RC-13-2091 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-199168 Permit Number: RC-9-13-2091
Scheduled Inspection Date: November 19,2013 Permit Type: Residential Construction
Inspector: Rodriguez,Jorge Inspection Type: Final
Owner: PAREDES, MAURICIO Work Classification: Addition/Alteration
Job Address:159 NW 109 Street
Miami Shores, FL 33138-
Phone Number
Parcel Number 1121360030190
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
REPLACEMENT OF TWO EXISTING COLUMNS Infractio Passed Comments
SUPPORTING PORCH OVERHANG WITH STEEL INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
November 18,2013 For Inspections please call: (305)762-4949 Page 9 of 31
Miami Shores Village
Building Department SEP 1 b 20J3
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 2010
BUILDING Permit No.4c.) 1-5-Lcq,I
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: /s1-7 A/�z) 4�1
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder):, .,f4 1e-11'7 /-_ AAA ES Phone#: 3oS°56Z,-,56Z
Address: 4 N w 14'r-7 5�4e -/
City: State:
Tenant/Lessee Name: Phone#: 3`�S_S6��O'��ZZ p
Email: ��► EG�Se�J�' G/l/ cZ�r�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:$ Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New C�V a r/Replace ❑Demolition
Description of Work: 00` 7ngo 42-f/-577 4? e 4-aA1 A1__S
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$
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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor
The for o' g' trunxf t was ac wledged before this The foregoing instrument was acknowledged before me this
day of 20_0 by Y1 day of ,20_,by
who is pe�sonally known to me or who has produced " who is personally known to me or who has produced
'1'I Q As identification and who did take th. as identification and who did take an oath.
NOT 4Y PUBLIC: cis\O��ao1� NOTARY PUBLIC:
e
f c
v-1 N108%°Psso
Sign: Sign:
AV
Print' N° o�� ss` ai` Print:
My Commission Expires: My Commission Expires:
J
�C3i'�CLY�YiYYCY.'�.".Y3t3C�t�i7k'x"x['Jt$CSY]if$C�[7�1'JC SY�Iti2Tt 'lY'kSY7t 9Tl'7Y7Y���.'���3C3C�3G�C�C���3J�G 3C7Y7Y�C���G'k�Ci�C7iC7Q'J�C'ETC'li"1C'�l"k'klt"x"TC7iC71C'$�$C]�C/'k'k"JCf��P'
�."�C'Jt'JTC'�['x"1C'JF
APPROVED BY �3 Plans Examiner C C t'" Zoning
Structural Review Clerk
10001 -1 1—
(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
CALCULATIONS FOR NEW STEEL
COLUMNS AT RESIDENTIAL HOUSE
Prepared for:
Mauricio &Talita Paredes
159 NW 109 St.
Miami Shores, FL. 33168
Prepared by:
V.M. engineering, Inc.
Certificate of Authorization No. 27633
11278 SW 153`d Pl.
Miami,FL. 33196
VILLA/y
Z:� No e0292
��� CAP:��i�N s�•.G�` iii
M S , '
Florida ic��ibli�b. 0292
Pages 1 to 9
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CHAPTER 26 WIND LOADS:GENERAL REQUIREMENTS
Wind Directionality Factor,1
Table 26.6-1
Structure Type Directionality Factor ICd*
Buildings
Main Wind Force Resisting System
Components and Cladding 0.85
Arched Roofs 0.85
Chimneys,Tanks,and Similar Structures
Square 0.90
Hexagonal 095
Round 0.95
Solid Freestanding Walls and Solid
Freestanding and Attached Signs 0.85
Open Signs and Lattice Framework 0.85
Trussed Towers
Triangular,square,rectangular 0.85
All other cross sections 0.95
*Directionality Factor Kd has been calibrated with combinations of loads
specified in Chapter 2. This factor shall only be applied when used in
conjunction with load combinations specified in Sections 2.3 and 2.4.
