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RC-10-1731Scope of work (467 1) Kitchen Area a. Replace cabinets and kitchen sink b. Relocate stove as per drawings c. Install over - the -range microwave oven d. Install recessed lighting in kitchen e. Open pass- through in a wall from kitchen to living room f. Disable and remove door that leads from kitchen into garage area and close with sheetrock g. Install a ceiling fan h. Open a new door from hall into garage area i. Replace /Install new electrical outlets as per drawings j. Remove and replace porcelain tile 2) Bathroom 1 a. Replace vanity and toilet 3) Bathroom 2 a. Demolition /replace tile, sheetrock b. Replace tub, sink, vanity, toilet and fixture c. Replace electrical outlets and light fixture 4) Other 0004) ti°wro, a. Illing ....err. p.-.d j g r: n in AFL. b. Replace ceiling light in Hall area Living Room 00 Bedroom 1 Walldng Closet Bathmom 1 Kitchen Family Room Closet Hall Bathroom 2 Closet Bedroom 2 A r-F- Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. 20 fpsPA�' �y c TECHNOLOGIES vilag Design 1 L2010 Printed: 9/20/2010 Allan Mota All I Drawing #: 1 Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. Allan Mota 20 TECHNOLOGIES ZE Designed�9 17/2010 Printed: 9/20/2010 1 All !Drawing #: 1 / 24"--/-121—/ / 36" 58," Z 117" 45" /12" / 24 " �i 39"- —582" 36" N CO M J N m 0 O) N M 24" 28" W W 9 iaa- Id�ass 1 01 2" All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. �.fX n„E LR ikT4 2 h.:. TECHNOLOGIES This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Allan Mota All "'I`O TMT co 24" 12" 117" 45" WD2436R- GW1236L u ► M1 BC36R / VAL45 BF3 11 SB39 WI 236 WD2436L -GL rr� BF3 / BC36L All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. 20 TECHNOLOGIES This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designe�9 /17/20 Printed: 9/20/2010 Allan Mota 1E11 Drawing #: 1 WD2436L- GW1236R 1 1p 0 W302012 1111 W3618 WF3X15 11 10 MW.HOOD I1 00 00 //4 -BC36L i6 1 B30 -2 ■ 36REF1 -2DI 10101010000000000000000001010 37 All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. TECHNOLOGIES �� This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designe • 9/17/2010 Printed: 9/ 0� Allan MotaN I El 2 I Drawing #: 1 PERMIT MIAMI SHORES VILLAGE STRUCTURAL ELECTRICAL SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REC'myI; Ai/ 2 e 17/7-01-f err Rj7ey'ee_rpQC 'e,VTI c) t gk"le/e4-14-g,,air,err,fixi`cle 5ialzePow R % Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 151816 Permit Number: RC -9 -10 -1731 Inspection Date: April 20, 2011 Inspector: Bruhn, Norman Owner: MOTA, ALLAN Job Address: 467 NE 100 Street Miami Shores, FL 33138 -2446 Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (305)970 -3131 Parcel Number 1132060170530 Building Department Comments REPLACE KITCHEN CABINETS COUNTERROP AND RELOCATE WAL FROM KITCHEN TO THE GARAGE AS PER DRAWINGS. Passed '- Inspector Comments C__ Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 19, 2011 Page 1 of 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 467 NE 100 Street Miami Shores, FL 33138 -2446 Owner Information Address Parcel Number 1132060170530 Block: Lot: Applicant EDUARDO MORAN Phone Cell EDUARDO MORAN 467 NE 100 Street MIAMI SHORES FL 33138 -2446 Contractor(s) HOME OWNER Phone Cell Phone (305)527 -2305 Valuation: Total Sq Feet: $ 8,000.00 0 1 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: REPLACE KITCHEN CABINETS Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : , Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $4.80 $3.60 $3.60 $1.60 $240.00 $12.00 $6.40 $272.00 Pay Date Pay Type Invoice # RC -9 -10 -39031 09/30/2010 