UAE!UTY ANY AUTO AUTO ONLY - EA ACCIDENT 8 OTHER THAN AUTO ONLY: Myy r; r:i %2 •'siN:;at:>: • ' •x : y: EACH ACCIDENT 8 AGGREGATE 8 EXCESS LIABILITY R UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE 0 AGGREGATE 8 8 WORKERS COMPENSATION EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE: AND INCL EXCL WC 87A7U- ! OTH- TORY ! IMiTR FR EL EACH ACCIDENT . ..,; %. ,• '^ , �. ., .::... .. %`'�`' 8 EL DISEASE - POLICY LIMIT 8 EL DISEASE - EA EMPLOYEE 8 OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/SPECIAL ITEMS - ELECTRICAL CONTRACTOR �'y:'• `.`[,9lI �JC'.... RIFE$ Mkt. '-'..P.:' �. f'n 2;9}• r : :?LZO• a.'}{p.. }+ y ` 'tlx°` .....• ,, ,., .. D fy a `'" .. era{ . fi:. "'ma �rtay •r c, muVa. ��,. d� .�`•<a�<:a)a�«SS:�aeaoxceir. {s% � :ISO •yu•'•'. .rt�•Satii43; }+"rrA'•.0 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 2ND AVENUE{ MIAMI SHORES , FL . 33138 •vrn•{..n v• l...w. .,., y. ^• ^:' <: f fK'F� Lia: Yi �A,' r J Cv`.+rM•'9' i ; i s i!a 9i$.'1•:•'•.'s:L••x., ... '.; ...w.. . :.r r�w x,'''c'.'"r :.:.`��'3lt i:E:#w;3v?:itiVO Ci ,.'rJ:r..^a`r'• 4 ,.J' ,arI44 •.>L:':.��e3si .,.�.• v...:v.•I:. }r rt. +u^e.: . .,�'' e `f,, ,a. ^9( n - •' i • S o :. itir1. .`:4q, , . };e ?f •, to.'•% .�:e ; is •. �'S�'. � ' a.�. •'' � ��..A'Se�:� w'�bk�•``m � K�a:a�sa•. of'iav iy'��'^ ti R^. 3% f a . +\ r. )� rfi• ' �•: j�x••§'h.��f/;f> \..\:.•'. .•kE%'Va'•}9.ci:'�,°•ia >:::{:. k2 SHOULD ANY OF THE ABOVE DESCRIBED POu01E3 ILIE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 bAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT PAIWRE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION 010 LUIBILRY OF ANY KIND UPON THE COMPANY. ITS AWAITS OR REPRESENTATIVES. AUTHORRED R 3:'a. • AT / • /' /j /�� C+ T,a } ��a� r'd'•,.•, 'a , : MOM* • ^x, w •�;r.. ••.''ikr 4..': ' yam •". `'•,• .:'L.,...:.;n. .,.:in0...: pli.%..), S: n R.v.S; .. V,i•. _.' :• ,.t. APR /16 /2010 /FRI 09:22 AM FAX No, P. 002 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Value of Work For this Permit $ f Type of Work: Addition Describe Work: Submittal Fee $ Notary $ Scanning $ ; '00 ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 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 Owner's Name (Fee Simple Titleholder) ` \ e_ 1( Phone # Owner's Address � 1 , City (j State Zip �a 1 Tenant/Lessee Name ( - i "? e Phone # Job Address (where the work is being done) 5 Ni City Miami Shores Villa a County Miami -Dade FOLIO / PARCEL # )1 g Is Building Historically Designated YES Permit Fee $ Master Permit No. Flood Zone Contractor's Company Name S vil.) 5 A vim. Out C. P Contractor's Address / 3 64 £ w City /41,.} — �J State Zip lts Qualifier Name/ i Phone # U s' 4 4C g$-' State Certificate or Registration No. it? C dv (./ 7 Certificate of Competency No. 6„,? E. CD O 0 • '3 Contact Phone 7P 4 E -mail Architect/Engineer's Name (if applicable) Phone # Square / Linear Footage Of Work: :New EKRepair/Replace {" p 't. (1 L ** Fees*** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * ** CCF $ `t' Trai duucation -Fee $ Radon $ V DPBR $ .25 r MAR 2t2010 Permit No. 10 ` Phone # � b �. (-f Cp /CC $ 4c) Technology Fee $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ t U 2 ( Q' See Reverse Side - ❑ Demolition 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 re- inspection fee will be charged. Owner or Agent Contractor The fore ing instrument was ac