250
b
CHAPTER 26 WIND LOADS:GENERAL REQUIREMENTS
Main Wind Force Resisting System and Components and All Heights
Cladding
Table 26.11-1 Internal Pressure Coefficient,(GC I)
Enclosed,Partially Enclosed,and Open Buildings Walls &Roofs
Enclosure Classification (GC I)
�► Open Buildings 0.00
Partially Enclosed Buildings +0.55
-0.55
Enclosed Buildings +0.18
-0.18
Notes:
1. Plus and minus signs signify pressures acting toward and away
from the internal surfaces,respectively.
2. Values of(GCO)shall be used with q,or qb as specified.
3. Two cases shall be considered to determine the critical load
requirements for the appropriate condition:
(i) a positive value of(GC I)applied to all internal surfaces
(ii) a negative value of(GCPj)applied to all internal surfaces
258
MINIMUM DESIGN LOADS
Velocity Pressure Exposure Coefficients,Ka and Kx
Table 30.3-1
Height above Exposure
ground level,z
B C D
ft (m)
0-15 0-4. 0.70 FO.85 1 1.03
20 6.1) 0.70 1.08
25 7. 0.70 0.94 1.12
30 9.1 0.70 0.98 1.16
40 12.2 0.76 1.04 1.22
50 15.2 0.81 1.09 1.27
60 18) 0.85 1.13 1.31
70 21.3 0.89 1.17 1.34
80 (24.4) 0.93 1.21 1.38
90 (27.4) 0.96 1.24 1.40
100 34.5) 0.99 1.26 1.43
120 36.6) 1.04 1.31 1.48
140 42. 1.09 1.36 1.52
160 48.8) 1.13 1.39 1.55
180 54.9 1.17 1.43 1.58
200 (61.0) 1.20 1.46 1.61
250 76.2) 1.28 1.53 1.68
300 91.4) 1.35 1.59 1.73
350 (106.7 1.41 _. 164 1.78
400- 1219 1.47 1.69 1.82
450 (137.2) 1.52 1.73 .1.86
500 (152.4) 1.56 1.77 1.89
Notes:
1. The velocity pressure exposure coefficient Kz may be determined from the following formula:
For 15 ft.15 z!9 zg For z<15 ft.
Kz=2.01(zt%)"6 Kz=2.01 (1517,)'1a
Note: z shall not be taken less than 30 feet in exposure B.
2. a and zg are tabulated in Table 26.9.1.
3. Linear interpolation for intermediate values of height z is acceptable.
4. Exposure categories are defined in Section 26.7.
317
MINIMUM DESIGN LOADS
h:5 60 ft.
72a 30.4-5A External Press=Coeffidents,G Monoslope Roofs
ed,Partially Enclosed Buildings 30<0 510°
2a
10 100
3' ;------1-r -3.0 -
I CL 3
_ -2.6 26
I C {1
I CS -2.4
12 22
1 -2.0 3
—j d -1.6 mom
I j C)' -1.4 2 -1.5
d 12 �2
3' r------�-� L •t.1
G. -0.6
-0.4
c -0.2
m
W
+0.2 ALL ZONES +2
0+
+0.4
$, +0.6
1 10 Q 50 100 200 5001000
(0.1) (13) (4.6) (9.3)(46) (46.5)(92.9)
Effective Wind Area,ft 2(m2�
�W
Notes:
1. Vertical scale denotes GC,to be used with qh.
2. Horizontal scale denotes effective wind area A,in square feet(square meters).
3. Plus and minus signs signify pressures acting toward and away from the surfaces,respectively.
4. Each component shall be designed for maximum positive and negative pressures.
5. For 0:5.3%values of GC,from Fig.30.4-2A shall be used.
6. Notation:
a: 10 percent of least horizontal dimension or 0.4h,whichever is smaller,but not less than
either 4 percent of least horizontal dimension or 3 ft(0.9 m).
h: Eave height shall be used for 0!9 10°.
