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RC-10-2108Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 153752 Permit Number: RC -11 -10 -2108 Scheduled Inspection Date: May 02, 2011 Inspector: Bruhn, Norman Owner: MARIANO PINA, MIGUEL Job Address: 349 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132060135910 Building Department Comments REPLACE KITCHEN CABINETS Passe Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 29, 2011 For Inspections please call: (305)762 -4949 Page 4 of 27 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 349 NE 96 Street ° Miami Shores, FL 1132060135910 Block: Lot: MIGUEL MARIANO PINA Owner Information Address Phone Cell MIGUEL MARIANO PINA 349 NE 96 Street MIAMI SHORES FL 33138 -2717 349 NE 96 Street MIAMI SHORES FL 33138 -2717 Contractor(s) HOME OWNER Phone Cell Phone Valuation: Total Sq Feet: $ 10,000.00 80 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: KITCHEN CABINETS Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: _Bond Return : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $6.00 $4.50 $4.50 $2.00 $5.00 $300.00 $12.00 $8.00 $342.00 Pay Date Pay Type Invoice # RC -11 -10 -39525 11/30/2010 Credit Card 03/04/2011 Check #: 104 Amt Paid Amt Due $ 50.00 $ 292.00 $ 292.00 $ 0.00 Available Inspections: 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. March 04, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 04, 2011 1 12-1000 1,2,o - VA] - 1,49 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 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): �IIe / 177. �'7 Cl Phone #: OAS ? 49)- er/a S Address: 11c City: tg�i State: I Zip: 33( 3 Tenant/Lessee Name: Phone #: Email: NOV 5 0 at Bt: Permit No. if2--c- i 0-2i 08 Master Permit No. JOB ADDRESS: e- cOg,,T kc() r 2 City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes County: Miami Dade Zip: Flood Zone: /JC CONTRACTOR: Company Name: d'r'l e s.) Phone #: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: DESIGNER: Architect/Engineer: Value of Work for this Permit: $ Type of Work: Address DAlteration Description of Work: Email Address: Phone #: /0 c•V�k Square/Linear Footage of Work: New DRepair/Replace ❑Demolition ■Afb I,�l.1Ci1 DIC�'I I COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: Submittal Fee $) o Permit Fee $ Scanning Fee $ Notary $ Double Fee $ CCF $ Radon Fee $ DBPR $ Training/Education Fee $ Technology Fee $ Structural Review $ CO /CC $ Bond $ 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 ent The for _o g i strumen s ac wledg be me this day o ik ALL 2010 ,, by wh is per nally known to me or wh has produced I t n � 111 �b ' �01 As identification and who did take an oath. NO AR /1 � Sign: Print: My Commission Expires: UBLIC: 1 Signature Contractor The foregoing instrument was acknowledged before me this day of ,20_,by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY /47; et 4 4c9 1,b Sign: Print: My Commission Expires: ******************************* ** * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)(rev6/4/10) 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 1111111 1111111111 11111 11111I I I'll 11111 1111 1111 CEl•l 20111R10124174... OR Bk 27597 Ps 3500; (1Ps) RECORDED 02/24/2011 14:20 :00 HARVEY RUVINr CLERK OF COURT IIAIII —DALE COUNTYr FLORIDA LAST PAGE description of property and street/address: —Cc:::( t It ° 'WO 60 1'3 Ctc iezo : z.mq the octet; 2. Description of improvement: Space above reserved for use of recording office ALI- /MIL PIM 41•11 Ink •_ t 411118. as, 3. Owner(s) name and address: Interest in property: .Z.e..2:4 Name and address of fee simple titleholder: 4. Contractor's name, address and phone number: 5. Surety: (Payment bond required by owner from contractor, if Name, address and phone n ber: 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)(a)7., Florida Statutes, Name, address and phone number: • + L e- c46 ( ; 2. 6 32 k 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, address and phone number: 9. Expiration date of this Notice of Commencement "V- (the expiratlon date is 1 year from the date of recordtrtg unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES; AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Ownelt or Owner(s)' Auth Prepared By L .• t. q c s ( E'ti�f1' Print Name Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was ackno (edged before me this a Y By Lsi4eeSSA C��#�zda (- :�Rrev, -## Di Individually, or ❑ as for Personally known, or 0 produced the following type of identifica Signature of Notary Public: Print Name: (S o zed Officer/Director/Partner/Manna r Prepared By Print Narne Title/Office el* a • day of rr+AQuARI (FICA ON PURSUANT TO SECTION 92.525 FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. AREZCAP1RO MY lhOSSSICAI #l)070E353 E PlllEt: 15,2011 BoaledT ruNot y Unclosattets Signature(s) of Owner(s) or Owner(s)'s Authorized O fficer/Director/Partner/Manager who signed above: By STATE By psas,' 1230+.52 Pia 3 310 i HEREBY CERTIFY the this Is r,:r ..r Qite e in Otis ales !f 77 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: r (.