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DS-13-1258 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-204023 Permit Number: DS-6-13-1258 Scheduled Inspection Date: December 09,2013 Permit Type: Driveways/Sidewalks/Slabs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: SHAARBAY,TIRSIS Work Classification: New Job Address:118 NW 93 Street Miami Shores, FL 33150- Phone Number Parcel Number 1131010330910 Project: <NONE> Contractor: HOME OWNER Building Department Comments NEW PLAIN CONCRETE APPROACH Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-192942. Footing inspection never approved. Sod disturbed area Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 09,2013 For Inspections please call: (305)762-4949 Page 24 of 29 NhamY Shores Village JUN 0 6 2013 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., 1 L47—) PERMIT APPLICATION Master Permit No Permit Type: BUILDING ROOFING JOB ADDRESS: U-113 City: Miami Shores County: FE;;ami Dade Zip: ? Za f Folio/Parcel#: Is the Building Historleally Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): Phone#: ®6 219 Address: City: M`C, . e State: Zip: �a�j ( �S�� Tenant/Lessee Name: Phone#:�=Email: l CONTRACTOR:Company Name 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:$ 1 , `1 Square Jaear Footage of Work: Type of Work: OAddition OAlteration ONew ORepairMpplace ODemolition Description of Work: COZOP thru lik: 2c. CIO'Submittal Fee$ Permit Fee$ © � CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Tndning/Educadon Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$_ � � Bonding Company's Name(if applicable) . Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be proved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The f oing instrument as ac owledged ore me s The foregoing instrument was acknowledged before me this day o�20 by �� day of .20_,by wh s pe onal known to me or who has produced who is personally known to me or who has produced 2• •2MIntification and who did take an oath. as identification and who did take an oath. NOTAR UBLIC: twos NOTARY PUBLIC: grate of Flot�da Sep 2 it s 881015 Sign: Si :gn Print' - Gammts yational NotatY As Print My Commission Expires- "'"',"" My Commission Expires: Lek&kRWk�sk&SdaAdjsAkdBffi&ok+dkA+k$`&�SaHP F#kk'k&kk#bd��kk�kk'kkkkS«*kd&*4�+PEA'k+k&+k�&i�6#d�&di'A*A'kaRsR�+B��B �$t� 6&#+k&6�Qrffi APPROVED BY `—� Plans Examiner (O Zoning Structural Review Clerk (Revised 3/1212012)(Revised 07/10/07)(Revised 01d10=09)(Revised 3/15109) 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: ti s'•�`t � ZC;rAO DATE: ADDRESS: Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the lams 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 safe 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 aunty 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 bylaw.Your construction must comply with all applicable laws,ordinances, buildings codes and zoning regulations. Please read and inlUal 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. 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 not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that as an owner builder,I am the responsible party of record on a permit I understand that I may p tact 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. 1 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 ubstardially Improved it for sale or lease,which violates the exemption. Inigat 5. 1 understand that as the owner=builder,I must provide direct orsite supervision of the construction. Initial 6. 1 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 aunty or municipal ordinance. initial 7. 1 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,maybe held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees t 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. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work Ding 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 than may subject to serious financial risk Initial 9. 1 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. 1 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 httoJAvww.mvfloddalic rse.coMdb r/)ro/dlbfindei I Initial 11. 1 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: initial4 12. 1 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 Constr4udion Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that if an unlicensed contractor or employee of an individual or firm Is Injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for Issuing the permit A copy of the property owner's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this _day of �ayv-./ 20 L!2 _ B S �+F� who was personally known to me or who has Y Y Produced there License or 2 +� '90 6S identification. 0 IVER I OTARY CLAUDIA V.CUBILLOS " '`'`�'• Public-State of Florida Notary h • . �,y curnm.Expires Sep 23,2015 J�•°�,; Commission#EE 128810 F ��••' Tonal Notary Assn. 'a c' ��` Bonded Through Nat Miami Shores Village APPROVED BY pDATE ZONING DEPT BLDG DEPT 9 T" SUBJECT i O CC IVIPLIANCE WITH ALL-FEDERAL STATE ANv CC UN'i Y r1L;l:=S AND REGULATIONS NO r� 0 0 0 a � N W ,oo'•�i s-c d/ ,r- (A A ; . 4, ,v 8z ,.sW IA loo lK arm s•y. . 4 iS'��y��..u..rr- .. - �F.w..��r• �{8��� R��l �.'F �y.�i•/rte .�,. ��I / 'im; JUN ®.6 2013 elms l u _ dO z. 'ON133HS SHOA3AbnS aNVI 7Z Lam' -/0 'ON Ja mnS � 0993-M c �N0HHa3l33l Meo tl01NClld."m ma 31m-ja3H1.j SAL M'N_Z999 MWWAMWli