W. Building width,in feet(meters).
0: Angle of plane of roof from horizontal,in degrees.
341
3.2.6 HIT-HY 150 MAX Adhesive Anchoring System
HIT HY 150 MAX Allowable and Ultimate Bond/Concrete Capacity for HAS Rods in Normal Weight Concrete''
HIT-HY 150 MAX Allowable Bond/Concrete Capacity HIT-HY 150 MAX Ultimate Bond/Concrete Capacity
Anchor Embedment Tensile Shear Tensile Shear
Diameter Depth f�a=Y000 p� f'oe 4000 psi f'o=2000 psi f,-4000 psi f'o=2000 psi f'o=4100 pal f',=2000 psi f'a=4000 psi
{13 8 MPs) (27.6 MP4 03.8 MPs) (27.6 MPa) 03.8104 (27.6 MPa) (13.8 MP6 (27.6 MPs)
In(mm) In mm lb lb lb W lb(k Nj Ibn lb W lb P"
-
13/4 T25 1155 1675 2360 2900 4620 5020 7080
(44) (5.1) (7.5) (10.5) (12.9) (20.6) (22.3) (31.5)
3/8 33/8 2110 3055 3155 4460 8440 12220 9460 13380
(8.5) (86) (9.4) (13.6) (14.0) (19.8) (37.5) (54.4) (42.1) (59.5)
41/2 2150 3055 4855 6860 8600 12220 14560 20580
(114) (9,6) (13.6) (21.6) (30.5) (38.3) (54.4) (64.8) (91.5)
21/4 1385 2090 2750 3890 5540 8360 8240 11660
(57) (62) (9.3) (122) (17.3) (24.6) (37.2) (36.7) (51.9)
1/2 41/2 4000 4980 5610 7935 16000 19920 16820 23800
(12.7) (114) (17.8) (222) (25.0) (35.3) (712) (88.6) (74.8) (105.9)
6 4705 4980 8635 12210 18820 19920 25900 36620
(152) (20.9) (222) (38.4) (54.3) (83.7) (88.6) (1152) (162.9)
27/8 1940 2730 4095 5790 7760 10920 12280 17360
(73) (8.8) (12.1) (182) (25.8) (34.5) (48.6) (54.6) (772)
5/8 55/8 5955 8410 8760 12395 23820 33640 26280 37180
(15.9) (143) (26.5) (37.4) (39.0) (55.1) (106.0) (149.6) (118.9) (165.4)
71/2 7320 8410 13495 19080 29280 33640 40480 57240
(190) (32.6) (37.4) (60.0) (84.9) (1302) (149.6) (180.1) (254.6)
33/8 2625 4295 6110 8635 10500 17180 18320 25900
(86) 01.7) (19.1) (272) (38A) (48.7) (76.4) (81.5) (1152)
3/4 63/4 6460 9985 12615 17840 25640 39940 37840 53520
09.1) (172) (28.7) (44.4) (56.1) (79.4) (114.9) (177.7) (188.3) (23(.1)
9 11175 11175 19430 27470 44700 44700 58280 82400
(229) (49.7) (49.7) (86.4) (1222) (198.8) (198.8) (2592) (386.5)
4 3375 5300 7670 10840 13500 21.200 23000 32520
(101) (15.0) (23.6) (34.1) (482) (60.1) (94.3) (102.3) (144.7)
7/8 77/8 9910 14815 17175 24290 39640 59260 51520 72860
(222) (200) (44.1) (65.9) (76.4) (108.0) (176.3) (263.6) (2292) (324.1)
r(2 0 1/2 14385 15345 26440 37390 57540 61380 79320 112160
67) (64.0) (68.3) (117.6) (166.3) (255.9) (273.0) (352.8) (498.9)__
41/2 5210 6570 9990 14120 20840 26280 29960 42360
(114) (232) (292) (44.4) (62.8) (92.7) (116.9) (133.3) (188.4)
1 9 11595 17475 22435 31720 46380 68900 67300 95160
(25.4) (229) (51.6) (77.7) (99.8) (141.1) (206.3) (310.9) (299.4) (423.3)
12 17340 18685 34535 48830 69360 74740 103600 146480
(305) (77.1) (83.1) (153.6) (2172) (308.5) (332.5) (460.8) (851.6)
55/8 6985 9935 13180 18640 27940 39740 39540 55920
(143) (31.1) (442) (58.6) (82.9) (124.3) (176.8) (175.9) (248.7)
1-1/4 111/4 18345 30086 35050 49570 73380 120340 105140 148700
(31.8) (286) (81.6) (133.8) (155.9) (220.5) (326.4) (535.3) (467.7) (661.4)
15 25575 30085 53980 76300 102300 120340 181880 228900
(381) (113.8) (133.8) (240.0) (339.4) _ (455.1) (535.3) (720.1) 00182)
1 Influence factors for spacing and edge distance are applied to i cable concreta fond values above,and Man compered to the steel value.