Credit Card 10/13/2010 Credit Card Amt Paid Amt Due $ 50.00 $ 222.00 $ 222.00 $ 0.00 Available Inspections: 1 Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use 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. October 13, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 13, 2010 1 16161a- Miami Shores Village Building Department W) 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 4agi SEP 3 Tel: (305) 795.2204 Fax: (305) 756.8972 1! INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. l 6 -'' 1 '73 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING A OWNER: Name (Fee Simple Titleholder): A LLJ \ N mernh Phone #: 'mss q40 3, 3 Address: 111.)- � O E Itoo s1 City: Mt A Olt S4 V F State: Zip: 33 13e Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1164 Me: /00 9I-- City: Miami Shores County: Miami Dade Zip: 3 31 3 8' Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ` V Y t /r 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: $ ! � 000 Square/Linear Footage of Work: [6Z -53-N" ff Type of Work: OAddress ❑Alteeration / New ORepair/Replace ❑Demolition Description of Work E Ritz E k i 'r4 CAS MR 7-51 CoukileVriP / v 2e10 G J Lat'LL f(,fGA 61 TO ►1 Cr j,� P-s rA's5 —fit; O1tfl av *kite LF oty6 Sllet:1)2 o 44 9 k- lt)b fif�i souk. �7 1 kT JL.S .. f tEc iA c #t c)-#T L $( thi6 G yT k iv 6 COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ** ** * * *** ***x *** *** **** * ********* * *** ** Fees * * ** ******** * * ** **e******** **** ********* Submittal Fee $ .'� _w Permit Fee $ e31 CCF $ CO /CC $ , Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ a . V o Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature �r Contractor The foreioin: instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Owner or Agent Signature by` , who is personally known to me or who has produced ' D O11Do_ NOTARY PUBLIC: Sign: Print: identification and wilRislipbtke an oath. U of4 i w , , r:49 i t‘ /a /ad , .. , 1 7; ; . , . s . .) ° , 75 . . 9 � ,''%/ ORIDP \ \\ \ \ 'olitininu" My Commission Expires: 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: * * * * * * ******+x *******+ a* ******* *x ******* ** *w******+x** ** * * ** x********* *** ***+ s* *****+ x ****** * **** * **** * ********** APPROVED BY ✓ /�C� Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) Clerk NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 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. 111111111111111111111111111111111111111111111 CF14 201108065 a 4-11 OR Bk 27435 Ps 378771 (1Ps) RECORDED 09/28/2010 12:52:05 HARVEY RUV'INr CLERK OF COURT MIAMI -DADE COUNTY? FLORIDA LAST PAGE 1. Legal description of property and street/address: Li e- 100 5 % (�likrvu SfQC� 5, ft, 3 l 5e 2. Description of improvement: k 1 It it C-Y1 fr & ri 'eNOvMl OA) ' 3. Owner(s) name and address: Interest in property: AL (r- i JAS % Ai ,e(' NW* Pr !a2 5 i M1 h 3( � Name and address of fee simple titleholder: 4. Contractor's name and address: A 1-A 5- 1 V U 1 L(, -etiE 1CC) si Ail MI s 01"£s fv 3313f 5. Surety: (Payment bond Name and address: Amount of bond $ 6. Lender's name and address: required by owner from contractor, if any) ST ,; RF FLORIDA, COWRY ..