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RC-11-285Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156206 Permit Number: PL -2 -11 -287 Scheduled Inspection Date: June 08, 2011 Inspector: Hernandez, Rafael Owner: BENEDETTI, LILIANA Job Address: 864 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060050330 Building Department Comments PLUMBING RE ARRANGEMENT FOR WASHER & DRYER RELOCATION, AND BATHROOM REMODEL IN UTILITY ROOM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 07, 2011 For Inspections please call: (305)762 -4949 Page 6 of 24 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 BUILDING PERMIT APPLICATION FBC 20 FECIEEWIE FEB 2 2 gt BY: - --------- ® ®00000 - -_ Permit No. 11 11 Master Permit No 11-26 Permit Type: PLUMBING 'L ""�� ` OWNER: Name (Fee Simple Titleholder): Ra .Q0ei �2r¢:�e` ‘.IA to ta.Kor i phone #: 306 6OO 0 54 Address: ova, ` PE; G(( Tom° City: avita fill 5rUci Tenant/Lessee Name: State: Email: tt �d �1'f®p� mac r zip: 3 3 138 Phone#: JOB ADDRESS: C3 W-f N�% ell TeX City: Miami Shores County: Folio/Parcel #: l (r 3W6 — 006 0:330 Miami Dade Zip: 5313e Is the Building Historically Designated: Yes NO Flood Zone: iiC) CONTRACTOR: Company Name: liOnIVCO CL) 2' 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: $ 4160 Square/Linear Footage of Work: el® ONew ORepair/Replace J ODemolition Type of Work: ❑Address sgAlteration Description of Work: Zaeltet1 61. '• ,' i , 1 /gy p ,,Ci• ******** ** ****** ** ****** *** ** **** * ***** Fees************* ************ * ** ****** ******* * ** V Submittal Fee $ cDO-no Permit Fee $ ii, 0 — CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ (P142.V9 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address P., 0 ° City state tt zip 15457 04- - 6� 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 reinspe tion fee will be charged. Signature The for ;;mg�nstrument was a day of NOT Sign: Print: My Commission Expires: Signature Contractor Ths foregoing instrument was acknowledged before me this f ,20_,by ho is personally known to me or who has produced as identification and who did take an oath. R+ NOTARY PUBLIC: . ign: 1 Print: My Commission Expires: ******** ***+ p +x *+x****** *+x *+x*+x****x *** ***** :**** ********* ** ** *** * *** ** x****** ** *+ x***s: *+x************ ** ** * * *** *** APPROVED BY .2-Z 3 -i/ Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 J OWNER BUILDER DISCLOSURE STATEMENT NAME: Lt (a R 0 , - ) R 0 , - ) 1 ' / - 0 _ d 1 r DATE: `d'(8a / f I ADDRESS: 86 64 1 M 1 G fl11 G hOr . 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 Iicensg 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 ogr,substantially improved it for sale or lease, which violates the exemption. 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initia 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. 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.myfloridalicense.com /dbor /pro /cilb/iindex.ht I 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: ere,et 0" c ier 1,41 a �i �h�rC s Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information tha 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 By UL Produced there License or 0i' VIC114—;vho was personally known to me or who has 921(p (p rL /JO lidentificati .., �)_ �� .:. c�Z3 tb� p} C o� iD3 X1 �s t� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156203 Scheduled Inspection Date: June 08, 2011 Inspector: Devaney, Michael Owner: BENEDETTI, LILIANA Permit Number: EL -2 -11 -286 Job Address: 864 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060050330 Building Department Comments ELECTRICAL ARRANGEMENT FOR WASHER & DRYER RELOCATION, AND ELECTRICAL WORK FOR BATHROOM REMODEL IN UTILITY ROOM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 07, 2011 For Inspections please call: (305)762 -4949 Page 5 of 24 Miami Shores Village 11,E FEB 2 2.2011 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical Permit No. Master Permit No. BY: OWNER: Name (Fee Simple Titleholder): " elew iiktitt ma) `'it ' Phone #: ' 60 '..C4561 Address: SG+ ,Je CI( ore/ City: I [ot f'i'lm P1G t S State: Zip: 3-3 13 