The lesser of the values Is to be used for the design.
2 For hdZ h.average ultimate concrete shear capacity based on Strength Design method.For h.<ht,average ultimate concrete shear
values based on testing.
160 H181,hr.(US)1-800-879-8000 1 wwv ueJdNxom I an eapaftj 1-800-879-80M 1 MM(Canada)Corp.1-800-3634458 1 a vvwJdM n I Anchor FsderdW TSOMO l GUWG 2011
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4�40M
DECORATIVE STEEL COLUMN 1l E PLAN C'EMENT ------r
159 NW 109 ST II9li1 - J
ami Shores vinage
MIAMI SHORES, FL 33168
APPROVED BY " FDA
TONING DEPT
1 v]/v]j� ]� v]/v]j�J� PLANS ® G DEPT ' /3
11 R IlJ C JL �L.J Jl O AL
SUBJECTT COMPLI CE ALL FED
i
STATE AND COl1NTY RULES AND REGULATIONS
NW 110 ST NW 110 ST
Plans prepared by:
V.M. engineering, inc.
INDEX OF STRUCTURAL PLANS 11278 SW 153 PL.
Miami, FL 33196
SHEET NO. SHEET DESCRIPTION
Certificate of Authorization No. 27633
S-1 Cover Project Location
S-2 General Notes, Plan View and Details (one-Story Residence)
NW 110 ST
W
Q Shop Drawings to be
N submitted to:
NW 109 ST Morgan Vil
Z V.M. engi n in
11278 1
NW 109 ST Miami, 9
Certificate of Auth ti o. 33
F-
U
N COPY
NW 108 TER Plans prepared for:
NW 108 TER Mauricio Paredes & Talita Paredes
159 NW 109 ST
Miami Shores, FL 33168
LOCATION MAP �N G
NOT TO SCALE `�� �I•��cENB,F--�� EN61NEEROFRECORD.- AMMAN VILLANUEVA, P.E.
No
Z ,y P.E.NO.: 60492
Revisions W Z
kl SHEET
Date Descr!DtiOn
Q �� t1►` Note:
i •-�L�R�O.•• �`�� The scale of these plans may have NO
•.....• changed due to reproduction
,����� S-1
, - w
o �
STRUCTURAL NOTES a
1. GENERAL NOTES _ r P
Exist wood beam
A. All construction shall be made in accordance with the Florida Building code, 2010 41, x 8"
edition & plans of all disciplines. the contractor shall verify all plans,
dimensions and existing conditions, and notify in writing to the engineer, prior to d
construction, of:
a. any conflicting detail or discrepancy within plans, specifications, or Steel plate 4" x 4" x %" A36,
between them. ) each side
b. any interference of new with existing construction to remain, or of 2 -%2 0 bolts with nut and washer,
inserts, conduits, openings or any installation with any structural 3" spacing
element, new or existing.
