PL-11-1180Inspection Number: INSP- 161498
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 1 1 '
Permit Number: PL -6 -11 -1180
Scheduled Inspection Date: September 23, 2011
Inspector: Hernandez, Rafael
Owner: QUINONEZ, FRANCISCO
Job Address: 188 NW 104 Street
Miami Shores, FL 33150-
Project: <NONE>
Contractor: HOME OWNER
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360131500
Building Department Comments
CHANGE FIXTURE IN BATHROOM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 22, 2011
For Inspections please call: (305)762 -4949
Page 2 of 6
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NW
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
188 NW 104 Street
Miami Shores, FL 33150-
1121360131500
Block: Lot:
FRANCISCO QUINONEZ
1
Owner Information
Address
Phone
Cell
FRANCISCO QUINONEZ
188 NW 104 ST
MIAMI SHORES FL 33150 -1240
Contractor(s)
HOME OWNER
Phone Cell Phone
Valuation:
Total Sq Feet:
$ 750.00
0
1
Type of Work: CHANGE FIXTURES ONLY
Type of Piping:
Additional Info:
Bond Retum :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$0.60
$2.25
$2.25
$0.20
$150.00
$3.00
$0.80
$159.10
Pay Date Pay Type
Invoice # PL -6 -11 -41328
09/21/2011 Check #: 4712
06/29/2011 Check #: 4689
Amt Paid Amt Due
$ 109.10 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Final
Underground
ti
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL PLUMBING, MECHANICAL WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
September 21, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
September 21, 2011
1
-1 IS
-4eTe
16k 11
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
a JUN 2 9 2011
B°io__a
Permit No. PL. I t ®� t
Master Permit No.
Permit Type: PLUMBING
OWNER: Name (Fee Simple Titleholder): 1 DCIGCC) l) t ) O )€2-Phone#: --(g6-aso c�-3
Address: *S U')
LOA
City: 1-'Al t G State: Zip:
Tenant/Lessee Name: Phone#:
-1-iQ 0[1.90 €7- 3a. o GDS
Email:
JOB ADDRESS: t vio. y.) t) 1154
2
City: Miami Shores County:
Miami Dade
Zip: 3-5 CS-230
Folio/Parcel #:
NO ° Flood Zone:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name: tXL— 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: $ 75b Square/Linear Foo e of Work:
Type of Work: ❑Address DAlteration UNew I�Repair/Replace ODemolition
Description of Work: Cobt� -�-1E e' lLE , - 14 V1.t-i t i 7c C.- 5 � erotti n
PeLiv* 1(5 c��i'1 c ovn - N1eu- 1 tLe -1-4=3 +treE1 11-40Q —
** ** : ** **** ***** ***+ n****************** Fees*+ x** ******************* * * ** x *+x*+xm***********
Submittal Fee $ Permit Fee $ /6 6 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ I 01' 1,
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 '• attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whiiccurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approv d spection fee will be charged.
$Signatur
wner or Agent
The foregoing instrument was acknowledged before me this
day of ,20_,by
who is personally known to me or who has produced 1
lc� i 11l.ja4,
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
111 u ut)/, //
.... ', .
b
44c4 4:ek
.y': J=
.�
-* <4, 0�
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:
* * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Sign:
Print:
My Commission Expires:
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: Z-9,- ' Q,,, DATE: Z/B
ADDRESS: t 42)S Ord t 0-4
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 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 resp
construction and is not hiring a licensed contractor to assume responsibility.
Initial
for the
3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may p i ct myself
from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instea of my own
name. I also understand that the contractor is required by law to be licensed in Florida and to list his or lice 5 bers 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 ' uil . 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 substan i. improved
myself is sold or leased within 1 year after the construction is complete, the law will presume that I bui • •.tantially
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.
Initial
Initial �_/
/building or
unty or
6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on
residence. It is my responsibility to ensure that the persons whom I employ have the license required by law a
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
8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is ninses 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 =1 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.myforidalicense.com /dbpr /pro /cilb /ind
Initial
11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am
legally and financially responsible for the proposed construction activity at the following address:
Initial
12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informati
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 no e 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
By who was personally known to me or who has
Produced there v .r as identification.
NOTARY