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RC-10-1527Inspection Number: INSP - 150433 Permit Number: RC -8 -10 -1527 Scheduled Inspection Date: April 11, 2011 Inspector: Bruhn, Norman Owner: MARIN - CASTANO, MARIA Job Address: 63 NW 103 Street Miami Shores, FL 33150 -1233 Project: <NONE> Contractor: HOME OWNER Building Department Comments BATHROOM REMODEL REPLACE CEILING AND WALL TILES IN BATHROOM. passed 9j4_41 /� % Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 08, 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 Building Work Classification: Alteration Phone Number Parcel Number 1121360131100 Page 3 of 20 BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: 63 A) - W l 03 saree4 City: Miami Shores State Certification or Re Contact Phone #: DESIGNER: Value oW orr for • T' ' �k� ' ` Miami Shores Village Building Department r amw BY:......................a 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 4 C1 1Q)SZ Permit No. Master Permit No. Permit Type: BUILDING 6i�} �p OWNER: Name (Fee Simple Titleholder): 44 E. !�K%i21 64-77 - 19700 Phone #: �O 6 - 2 2. --C ct? 7 Address: 6,3 /V • W 153 S e e± City: WA/LIZ WA/LIZ SMO2ET State: FL Zip: 3.g /S Tenant/Lessee Name: Phone #: Email: County: Miami Dade Zip: 33 / S J Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: kr " Phone #: VS • 2°M ` 501D !u Address: City: State: Zip: Qualifier Name: Phone #: ermit: $ Email Address: Phone #: ddress ❑Alteration Square/Linear Footage of Work: ❑New ❑Repair/Replace ork: ❑Demolition Certificate of Competency #: COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ********** * ** * * * * * * * * * * * * ** * * * * * * * * * * * *F ************* ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ _ Permit Fee $ / , CCF $ CO /CC $ Scanning Fee $ • WO Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ g) 'Ct) 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 • t be approved and a reinspection fee will be charged. Signature Ai r , r ner or Agent Contractor The foregoing instrument was acknowledged before me this day of ,/ti , 2041, by j1f.�Eu.. E. 1 ( X) day of , 20 by who is personally known to meter who has produced r 1 � who is personally known to me or who has produced rffc NOT Sign: Print: My Commission Expires: t ation and who did take an oath. A - s NOTARY PUBLIC: r > ff c� � tir'° Print: � ���` 4 " My Commission Expires: 17 `= �, *d APPROVED BY Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Signature The foregoing instrument was acknowledged before me this as identification and who did take an oath. Structural Review Clerk Bonding Company's Name (if applicable) ' Bondinn 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, l IEATERS, 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 building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such T, sted notice, the inspection will not be approved and a reinspection fee will be charged fig Signature OWtuer or Agent Contractor T h e f o r e g o i n g i n s t r u m e n t was a c k n o w l e d g e d b e f o r e me, this 1 / The ' ing instrum was acknowl before ' 1 this 3 d a y of Tan , 20 N b y 2 Mat-1 t triar `Y] , day of y a tl J V rt.( , 20 JL by . '2 who is personally known to me or who has produced who is per known to me or who has produced As identification and who did•take an oath. as identification and who did take an oath. Signature NOTARY PUBLIC: Sign: (LL iC Print: My co l mission E ' at adra' L Noz 4 ADR a S, Corner# DD0686010 i sa i 1 >i **** ** ***** *** * ** ** ****** *,±,,�i +ii ,rte , rasa ** tar****ae+ok t,rw,�a,*** *jr 9 'a �e�a a� ,� ,tea Ag, t r.. Florida t a`. 1 nxn�• 99 9 aaaaeaaaaaa60aaaaaa0eoaaeaaaaaeaaa ■ a4 Taal � " � �}J�$rli, Inc _ t AAuaaaaeaaaaaaaaaaaaa9aaaa0aaLa ltO ri p Plans Examiner Zonmg Sign: Print: My Commission Expres :00' t? ' APPROVED BY e r®s "X aaaaaea mesenailli gzaanua ADRfANA MUNOZ ma Oamnu# DD0686018 Expires W17/2011 (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)(rev6/4/10) NOTARY PUBLIC: Structural Review Clerk BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: 63 N.A.) / b S? ee7 City: Miami Shores Type of D 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 County: Miami Dade NO OWY10.0 r at' A�1 9 1011 Permit No.. j IO/S2 I Master Permit No. Permit Type: Electrical /� OWNER: Name (Fee Simple Titleholder): / ir/2 E. /Q/?