0 1/" top plate
c. any missing information (dimensions shall not be scaled from plans) X8
d. any discrepancy with field verified existing conditions including, but not ONE STORY
RESIDENCE No. 159
limited to, details, sizes, elevations and dimensions of, to or from
existing
elements and/or installations.
B. the contractor shall be solely responsible and take all the measures necessary HSS 3" x 3" x %"
to that all construction, demolition, excavation shall be made and protected as to
prevent failure of sides or slopes, harm to life, property, and to any existing
structure.
+1
C. provision for details not specifically shown shall be made by the contractor In Exist st columns
accordance with recommended standard practices and/or clarified with the ale in be rep d
writing prior to pricing and construction. (ref to ele tion
detail and sections shown in the drawings shall be construed to apply to similar view fo )
conditions elsewhere in the project, unless a different detail, or section, is ------ ---- --------------- --- ------
shown.
2. STRUCTURAL STEEL
A. Structural steel shall comply with RISC "specifications for design, fabrication
and erection for structural steel buildings" NW 109 ST
i
B. Structural steel plates & channels shall conform to ASTM a36, fy=36 ksi. fA A
C. Structural steel tubes shall conform to ASTM a500, grade b, fy=46 ksi. - —
D. Welding shall be done with a-70xx electrodes. Welders shall be aws-certified. PLAN VIEW SCALE:%32' = 1'-0
E. All wood in contact with concrete or masonry shall be pressure treated.
3. DESIGN LOADS
/NN \11,�, M 'M X� M Xl� X,
A. Wind Loads as per ASCE 7-10 10
2" 6„ � Exist 4" conc slab
a. Wind Speed = 775 mph (Miami-Dade County, Risk Category 11, Ultimate) Exist fill
b. Exposure C
Exist steam wall (CMU)
c. Protected: GCpp = ± 0.18
d. Component and Cladding `���PNd�NWNV �i/ ❑ o
B. Roof Loads
a. LL = 30 psf 0' — ELEVATION VIEW (Decorative Steel Column)
• �' SCALE: 1" = 1'-O"
b. DL = 15 psf •j[ W
4 3/a' 0 HAS rod,
2" embed. with
i •.� P�(� �a epoxy from Hilti
,OQ
NP►�.Q```\�� Steel plate 10" x 10" x IQ"
/��I/111111111��` VIEW A-A
SCALE: IK" = P-O"
REVISIONS project address: sheet title: SHEET
D c E D V.M. engineering, inc. Mauricio Paredes & Talita Paredes Residence GENERAL NOTES, PLAN VIEW AND DETAILS
11278 SW 153 PL. 159 NW 109 ST NO.
Miami, FL 33196 Miami Shores, FL 33168 project name:
Certificate of Authorization No. 27633 Decorative Steel Column Replacement S-2
Morgan Villanueva, P.E. No. 60292
Miami Shores Village
Buitding Department
.. ,_:..: 10050 N.E.2nd.Avenue
Miami Shores. Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE.STATEMENT
NAME: ��',�,`coiP sc=/°� ��'/� � DATE: "/,�, tea/ ,
ADDRESS:
Do hereby petition the village,of Miami Shores to act a;my own contractor pursuant to the Jaws of the State of Florida,RS 489.103(7).
And.1 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-loss(The new form states 75,000).The buHdirgl°must be for,yourown use and
occupancy.It may not be built for sale or lei:ff you:sell or lease a building you°have built yourself withht,one year after the
construction is�*111te the taw wlt presume thi tyou burst for sale of[am,which[we violation Of this ezanption.You may not hire
an unlicensed person;;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.CA and with-holdings tax and provide workers'
compensation forthat`erriployeev all prescribed bylaw.Your construction must comply with all applicable laws,ordinances,
buildings codes and zoning regulations.
Please read and inittaal each paragraph.
1. I untlomtand that state law requires construction to be done by a licensed contractor and have.appHed for an owner-gilder
permit under an exemption from the law.The exemption specifies that I,as the owner of the properly listed,may act as my own
conractor with cartain restrictions even though I do not have a license.