owledged before me this 10 The foregoing instrument was acknowledged before me this day o My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) 201G; ;i who is personally known to me or who has produced 4 - identification and who did take an oath. NOT ' Y ' UBLIC: 9 cN �ce•� �a . �1 X04 a Engineer day of441/4 , 20 te), by 1��1��G `. who is personally known to me or who has produced NOTARY Sign: Print: tification and who did take an oath. ROBERTO SANCHEZ ire at 5 * MY COMMISSION # DD 619936 EXPIRES: December 5, 2010 rn .j P or ftssr Bonded Thru Budget Notary Services * * * * * * * * * * * * * * * * * * * * * *- _: * * * * * ** dew` F: Y*afrk**** 3:**** 3rdt4t** 3e3:**** 9f9e* *** *3t*3r*eY9e4e **Y****4t3 **** 7k4t*4e k4z9t9e3e4t4e3e4t9Y3e9e*** � Plans Examiner Zoning Clerk checked THE POUCIES OF INSURANCE U ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE YUK l rrt rvuvr rcIW ' ............ • - ... -.-. -M .... •• ANY ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. `iNSRIa POLICY M AGER DATE /A 1 ppi�pA_ �/AAMiDOA'YXYI DATE LBIJTS LIR �'NpSRD LTR TYPEOFINSURANX�' - Maim EACH OCCURRENCE $ GENERAL UNARM COMMERCIAL GENERAL LMBRITY To RENTED PREMISES (Eaomaranoa) $ MED RIP (ArN One Pte+) PERSONAL& ADV INJURY GENERAL AGGREGATE $ $ $ I CI.P3MS MADE OCCUR PRODUCTS - COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPUES PER POLICY n n LoD AUFOMOBILEMABMY .m ANY AUTO ALL omen AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OVMIE AUTOS . COWED SINGLEUMET gsmidm* $ BODILY $ BO $ (Per�idU $ AUTO ONLY - EAACODENT $ GARAGE LUiBI.ITY EAACC $ ANY AUTO OTHER MITO O AGG $ EACH OCCURRENCE $ EXCESS / UAII:IRB.LA MAMMY 11 OCCUR ❑ CLAIMS MADE f AGGREGATE $ $ DEDUCTIBLE RETHNTION $ $ A MC0707E1169 7/16/2009 7/16/2010 WC SiATU ' �OTFI X TORYUMRS ER jMITS =ream COMPHmA-nDN AND EMPL0YEIMIummxY Y ANY PROPRIETORIPARTNEITN Mandatary oTFIC I A Daman u I &� PROVISIONS below EL EACH ACCIDENT $ 100,000 EL. DISEASE- EA 8UPLOYE$ $ 100,00 $ 500,000 EL DISEASE -POUCY UNIT AL OTHER . DESCRIPTION electrical OF OPERATIONS[ LOCATIONS /WHOLES iE=AEONS ADDED BY ENDOIMBAENT /SPEGAL PROVISIONS contractors CERTIFICATE HOLDER CANCELLATION Village of Miami Shores Building Department 10 050 NE 2 Avenue Miami. Shores, FL 33138 SHOULD ANY OFTHEABOVEE DESCRIBED POUcIEsB CANCELLED BFFORE THE EXPIRATION ENDEAVOR TO -3Q DAYS WRITIBI DATE THEREOF, THE ISSUING INSURERINILL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE L .EFT.AIIT FAILURE TODOSOSHALL Ira'OSE No OBLIGATION OR UABH.rrY OF ANY MED UPON THE tNSIRER. nS AGHNTS OR REPRESENTATIVES. AUTHORIZE) REPRESENTATIVE David Lopez /AMANDA s 4 0RA_winn ACORD CORPORATION. All rights reserver AWRU, PRODUCER (305) 595 -3323 FAX: (305) 595 -7135 Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 INSURED Sunshine Electrical Contractors Corp 7512 NW 55 Street Miami FL 33166 THIS CERTIFICATE IS ONLY AND CONFERS NO RIGHTS UPONTHOE IN HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE iNsuRERNAequicap Insurance Company INSURERS: INSURER C: INSURER D: INSURER E: NAIC # COVERAGES ACORD 25(2009/01) INS025(20o9O1) CERTIFICATE OF LIABILITY INSURANCE The ACORD name and logo are registered marks of ACORD 8/25/2009 s: r:. vrr..•:::»•::..:: ..- :.- ...,.:- :.:,Kr:. ❖.- . -:,..c >:r •: t».- C. va:•:? cw ::.S:iri::{ ?f{{{:- .r =.= x ?-:'?; x {5i6+:?'v. 