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BP-03-1577 Miami Shores Village BUN1119 Department Y - 10050 N.E.2nd.Avenue Miami Shores, Florida 33138 Tel: 305 0 Tel: (305)795.22 4 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE_ STATEMENT NAME: 1 L1.1 �/�I- DATE: g -Z`1 13 ADDRESS: S Nix I-)do S-_ Do hereby petition the Yll-age of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,KS 489.103(7). And I have had and understood the following disclosure statement,which entities ire to work as my own cgntractor,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 through you do not have a license.You must supervise the construction yourself.You may build or improve a one-family or two-famr7y 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-but for sale orlease:b.yWeWl or lease a building you'have built yourself within,bno year after the constructlon ls,bdWotet ft taw wili ptesurrre#wtyoa built for sale of lam,which We vlohdtoh 6f thi9"exeriiption.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 FICA and with-holdings tax and provide workers, compensation forttiat erfrployee,all as pr gibed bylaw.Your tonshuction must comply with all apfpilcable h6s,'ordinances, buildings codes and zoning regulations. Please read and InNai each paragraph. 1. I undestand that state law requires cmnsUucion to be done by a licensed contractor and have.applied for an owner-builder ` pemdt under an exemption from the law.The exemption spedtles that I,as the owner of fire property Oft,may act as my own contractor with certain restrictions even though I do not have a license. 2. 1 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 no hMng a licensed oontracor to OWN respons tniti� 3. 1 understand that,as an owner binder,I am the resRWble party of record on a permit I understand that 1 may protect myself from potential financial risk by hiring a licensed contractor and having the permit OW in his or her name,Instead of my own name.I also understand that the c rdractor is required by law to be bersei In Florlde and to Itst his or numbers on permits and cortrac . ` 1 4. I understand that I may build orInprove a bne ft*or Wo4amlly resken ce or a farm oulbu>Iding.I may also build or improve a commercial building if the costs do not exceed$75,000.The buildhig or residence must be for my use or ocxMLIP11'ihcyy.It may not be bulk or substantially Improved for sale or lie. If a building or residence that I have built or suW%nd lly improved myself Is Sall or leased within 1 year alter the corstuction Is cormplete,the.law win pmsurre that I built or substantially improved it for sale or Ise,which violates the exemption. 5. 1 understand bled,as the owner-ttundrtr,I mW provide direct orsite supervision of the construction, Initial, .6. 1 understand that I may not hire an unlicrersed person to act as my contractor or to supervise persons working on my bull"or residence.It Is my responsibility to ensure that the persons whom I employ have the ncerse required by law and by county or municipal ordinance. Initlal�, , 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner bolder permit that erronediely implies that the property owner is providing his or her own later and materials.I, an aromer-builderr,may Ile held Gable and subjected to serious financal risk for any injuries sustained by an unlicensed person or he or'emplo pile working on my property.My homeowner's Insurance may not provide coverage for those injuries.I am willfully aft ae an owner-builder and am aware of the limits of my Insurance coverage for injuries to workers on my property. initial,_ 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed cmntracttor who is not tioerses to perform the workbeing done.Any person working on my building who is not.ticerud must work under my direct supervision and must be employed by me,which rrreafis`thet I must oompty with laws raqutilig the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act(FiCA)and mint provide workers compensation for the employee.I understand that my failure to follow these may subject to serious financial riwalc. Initial 9. 