`F r)ADE • Krd.T, .1 dy 1, a'��lifl it _ 1417W, I. , s=t ..E Inv rr� /✓ T „ who •ti a • •I $; 7. Persons within the state of Florida designed b provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: d``1� fiat' e served as 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a di I-r,..1 t is specified) L s..;•"6"-re of Owner Pri,t Owner's Name . A Swom to and s Notary P Print No Prepared by ►'It f4 before me this v day of Address: My commission expires: 123.01 -52 PAGE 4 8102 QM CHASE A LALAN1 •' MY COMMISSION # DD977161 EXPIRES March 31 2014 (407)Z-0153 Floridallo a,ygervic .c , MIAMI -DADE COUNTY CLERK OF COURT RECORDS DEPARTMENT 22 N.W. 1ST STREET MIAMI, FL 33128 DATE:09/28/2010 TIME:12:52:05 PM RECEIPT:2461402 ALLAN J MOTA REF: 305 -970 -3131 ITEM -01 NCO 12:52:05 PM FILE:20100657411 BK/PG:02743513787 RECORDING FEE COPIES CERTIFICATION POSTAGE FEE 0A4 Sub. Total 13.44 AMOUNT DUE: PAID CASH: CASH RETURNED: TOTAL PAID: REC BV:GIRLYNE DEPUTY CLERK $13.44 $14.00 $.56 $13.44 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: /)LLI Y) M I)'1 DATE: 600/20 , v ADDRESS: 41 b 1VG . o1 i- ffl 1 stlottE 5, & L 3 3133 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 I" 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 Y OVv1 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 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 OM 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. 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 ' o 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.mvfloridalicense.com/dbor/pro/cilb/index.html // Initial °�e/rr) 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 IY" r 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the 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 acknowle..ged before me this day of , 20 By ho was personally known to me or who has Produced there License or --( 11 OWNER Return to: CV,RISTOPHER P. KELLEY, P.A. : 1198 Biscayne Boulevard, Suite 205 Miami, FL 33161 Instrument Prepared By: CHRISTOPHER P. KELLEY, Esquire 11098 Biscayne Boulevard, Suite 205 Miami, Florida 33161 Folio No. 11- 3206 - 017 -0530 11111111111111111111111 1111111111111111111111 Cr14 2010RO617794 OR Bk 27418 Pas 0007 - 81 (2pss) RECORDED 09 /13/2010 12128:48 DEED DOC TAX 1 +704.00 HARVEY RUVINr CLERK OF COURT NIAttI -DADE COUNTY, FLORIDA WARRANTY DEED THIS INDENTURE, Made this d day of .. L , 4L .-. , 2010, Between EDUARDO MORAN and SOPHIA LORAN, husband and wife, GRANTORS, and ALLAN J. MOTA and DIANA BAQUERIZO, husband and wife, whose post office address is 467 N.E. 100 Street, Miami Shores, FL 33138, GRANTEES, WITNESSETH, That said GRANTORS, for and in consideration of the sum of Ten and NO /100 Dollars, and other good and valuable considerations to said GRANTORS in hand paid by said GRANTEES, the receipt whereof is hereby acknowledged, have granted, bargained and sold to the said GRANTEES, and GRANTEES' heirs and assigns forever, the following described land, situate, lying and being in Miami -Dade County, Florida to-wit: Lot 22, Block 90, MIAMI SHORES SECTION 4 AMENDED, according to the Plat thereof, as recorded in Plat Book 15, at Page 14, of the Public Records of Miami - Dade County, Florida SUBJECT TO: Applicable zoning and /or restrictions and prohibitions imposed by governmental authority; Conditions, Restrictions limitations, reservations, easements, and other matters appearing on records, if any; Utility easements of record, and taxes for the year 2010 and subsequent years. and said GRANTORS do hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. IN WITNESS WHEREOF, GRANTORS have hereunto set their hands and seals the day and year first above written. Signed, >; aled, and delivered in our presence: 7-171r105717.7-41-0 "Now- - ntor 101 Street Shores, FL 33138 Print Name STATE OF FLORIDA LORAN 101 Street i Shores, FL 33138 Grantor COUNTY OF MIAMI -DADE ) I HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and County aforesaid to take acknowledgments personally appeared EDUARDO MORAN and SOPHIA LORAN, who produced / DL and fin