'v+r"°r » <:>:z:= =fii- ?'tY:.C:;:;:•: PRODUCER . DISCOVERY ENTR INS AGENCY, INC 10733 NW 58TH STREET DORAL, FL 33178 (305) 718 -8919 FAX: 718 -3584 ix� - xuccxm •ac•:x?:•:o;ri- .:.va•:.,::r.:•. n .»<::•:. n:.:»:: rs.:.- rr:.:»:: »._ : :.: <:r. »:.:' : -.•.,. - - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A PENN AMERICA INSURANCE COMPANY INSURED SUNSHINE ELECTE.ICAL CONT. CORP. 7 512 N. W. 55 STREET MIAMI, FLORIDA 33166 t COMPANY B COMPANY C COMPANY D :::� , -• v ::�y�. f'r { {•:•� vi ?tl }v r; ... 'h`?x: =..• - { + fi • w f •{ ve yS} }i4.:vr�_ 'i a Sv:•.'�iu:- v vvrt •_"_ _ _ •3' • �(r : _ i± �f^: _ J: :jt6'.- b .. M . : r bo: : f� _ :e. -ti�..2"fiy : ii- : _, 't :m fi +:,r. :.{ca's- ?�S.'y:�- :t.`' -�' ~ `'�:`:�-t`-'•r.rq • ,. v': -: tY' �;?.;:::C;`�: - tip _ . . _: c3:. r '�L ?{- _ -x::: ' `.:>3: :. »fi4 - ».: : :•: _• ::•::. _.:v:r _: i0:: t{ _i =mss:_ �F•�{.i-_ .+�` ,l` -? : -, : :�r �-= - ? :•r-?" .::� .» - 3 - i sf'�_ •. r'r-. • �} - ,; ..: ..:i 3f Y= - 4.$Aw��X?i� �=�-st x- i'viilS.2 {{. xL •i.•iAxfi'i:{':•.��L?-r- =_ =+.- ___ : >.Cv3 sn. Lx�1.24•�dA w:s3.�'£' niS�C+' i°�?T�+}:�vsi �.�wi' { �'' �icvx- 5_- i} i6• Yio�.•' ��: t: �. xC: fGn'• �i' �/iJ+a - -. �4�iCil-v".- 2f-.v:• :'.• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUC(ES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 8 TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE DATE IMMIDWYW POLICY EXPIRATION DATE IMMIDD/YY1 WAITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PROT PACE 8 2 4 9 5 8 04 / 0 3/ 0 9 _ 04 / 0 3/ 10 GENERAL AGGREGATE 03,000,000. X PRODUCTS - COMPIOP AGG s3,000,000. IN ♦.• J CLAIMS MADE J X I OCCUR PERSONAL & ADV INJURY 03,000,000 . owNER•s & coNTRacTOxs B . I . & P . D . EACH OCCURRENCE 03,000,000. X Fug DAMAGE (Any one Imo) $ 100,000 . $500 OED. MED MCP (Any one person) $ 5,000. AUT OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCl PULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE UMIT $ _ BODE INJURY $ BODILY INJURY (Per aecWenU $ PROPERTY DAMAGE 5 GARAGE UABIU fY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: . .....................:......... _ EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE 0 AGGREGATE $ — $ WORKERS COMPENSATION EM PLOYERS LABILITY THE PROPRIETOR! P ARTTYEFiS1EXECU77VE OFFICERS ARE AND INCL EXCL I TORY LIMITS I ICITEr :' a ? > ' ':' • '` rt ' :`'::` -': :.. EL EACH ACCIDENT $ EL DISEASE - POUCY UMIT $ EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS /VEHICLES /SPECIAL ITEMS ELECTRICAL CONTRACTOR xY- i :- r:::.t< y - r rr. ; • _� 1 ��ii • VAT _ � -..•:: y =: ss<y: - -. -. - - :: :r"�. =: -'$. •'�' 3f r:.: • ::: :a� 3r: :.un MIAMI SHORES BUILDING 10050 N.E. MIAMI SHORES, = :r:. _ :: .. :r , - rn.•: r••r :•_.. -� {__ ff- _v: .. x' fi'"-- i=-"lliv:t•' + •.L- •�- � - . ��r< , rY.zi i'�i cv 4'Y ° ° {: {- w :�d• DEPARTMENT :: sr {:v> . T'•.+ r��.'.•% :Fi - °° �'v � ='}-- _ "• — _._ 'r.-`ry7 r' >- •ii_`- ':vvr: '� r SX.3*.' l � y'. v. a },, -� • s{ >� y Y':. _:' Ii - Y.Y :{' � � ' ». ;• : - ?:•. pr ::. { �: f s ;; :3.%sir ; i =.: 5 'n W i ti •:E {.- .L'.• : = ':x { :. ' 4... : : :::: Yf •: >:i::G3.Z :fii�r:H.� a'�7'.rvl : •:: �: :!:isitiiv %tifii.:i� }'- _;3 3: n }:'_»� :.:v--ss VILLAGE 2ND AVENUE FL. 33138 = =•xr._y •:.:•• {r {:::::,.a:, •: �.:= x : • .:i:•'3•_::•Jv:� ::. •v :•ii ::v z :_ v.{• ;Z•v.�$:ji {f::iti ?^' }':j•�l�p.4. ?fi W ' ? ?`::Y£_ } r :: � >ir r:m\Y' : :• :z'iv:ir?Y r'x. �:{ 5' r_ i' e:°{. •l.