Loading...
RC-11-258Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156047 Permit Number: RC -2 -11 -258 Scheduled Inspection Date: July 26, 2012 Inspector: Rodriguez, Jorge Owner: RIVAS, REBECCA & RODOLFO Job Address: 145 NE 110 Street Miami Shores, FL 33161- Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)458 -1933 Parcel Number 1121360040190 Building Department Comments REMOVE EXISTING WOOD PANELS ON WALLS AND REPLACE WITH DRYWALL AND INSULATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 0 July 25, 2012 For Inspections please call: (305)762 -4949 Page 1 of 26 September 8, 2011 Rudy Vivas 601 Channelside Walk Way #1338 Tampa, FL 33602 305 - 458 -1933 rvivas @gmail.com RE: Building permit extension request for 145 NE 110 Street, Miami Shores, FL 33161 Residential Construction Permit # RC -2 -11 -258 Good afternoon, Please accept this letter as my official request for an extension on the currently valid building permit for my house located at 145 NE 110 Street, Miami Shores, FL 33161. I need an extension granted because shortly after receiving my permit I accepted a job in Tampa which forced me to relocate, therefore, restricting the time I've had to work on the project. With that said I have made considerable advances to the project and anticipate being finished within a few more trips to the house. I appreciate your attention and support of this matter. Please feel free to call or email me with any concerns or if there's anything else I need to submit to have the extension granted. Thanks again! Best regards, Rudy Vivas (yVJ pro do-�s aIabItou tep. 314In r Miami. Shores Village f EB '' 1311 Building Department BY: ppp0O ..a0 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. f-Co) 11 9°S Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Type: UILDING ROOFING OWNER: Name (Fee Simple Titleholder): TRex'cco -4- 1 Oci01 co V i \do& Phone#: 30S- 401-52.14 Address: 1'-1 S Iii C. 11 O 5 T. City: N\ \ LRv,n\ State: L Zip: .31 Co 1 Tenant/Lessee Name: Phone #: Email: \DCCccx \ou os ,r,eti- JOB JOB ADDRESS: \ 1\1>; \ to ST City: Miami Shores County: Miami Dade Zip: 3 31 to 1 Folio/Parcel #: 1- - (71 Is the Building Historically Designated: Yes NO v" Flood Zone: X CONTRACT R: Company Name: 0 W nee Y Phone #: Address: City: State: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #:, Contact Phone#: Email Address: ESIGNE .: Architect/Engineer: Phone #: Zip: 600 rr 2 Value of Work for this Permit: $ Square/Linear Footage of Work: y3- T t Type of Work: UAddition ®Alteration ®New A`' epair/Replace UDemolition Description of Work:..Relav e. e.X 1SA-1 +nc or c ? c nf1S n`n k a \\ S a SCI re \D1ace \N.) r\-V, �1Yy.�1U\1.ra�nd ttnS()\ct1icurl N�9 �j,. V. ' 1 * * * * * * * * * * * * * * * * ****** *** * *** ********Fees************* * * * ** ***** *** * * * *** * *** * ***** Submittal Fee $ Permit Fee $ 75-21 P °O 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 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 CONDTTIONERS, ETC OWNER'S AI'FIIAVIT: 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 &9L' P,t' a V..l,(.a(f2 Owner or Agent Signature Contractor The foreg n instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ((''i > 20 ` -1 by (V `� �L-U� A Nic 1 -5 day of , 20 by who is personally known to me or who has produced Pt, 1 0 who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC.: T NOTARY ?" U t LIC: Sign: Print: My Commission Expires: APPROVED BY 1. oTV . • 617 uct "�0:._ Sign: Print: My Commission Expires: **4,4146145** k *sk**naga*****sk***************rla:k****** J : Q ~ ner / 00 (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review * * *** * * *** **S*** * * * * ** 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:2ebeCCa\IAias DATE: 2-15 - \ 1 ADDRESS: \ IA E, \ 10 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; 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 Rv 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 P V 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 "Rv 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 fF 5. I understand that, as the owner- builder, I must provide direct, onsite supervision'ofthe construction. Initial "-RV 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 RV 7. I understand that ft 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 7 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 -RV 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.mvfloridalicense.com/dbor/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: t...1E 110 St. Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial 'RV 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 13 day of 7 , 20 ( I Produced there License or owl M.C.Oe U .r.41G� OWNER who was personally known to me or who has 001111/w/o, as,.' nti "/ �> ��yo'' , f��OO, a% • co oing111111$0t \‘‘ THIS INSTRUMENT PREPARED BY; Kishisha B. Sharp, Esq. K.B. Sharp, P.A. 180 N.W. 183"' Street Suite 117 Miami, FL 33169 Property Appraiser's Parcel Identification (Folio) Number: 11- 2136 -004 -0190 WARRANTY DEED 1 11-111111111111111 -11111 11111 1111111111 CF`N 201 OR 04 -139'4 0 OR Bk 27325 Pss 2172 - 2173; (bps) RECORDED 06/1B /2010 14 :36 :07 DEED DOC TAX 1,668.00 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA THIS WARRANTY DEED, made this 14 day of ja rte._, 2010, between Rodney K. Carey and Denise S. Whisenhunt, husband and wife, whose post office address is 10232 Rue Saint Jacques, San. Diego, California 92131, hereinafter called the Grantor*, and Rodolfo Vivas and Rebecca Vivas, husband and wife, whose post office address is 145 N.E. 110th Street, Miami, Florida 33161, hereinafter called the Grantee *. *Wherever used herein the terms "Grantor" and "Grantee" include all the parties to this Instrument and the heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporations, wherever the context so admits or requires. WITNESSETH: That the Grantor, for and in consideration of the sum of TEN AND NO /100 ($10.00) Dollars, and other good and valuable consideration to said Grantor in hand paid by the said Grantee, the receipt whereof is hereby acknowledged, does hereby remise, release, and quit -claim unto the Grantee forever, all the right, title, interest, claim and demand which the said Grantor has in and to the following described lot, piece or parcel of land, situate, lying and being in the County of Miami -Dade, State of Florida, to wit (the "Property"): Lot 20, Block 1, COLLEGE HEIGHTS, according to the map and plat thereof, as recorded in Plat Book 42, Page 8 of the Public Records of Miami -Dade County, Florida. TOGETHER WITH (i) any and all structures and improvements on the Property; and (ii) all easements, rights of way, privileges, licenses, appurtenances and other rights and benefits belonging to, running with the owner of, or in any way related to the Property. TO HAVE AND TO HOLD the same in fee simple forever. SUBJECT TO: real estate taxes for 2010 and subsequent years, covenants, easements, and restrictions of record, matters appearing on the plat map, existing zoning and governmental regulations, and any mineral rights (collectively, the "Permitted Exceptions ") without intent to reimpose same. AND the Grantor covenants with the Grantee that the Grantor is lawfully seized of the Property in fee simple; that Grantor has good right and lawful authority tb sell and convey the Property; that Grantor fully warrants the title to the Property and will defend the same against the claims of all others; and that the Property is free of all encumbrances, except for the Permitted Exceptions. -e A ti n rD • ' ID 'i'1 ILE SERVICES CO 1175 N.E. 125th. ST, S -512 N, , it . FL 33161 Permit No: 11- Job Name ,2011 Miami Shores Viiiage Building Department Building Criti a Sheet z120,G4:dee 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE TED ON THE JOB SIiE AT TIME OF FIRST INSPECTION PERMIT NO. 1— 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 inn accordance with Chapter 713, Florida Statutes, the following fr formation is provided in this Notice of Commencement. 111111111111111111 1 11111111111111111111111111 CFN 2011R0145819 OR Bk 27607 Ps 4035; (ups) RECORDED 03/07/2011 10 :31:10 HARVEY RUVIN, CLERK OF COURT HIANl -DADE COUNTY, FLORIDA LAST PAGE Space above reserved for use Of recording office 1. Legal description of property and street/address: Lot 20 3 Plot k % cot e- WY' i ►<, °rt 1L WE I1® St' Minorti,FL (ol 2. Description of improvement 1 lmOVO -.1 o (` wood , oiiP.i nil 4- Pe pin ctr. w )1 +t Aµ/ wa 11 4- rvisufr*on. 9 .9. 3. Owner(s) name and address: 'Rodol RD 4- IZI.ehe ce a V )vas Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone number. Owner $vi 1 der 5. Surety. (Payment bond required by owner from contractor, H 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 other documents may be served as provided by Section 713.13(1)(x)7., Florida Statutes, Name, address and phone number. 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(6), Florida Statutes. Name, address and phone number. 