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EL-13-1631 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-201603 Permit Number: EL-7-13-1631 Scheduled Inspection Date: October 22,2013 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: VENGER, KEVIN &SHARON Work Classification: Alteration Job Address: 10000 N MIAMI Avenue Miami Shores, FL Phone Number Parcel Number 1131010210130 Project: <NONE> Contractor: HOME OWNER Building Department Comments REPLACE Existing FIXTURES AND REPLACE WITH NEW I Passed Comments FIXTURES INNSPECSPEC TOR COMMENTS False Inspector Co n s Passed J 77 Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. October 21,2013 For Inspections please call: (305)762-4949 Page 31 of 42 i k Miami Shores Village Building Department "1 19 2013 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.4 0 13 ®'M3 PERMIT APPLICATION Master Permit No-2C-A?)— 16-1-9 Permit Type: Electrical JOB ADDRESS: I nwo N o " ( A-V-L I A-X ��j ya City: Miami Shores County. Miami Dade Zip: 3 3 l S-® Folio/ParceM f 0 ' ;(0 ( ° 021 ° 013 0 Is the Building Historically Designated:Yes NO_ Flood Zone: OWNER:Name(Fee Simple Titleholder):Imo" 5, V Phone#: 50f- -7 s,-1 --7 l I`7 Address: 10 O 0 0 L , 111 City: 01 Al-I I 5 4b i`g� State: , Zip: 3 3 1 Ste® Tenant/Lessee Name: Phone#: .K— 7S� —711-7 Email: ti UsFy t,T kp,LL S� Ln H CONTRACTOR:Company Name: E= Phone# . Address: City: State• Zip: er Name• Q�fi Phone#• State Certification or Registration#: Certificate of Competency#: Contact Phone#: Email Address: DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ t ®®� Square/Linear Footage of Work- Type of Work: DAddress DAlteration ONew ORepair/Replace ODemolition Description of Work. Submittal Fee$ Permit Fee$2-Z���� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 4 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 inspe Hon 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 JIV Signature Owner or Agent Contractor The for o' g instr7220 owledged bef a this The foregoing instrument was acknowledged before me this day o 1 day of 20_,by Who is pens ykn own to me or who has produced w is personally known to me or who has produced b 3 D- Us identification and who di an th as identification and who did take an oath S NOT AR UBLIC: - c�ee o F�0`2o�5 NOTARY PUBLIC: q. ��� aSeQ23g10 SS 12a�Y PSS� Sign: / ° ° ° °`�a�N Sign. Print: _ a��tOJg� Print: My Commission Ex pires: , My Commission Expires: 2� ✓'7�L � 2a /3 APPROVED BY 7 Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009XRevised 3/15/09) e s 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: I K S ' J"GE&, DATE: ADDRESS: 10000 P . In k-1 t tk-/g:v✓F I AM- 1 5 Ma(L-S 411-C, -(O -5I1�20. 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 entities 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.CA 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 ct 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 res nsible or 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 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 Ii se nu rs 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 ilpmved myself is sold or leased within 1 year after the construction is complete, the law will presume that I b or su taptially improved it for sale or lease,which violates the exemption. ' Initial T' 5. 1 understand that,,as the,owner-builder,I most provide direct,onsite 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 bylaw and by-co ty or municipal ordinance. Initial r a 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,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 W Ily acting as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my prope 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 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 co pensation for the employee.I understand that my failure to follow these 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. 