1 agree that,as the party Dally and financially responsible for this proposed Construction artivity,I will abhde by all applicable laws and requirement that govern owner4ruilders as well as employers.I also urmerstshd that'the Construction must c amply with all applicable laws,ordinances,building cam, `and ronirig regulations. Initial ,+ 10. 1 understand that I may obtain more bdormation regarding my obligations as an employer from the Intemal Re remn Service,the Unite States Small Business Administration,and the Florida Department of Revenues.I also understand that]may contact the Ftorkia Construction Industry Licensing Board at 850.487.1395 or hhttol tlm—W hoarse co fd I Initial. 11. 1 am aware of,and consent to;an owner-builder building perm applied for in my name and understands that I am the party tegatiy and flnencidy responsible for the proposed construction activity at the following address. i6 NE I--�LJk tnlfial `` _ 12. 1 agree to nobly Miami Shores Village immediately of arty additions,deletions,or changes to any of the Information that I ` have provided on ft 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 Corstr4uction 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 dd court.It Is also kiportent for you to understand that If an unlicensed contractor or employee of an individual or firm Is frqu?ed while working oh your property,you may be held liable for damages.H you obtain an owner-builder permit and wish to hire a licensed crontmctor,you will be responsible for verifying Whether the contractor Is property licensed and the stabs of the contractor's workers cmnpersatlon coverage. Before a building permit can be Issued,ths'disclosure statement mist be completed and signed by the property owner and returned to the local permitting agency responsible for Issuing the penult 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 periftIng agency Is required when the permit Is issued. Was acknowledged before me this I., J day of 201 _ By who was personaily known to me or who has Produced there License or 0—&&QIR.* as identification. VA- v' `e OWNER P"" aa� ,:. - Goer n�ou9hN Q: goy r4 F'` 0 nw uml Miami Shores Village g Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795-2204 • Fax; (305)756-8972 7/31/2006 To: Current Owner 1065 NE 97 Street Miami Shores Village, FL 33138- Permit: SP2003-1577 Address:1065 NE 97 Street Miami Shores Village FL33138 Date Expired:3/28/2004 Dear Sir or Madam In order for us to serve you better,we need to keep our files up to date. Our records indicate that the above reference Permit has expired. The Building Department has determined that the work applied for has been completed with out the required inspections and it has been more than 180 days since your last approved inspection and thus your permit has expired as per Sec. 104.5.of the Florida Building Code.You are required to renew your permit and schedule all required inspections. In the event you do not comply with the requirements herein the Building Department will file a complaint with Miami-Dade County Building Code Compliance Office for possible disciplinary action against your licensed contractor And/or if permit was obtained by the home owner the requirements of the Unsafe Structure Code of Miami Dade County Sec. 8-5. (3)will apply. "The building shall be presumed and deemed unsafe and a permit shall be obtained to demolish the structure or bring the building in to compliance with applicable codes as provided herein. Please contact the Building Department, immediately upon receipt of this letter. Sincerely, Mabel Vargas Administrative Assistant �� rye JOHN BERRYMAN, PE 0 � �711AI 248 ne 98TH Street Miami Shores, Fl 33138 305 903 4866 12/17/2013 Revised 12/30/2013 Mr. William Manso 1065 NE 97th Street Miami Shores, FL 33138 RE: Engineering Certification for Driveway and Rear Yard Fence Foundations at 1065 NE 97th Street, Miami Shores, FL 33138 Permit#'s BP2003-1577 & BP2004-1086 Mr. Manso, On 12/12/20131 visited the above residence and