respectively, as identification, and who executed the foregoing instrument and acknowledged before me that they executed the same. „WITNESS my hand and official seal in the Co and State last _ 'd this 0 day of 1rit. a.. , 2010. LIC, Sta. taty. F 4 - IDA at Large My commission expires: r Ciil8870 FIER R KEUEY aalM•� w c t . MY0284631091109 760754 EXPIRES: May 21, 2012 atemilw mot woo gems Baok27418 /Page7 CFN #20100617794 Page 1 of 2 Permit No: 10 -, 7f/ Job Name /0_5 ,2010 Miami Shores Village Building Depart �' "4/40€6. ilding Cr' ique Sheet 4a�i�� �� sepei U ent 10050 N.E.2nd venue Miami Shores, Florid 33138 Tel: (305) 7 5.2204 Fax: (305) 7 6.8972 Page 1 of 1 CD/ib 4 lecrd E:-4/104.1.4 Fax 5i 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 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 0475i Inspection Number: INSP - 156341 Permit Number: EL -11 -10 -2064 Scheduled Inspection Date: February 28, 2011 Inspector: Devaney, Michael Owner: MOTA, ALLAN Job Address: 467 NE 100 Street Miami Shores, FL 33138 -2446 Project <NONE> Contractor: 1E I ELECTRICAL CONTRACTORS INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)970 -3131 Parcel Number 1132060170530 Phone: (786)621 -5215 Building Department Comments ELECTRICAL FOR KITCHEN AND BATH AND NEW GROUNDING SYSTEM CONCEAL OPEN WIRES ABOVE ELECTRICAL PANEL PLEASE DO NOT SCHEDULEANY INSPECTIONS UNTIL BOUNCE CHECK IS CLEAR.2/24/2011 BOUNCE CHECK PAID. Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Fz_ Zgfe,6 zG/ February 28, 2011 For Inspections please call: (305)762 -4949 Page 25 of 33 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 467 NE 100 Street Miami Shores, FL 33138 -2446 1132060170530 Block: Lot: ALLAN MOTA Owner Information Address 467 NE 100 Street MIAMI SHORES FL 33138 -2446 Phone Cell Contractor(s) Phone Cell Phone I E 1 ELECTRICAL CONTRACTORS INC (786)621 -5215 Valuation: Total Sq Feet: $ 475.00 0 1 Type of Work: NEW GROUNDING SYSTEM Additional Info: ELECTRICAL Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $100.00 $3.00 $0.80 $109.10 Pay Date Invoice # 11/19/2010 11/29/2010 Pay Type EL -11 -10 -39472 Check #: 1421 Credit Card Amt Paid Amt Due $ 50.00 $ 59.10 $ 59.10 $ 0.00 Available Inspections: Inspection Type: Rough 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. November 29, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date November 29, 2010 1 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 Permit No. Master Permit No. RL 7-- r2 - / BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical /�� OWNER: Na e (Fee Simple Titleholder): �s� t--f e ? Address: (� 9 % ®(� ` State: Phone #: / — - / 3/ City: r __ Tenant/Lessee Name: Phone #: Email: Zip: JOB ADDRESS: e--7-6 9 r).? /6-2),..s City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ,:i - 06 %Pc 63-,' „I Phone #: 6g6) c / 'f,5-0,4,c--- - 0,4g Address: 5. 1--/ / City: /93i ArGe-t State: Qualifier Name: /1-1/42e '7a9 -.)1' State Certification Registration #: Elea) / •'.a. v p / 9 Contact Phone #• ) 50 / Email Address: DESIGNER: Architect/Engineer: Phone #: � ��J 04;9/ 6 2 JJ Certificte of Competency #: 0000 / 89 7 l / /e.i`, -Cei °xi -co Value of Work for this Permit: $ 75" — Type of Work: ❑Address a OAlteratio Phone #: Square/Linear Footage of Work: ONew ORepair/Replace ODemolition ******** ****** **** ***** ** ** * ** ***** ** ** Fees** *** *** * ******* Submittal Fee $ Scanning Fee $ Notary $ Double Fee $ Permit Fee $ ' 6.40 F e Radon Fee $ Training/Education Fee $ Structural Review $ * ** CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ JT . S D 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 O RE RECORD