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 htto:/AwAv.myfioddalicense.com/dbor/oro/cilbfiidex.htmlI dex.htmlI 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: Initial 12. I agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the info lion 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 _day of , 2013 l3v 40V\ who was pe rsonall y n own to me or who has q� , Produce there License or*V o' ' )Is identification. J, 3.2 55e �p NER �OT Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-201839 Permit Number: RC-7-13-1629 Inspection Date: October 23, 2013 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: VENGER, KEVIN &SHARON Work Classification: Alteration Job Address: 10000 N MIAMI Avenue Miami Shores, FL Phone Number Parcel Number 1131010210130 Project: <NONE> Contractor: HOME OWNER Building Department Comments RE TILE 2 EXISITING BATHROOMS Infractio Passed Comments INSPECTOR COMMENTS False RECEIVED N.O.0 8/26/13 Inspector Comments Passed -&I Failed El Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 October 22,2013 Page 1 of 1 RECORDED 08/06/2013 11:29:42 HARVEY RUVIH CLERK OF' COURT NOTICE OF COMMENCEMENT MIAMI-DADE eOUNTY P FLORIDA A RECORDED COPY MUST OE PASTED ON TI IE JAB SiITE AT TI EOF IiST PECTION LAST F!AGE F 9 Ftir.. PERMIT NO J,' ' It' � .'tAX ErjLIO f�1(��� "�� `��3 .'; STATE 6E FWRIDA• COUNTY OF MIAMI-DADE: i THE UNDERSIGNED hereby givegu do peat Impmyerpents will be made to certain real property,and`in abcor iti ice w i Chdpto 113,Ftorid"a Statutes,the following Womtallon- Is provided in this Notice of Commencement, $pane above reserved for use of recording office 1 Legal descri Mon of"roar end Vaddre§s (. 2.Description of improvement Vff 3:Owridr(s)naime'rdrid ad°tl H interest in property: HIAH Name and address of fee simple titlehbldar 4 Contractor's name,address and phone number-. t i-- 5 Surety(Payment bond required by owner from contractor,If any) Name,address and phone number., Amount of bond$ 6.Lentler's'n me.and address: 4-_ 7.Persons within the,�tate of Florida.designated by Owner upon whom notices or other documents may served as provided by Section 713.i3(1)(a) .k Florida Statutes, Name,addressrand phony r►umber �h' P - S.In addition to himself,"Owners designates the following person(s)to receive a copy of the Usnor's Notice as provided In Section 713.f3�1j(i),Florida Statutes, Name;address and phone Rymber, , 8.Exptra l6n'data of this Notice of Commencement: (the-pirat►on date is year from the date of repordlre unless a dlTferent date is specifiso i ." WAAN-19t's TO OWNEii ANY PAYMENTS MADE BY THE O,WNER,AFTER THE'WIA&ION OF TIDE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS Ut�I�ER C�iAPTER 713,PART 1,SECTIQN 713.13:'°FLORI�A'$TATUTE� ANt)CAN RESULT IN YOUR PAYING TWICE FOR IM!?ROVEMENTS TO YOUR PROPERTY,"'A NOTICE OF COMM"E"NCEMENT MUST BE RECOROED`AND'POSTED'ON•THE`JOB SITE BEFORE THE FIRST I SP 3.ON IF Y. INTEND TO`OBTAiN,FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK G Y R NO CE OF COMMENCEMENT,: =e I Signature(s)o s) r er(s)'Authorised Officer/Dh?ector/Partner/Manager Pre ,0y ;e S Prepared By. Print Name a a -; Print'Name - Titie(Office STATE OF FLORIDA t' , COUt�T1/OF"_MIAMI-b - The fo in e t „ w edi before rite this day BV Individually,or ❑ 7 s. r: for sonlii`kttowri or ❑ �aruted;the follo �rg• ypPe wa.ot4dentifcati 5i$n t$e of.NQtar�C;Publl� ' a Print Name: MW CLAUDIA V.CUBILLOB :. tiaN �V6 .01 1A'"T TO SEC-1110,114 92JWiR 0Y` ,`� Notary Public.State of FI^ .oa Under penaitfes of perjury,l declare that l have read ihe•fciregoing`arid �A My Comm.Expires Sep 3; '^' that the 66 ted'in it are true,`to the best of my ImOwlt3dge and bell Commission EE 128 ,;�QpO` Bonded Through NatioiTal Notary Assn. Signatu, s)of rr(s)o . sr(s) rized CNflcer/Direator/P` By By i89A1.62 PAGES 0 1 G M AM D(kDg COUNTY CONSTRUCTION UEN LAM/-FOR O: i WNERS .r NOTE: IF YOU SIGNED AS THE OWNER'S AGENT YOU ARE RESPONSIBLE FOR DELIVERING THIS INFORMATION SHEET TO THE OWNER OF THE PROPERTY. ' WARNING TO OWNER Florida's Construction Lien Law (Chapter 713;Part One, NOTICE TO OWNER FROM + Florida Statutes) requires the recording with the Clerk of the SUCClNTRA�"IORS AND SUPPLIERS t Courts a Notice of Commencement for real r You may receive a Notice to Owner from subcontractors Property improvements and