/ZII�- C4777")3 Phone #: Address: g� �3 .1..0 /o3 Sew City:� riMee 3e -ottET State: Ft- Zip: 33/ S �+ Tenant/Lessee Name: Phone #: Email: 736 - ZJ'z- -o �r Q Zip: ?3 /St Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: I� Address: New ❑Repair/Replace Flood Zone: Phone #: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/En Phone#: ❑Alteration Value of Wor ' eir `> Square/Linear Footage of Work: ❑Demolition *********** ** ************************** Fees**** ***+ x* **** a:******** *******a: ************** Submittal Fee $ Permit Fee $ � e CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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: APPROVED Owner or Agent Contractor The foregoing instrument was acknowledged before I me this The foregoing instrument was acknowledged before me this day of 1q , 2044, by N rGizl E • /� A-aaio - ), la y of , 20 _, by who is per d 1 all own to or who has produce 1 d/ who is personally known to me or who has produced qy r-o i - - ill ation and who did take an oath. as identification and who did take an oath. NOTA , ,` ' °q"a�� t�l s � „,v ' l la ' p NP. c ' l - c, ,5,• e0' C s - 4..e,r v C9 . ' i _ % " 4 1,0 i ' UBLIC: (11.1_- My Commission Expires: Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Signature NOTARY PUBLIC: Sign: Print: My Commission Expires: *** g ,p, k* , g ,p, g** t • k• kg ** kek**=k8+*ak*+k******** k***,kskiH*sN,hsk* +RS**** * * * * * * **** * * * * ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** /1 ?G 1 Plans Examiner Zoning Clerk BUILDING PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) Am E. /11,90,,70_6 Phone # 6 e ZrZ - Owner's Address f.) W 10 3 - 4e2-t- city Okt atui SILO State tL. Tenant/Lessee Name Email Job Address (where the work is being done) S3 A). ' t 3 . e City Miami Shores Village FOLIO / PARCEL # Is Building Historically Designated YES NO VW Contractor's Company Name Contractor's Address City State Qualifier Name Contact Phone Architect/Engineer's N Value of Work For Type of Word: Describe Work: Submittal Fee $ Notary $ Scanning $ Radon $ Double Fee $ Structural Review. $ Miami Shores Village 1Z"3 Building Department JAN 1 9, 201 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 .... INSPECTION'S PHONE NUMBER: (305) 762.4949 State Certificate or Registration No. Certificate of Competency No. Permit Fee $ Training/Education Fee $ County Miami -Dade Zip 327S O E -mail Zip 33 I s Phone # Phone # Permit No. Flood Zone Zip Phone # ['Alteration Phone # Square / Linear Footage Of Work: ['New ❑ Repair/Replace ❑ Demolition Violation date: DPBR $ CCF $ CO /CC $ Total Fee Now Due $ Technology Fee $ 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. Signature NOT Sign: Print: Or or Agent The foregoing instrument was acknowledged before me this ( , 244 bai . /911.4-641 day of 4 's J pe � sonally o o t me or who has produced 0 /1)--:/--- me and who did take an oath. My Commission Expires: APPROVED BY (Revised 07/10/07)(Revised 06/10/2009) gt r1. � � o pt .,' iro. 1 �1L C `j j ai• cy (9W/ Plans Examiner Engineer 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: LL Print: My Commission Expires: ** *********** Zoning Clerk checked Inspection Number: INSP - 156130 Scheduled Inspection Date: March 16, 2011 Inspector: Perez, JanPierre Owner: MARIN - CASTANO, MARIA Job Address: 63 NW 103 Street Miami Shores, FL 33150 -1233 Project: <NONE> Contractor: HOME OWNER Building Department Comments March 15, 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 Number: MC -2 -11 -273 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1121360131100 EXHAUST FAN INSTALLATION FOR BATHROOM REMODEL 7-; lat. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 22 of 35 BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: g.-'3 4)4.14) City: Miami Shores County: 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 /c. id? ee Miami Dade FED BY Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): ki 4174 o N4/i)V � 1 Phone #: 7 2 2 0'3 2 A) Address: 613 /) 9 / j�j c,.02 ee City: � 10, 17411..1 i ,J )to 2. State: FL zi p: 33_6 0 Tenant/Lessee Name: Phone #: Email: Zip: 3315 3 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 1 W Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ❑New ❑Repair/Replace ❑Demolition Description of Work: **** **+ r********°x****** ********** ***x *** F ** ***** **, x* **** ********** **+x******** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 I The fo e _ . g instrument day of , 0 f1, by who is per snally kn i'wn t r who has produced � r� o e o "" 1!<.Rv I `.21 • ' fication and who did take an oath. NOTA ' i ' UBLIC: Sign: Print: My Commission Expires: (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) $� b` Y �� APPROVED BY Plans Examiner Structural Review Signature Contractor e foregoing instrument was acknowledged before me this ,20_,by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 1.