A TWICE NOTICE FOR COMMENCEMENT MAY RESULT • IN YOUR IMPROVEMENTS TO YOUR PROPERTY. IF INTEND ATTORNEY BEFORE FINANCING, CONSULT WITH YOUR LENDER OR AN RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person th a .orded notice of commencement must be posted at the job site whose property i for the first ins inspection will Signatu subject to attachment. Also, a certy ed copy of e r :t ',1. which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the roved and a reinspection fee will be charged. Owner or Agent The forego' g instrument was acknowledged before me this day of ; , , 20 /0,, by "/i..� 1'1 /7012-14-d who is personally known to me or who has roduce As identification and who did take an oath. /6 NOTARY PUBLIC: Sign: Print: My Commissi e r$ DRA PENNY My Comm. Expires Apr 19, 2014 y�'`��: v;= Commission # DO 983134 " ,,,,A`• Bonded Through National Notary Assn. * * * * * * * * * * * * * * ** APPROVED BY Contractor The foregoing instrument was acknowledged before me this /6 day of )'7ti% , 20 /c), by 4, r?J , who is personally known to me or who has produced as identification and who did take an oath. f0 Plans Examiner Structural Review (Revised 07110/07)(Revised 06110/2009)(Revised 3115109) NOTARY PUBLIC: Sign: Print IP 40 w J ur e Florida My C, .c „� ,' IL, P comm. Expires Apr 19, 2014 ,,, .c.• Commission # DD 983134 '%fi ,rA,' "• Bonded Through National Nola,• Assn Zoning Clerk NO0 -16 -2010 11:52 FROM:I•WILSON WASHBURN FORS 3056667325 AWRD TO:7866215216 P.2'2 OP ID: OR CERTIFICATE OF LIABILITY INSURANCE I THIS CERTIFICATE I5 ISSUED AS A MAI ik' tt OF INFORMATION ONLY AND CONKERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER11FICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the po icy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policios may require an endorsement. A statement on this certificate does not comer rights to the certificate holder in Ilse of such endorsement s DAYS (MMI00i'CYYY) 11117/10 PRODUCER Wilson,Washburn & Forster Ins. Email: Inforawwfins.com 10301 So. Dixie Hwy. Ste. 300 Pinecrest, FL 33156 -3151 Philip S Yanan INIU� 1E1 Electrical Contractors Inc 5041 NW 176 St. #7 M ian i, FL 33015 305.66E -6636 305.662 -7778 NAM_ AFL : Amboy. IEIEL•1 1 1, NaI: !NSIIRER(S) AFFORDING COVERAGE INSURER A : SCOttsdale Insuranco Co. INUURI1R5;Castlepolnt Florida Ins Co INSURER C:Rediand Insurance Company 37303 NAIC I INSURER D INSURER E : IN RF: • COVERAGES G RTIFIGAIt:NUmatrs: THIS IS TO OERTIFY THAT THE POLICIES OF INSURANCE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. Y_.- ..-- • —. — - •-- _ LISTe.. 3ELOW HAVE GLEN TERM OR CONDITION OF' ANY INSURANCE AFFORDED BY THE LIMITS SHOWN MAY HAVE BEEN REDUCED ISSUED TO CONTRACT POLICIES BY PAID irMID�lYYYY1 THE INSURED NAMED AVM FOR THE' POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN I5 SUBJECT TO ALL THE TERMS, CLAIMS. EM - LIMITS I, - J.3 A TYPE OF iNnuRANCE Wart w POLICY NUMBER 0 1,000,000 CN3Nr:Fil1LLIAaiLPiY X COMMERCIAL GENERAL. LIA8A.11 Y I X I OCCUR CPSi 162646 03111110 LACkNOCCURRDNCi= 'IPREMIS 03111111 P° to occ rr' ('REMISES {Ea occlnrencel 9 50.000 MED EXP Arty one parser I $ 6,000 • � q,AIMSMADH � PERSONAL & ADV INJURY 1,000,000 X 3500 Deductible GENERA. AGGREGATE $ 2,000,000 PRODUCTS- COMP /0P i DO $ 2,000,000 GEM. AGGREGATE LIMIT APPLIES PER POLICY 1 ^ ! 0 El g I I LOC - `COMBINED $ C AL/MOMODII.UUA:ULITY X X X ANY AUTO ALL QWNED.AUTOS SCHEDULED AUTOS MIRED AUTOS NON -OWNED AUTOS RICI=L0003919 03111/10 03111111 SAIGLELIMIT (EA accidml) 1,000,000 pOplLV w t1RY (Poe. pommy e DOpLY1N,uRY(Per goo dent) S PPoPERTY DAMAGE (PeracCldent) $ . . .... ...