material-suppliers. This notice advises you that the sender greater than$2,500.00. However,if does nott apply to the repair is providing services or materials. Subcontractors and suppliers or replacement of an existing heating or air conditioning system must serve a Notice to Owner within AS days of commencing less than$5000.00 in value.This notice must be signed by you, work to preserve their ability to lien your the property.owner. r ...: property. If your address changes from that given in the Notice of Under Florida law, those who work on your property or Commencement,you should record a corrected Notice reflecting provide materials and re not paid,have a right to enforce their your current address.This is done to help ensure you will receive claim for payment your property.This claim is known as all notices. a construction lien. YOU MUST FILE A NOTICE RELEASE FROM LIEN FROM CONTRACTOR OF COMMENCEMENT of Venn and AAffidavit to the qt you need nt receive a Release For your protection under the Constriction lien Law and to payment-from the general contractor-The Relapse of Lien and Affidavit shall state either avoid the possibility of paying twice for improvements to real that all the subcontractors and supplier; have been paid or list property, you must record a Notice of Commencement in the those unpaid and the amount owed. The contracbr;is required Clerk of the Court's Office.You also must provide a certified copy to list on the Release of Lien and Affidavit any subcontraclor or of the recorded document at the construction site. The Notice of supplier that has not been paid. That amount moy-6e withheld Commencement must be signed by you, the owner contracting from the contractor's pay and-paid directly to the subcontractor the improvements,and-not by your aged. or suppliers after 10 days written notice to the''contractor. The Notice of Commencement form, provided with this If the balance due to the contractor is not sufficient to pay information packet, must be completed and recorded within 90 in full all subcontractors and suppliers listed on`�the contractors days before starting the work. affidavit,you may wish to consult an aftmey A co of the The- eneral"contrdctor shall famish a al Release of Lien copy payment bond, if any is r�uined`by you and g purchased by the contractor, must be attached as part of the and Affidavit to the owner indicating all subcontractors and Notice of Commencement when recorded. suppliers have been paid`at the time he final If improvements described in the Notice of Commencement You can rely on the affidavit in .makiri requests Vent. are not actually started within 90 days after the recording of the y payment Payment to the general contractor. If ou make final ent to the general Notice, a new Notice of Commencement must be record, contractor without obtaining the affidavit,, %our, property,can be You lase your'protection urger the Construction lien Law if !tared far'inn-paymenfi if the general writractor fans to pay the the payments are made to the contractor after the expiration of sr�bceritractors ar siipplrers You should,aM�ays obtain a Release of the Notice of Commencement. The Notice is good for one,year lien and Affidavit ficim the contractor to the extent of any payments after the recording date or u to the date specified under item being nee. nine to the form. RELY bN YOUR LENDER FOR-COMPLIANCE Honda law requires the Building and Neighborhood Compiianoe Department to be a second source of information concerning the 1NITr� CONSTRUCTION LIEN--.LAW ` improvements made on real property,The Building PermmoA lication If you have a lender,you may rely,on the Iginder to handle (included with this packet)has been expanded to include information recording of the Notice of Commencement Leann more"about on the construction lender and the contractors surety,if any.The new the Construction Lien Low by contacfing an q I -r,,your!archer, application you agent's,to inform you of or Flaridb Depaitrtient of AgritvltuQ and Corisuirier ServiFgs, p requires your signature or r the Constriction Lien Law. Division of Consumer Services.6.Doc!Nn*nmkff:11 