inspected the construction of the driveway at the front of the residence and the rear yard fence. The foundation of the driveway was exposed at the edge for viewing by digging down over 12" deep to expose the construction of the drive way in two locations approximately 8' apart. One of the fence posts was exposed clearing approximately 12" in diameter and down one side of the footing for approximately 2' in depth. The foundations dimensions were measured with a tape measure. Photographic documentation (on file)was made of the driveway and fence and their foundations. The driveway appeared to be properly constructed with 6"of compacted lime base, a sand leveling course and interlocking pavers with a properly constructed edge restraint/foundation of concrete in accordance with the village's requirements including but not limited to the Village's "Residential Driveway and Parking Standards". The rear yard fence was constructed of pressure treated 44 posts set in concrete foundation which measured 10" in diameter and 24" in depth, measured exposed in the hole, with 2x4 horizontal members as called for in the Village's "Wood Fence Detail"dated May 2009 except that there need to be posts added at the middle of each 8' panel span such that posts are 4'on center or less. This report only addresses the construction of the elements noted and does not make any reference or inference as to the performance of the construction. C- V ruly Yours, � t hn Berryman, PE ax sloe P E#66732 t tae Miami Shores Village g 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 FBC 20 BUILDING Permit No. (SP ZOOS— PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: 10 ;4V /11\j� 1 — City: Miami Shores County: Miami Dade Zip: Folio/ParceW IVY Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): l'L I/ i � — Phone#: / � 7 �✓ �,�� Address:_ city:— I /L State fL_ Tenant/Lessee Name: Phone#: Email: (A I N.(AA.0 a i 0 M f I Jr.. , CONTRACTOR:Company Name: Phone#: r Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: r DESIGNER:Architect/Engineer: Phone#: ' ti Value of Work for this Permit:$ `) () C) Square/Linear Footage of Work: Type of Work: OAddition OAlteration ONew epair/Replace ODemolition Description of Work: i L1 SG ).-1�l,{� /`1 1/r W ve. Color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ it Bonding Company's Name(if applicable) Bonding Company's Address City State �'` Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City S 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,BEATERS,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 approved and a reinspection fee will be charged. Signature Signature caner or Agent Contractor The fo going ii s Wmjent was ���dg d before a thi The foregoing instrument was acknowledged before me this day of ,b day of .20_,by , who is pe 11 onally known to me or who has produced who is personally known to me or who has produced t A^ �` 1qs identification and who did tak oath. as identification and who did take an oath. NOTA PUBLIC: •• �os t,\aa NOTARY PUBLIC: Sign: E�2 PSS ' Sign: Print: H \SS,o i�ona� %l.• .M mm Na Print: My Commission Expir �r ep°�e My Commission Expires: 'lll/llll,' APPROVED BY a g Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) R CEaE® Miami Shores Village SEP'3. 0 2003 Building Department _ _ _ - 10050 NY-2nd Avenue Miami Shores,Florida 33138 Tel:(305)7952204 �j Fax:(305)756.8972 �y\ BUILDING Permit No. lb?�U 7 PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type(circle). Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) 1,AJ i < < !V / Ct �;,f Phone# Owner's Address ' 6'1- C State �""�- Zip 7 / ) Tenant/Lessee Name Phone# ft Job Address(where the work is being done) I CRY Miami Shores Village County NO 3 I J 9 Is Building Historically Designated YES I .rt Contractor's Com P s S S Ph e G ` Y Contractor's A n City ��6 �".