-.00 Sign: Print: My Commission Expires: ••• IOM 0 ` . *** *********** + *+ x******** ** ********+ x*** r****** **********+ x+! x***************+ x* ******+ x*+ x+> , ***+x*********** ****** ** Zoning Clerk 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: E. Ea -)2t 7'U -64-5 DATE: 0Z /14'cPJ Z-0 ADDRESS: J dtes4- 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 C. 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. 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,ihe law will presume that I built or substantially improved it for sale or lease, which violates the exemption: >: ; 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. 4 �I Initial // G 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial C— Initial Al C— Initial / C 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 lac 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. QQ 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 govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http:// www. mvforidalicense .com /dbor /oro /cilb/index.html Initial �( C. 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial 11.1 G 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 contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this B `�•_J Y'D �� Y Produced there License or O W R day of / �zr , 20 42 ► 2 1 2 as identifi Initial ILL C Initial C Initial EC— ho was personally known to me or who has tion. UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU or PKG. UNIT MODEL # COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3) VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO AIR CONDITIONING REPLACEMENT DATA Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work is being done): City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS ARI (AHRI) DATA SHEET REQUIRED Change Disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES ❑ 1. Minimum Circuit Ampacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse /Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: Phone: State Certificate or Registration N. Certificate of Competency N Signature Date: (Qualifier's signature only) BUILDING PERMIT APPLICATION FBC 20 JOB ADDRESS: 63 1I kA.) . 1 03 ST►-ee_+' i L � 1 l` ✓J_ � cs L Miami Shores Village Al116 Z Z01U Building Department BY: t-SL 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. Master Permit No..P C In7 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): /`/�/ 41Zl A HA TZ! N — Cig SAND Phone#: *RC — 2S / K Z Address: 63 N) tOS S Cit 1 1�A SttofLES State: 'F L zip: 332.5 0 Tenant/Lessee Name: Phone#: Email: City: Miami Shores County: Miami Dade Zip: 3 150 Folio/Parcel #: 4 _A Z -1 3 60 13 1 4 Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: fl ""`"' Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: I10 Type of Work: ❑Address ❑Alteration ❑New epair/Replace ❑Demolition Description of Work: ReP /4(6 C,.EIZi ahcl WZl1 -4"l / Q T 2h h. 2 Yh1^a�h� COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ** **** * ** *,ray, , ray ** * *** * * * *, ***** * *, * **pees * *, **** gar* ** *, *, * * ** * ****, *** * ***** ******* Submittal Fee $ . Permit Fee $ /0 diva CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ (D' 40 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 AFF1DAVIT: 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. j f ► Signature i' �� -� �� t er o - gent The foregoing ins + ent was ackno ledged me q,f;,, day of ;i ! 20 %d , by b, h rAktA who is person ly known to me or who has produced Sign: Prin iae ntifiaatian and wha did takesn oath. 1 � a ,� ETILVIA SALAZAR NOTARY PUBLIC: , su � — � . Notary public - State of Florld? "s ! My Comm. Expires Jul 7, 201 � � . =mission • OD 888422 s1[� . i ii.f1i r 11 ' AINENTax My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6 /4/10) Plans Examiner Structural Review Signature Contractor The foregoing instrument was acknowledged before me thisQ-4 day of 20 b y m A k t a C 7 who is personally known to me or who has produced tO as identification an 6 wyVhho did take an oath. t ITIfI /! / NOTARY PUBLIC: // .e` . / ���� fr ;� d am . Sign: Print: h _ My Commission Expiure§ :4 :. S**** P,`c`,\\�`` 40/ /mu i n11 \\ Zoning Clerk NRIZT 6 • N42/XJ - LA S774 av ARAJ . !a 3 -S ee-)- �% i4/u;' J)(b,2ES r 33/I SD m 0 1 0 0 Toilette Before Window Broken sink and vanity l et C Cep 1� 1 C e k-D cce./.7 s l A b ki )4 tJ J &u AUG 2 6 010 Bathroom wor 0 0 R. Toilette PFO`HD 70P,iNNG DEPT BLDG DEPT gwcLoflrOcsE 7-e fr 2 oi 049 .45W, -- ,td SN4lf-eveiy ) e7t i 4 Replace ceiling Window _S S )7 0 tv,e Snores Village BY New sink and vanity DAIS • • •• ••• eiL+ . • • •• • • • • • • 1 • • FS • • • • • • • • ,i274 6: /1/ 42 a.1 TAW o 63 NoY e /o i Sko/ZES l 3 /53 Bedroom Garage room Dining room Kitchen Bedroom 1 Living room Back yard 1 • . 