YOU MUST POST THE NOTICE OF , ' %kDE OUNT1t'REC012DER,t URTHOUS, COMMENCEMENT AT THE JOB SITE N'w' D�' Imo•mi°rni• FIL 33128. By low, the Building and Neighborhood Compliance ongrnai Notice should be sent to the Coun R i Department is required to verify at the first inspection, after the ty Recorder, PO..Box buildin 41,1711, Fldgler.St'ation,micimijloxrida 331 1;'i'Iease make g permit is issued,that a certified copy of the recorded original Notice is signed and notaries.,also, remember Notice of Commencement,with coached bonds if any,is posted at to enclose the retarding fee (for c sin le sthe construction site.Failure to show the inspector a certified co ) 9 copy) and written of the recorded Notice will result in a disapproved ins py nstructions for,r�rding and returning a certified copy of the (Florida Statute 713.135(1)(d)). pp pion' worded documents. for additional information on fees and recording documents call(305)275-1155. 148.01-M PAW 0 Ofl0 ' Miami Shores Village _ Building Department IM50 N.E.2nd Avenue,Miami Shores,Florida 33138 JUL 19 2013 f Tel:(305)7951204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 - FBC 20 BUILDING Permit No. PERMIT APPLICATION Master Permit No permit Type: BUILDING ROOFING JOB ADDRESS: 10®®0 9 . f Al--t I AV Vo City; Nami Shows County: Miami Dade 73p: Folio/Parcelt — Ic ® {3 P> Is the Building Historically Designated:Yes NO ood Zone: OWNER:Name(Fee Simple Titleholder), S P Phone#: 3® §-1 —�f �'7 Address: [®a D 6 h S 1w fl AV r-iJ VF- city:_U 162j I State: zi p' 3 9 _ Tenant/I essee Nam: Phone#:_ 3 QS ° -7 S I -i 47 Email: CONTRACTOR:Company Name: hb> — Address: I City. State• 7aP: Qualifier Name: r Phone#: State Certification or Registration#: a ter f&ate of Competency#: Contact Phone#: Email Address: s 9 DESIGNER:Architect/Engineer: Phone#:. Value of Work for this Permit:$ SS, ®n, SquaredAnew Footage of Work: Type of Work: OAddidon OAlteration - It ONew Oltepairilkeplace ClDemoAtion Description of Work:�_'f� :gC 1<i/j46: Color thru tile: }*��«sF�* Submittal Fee$ Permit Fee$,(%'�J 0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ TrabdugfflAucatiou Fee$ Technology Fee$ Double Fee$ Shmetnral Review$ TOTAL FEE NOW DUE$ t . r Bonding Company's Name(if applicable) Bonding Company's Address City State zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City statep 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 EWPROVEMENTS 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 inspe Lion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not a ap roved and a reinspection fee will be charged. Signature Signature Owner or Agent Contractor The go' g instrument 5as owledged be me this The foregoing instrument was acknowledged before me this �Y o by day of .20 by who is ly o to me or who has produced who is personally known to me or who has produced to,I to ' 'In identification and who did take an oath. as identification and who did take an oath. NOTAk LIC: NOTARY PUBLIC: \VV Sign: �0\PV spa\e�\ 3.2 Sign: Print: `a\y 4 �xP``e �E 12a cY ASSN\ ,.,r My Commission Expires: _-r �o e rt0„�rNa\ My Commission Expires: APPROVED BY (� i .Plans Examiner. Zoning Structural Review Clerk (Revised 3/1212012)Tevised 07/10/W)(Reviwd 06/10/2009)(Revised 3/15/09) U Miami Shores Village Building Department a.. ... 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: ADDRESS: V. ✓e 9 .� aF-[Di�- 33IS— 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.CA 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 er-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,m act as m 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 protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her namr itad f my own name.I also understand that the contractor is required by law to be licensed in Florida and to list his or ars 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 im ved ' myself is sold or leased within 1 year after the construction is complete, the law will presume that I bu or subst ptially improved it for sale or lease,which violates the exemption. Initiat 5. 