�GL cye/L t State L Zip -� Y�" Qualifier � . Architeet/Engineer's Name(if applicable) Phone# Ar chitect/En eer s Address City ` State Zip $Value of Work For this Permit E Square Footage Of Work: 1 . Number of. •Ba Ys Stones Families Bedrooms Baths Type of Work: []Addition teration ONew Repair/Replace El Demolition Describe Work: ck)w e►r ` /C U/ce ' *� *f*,►;rte, ; *' ,r, ►,,, *,,*, ,� ,Fees,►#,, , , * ,r.r * ,�,�,�,�,�,� * ***,r,��,�,� �� 00 County Escrow Fee$ / Permit Fee$ 100 Notary$ �° Education/Training Fee$ Tech$ Scanning$ Radon$ �\ r Code Enforcement$ Bondy$ $truct.$ -----1=-- +T `� Minus Plans Check Fee$ Total Fee Now Due,S (Continued ono de)C� 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 re construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WO Ng WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... 'PLUMBING,SIGNS, OWNER'S AFFIDAVIT. I certify that all the foregoing information is accurate and that all work will be done incompliance 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 Cory BEFORE RECORDING YOUR NOTICE OF i vIENCEMENT." pNotice to Applicant:.As a condition to the issuance o a building SPermit with an estimated value exceeding$2S(10, the applicant must romise 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 sub,Ject 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 buildin g permit is inspection will noib approved and a reinspection fee will be charged. issued In the absence of such posted notice, the Signatwte Signature S E�ow Owner or Agent Contractor The foregoing instrument was was acknowledged before me this�1 v The foregoing instrument was acknowled ed before day of 0 VJ by l 1 day of 20 b g me this � y w o is onally known to me or who has produced who is personally known to me or who has produced As identifi and as identification and who did take an oath, NO Y '•`e`_Commission#02319W =" ° es:Jul 13,2007 NOTARY PUBLIC: Sign: �% °oiv4, Bonded Thru Print Sign:. Print. My Commission Expires: My Commission Expires: (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. •��*s�*�*sr�•�*�*�*s****•���**r�*�*�x����*�********�a******s�***�**** **s*****s*��**�***�+�**�**�**��#*s*�* ' t APPLICATION APPROVED BY. OCT 2 2003 Pl=Examiner Engineer &3 Zoning —W DR1UEWhV A PPS�r4Cff y�oRlFS t Miami S40re.4 L e F�ORIDp` 10050 N.E.SECOND AVE. MIAMI SHORES. FLORIDA 33138-2382 Telephone: (305).795-2207 (3051.75-6-8972... COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY ' l.�vrl t WHEREAS, t , ` OL(l � hereinafter referred to as the Owner of the (owner) following described property: - Legal description/folio#: Lot Block Subdivision Tax Folio 9: requests permission to install: [�PAsphalt,concrete,brick avers P [] Landscaping [.] Other within the public road right of way of 0(OC C �— - (address) IN CONSIDERATION of the approval of this permit by the Village,the Owner agrees as follows: 1. To maintain and repair,when necessary,the above-mentioned item(s)installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability,which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense,within 60 days notice by the Village to do so.Failure to comply with this notice will result in the Village causing the item(s)to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with'tlie land and shall remain in full force and effect and be binding on the undersigned,their heirs and assigns,until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County,Florida by the Village Manager of Miami Shores Village(or his fully authorized .re resentative P ) SIGNED,SEALED,EXECUTED AND ACKNOWLEDG4 on this 1 day of 60 , .ld I . (owner) 40,vP'% of :Conunission#DD2 1984 SIGNED,SEALED AND DELIVERED in the presence of: ► ' as Expires:Ju113u2007 Rn Atlantic Bonding UO.,Inc. v � #DD 148 OL 4 . 13.2007 Adantic�.�' p 29 03 08: 02p Wm%P§ent By: RAMON TOUR©EMAN; i •••�•�• ....ur aw.la 1 (i O 0 r- 0 Dolores 3052072727 p. 1 3057920676; Aug-27-03 1 :16PM; Page 616 �OY�4[OYaO TW."S J MELLY P+4GE ' 92 INACT 180 "A" m mw 0 r � CO a NE 97TH s'r Ammawr m 0 Zoning Ao)roved Sep 29 03 06: 02p Dolores 3052072727 p. 2 Sent 8y: RAMON TOURGEMAN; 3057920676; Aug-27-03 1 :15PM; Page 5/6 Ae..A c td*w41bgV4 TKNAS J MELLY PAGE 61 uEae1100lauarlllAlaliveA�01{a ......,.