Tenant/Lessee Name: Phone #: Email: 1 Itealltir ((ntp CZ JOB ADDRESS: E3G4 : clI City: Miami Shores County: Folio/Parcel #: U— 3Q aa 005 as 8 0 Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: DESIGNER: Architect/Engineer: Phone#: Miami Dade Zip: 33IB8 14o often W (lam Flood Zone: t Phone #: Email Address: Value of Work for this Permit: $ 600 Type of Work: ❑Address Alteration Description of Work: !' ! S�(- x10 -, a, r. i LUQ anCi Ql "n• Square/Linear Footage of Work: New ❑Repair/Replace eif(DI de � g 1 1 r) 1)6 ODemolition * * * * * * * * ** * ** Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ ** * * * *****x::**+x********** Fees***+ x***** ********** **** **** * **************** Permit Fee $ /✓ d e-a'a CCF $ CO /CC $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology 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) el H tt Coo Mortgage Lender's Address City LOCtter 00 State Zip S� L ii & 2 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 A14}1DAVIT: 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 rein ,section fee will be charged. Signature Owner or Agent The fo in instrument was kn day of ,20a,b Signature Contractor The foregoing instrument was acknowledged before me this yof ,20_,by ho is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: who is ersonally known to me or who has produced identification and who did take an oath. NOT Sign: Print: My Commission Expires: ******* ************d s****+k+k+k***** A* +k+k****** k********* k*+ k***+#+ k****+ k+ k+ h*sk****+ k***+ k****+ k*sk********************** Plans Examiner Zoning Sign: Print: My Commission Expires: APPROVED BY Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 p � OWNER BUILDER DISCLOSURE STATEMENT NAME: L1 t Crke-J -o CJ Y &CI DATE: p a l aR) ADDRESS: :Oa tk Ol I 4t f 1 OM( 6kilttoi g 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 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 licen ,; bers on 1 permits and contracts. Initial r 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 substanti ally improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. �� Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial (7;(-1 � 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property . Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that 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. Initial £ r 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 : /lwww.mvforidalicense.com /dbpr /pro /cilbfindex.ht 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: e6if 01/4.16 cu flitarni '3 13 Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatio 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 a day of was personally known to me or who has Produced there License or identificati Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156179 Permit Number: RC -2 -11 -285 Scheduled Inspection Date: June 09, 2011 Inspector: Bruhn, Norman Owner: BENEDETTI, LILIANA Job Address: 864 NE 91 Terrace Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060050330 Building Department Comments REMOVE AND REPLACE DRYWALL ON PARTITION WALLS IN UTILITY ROOM. REMODEL EXISTING BATHROOM IN GARAGE. Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 08, 2011 For Inspections please call: (305)762 -4949 Page 5 of 17 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. (( v" 2- TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. egal description of property and street/address: 2 Description of improvement: Owner(s) name and address: nterest in property: Name and address of fee simple titleholder 4. Contractor's name, address and phone number 111111111111111111111111111111111111111111111 CFN 2O11Re o1. tea-4 -9.3 DR Bk 27602 Ps 1081; (1nl ) RECORDED 03/01/2011 14:57:00 HARVEY R:UVII'ar CLERK OF C :OLIRT MIAMI- -DADE COUNTYr FLORIDA LAST PAGE Space above reserved for use of recording office (wail Sh -R319 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or of pC qppxl.ung may be sery vided by Section 713.13(1)(a)7., Florida Statutes, `��'�'$ Name, address and phone number. 8. In addition to himself, Owners designates the following p ron- recet �✓ c the' ers enor- siSIbtice 71313(1)(b) Florida Statutes. on a a es. f .,i�.