•�? {{+ { =ii {•iA'Y{ir::•L =�-i" f �• n: S�i�:.? v: �{ CYJ .':•:vifn'•'.: {T•�:'i:'•$.hv: _ � i . . S�' a -�_ ,Si . � s.:x r SHOULD ANY EXPIRATION 30 DAYS rx { _ d x j j :M1�: v:• {: •N•=yjy ., ..� S .. $ : : •?'?' r:i s '"?•c} --m- - : 4: -.- :- ' x: .: - . --K. e'�-{ J�. �5Y`.� f f3�•i:M: » - :.� : ?=- .'4:3f � _ � :•- _-_"- -_��i� <,- }.�:: _ _•:: : ^.'c ct n' bw-� �l".r.Kv :: .L=•c:v. .P �h :.ix:: ?V.::: [ f-:: [4r.» :u >r.-'- _�:va?'L{a- Ni'_-. ' ��4Ker: . OF THE ABOVE DESCRIBED POLICED BE CANCEIIED BEFORE THE DATE THEREOF. THE - -HS COMPANY WILL ENDFAVOR TO MAIL WRITTEN NOTICE TO ' i CERTIFICATE HOLDER NAMED TO THE LEFT, TO MAR SUCH N . .1 S$ALL IMPOSE NO OBUGAT ON OR LABILITY UPON THE o MP¢NY. ITS AGENTS gR REPRESENTATIVES. BUT FNWRE OF ANY KIND AUTHORIZED REPRESENTATIVE. .../ � •iirA � i j ,.. -s i x�, w }��:�C �.3 { ::r:ti:t t • : '`Ti - : • . ''if: - ''Y }i�- rl�i�.'ii:• ;:` - - .. a " p� •ry _ r ?.. :'SS ''A g i ` •'' ''''' $ •: _ .�. __a_:._ rl_-....-. �L�aO '�sS�,y -' •:. ti:l . : 1:t 6. '...,I ..tZid ' ' PRODUCER 4 ' tf .4.44:4 . , :ii* DISCOVERY ENTR INS AGENCY, INC 10733 NW 58TH STREET DORAL, FL 33178 (305) 718-8919 FAX: 718-3584 vs . s .44 04/16/10 7.::: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A PENN AMERICA INSURANCE COMPANY INSURED SUNSHINE ELECTRICAL CONT. CORP. 7512 N. W. 55 STREET MIAMI, FLORIDA 33166 .0 graNINIA„t" ..Pr,....'''...4,4u,' '''''''.s.'...v.,114:' '''...: : 4: . Itta; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. Limns SHOWN MAY HAVE COMPANY 13 COMPANY C COMPANY :11 l':" iiiiiik..!T . 452011•Migiiitab1/4..4 -* BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BEEN REDUCED BY PAID CLAIM CO LTR TYPE OP INSURANCE POLIOY NUMMI POUCY EFFECTIVE PATE IMM/DDNYI POUCY EXPIRATION DATE SIAM/DOM) Limn GENERAL LIABILM COMMERCIAL GENERAL LIABILITY 010389 04/07/10 04/07/11 GENERAL AGGREGATE e 500 000. PRODUCTS - COMP/OP AGG 8 500,000. CLAIMS MADE X OCCup PERSONAL & ADV INJURY 0 500,000. X OWNER'S & CONTRACTOR'S PROT 8.1. & P. D. EACH OCCURRENCE 6 500,000. 0 100,000. 0 5,000. FIRE DAMAGE (Any ono fira) $500 DED. MED EXF (Any one pereoN AUTOMOBILE 1111 1111141RED UABILITY ANY AUTO ALL OWNED Aims SCHEDULED AUTOS AUTOS NON-OWNED AUTOS COMBINED SINGLE unall 9 BODILY INJURY (Per perter8 0 BODILY INJURY (Per aniaeriS 0 PROPERTY DAMAGE 0 GARAGE • AUTO UABIUTY ANY AUTO ONLY • EA ACCIDENT 9 rinangaINW 8 OTHER THAN AUTO ONLY( EACH ACCIDENT AGGREGATE 0 MOWS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA PORM EACH OCCURRENCE 8 AGGREGATE 0 $ WORKERS COMPENSATION AND ENIPLOYBRB' LIABILITY TMIT6 ° kiti. 0 THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE - --••-, INCL EXCL EL EACH ACCIDENT EL DISEASE - POLICY UMIT 0 EL DISEASE - EA eMPLOYEE • OTHER ' OSSORIPTION OF OPERATIONS/LOCATIONS/YOWLER/SPECIAL ITEMS ELECTRICAL CONTRACTOR raitatf7:sufftfflialf . e ' VAJZILIONAWA, r*INtillem MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N. E. 2ND AVENUE MIAMI SHORES, FL. 33138 6 ::'.. illq%V.%w ;,,,i, a,,!' tLatamr.,:,:: - 41atskitimi, :AA SHOULD ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WIU. ENDEAVOR TO MAIL 30 DAYS WRITTEN NOME TO THE OER11810ATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAE. sUcH NOTICE SHALL IMPOSE NO OBUGATION OR UABEITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRIMENTATIVES, AUTHORIZED W ENTATI ...-: ., ''.0 .1 41111 . 