1•••• • •• •• • 1.. • .• • ..• 1. • • ▪ • i • •••• .• • i.... • • • • •• •. 1.. . • • • • • • • N. Door • • • o Window • • • • • • • • • • • • • • • • • • OWNE R BUILDER DISCLOSURE STATEMENT NAME: i2? e "113 OJ J — 6/1' Lv 7 DATE: e5 20 /C) ADDRESS: ‘ AJGAJ . Jrh ee J 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. 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. 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 C- 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 /tt 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 Initial At C_ Initial Al G 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. Initial r` C-- 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 it G 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http:// www.mytioridalicense.com /dbpdpro /cilb /index.html Initial /u G. 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial D c G 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 contractors workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property 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. Was acknowledged before me this ��day of By t 4 4 C'`'}O i 0 who was personally known to me or who has Produced there ,'cense or PL' 7 h (S2 -5 5019 Pte/ a s i dent i ficat i on. \o "Itiuurr is41 /4 \ \ , 20 1k) Initial it C, Initial R L Initial AC NA 2 iA E. NAR.i o- 4 Now l os A.e.4 Sr, UL NA C s - +C� \Da17) o� 5' :eIS Inspector: Hernandez, Rafael Project: <NONE> Contractor: HOME OWNER Building Department Comments April 07, 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 Inspection Number: INSP - 150456 Permit Number: PL -8 -10 -1528 Scheduled Inspection Date: April 08, 2011 Permit Type: Plumbing - Residential Inspection Type: Final Owner: MARIN - CASTANO, MARIA Work Classification: Addition /Alteration Job Address: 63 NW 103 Street Miami Shores, FL 33150 -1233 Phone Number Parcel Number 1121360131100 REPAIR AND REPLACE BROKEN PIPER REPLACE BATHTUB OR DO SHOWER. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 1 of 5 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) {'Y'�42j = . f `fRIZiN� � $7»J Phone # 7-p 6 - 2 2 — Z Owner's Address €.2 Ai. (- /0.2 5 cit /f j $Ji T State FL Job Address (where the work is being done) Contractor's Company Name Contractor's Address Architect /Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addition Describe Work: Submittal Fee $50 -�7 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Miami Shores Village Building Department Permit Fee $ Training /Education Fee $ E -mail Violation date: DPBR $ Permit No. PL. 10 1 s2 Master Permit No. zip 31 /..SO Tenant/Lessee Name Phone # Email City Miami Shores Village County Miami -Dade Zip ( S p FOLIO / PARCEL # 4/1 2 A. 2 6 013 -a -1 Is Building Historically Designated YES NO Flood Zone Phone # City State Qualifier Name State Certificate or Registration No. Certificate of Competency No. Contact Phone Phone # r7co•o ['Alteration Sgy4tre / Linear Footage Of Work: ENe Repair/Replace a pt .. ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ Notary $ Scanning $ Radon $ Double Fee $ Structural Review. $ Total Fee Now Due $ 1 r 0(Q Zip Phone # CO /CC $ Technology Fee $ Bond $ [fp (Mg"R'Zifi) Al AUG 2 ' 2010 BY:...' 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 reinspection fee will be charged. Signature The foregoing ins day of caner or Agent ment was acknowledged e, / e, this ,20�,by who is perso ally known to me or who has produced NOTARY PUBLIC o cia Hgtl .lo aii t •kn ai.: f..L tL �4• "� ETILVIA SALAZAR ? ' .� `o''s Notary Public - State of Florida •- a My Comm. Expires Jul 7, 2013 ' ' Commission # DD 899422 Bonded Through National Notary Assn. Sign: Print: My Commission Expires: 1 / 1 / 3 APPROVED BY (Revised 07 /l0 /07)(Revised 06/10/2009) /z74 Plans Examiner Engineer Contractor The foregoing instrument was acknowledged before me this2 day of 20 by RA-12.4A- 4 0 who is personally known to me or who has produced as identificatioront(iyyjVid take an oath. NOTARY PUBLIC: ��`��,0 3 .(a,'�� 106S91 ,� - uoIssiwwo,,� Sign: Print: ZLO !9010 My Commission Expir6s; ✓�� l .02) ` • ' +Sim∎\'' Zoning 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:/ /7 / fT(s — - ,s i s DATE: j, ADDRESS: ; At GU l © J,ee4 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. 