��'if M �f DATE: ` ©�629 /(7 ADDRESS: 34g A)& q -jf Nair( ct 1 f/ 3 31361 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 it/ e 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 411 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 f 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 lid 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial Y 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 "' 1 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial nip 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 )71 P 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.mvfloridalicense.com /dbpr /pro /cilb /index.html Initial__ 11. I am aware of, and consent to; an owner - builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial pi f 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 944' it Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. ��� ,ry Was acknowledged before me this '1 day of pal, 20 r10 Ovkoi who was personally known to me or who has Produced License orT ! Ill '1 3.31 • OV1 as identification. 'Na p rre b7-17*/ P (PA- p 04 a'ti/r /7,/ &/t/ Pat /6e- Ay /,)-ci 5,Lietle/giABPP /Le)t-icie-X/e it769/T,Pe,>esfe te #2 120 • 6-Fl. (; Z 9(0,r•ck 1 4C- cf' "-41111"\ AA or, C5o.,- q\cL, Mvmrwsiffil P BY: ..... .... i Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 349 NE 96 Street Miami Shores, FL 1132060135910 Block: Lot: MIGUEL MARIANO PINA Owner Information Address Phone Cell MIGUEL MARIANO PINA 349 NE 96 Street MIAMI SHORES FL 33138 -2717 N 349 NE 96 Street MIAMI SHORES FL 33138 -2717 Contractor(s) HOME OWNER Phone Cell Phone Type of Work: REPALCE SINK FIXRTURES Type of Piping: KITCHEN Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $5.00 $100.00 $3.00 $0.80 $113.60 Pay Date Pay Type Invoice # PL -11 -10 -39526 11/30/2010 Credit Card 03/04/2011 Check #: 104 $ 63.60 $ 0.00 Amt Paid Amt Due $ 50.00 $ p.so Available Inspections: Inspection Type: Top Out Final 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. March 04, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date March 04, 2011 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) I \Ace Tek hC 4 Permit No. -PLIc &cfa Master Permit No. (0- a l o s Phone # Owner's Address ?) L)'E. °t C G11 Cr.\ City G- i '5‘nctretate fi L Zip 33 Tenant/Lessee Name Phone # Email M Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address Flood Zone \ City State Zip Qualifier Name Phone -# State Certificate or Registration No. Certificate of Competency No. Contact Phone Architect/Engineer's Name (if applicable) E -mail Phone # Value of Work For this Permit $ :32C Square / Linear Footage Of Work: Type of Work: ['Addition EAlteration ONew ❑ Repair/Replace El Demolition Describe Work: Om wOY 1C.. t'oNr C I ******** * * * * * * * ** * * * *** * * * * * * * * * * ** * *** Fees************** * * * * * * ** ** * * * * ** *,* * ** ** * * ** *** Submittal Fee Permit Fee $ Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ CCF $ CO /CC $ Technology Fee $ Bond $ See Reverse side -3 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 .:. e approved and a reinspection fee will be charged. 4 - Signature _ Signature or Agent TO Contractor The foregoing ins' ' ent - . s acknowledged geed before me this �ZU The foregoing instrument was acknowledged before me this day of Nl�4 , 20t (., by t ` L (J ,-(..-- 9 k/A , day of , 20 _, by who is personally known to me or who has produced 1 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: 00,11111111/r,,r v�� ('e n i5 ",, ... P.........,. S, %G •,,, Sign: � ` — , t • co - Sign: wBp lll B //m v _ = Print: Print: My Commission Expires: APPROVED BY P458/6 ,f . My Commission Expires: F gp/ '2,, O'� FL OR\"P.�‘\. ° F1(1' Plans Examiner Zoning Engineer Clerk checked (Revised 07 /I0I07)(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 OWNERILDER DISCLOSURE STATEMENT % NAME: ! i' DATE: 1/7 J/ 0 ADDRESS: a Y9 /i%S. 9 col' , f /Z.l •i c ~ t�, C'� 3 313 a 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 PI, 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 Mfi 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 improved it for sale or lease, which violates the exemption. (1 Initial 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. m� Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner- builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial tY1 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 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 1t1(2 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http : / /www.myforidalicense.com /dbpr /pro /cilb /index.htmy, Initial Pi ( 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 mn 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that J, have provided on this disclosure. Initial in 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 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. d'1 L Was acknowledged before me this day o Owtst-% , 20 I 0 By who was personally known to me or who has Produced there License or as identification. NOTARY Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 153766 Permit Number: PL -11 -10 -2109 Scheduled Inspection Date: April 29, 2011 Permit Type: Plumbing - Residential Inspection Type: Final Owner: MARIANO PINA, MIGUEL Work Classification: Addition /Alteration Job Address: 