■.r,ne.. iuc...,reti.eww.. w...saw.suoaw.ws ISM... Sant 1 wa • a.....ca914a+a ca....staswr era..Ar#wr rRM�N Mt...rarra�gYesforn■et1/ aa....sw M...IMMAGa �s4..rOwvanmeelsa w....w>w FLOW Lard X se... •• .a...arawsaeRw aae..iwnrw�rtir w..yctrwr —,I WS 2D�OIrE rr....�wAtrew ■ra..rrwrr�■ rAr..rrwe oc...rR,v )<311�TAAW00 ae..,rwa� r�a...rr�ww�w EGA.... re�e�gyw NAZAlO=OF! A&......rrs+.w. Kt...anae.rr CANE4NIl.:. 4L7 �r..wrwnrw ewe..wsnss .a...0mm"Imw w..amwu COMIAAILMM.R OWS e►...u+rw�KV .a..,,erw r.....rr.e w....�n.arrs..e. OAfeOFFIRM., Ufflnl6S corm►To. ev.....arwwpope D&W ROM WA wa A erwha k Am" RAM WA 000"TWAVARM.P.A. A AN mm wa OJ i1tA0E LECAL Loh Sinks am &"+ii"- 6kmind Pkt of ft&W Shame,a". ■ AcmP01V to fM Rtf"Waal Y rowdad is Md seek: 43 FW&I 51 "a 949111W Rt AUAMZ-D&N Cri". FlarW. �oo�sa: $00 NE 97 SLUM WAAR mss.a n138 aa madarorta 1181 d:.L&W {Oraf1OY. "*# wLD N.T.9 , 0 TRACT 1M ■Ar (31-41) Ltm- --------------------- � 1 D o 8 z I■uL so•�oo�c) 4 COR NE - 97�TH Sr All As MVAPSBMNWN�om b�r.rwwa rr&AGft r •�.-...err w wr..+�,.ewr � ��� �■ sAr1R• A ar..rrrwrwewre■r"AGING •wAe,4. •wrbwMrr.irrr.r.rrwrrry +r+r�wrw.ry+ir..rr. - �r+ar�/eew rrrr...reA� .�r�..w�r a.► flow, rw�rwee fm fw.-.rr rswr,., . a a�raawrM..w.�rrr�b ye.eeMK.1 r rre s r.��r rwrri a\eser!r rare . `me=re�eie.4 1r�Mfr%e��MM&V1rft-rrir Mb. r �MFl6�elr■.iY■/� THOMAS J. KELLY, V-X. (15%2me'a.P--%a�Sfta.*m WMEYOU-NIAPMU-1AND PLANNM L.N.ohm TAXIM as&W I4 STMT /D1Mmm.R0404 231% Mww max 0%)"A-742 UAW s OINK uas.wto r+A+AMIa► (Y")W-"""M FM (M)719•1QiO OWO PAX t s ~ n+se a we�euaarwrearwerw. weM0110.6IND. PATE F=6 WOQK )■ Y NO. A, mT.5 -46M I OR2F4 D, ,,, r Vi tamt, o!' �e� e 10R1�' .: • .• ... - AFFIDA'i�IT ... � .: . _{$. -- - : . =STATE OF FLORIDA) COUNTY OF DADE) The undersigned Affiant, "`� s ` "l �- J° .does hereby attest that the -� (property owner) attached survey,performed by I 1 o M CLS T, 16e, (name of surveyor's company) performed on ® is an accurate representation of the existing conditions and ( to of survey) locations of all structures on the property as of this date. ' The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six(b)months old. The Affiant,as property owner,further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further,Affiant sayeth naught. Affiaraftoperty owner Witness(sign and print) Witaess(siga and print) SWORN TO AND SUBSCRIBED before me this SO day d5�PP Affiant is personally known to me,_produced identification. lwuuy- Label Vargas ' commission#DD231984- =* <: --=Expires:Jul 13,2007 - '9v •P� Bonded Thm Atlantic Bonding Co.,lnc. 'r • t . VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT OWNER BUILDER DISCLOSURE STATEMENT I `!� it OLiV-- r �-� being the legal property owner,for the property Located at: Legally described as 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 understand the following disclosure. Statement, which entitles me to'airork as my own contractor, I further understand that I as the owner must appear in person to complete all applications. DISCLOSURE STATEMENT State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to that 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 constfuction yourself. You may build or improve a one-family or two-family residence or a farm out-building. You may also build or improve a commercial building at a cost of$25,000.00 or less.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 completed, the law will presume that you built it for sale or lease, which is a violation of this exemption.You may not hire an unlicensed person as your contractor.It is your responsibility to make sure. that 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-holding tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws,ordinances,building codes and zoning regulations. Proof of ownership provided( ) initial of reviewing clerk.Tlie foregoing instrument Was acknowledged before me this day of L I 2C(,� . n1 By who is personally known to me or who has Produced as identification and who did take an oath. e / Owner °�Y "" - label Vargas mission D231984 =E 13,2007 Owner r Bonded 77w � AdwWc Bonding Co.,Inc.-