� "a Name, address and phone number RD v� 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Prepared By Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADS Be f�ggoin• in 1 ment was acknowledged before me this day of �tf By IL ❑ Individually, or ❑ as ❑ Personally known, or Officer/Director /Partner/Manager Prepared By Print Name :. 't ►,l f Title /Office - 4 I M l�(_ M t 744)-62 t PL -i'3 H/�eCAr `````<1/lltflffftP!/���/f (1 ,�`�'� -� mil``\, for roduced the following type of identificatio Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. sue0 0 $/Off11114}} \ \ \ \` \\\`\` Signature(s) of Owner(s) or Owner(sys Authorized Officer/Director/Partner/Manager who signed above: By By 123.01 -52 PAGE 3 3/10 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Te1: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type •' UILDING % ROOFING OWNER: Name (Fee Simple Titleholder): Rafael. Seneadi L�J RM@METTEll IR FEB 2, 2011 BY: Penult om 1) — 2.16 No. Master Permit No. atAphonet h Address: e4 1r e- q I City: t 10 011 4 Oe5_ State: Tenant/Lessee Name: Email L! l lsl4.o�s � Ct C ° CC'Yr Zip: 3 1 Phone #: JOB ADDRESS: f3(7°T 9t City: Miami Shores County: Miami Dade Folio/Parcel#: ° 5� ®-c — 0 0 5 ° 0 30 Zip: 3-3 )3Y Is the Building Historically Designated: Yes CONTRACTOR: Company Name: 1 Address: City: State: Z p: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Q NO 4 Flood Zone: fl Phone#: Value of Work for this Permit: $ Type of Work: OAddition UAlteration Description of Work: `Pe tQce. uh 1 cd ,s s e�h Phone#: Square/Linear Footage of Work: /03. UNew 'Repair/Replace Demolition 0rn k and co) I new trt n c'd —re/rink c -•er 0 2- CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ UW Submittal Fee $OOQ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ° � 9 3 = . Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) `e m �/ 1 e Mortgage r f. Lender's Address 0 J J t A ' 92 V � City a *e400 State ) A- zip Qt ' 6 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reins ection fee will be charged. Signature ot,4 Owner or Agent The f� , instrument was ac n __ led ed before day of 4 ,2011,by �b sonally known e or who has produced ntification and who did take an oath. �ma1���titi me this' / NOT Sign: Print: My Commission Expires: Signature Contractor TO foregoing instrument was acknowledged before me this y of , 20 _, by o is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: * * *** R****9+ 6***4 ****+ U*****N ***+ M**** *+ F****** ********aR +R**aM ****+U***dR**+ *** **B **+ R**aA***R+ **$ ********+k********** APPROVED BY 0 42Cif Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /1012009)(Revised 3/15/09) 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: (J t.k G r! DATE: O9I9I L ADDRESS: 636q I Fez Ol iom i (Shc yeJ .33 I3 Si 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; 1 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. 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 licenspnrjumbers 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 s antially improved it for sale or lease, which violates the exemption. Initial 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial �� 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner - builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner- builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial r 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.myfloridalicense.com /dbpr /pro /cilbrndex.htmle 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: ° l JEgI , -orni 6kore_s .93)ae 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatio, t at have provided on this disclosure. Initial 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 Produced there License or—TA , 20 \ICL;tho was personally known to me or who has 26-0 % _ (.identification. Pet? �' /� a c ��% �--c e 47-/ 77 °-/z7):- - r 2 9Jvei9/2" /to �,� t�e���!�aG p e7@e,%A9 sue 1 'Tee' T�tct�nr glOrfsfv3 C2 C,° `(i ;("Cd ftT‘ red s I via 11 crM° I Yn lace, (s� t (tLLA) ,grid 7 . ,» ' 7 • • • •• • • ••-_ •••••• • •••• • • •••• • • •• •• • • • • • • • •• • colt° IC.