- i • —•- • $ UMDRDLLA L1AS E1CCuse LAG OCCUR CLAIMS-MADE Efr CH OGC PRENCE AGGREGATE S S _ DEDUCTIH.E' RF.TFNTION $ $ B WORKERS AND OPFttcPirt (Matld4Epry 0 pit COMPENSATION F,MPLOYEH.6' L1Aea.n'V MBEREXCLID DXBCUTIVE Y�`� fir, NMI' j &maibotattler OF OPERATION; N/A WCiP7�3211 03124/10 03!24111 I f X WC TA7U- j 1 711 EL EACH ACCIDENT i 100.000' E.L. DISEASE' EA OAK oYEE $ 100,000 E.L.OISCAiG POLICY LIMIT $ 300,000 ARSCRIPTION IMN4W CBSCRIF'n0N 05 wass TION91 LQCAT10N$ IVEHICLE8 (Oat ACORD 101, Additional 'Sato** s Srhadula If mun spat Is requlndl CERTIFICATE HOLDER VI lago of Miarn i Shores 10050 NE 2 Ave Miami Shores, FL 33138 I YILLAG6 „ ^ ,.G "-^ - ""° SHOULD ANY OF THE ABOVE DESCRIBED POLICies BE CAN &ELL.ED SEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL r9$ ` 0.1yeRED IN ACCORDANCE WITH THE POLICY PROVISIONS. - AUr14RIt80REPRESENTATIVE 5. '°" ATIQN All elnh4¢ raeeroari. ACORD 26 (2009109) .2009 ACORD "A[112/%0 The ACORD name and logo are registered marks of ACORD 11/18/2010 THU 10:28 [TX /RX NO 5762] 0 002 MIAMI-DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT 2011 MIAMI-DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2011 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 THIS IS NOT P, 12,ILL - Do NOT PA' ?` RENEWAL 647035 -5 RECEIPT RE. 673949-5 BUSINESS NAIVE ! LOCATION CC # 0 0 0 018 971 IEI ELECTRICAL CONTRACTORS INC 7 5941 NW 176 ST 33015 UNIN DADE COUNTY OWNER IEI ELECTRICAL CONTRACTORS CONTRACTOR Sec. Type of Business 196 ELECTRICAL THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE DOESTMIT REXEMPT THE HOLDER FROM ANY �OOTHER PERMIT OR REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED IBIAMHJADE LL COUNTY TAX 07/26/2010 02210012001 000075.00 i SE=E O T PIER SEDE. — INC WORKER /S 7 DO NOT FORWARD IEI ELECTRICAL CONTRACTORS INC SANDRA PENNY PRES NW 7 33015 141 FIS11 sill Construction T Q9 . SUS €NESS CERTIFICATE OF O COMPETENCY 000018971 ELECTRICAL CONTRACTOR INC D.B.A.: ROBBINS MARK NORMAN Is certified under the provisions rr of Chapter 10 of Miami ....... -.:i-:I . 1AiN04. 11A44Pt O N T Y ..- 41O .-•• :. #.A, .,• 0, R.P. , : NIO W At60NT-.•_-,RA.:..:-O,,..- . -O r .'S 2011 : -: .-.-'j,. • l-. ,-: 17X0PKIV IAKlgp0*10W 94PkgWSC M140*— STAT jPO11 ,00EISEa-1000glri44 1.A63P1 •, . .-- •::-...-.....2:::-..:• . .., THIS IS NOT A BILL — DO NOT ., . . RECEIPT NO. 30-67q49$ CC No: 140014971 BUSINESS NAME / LOCATIPM. IEI ELECTRICAL CONTRACTORS INC 5941 NW 176 ST OWNER :IEI ELECTRICAL CONTRACTORS INC SEE BACK OF RECEIPT FOR A LIST OF NON-PARTICIPATING NUNICIPALITUS Receipt holder must register in the city where work is to be done. PAYMENT RECEIVED MMWDADE COUNTY TAX GC937730 /201 0 02290046001 000200.00 FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD IEI ELECTRICAL CONTRACTORS INC SANDRA PENNY PRES 5941 NW 176 ST 7 MIAMI FL 33015 4 " 1M 1 1M THIS RECEIPT IS NOT VALID IN THE FOLLOWING MUNICIPALITIES: AVENTURA DORAL HIALEAH KEY BISCAYNE MIAMI GARDENS MIAMI LAKES PALMETTO BAY PINECREST SUNNY ISLES BEACH TOWN OF CUTLER BAY FOR MORE INFORMATION VISIT WWW.MIAMIDADE.GOV s DA- 33 t 3y 64/e t2 (ktQuicr vc). 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Expiration: 04/11/2011 Parcel Number Applicant 467 NE 100 Street Miami Shores, FL 33138 -2446 1132060170530 Block: Lot: EDUARDO MORAN 1 Owner Information Address Phone Cell EDUARDO MORAN 467 NE 100 Street MIAMI SHORES FL 33138 -2446 (305)527 -2305 Contractor(s) HOME OWNER Phone CeII Phone Valuation: Total Sq Feet: $ 1,800.00 0 1 Type of Work: KITCHEN AND BATH REMODEL Additional Info: ELECTRIC Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $1.20 $2.25 $2.25 $0.40 $150.00 $3.00 $1.60 $160.70 Pay Date Pay Type Invoice # EL -9 -10 -39039 10/13/2010 Credit Card 09/30/2010 Credit Card Amt Paid Amt Due $ 110.70 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: 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. October 13, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date October 13, 2010 1 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 FBC20 Permit Type: ELECTRICAL Permit No. EL'1 0 ti3 Master Permit No. Owner's Name (Fee Simple Titleholder) ALLA tJ T Phone # 30S 6n0 31 3 Owner's Address `f (aj City Mt Ak m I S i_5 State Zip 33S 3 ff Tenant/LesseeName Phone # Entail Job Address (where the work is being done) b )' iJ ta9 S r City Miami Shores Village County M'ami -Dade Zip 3 3 l 3 g FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name Contractor's Address Y"v0 Phone # City State Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: gue.... Type of Work: DAddition DAlteration ❑New ❑ Repair/Replace ❑ Demolition Describe Work: v(,fC E i 6,6g2.1 C*A t coqh. ( IA) k1 rd 61 th,1 bilvolobem es tkx (1 65 `fii cpa- inu,5Y4tc, GCS L Ai k( P-a --piA44u) Ik) itn6 3 coPt5 Submittal Fee $ Permit Fee $ / ...4-49 ' 00 Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: CCF $ CO /CC $ Technology Fee $ Bond $ Structural Review. $ Total Fee Now Due $ -- See Reverse side –> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for. ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITII 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 ill not be approved and a re- inspection fee will be charged. Signatur Owner or Agent Signature Contractor The f• egoing instrument was acknowledged before me this cam The foregoing instrument was acknowledged before me this day of , 20 , by who is personally known to me or who has produced f1 who is personally known to me or who has produced as identification and who did take an oath. day of ,20 to, by b As identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: "Iluui►rn lienieii°''% Sign: :` _ �� ' ,y.E .J... sign: Print: = tf� �� ? ©e r Print: . l/® My Commission Expires: ---:::::"..:A. QOl6�yon /�., ��= My Commission Expires: APPROVED BY S *' 9 -f2®Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) 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: ALL A-70 T ) MOT r 1 DATE: l3' 3ko 1 b ADDRESS: /10- A) too $f pIu m 1 S'ibtf5 ('L 3 3i 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 /431/list 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 frYIA 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 r I 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial /'I `tAi\ 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 /tl\ 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 �� a ► 1 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 1 17"1 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 /dbcr /pro /cilbfindex.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 4)44 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. ,g► Initial O 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 owners driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of , 20 4, who was personally known to me or who has as identification. By oduced there License or OWNER Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 156413 Permit Number: PL -9 -10 -1735 I Inspection Date: February 28, 2011 Inspector: Hernandez, Rafael Owner: MOTA, ALLAN Job Address: 467 NE 100 Street Miami Shores, FL 33138 -2446 Project: <NONE> Contractor: HOME OWNER Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)970 -3131 Parcel Number 1132060170530 Building Department Comments REPLACE FIXTURE IN KITCHEN AND