1 understand that,as the owner-builder,I muit provide direct,onsite supervisioh 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 buildi or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law,and by cou or municipal ordinance. Initial G' I r r 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,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 wii ily acting 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 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 co pensatio for the employee.I understand that my failure to follow these 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 Ian and requirement that govern owner-builders as well as employers.I also understand that the f Construction must comply with all applicable laws,ordinances,building odes, 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 h :/Avww.m floddalicense.com/db rl ro/cilbfrnde chtrnI Initial J,�, 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 Dally and financially responsible for the proposed construction activity at the following address: Initial 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the inform 'on 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 property 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 day of B Y who was personally known to a or who has Produ d there License or i�® •3U• as identification. L 0 NER .,G„..... No�alY Q�94 12aa�o n• Go'^ �oo� � o�acY ass 01 �ss n-g •oc djp�ou9h ` CFN 2013Rr-0617725 OR Bk 7875? Pg 1706; (fps) RECORDED 08/06/N13 *11.'29.42 HARVEY RUVINt CLERK OF COURT NOTICE OF COMMENCEMENT MIAMI-°ADE COUNTYP FLORIDA GE A RECORDED COPY MUST BE POSTED ON .IOB$fTE A ]1 1E OF, PECTION LAST �- PERMIT NO. _ t�,r ' 7AkOU( Y( �: N $. Laf Q13 STATE t3E F 61AII) : COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby l ryoit errr is win be made to certain real property,and in acc�W Chapter X13;Fforld6 Statutes,the foUovoig Information,* Is provided in this Notice of Commencerrrent. space.owe reserved for rise of recordng office 1,Legal descri tion of party End " t/addressi >� . ' . N _. 2.Description of improvemer 3 Oti�mr (s)=riarte aric!' d all,14M-0.,T-7-10 : .Interest lr}property: , �' ,: Name and address of fee simple'titleholder: 4.CsmtXpctor's hame,'address and phone number. IL 9 th 5 $uretyr(Payment•bond required by owner f n1 cor tractor,if any} N e,address and phone number °°°^ Tq, Amotmt of bone}$. FLORIDA.COUNTY the 6.164n-dg s naive and address: . 7 Persons wttlin the Mate of Fltxida designated° rb ces or is aY as Q dad by wrATE Of ' f31ed in PhoS G A D 20 Sectirirt�131�.�1}(a)�,�Florida Statutes, ,r+go Name;ad�fress and�h�?�;number , ,a+.�n 8.in addttfon fo himself,Owners designates the foe p a per's Notice ed In Section T1313(1) ),Florida Statutes. ey Names and jahone ntimber. 9 E�Epira'"on date of tti�Notice of Commencement:.. .. �explrallon ddtd Is t from tfre dale of r�r urdess a olitfer�t date is specttledl AfiN1S1 TO 01AfNElt ANY PAYM MADE BY THE OWNER=AFTER THE E)(I�IiiATIO OF TF(E NOTICE OF COMMENCEMENTABE CONSIDERED 4Mf3ROER PAYMENTS Ut1ER CiA R T13,PART I,SECTION 71313=FL��1IAaSTATIiTES,ANb CAN RESULT IN�i'OUI PAYING TWICE FOR imp 0,%MENTS TO.YOUR PROPERTY''A NOTICE OP COMMENCF�AENT kAl1ST BE°RECORDED ANf)iP,STED-014 THE J013 SI TE`$EFCSRE THE FIRSfi IRiS�E T1,OfV IF Y. I", JD-T6.OBTAIN FINANCING,CONSULT WiUITH YOUR LENDER OR AN ATTORNEY BEFORE'COMMENCING WORK O`R embikk INQ�' R NO CE OF COMMENCEMENT,,,, Signatures)o s) r r s)1/�uthpriZed Officer/Director/Partner/Manager irey Aa By. Titie�Offic@ TltlOfflce v sTA`TE( =ELOF iIDA COUi�IY OFF MIAMI 0r `fo' p t. w efhbefora rate this da of ,: :. y . A-P,j irlowidualiy,or ®as. K for foil omdentiflcati s oia)ylcitotnm,erPfuced;the oM►Ir19pe pre fNA 'Ibllc ion Print Name: _ - 4sAl�, au�ta v.cua LLOS C � l ISALPrTo low, °, ib`r` Notary Public-State of flr. :oa Under haft, of perjury,l declare that 1 have read the foregoing and'' =my Comm Exprrt s Sep ..#� '"'• y! !P. �dg that the eii"it it are true to the best of n1 w e and half ���y Carrimass�on �EE 12E ; $ottded 7brough National Notary Assn. ' /!!11111/ Ctgnatur s)ot. s) er(s) ed=0fftcer/D(rectorft' ' IN $y , BY .� 123.01-52 PAGES 0 i °,