Iniitiat--
2. 1 understand that building permits are not requirei to be stned by a properly owner unless he or she Is responsible for the
corstrucaloq and is not hiring a licensed aorrtractar to assume responsibliUy.
Initial
3. I undemtend that as an owner bull*I am the resporslofe party of record on a permit I understand that I may protect myseiF
from potential financial risk by hiring a licensed contractor and having the permit filed In his,or Isr name I stead of my own
name.I also understand that the contractor Is required by law to be licensed in Florida and to list his or Hoarse numbers on
psrr i and coirtracw.
Initial
4. 1 understand that I may build or Improve a one family or two-family residence or a farm�.I may also bold or improve
a commercial building if the cxsffi do not exceed$75,000.The building or residence must be for my use or occupancy.it may
not be built or substectialy improved for sale or lei. If a building or residence that I have built or scrbstanu*bnproved
myself Is sold or lessed within 1 year aver the construction Is complete,the law will presume fist I butt or subsfarMy
Improved it for sale or loase,which violates the exemption.
Initial
5. 1 understand that,as the owner-bulkier,I must provide direct,onsite supervision of the construction.
ln�
ti i understand that I may not hire an unlicensed person to act as my for or to supervise parsons working on my building or
residence.it Is my resporsiblity to ensure that the persons whom I employ have the Hearse required by law and by cxxndy or
municipal ordinanics.
7. 1 understand that it is frequent practices of unlicensed person to have the properly owner obtain an owner-builder, permit that
enonedusly impM that the property owner is providing his or her own labor and materials.I,as an owner-bull tynta�,beheld
Belie and subjected to serious financial risk for any Injuries sustained by an unlicensed person or his of emplo Ile
wor"'on my properly.My homeowner's Insurance may not provide coverage for those Injuries.I am witiftdly_acting as an
owner-builder and am aware of the limb 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 ticanses to
perform the work Nft,done.Arry person working on my bull"who Is not 1ioonsed must work under my direct supervision
and must be employed by me,which mew that I must cao mplq with laws r;a4u,ft- the withholding of federal Income tax and
social security contributions under the Federal Insurance Contribution Act(FICA)and must provide workers compensation for
the employes.I understand that my failure to follow these may subject to serous financial risk
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9. 1 agree that,as the party legally and financially responsible for this proposed Construction achy,I will abide by all applicable
laws and requirement that govem owner-bufldem as weU as employers.I also wxlersfetid thit the
Construction mist with all applicable laws,ordinances,'Weling codes, 'and zoning regulations.
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10. 1 understand that I may.obtatn more infommaton regarding my obligation as an employer from the Internal Revenue Service,the
United States Small Business Administration,and the Florida Department of Revenues.I also understand that]may contact the
Florida Construction Industry Licensing Board at BM-487-1395 or t>taJMnaw.mvfloridaftruse.coMdborbro/dtb/fndex.html
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11. 1 on 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:
u.> ,o ; 14 ft. :�i/4f
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12. 1 agree to nottiy Miami Shores Village immediately of any addition,deletion,or changes to arty of the Information that I
have provided on this disclosure.
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Licensed cuntradors are regulated by laws designed to protect the public.If you contract with a person who does not have a
tioense,the Contr4ucton Industry Licensing Bard 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 dvg court.If is also hiipbrtant for you to
understand that,ff an unlicensed contractor or employee of an Individual or firm Is injured while working do 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 mist be completed acrd signed by the property owner and
returned to the local permitting agency responsible for Issuing the permtt.A copy of the property pwnbei driver license,the
notarized signature of the property,miner,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 Q�mkC20 1 3 .
S ` who was personally known to me or who has
Produced there License or 7 t961 as identification.
BILLOS
e of Florida
OWNER OITARlfublic ires Sep 23.2015
h�'' •n My ;omm.Exp
s`.
ommis
Csion#EE 12881pssn.
Bonded Through National Notary
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