9. Expiration date of !his Notice of Commencement (the eapbUon date is 1 year from the date of recording urdess a different date ig spedfted) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTIQE 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. Signatures) of Owner(s) or Owner(s)' Authorized Officer/Director/Partner/Mana4 Prepared By Prepared By CCOVNAc ,.et".ea. tkfit/agc- Print Name Print Name 1ehecca VNas Title/Office Me/Office (4S Ni e, 11 O 5 } H t Qm i ,s---1, 331(4 ( STATE OF FLORIDA COUNTY OF MIAMI -DADE /�/� B The .. , y w1i1 was :.,,,�., ifged before me.this 4. day oft WI 1. Y. �a Individually, or 1 as L° - ill for a s produced the following type of Identiflcati. "' ®r. � tillte rlt2 Signature of Notary Public: 1 A TTIM 11,11! I -' Print Name: it 1 #Lr f��i4911sra (SEAL) T107AI2i'IUBIICSTATb01 : �ll TO : C i • : _...• 0 a ! . Claudia - Ls - ri' "" 'rE V cubillOS- Under penalties of perjury, ) declare that 1 have read the foregoing and E. ,1 -Commission #DI)7 7 3 __._thatihe..factsstatedto karea _,;- yy s$ r- tQ�he- best- Qf- myla�owlBdge -aitd- belief 4aeaWar pixes: ElP. 23, 2011 Si aatttre(s) of Owner(s) or Owner(s)'s Authorized Officer/ Director /Partner/Manager who signed above .31217411AMMEMMRSC°1317C. 1 k By Personally known; or trdmda PAGES 3110 — I A�TEOFFLORlGA, t OUNTY' 6F t3%t( f HEREBY CERTIFY that this is a true copy of the armenial Ned in Ihis office on _ day of PR 0.1 2011 ,AD20 NITNESS my hand and Official Seal. -iAR RUVIN, CLERK, °I C/ it and County Counts R: a _i r -� D.C. Sketch of i;,tt: c 0 QMPLIRIVC WCTH FEDERAL . IlT1' RULES AND RE GULATIONs s tez ° r'. describe as.; COLLINS .HRXGRTS. e€d .rig to the Plat thereof. as recorded in Plat hook 424. Page $ of the Public Records of du County. Florida, x„ Re%MO\70.\ OF WOOL por.e\inq 4 replao wO ;n u1a-h n and cryuoat1. a • • ... • • • ... ■ • • • • •.■ • • ■ • • • • . . • • • 009 ..:•. •• ■ • ■ ♦ • • Insulation Info 314 in, 4 ft, x 8 ft. R5.O R•Matte Plus 3 Energy Star Compliant : Yes Insulation Type : Sheathing Interior /Exterior : Interior /Exterior R Value : 5.0 Sheathing Type : ISO 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 FEB '4 8 2011 Permit No. f .\ 1 °' Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): R&P Oa V 1 VaS Phone #:3©S °901-58 Address: \ L\ 5 1J E 1' 0 s-r- City: (Q■ \001`1 State: 1 , Zip: 110 ) Tenant/Lessee Name: Phone #: Email: be CC a \ e k 1Sov JOB ADDRESS: OA 5 £E \1 O S-T City: Miami Shores County: Miami Dade Zip: 7)3 (s) Folio/Parcel #: Is the Building Historically Designated: Yes NO X Flood Zone: 7( CONTRACTOR: Company Name: Owen f-`e - a‘) ►1 d 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: $ !L X1 Type of Work: Address ❑Alteration escription of_Workn 9• CN1.r • Square/Linear Footage of Work: ❑New Uftepair/Replace ❑Demolition * * * * * * * * * ** * * * * * * * * * * * * * * * ** ** * * * * * ** Fees************* * * * * * * ** * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ /s( Permit Fee $ )Sb 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: 1 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. Signature3.a.t lJ,cnU(D� Owner or Agent The foregoing instrument was acknowledged before me this day of , 2011, by 'X-t-4 V fV who is personally known to me or who has produced if As identification and who did take an oath. NOTARY PUBLIC: Sign: 00111 fili40 Print: = f ;oo O / /llllllll\I \\ C/ APPROVED BY /- = if."6' Plans Examiner Zoning My Commission Expires: g2. mil`'' cr.-a • Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Structural Review 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: Re4 cca\j 1VQS DATE: 2 -2g - ADDRESS: 1 4,5 K1 E.) l (1) S-1" Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations, Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial_) 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial W% 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 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. Pk \I 7C v 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 RV 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 !, V 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. mvfioridalicense .com/dborloro /cilb/iindex.html Initial /\ V 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: 1 elOeCca \91 VO S Initial p V 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 eR V 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 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 By (04- day of , 20 ( NI \.lam who was personally known to me or who has Produced there License or k D as identification. OWNER 4, �y .0 i�. , - = O ff , ■ ',,��,!/!// /!!III 1111���`1\\*`s`