1 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 /u (� 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 1l C 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 C- 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. " G lnitiat NG 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial it 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 /' L 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.myfloridalicense.com /dbpr /pro /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: 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. Was acknowledged before me this day of , 20 Produced there License or F D 5 - -as identification. ti • � .i mow/ ■eflia4PW.,11409110"■ 7: e Initial NZ Initial Initial 6- By rn 1 L\ E1/4`- u who was personally known to me or who has Inspection Number: INSP - 157983 Scheduled Inspection Date: April 06, 2011 Inspector: Devaney, Michael Owner: MARIN- CASTANO, MARIA Job Address: 63 NW 103 Street Miami Shores, FL 33150 -1233 Project: <NONE> Contractor: HOME OWNER Building Department Comments REPALCE OUTLET TO GFI IF NEEDED. Passed • Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 05, 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 Number: EL -8 -10 -1529 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number ,\z-7 Parcel Number 1121360131100 Page 16 of 16 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL, Owner's Name (Fee Simple Titleholder) 4// iV. e , kf/Z ))u v "%-,Phone # Owner's Address CZ /U. W. 11, City zfvvr. J Tenant/Lessee Name '-- Email Contact Phone Architect /Engineer's Name (if applicable) Value of Work For this Permit $ 0 . Type of Work: DAddition [)Alteration Describe Work: Submittal Fee $ 10 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 State F/ E -mail Permit Fee $ ar d CCF $ Zip 3 3 1 S Phone # paNg Ai AUG 2 f 2010 BY: �» Permit No. I V 15,2.'9 Master Permit No. Phone # ZP' 4-? Job Address (where the work is being done) 63 D . f, City Miami Shores Village County Mianu -Dade _ Zip 33 FOLIO / PARCEL # //J 2 3 6 0 4 ,/ Is Building Historically Designated YES NO Contractor's Company Name tk-04".1C�Z..2- Phone # Contractor's Address Flood Zone City State Zip Qualifier Name : Phone # State Certificate or Registration No. Certificate of Competency No. *warn/ Linear. Footage Of Work: [140: l(R air/R lace eP �P ❑ Demolition **** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * * F ees* * **** * **** * ** * * * * * * * * * * * * * *,* * * * * * * * * * * * ** C $ Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ )0 Technology Fee $ Bond $ See Reverse side -a 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 The foregoing instrument was acknowledged before efore thi day of ,� ` , 20 1 0, by NOTARY PUBLIC: * * * * * * * * * * * * * * * * * * ** APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) who is perso ally known to me or who has produced As identifiF;l }iiri"ll5tf'VOI r ° `.R Notary Public - State of Florio • 6 � : • = My Comm. Expires Jul 7, 20' JAI b � Commission #r DO 899422 ' °` '� Bonded Through Natio Notafy As:. Sign: �� Print: ati h My Commission Expires: i/ 1 // 3 Engineer Signature The foregoing instrument was acknowledged before me thi day of , 20 by k4Jn►C who is personally known to me or who has produced RJ9 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Air # uo∎cs My Commission Expires: : 11160d ��tl1ON Z4011901t0 .� •. saa i d�'� ' �S 01 , £Plans Examiner Zoning 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: 111 9.64 . Will Ij 64: 0 DATE: I/ ADDRESS: A) LU `v3 f?1ee) 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 1 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 G 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 it 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 N C. 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 / G 5. I understand that, as the ownerbuilder, I must provide direct, onsite supervision of the construction. Initial A G 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 /'I C. 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 ,1 C 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 G 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 /prolcilb/index.html Initial ki G 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 c 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. 6B�' Initial /°G c 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. Was acknowledged before me this day of ---- , 20 10 BylAQial 1 CASIAcr who was personally known to me or who has icense or c l 1P H 2 - 5 '6 1 p9 • asA� Produced the VAIIIP' • WNER • /ii eietkrao