1111,11111111VON0603fiffidCOMBRAIRE APR/21/2010/WED 11:16 AM FAX No, P, 002 Inspection Number: INSP - 139174 Scheduled Inspection Date: February 25, 2011 Inspector: Hernandez, Rafael Owner: THORNE, OLIVE Job Address: 573 NE 106 Street Project: <NONE> Miami Shores, FL 33138- Contractor: HOME OWNER Building Department Comments February 24, 2011 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 Phone Number Permit Number: PL -3 -10 -519 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Parcel Number 1122310140150 plumbing ofr bathroom remodel Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Commends / Page 1 of'1A Y' BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) (Oh 57 / O CSI City ,4 9Gi21' c) State V Zip 3 Owner's Address Tenant/Lessee Name Email 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 Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES Contractor's Company Name Contractor's Address Architect/Engineer's Name (if applicable) e. G' City 'State Qualifier Name aloe f nrJc��r� his 0.00 Type of Work: ['Addition EAlteration Describe Work: q `S { , Master Permit No. Phone # 7 3 <3,3 Phone # s � vv-Q___ County Miami -Dade Zip NO Flood Zone Phone # — 3aJ 75 r o ff' MA' 2 o BY: saes rs71;. .•.yebdA'd Permit No. PL l D ` 519 C, ID-38 Zip Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Phone # Square / Linear Footage Of Work: ❑New ❑ Repair/Replace ❑ Demolitign Lror , O ** * * * * * * * * * * * * * * * * * * * * * * * * * * ** * *N F p4 � Submittal Fee $ Permit Fee $ 5 CCF $ Notary $ Training/Education Fee $ ' RO Scanning $ 6, Radon $ 0 DPBR $ 0- Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 1 U. , * * * * * * * * * * * * * * * * * * ** Bond $ CO /CC $ Technology Fee $ O 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. Owner or Agent The foregoing instrument was ac owledged . efore me this day of , 20 , by who is . ersonally known to me or who has produce 10 NOTA Y PUBLIC: Sign: Print: My Commission Expires: APPROVED BY 1 1 4-identification and who did take an oath. •nc ***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (Revised 07 /10 /07)(Revised 06/10/2009) 4 '/ 3/ /e- Plans Examiner Engineer Signature Contractor The foregoing instrument was acknowledged s wlledged before me thi day of to ll. , 2016 , by Cut L vicYLNIL who is personally known to me or who has produced L l7) as identification Rts6 i:°: an oath. NOTARY PUBLIC: .�� '''''''' , �' , ' %, Sign: Print: My Commission Expires: \\ :7 < ************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk checked NAME: 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 l� ADDRESS: S E \ a,rn\ X31` 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 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 Initial 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. 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_c J - 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 C57 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:// waw. mvforidalicense .com/dbprtpro/cilbfindex.html Initial 57 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: 5 2 A 6 / c�‘S, ! <S11-0- ate'/ MS t 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. 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 Ices 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 day of , 20 By who was personally known to me or who has Produced there License or as identification. OWNER NOTARY Initial