349 NE 96 Street Miami Shores, FL Inspector: Hernandez, Rafael Project: <NONE> Contractor: HOME OWNER Phone Number Parcel Number 1132060135910 Building Department Comments REPLACE FIXTURES Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 28, 2011 For Inspections please call: (305)762 -4949 Page 1 of 16 d Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 349 NE 96 Street Miami Shores, FL 1132060135910 Block: Lot: MIGUEL MARIANO PINA Owner Information Address Phone Cell MIGUEL MARIANO PINA 349 NE 96 Street MIAMI SHORES FL 33138 -2717 349 NE 96 Street MIAMI SHORES FL 33138 -2717 Contractor(s) HOME OWNER Phone Cell Phone Valuation: Total Sq Feet: $ 500.00 80 Type of Work: ELECTRICAL FOR KITCHEN Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $5.00 $150.00 $3.00 $0.80 $164.10 Pay Date Pay Type Invoice # EL -11 -10 -39527 03/04/2011 Check #: 104 11/30/2010 Credit Card Amt Paid Amt Due $ 114.10 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. 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. March 04, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy March 04, 2011 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 FBC 20 �r. Permit No. 1 V— 2 I 1° Master Permit No._2C.10 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) C.— t G Owner's Address '5 G City `,� �L A, 1 C e '`�1, r 3 ' Tenant/Lessee Name Phone # 3 �R 925 Zip 2r Phone # Email Kam. Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # County Miami -Dade Is Building Historically Designated YES Contractor's Company Name Contractor's Address City State /6\ Zip Flood Zone 0 +-‘ Cie' 0......LAJerealSone # Zip Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # fi Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration :New Describe Work: ❑� Repair/Replace ❑ Demolition ******** *** ** * * * * * ** * * * * * ** ** * * * ** ** * ** Fees*********,****** * ** * * * *,* * *,* * ** * * ** * ** * * ** * * ** Submittal Fee $ Permit Fee $ /'J' ,00'.' CCF $ CO /CC $ Notary $ Training/Education Fee $ Scanning $ Double Fee $ Violation date: .lv Total Fee Now Due $ t (.1) lJ Radon $ DPBR $ Technology Fee $ Bond $ Structural Review. $ 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 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 b ' = oved.atd a re- inspection fee will be charged. Signature Signature r Agent Contractor The foregoing instrum ... acknowledge • efore me this The foregoing instrument was acknowledged before me this day of , 20 U by ° ( T) h, - , day of , 20 _, by who is personally known to me or who has produced 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: Sign: Print: My Commission Expires: NOTARY PUBLIC: . �• Grp /re /�� ^a'A, uJ /og? de .•. 9 `'_ Sign: Print: y' .Dp j �SSioq My Commission Expires: '', / / /Iljilll\\ \\ *le9e********* Y3e4e: Y********* skeYit**** tkde****k& n' c9rit**** aednY9e*eY*'+ t'* 3r4edr4r9rdr*9e3e9e*nY*sYk :iroY4r9r*a*** * 76 I/ 'Plans Examiner Engineer (Revised 07/10/07)( Revised 06/10/2009) Zoning Clerk checked 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: 'VA t S 'Ti ry"-, DATE: \1 \-30110 10 - ADDRESS: 3 t4 et M)E. � �� -t arc � 4•A�cr -►-, � ' �L'�,.'''G'° Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one - family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with- holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 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 ,r, 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. #1") 0 Initial 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial M 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. /r1 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 "I 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 M" 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilbfindex.htm a 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 contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this c.Ai day of $•-• , 20 L By 1rp1LAZ,L \)1 haP' who was personally known to me or who has Produced there License or as identitipp4pn;,,/� I,t #e is -7 J, .00� %sso�ii/C. F' ' ''''..`..., F40 Rlp ' `��\\,1 r� +4htili111oo Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 0-%ab Inspection Number: INSP- 153774 Permit Number: EL -11 -10 -2110 Scheduled Inspection Date: April 28, 2011 Inspector: Devaney, Michael Owner: MARIANO PINA, MIGUEL Job Address: 349 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060135910 Building Department Comments ELECTRICAL FOR KITCHEN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Y"'i'%I/2-' acs // April 27, 2011 For Inspections please call: (305)762 -4949 Page 3 of 22 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NSP- 153773 Permit Number: EL -11 -10 -2110 Scheduled Inspection Date: April 27, 2011 Inspector: Devaney, Michael Owner: MARIANO PINA, MIGUEL Job Address: 349 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Electrical - Residential Inspection Type:gh Work Classification: Addition /Alteration c Phone Number Parcel Number 1132060135910 Building Department Comments ELECTRICAL FOR KITCHEN Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector C ,4,771L V pl/402-t gP/1 April 26, 2011 For Inspections please call: (305)762 -4949 Page 8 of 36 3(/