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PW-11-442Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ei -310 Inspection Number: INSP - 157159 Permit Number: PW- 3- 11-442 Scheduled Inspection Date: June 07, 2011 Inspector: Bruhn, Norman Owner: LOUZADO, LYLLIAM Job Address: 33 NW 98 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number Parcel Number 1131010330150 Building Department Comments TRENCH IN ALLEY FOR UNDERGROUND SERVICE Inspector Comments PasseJ�' (121,� Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 06, 2011 For Inspections please call: (305)762 -4949 Page 2 of 11 ROVTin 14010 2.01 Miami Shores Village Public Works Department 10050 N.E. 2nd Avenue, Miami Shores, Florida 33138 ^� Tel: (305) 795.2204 Fax: (305) 756.8972 J 1 1 G / Public Works 0,Sl(i%Perm t iNo E L- 2 - (310 Permit Application FBC 2004 ( % Permit Type: Public worm WATER Phone 0: •� `J - �l g '� -J6- 8 owners Name (Fee Simple Tttleholder) 2 d Z 1 r Owners Address 3 3 ti l6,1 I . city If; H i 0 iZ F S state. . 1G ZIP 33/6 .a Tenantlessee Neale. Job Address (where the work is being done) City Miami Shores Village 33 iz-)&-) 9 (' 971- County Phalle 0: Is Building Historic* Designated: YES opo-)Fk, Rf C4 6 rcc% Contractors Comparry Name Contractors Address City Zo U 6(-; !Aland Dade NO . uz zip 73 I-6 3s nip H1 664(s Phone 0: 30c:76-6-59-88 State Archited/Engineers Name Of applicable) Phone B: $ Value of Work For this Pemdt Type of Worts Describe Work: Zip 33 / 'D LInea Footage Of work: for Bonding Company's Name Cif applicable) Bonding.Companys Address N/A City State Mortgage Lender's Name (if applicable) N/A Mortgage Lenders Address City State 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 permft and that all work will be performed to meet the standards of all laws regulating constgdion in this jurisdiction. I understand that a separate permft 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 this Issuance of a Public Works permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and cor sb ,ctlon lien haw broohwe will be delivered to the person whose property Is subject to attachment. Also, a certified copy of the reowded notice of commencement must be posted at the Job site for the list Inspedfbn which occurs seven (n days after life building permit is issued In the absence of such posted notice, the inspection will not be approval and a refnspecition fee will be charged Signature Signature Owner or Agent Contractor The foregoing Instrument was admowtedged before me this l The foregoing instrument was adcnowledged before me this day of , 2011., by, `L Loolakci day of , 20_, by who is personally known to me or who has produced _D Who is personally know to me or has produced ow i I it rho as identification aq( \`%6Qhkqty 6tjth. as identification and who did take an oath. NOTARY PUBLI NOTARY PUBLIC: a0' Sign:. � Sign: Print: ?10?/90//0 Print My Commission Expires: , q ' d' My Commission Expires: APPLICATION APPROVED BY: :r 11/17/2005 Public Works Director or his designee. 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: 2 i c(/dd / a �-0. ?Ad3 DATE: �((t l a J 1' ADDRESS: 3 3 5 a- 1-0 A 1-17 o 4 s TL 3 3 5 3 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 R 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Q / 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 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial L 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 k. <- 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 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: Initial a- ` �' 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 ` L 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 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 By (Lqe�j Produced there License or day of RA. , 20 I l who was personally known to me or who has d ty > 4 C(0 OWNER as identification. �11111111l/r1,,, p,rlen;o/ NOTARY�l'p `� %6i co c 2,� �o� 03 ro U 0 Zone Inf b 0 0 w nl i MAR 11 2011 jh, 5 -05 -03 "Grade Elevations" added . -7)n��� �� � 47 Miami Shores VIIlage APPRQ ; ° , BY-- - itsATE ' ZONING • EPT ?/C/F/1 FEDERAL BLDG DEPT /� SUBJECT TO COMPLIANCE WITH ALL STATE AND COUNTY RULES AND REGULATIONS 5 -05 -03 "Grade Elevations" added . -7)n��� �� � 47 kJe ct,t e H v e„.1/\ GQQVUvee pe twu f 11146vc Oven -end p � e 1 e s el e(-97a .uf-c The j � - I0 - � ce 19-e k cal -i-�, € �.c� 5 ot v -e c A.e .5 �. c a, �7z r vv`\ la C * 0,)1 11 v OW-e l Vi-e. s he the c) 10 ► s IAAO v\v-e kAa p c‘.1 ck 5 13 oi 1-f K;c/cA,