BATHROOM Passed M Inspector Comments CREATED AS REINSPECTION FOR INSP- 151856. no access Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 February 28, 2011 Page 1 of 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 467 NE 100 Street Miami Shores, FL 33138 -2446 1132060170530 Block: Lot: EDUARDO MORAN 1 Owner Information Address Phone CeII EDUARDO MORAN 467 NE 100 Street MIAMI SHORES FL 33138 -2446 (305)527 -2305 1 Contractor(s) HOME OWNER Phone Cell Phone Valuation: Total Sq Feet: $ 800.00 0 1 Type of Work: REPLACE FIXTURES Type of Piping: PLUMBING Additional Info: Bond Return : 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 -9 -10 -39038 10/13/2010 Credit Card 09/30/2010 Credit Card Amt Paid Amt Due $ 109.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory Underground 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy October 13, 2010 Date October 13, 2010 1 BUILDING PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) /t LL; iJ M01-4 Phone # 30C 990 3/ 31 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 Permit No. ?l. 1 O �' r735 Owner's Address q %UF (l) S� City (W1 ik-irn l S I state f Zip 3 3/ 3' Tenant/Lessee Name Email Phone # Job Address (where the work is being done) City Miami Shores Villa e FOLIO / PARCEL # tuf, foo sr County Miami -Dade Zip 3 3 / 9r Is Building Historically Designated YES Contractor's Company Name Contractor's Address NO Flood Zone 1`1q Phone # City State Qualifier Name Zip Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ (O® Square / Linear Footage Of Work:" \ Type of Work: ❑Addition ❑Alteration ❑,New ❑ Repair/Replace ❑ Demolition Describe Work: t. "c h X 1. ►d S /N ('I 1 (Y� / hT Vtl . ******** * * * * * * * * * * ** **** * * * * * * * * * * * ** ** Fees************** * * * * * * * * * * * * * * * * * * ** * * * * * * *:r ** Submittal Fee $5Q ,00 Permit Fee $ /522 s CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 109' 0/ r See Reverse side —> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name l (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a, condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not . e approved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The fore ing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 , by RUAN Mall , day of , 20 _, by who is personally known to me or who has produced CL, 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: NOTARY PUBLIC: •SOq :►ttRUitttn� Sign: `.. . At/ t, ��� Sign: Print: $ 0) °% ®f u'ipy�.` !.% Print: My Commission Expires := m D,- ,��,„0 i - My Commission Expires: - — i I Iu �111155ti��� /0 .1'1 4). APPROVED BY Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) 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 STATEME T NAME: L L O Cv .o Ill' DATE:l"O ADDRESS: q b J G- (a) s T--( S% J i 3 3i 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; !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 1, 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 4. I understand that I may build or improve a one family or two- family residence or a fame 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 All(\ 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 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: /Iwww.myfioridalicense.com /dbpr /pro /cilb /index.html Initial ex 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__ 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. �� Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the 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 day of Ct , 20 t By who was personally known to me or who has Produced there License or PL-C D as identification. OWNER