RC-13-1215 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-192625 Permit Number: RC-6-13-1215
Scheduled Inspection Date:August 08,2013 Permit Type: Residential Construction
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: GOMEZ,LINA Work Classification: Addition/Alteration
Job Address:10109 N MIAMI Avenue
Miami Shores, FL 33150- Phone Number
Parcel Number 1132060131510
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
REPLACE KITCHEN CABINETS, REMOVE HALF I Passed Comments
DRYWALL IN THE KITCHEN AND LAUNDRY AREA INNSPECSPEC TOR COMMENTS False
NOC PENDING 6/5/13
Inspector Comments
Passed
JE-
Failed
Correction
Needed ❑
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
August 07,2013 For Inspections please call: (305)762-4949 Page 8 of 36
e
Miami Shores Village
Building Department JUN 0 3 2013
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 r.
Tel:(305)795.2204 Fax:(305)756.8972 -------
INSPECTION'S PRONE NUMBER:(305)76IA949
FBC BUILDING Permit No. 9&M_)2
S
PERMIT APPLICATION Master Permit No.
Permit Type: Qii4 i ROOFING
JOB ADDRESS: 410q N
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11 2A n16 Q[9 1110
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): [ w,9- c�®�—� e#:
Phon
I"� � _
Address: 10112q 1J AIV f A U 6
City: Stater Zip• ���®
Tenant/Lessee Name: Phone#:
Email: CQomel 3�� ydnaq.com
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#:
e7oo 0
Value of Work for this Permit:$ SquareAUnear Footage of Work:_j
Type of Work: OAddition OAlteration i,INew *1epair/Replace []Demolition
Description of Work: 4'J t r
Color daR fi
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/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.
"WARMING 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 I appro a reinspection fee will be charged.
Signature Signature
(Owner<rAgent ;� Contractor
The foregoing instrument was ac o edged bef a me thi.999 The foregoing instrument was acknowledged before me this
day o 20 La by `7 'L°Z day of .20—,by
who is;::Lly known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOT RY PUB NOTARY PUBLIC:
ELISA GARCIA PUPO
Si •4, N Sign:
Print t Comm.Ex e o Florida
O!FLOP,O pares May Print:
n#DD
My Commission 9gsP51 My Commission Expires:
Expires:
APPROVED BY U- [ Plans Examiner Zoning
Structural Review Clerk
(Revised 3/12/2012)(RrAsed 07/1 offn(Revised 06/1=009)(ReWsed 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: CMpt e�OM�2: DATE:
ADDRESS: to/Og tj• m!-w l ih,_
Do hereby petition the Village of Miaml Shores to act as my own contrpctor pursuant to the laws of the State of Florida,RS 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 We or lease.-If you-sell or lease a building you have built yourself within:one'year after the
construction is completerthe law will presume that-you built for sale or lease,which We 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 forthat employee,all as prssc►ibed bylaw.Your construction must comply with all applicable laws,ordinances,
buildings cedes and zoning regulations.
Please read and inIdal each paragraph.
1. l 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 properly list,may act as my own
contractor with certain restrictions even though I do not have a license.
. initial
2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the
construction.and Is not hiring a licensed contractor to assume responsibilmr. /
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 bardal 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 6 list his or averse 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 w hNn 1 year after the construction Is complete,the law will presume that I built or subsieftly
improved it for sale or Vie,which violates the exemption. l
Initial G�
5. 1 understand that as the owner-builder,I.must provide direct orske supervision ofthe construction.
Intoal
6. 1 understand that I may not hire an unlicensed person to act as contractor or to supervise my ns working
residence.It ism responsibility to ensure that the u a by building or
y pons lfy persons whom I employ have the license required by law and by county or
municipal ordinance.
Initial
1
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 a
liable and subjectad to serious financial risk for any injuries sustained by an unlicensed person or his or emptoyees'while
working on my property.My homeowner's insurance may not provide coverage for those injuries.I am willfully acting as an
owner-builder and am aware of the limb of my insurance coverage for injuries to workers on my property.
InIfi
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 notAcensed must work under my direct supervision
and must be employed by me,which means that I must comply with laws-requiring the withholding of federal income tax and
social security contributions under the Federal Insurance Contributions Act(FICA)and must provide workers compensation for
the employee.I understand that my failure to follow these may subject to serious financial risk
Initial
9. 1 agrer3 that,as the party Daily and financially responsible for this proceed 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 trust comply with all applicable laws,ordinances,building codes, and zoning regulations.
tnitlal�_7"_
10. 1 understand that I may obtain more Irdonnation 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 hbl&sw.mvbdddoetee.2gmLdbgrr r–Qfc lblindex.html
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:
f41oq lV 1VfftL #66
Initial-4—
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 the disclosure.
Indtial�
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 f rumcial 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 told liable for damages.If you obtain an owner-builder permit and wish to hire a licensed cordracbe 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 ie Issued,this disciosure statement must be completed and signed by the property owner and
returned to the local per iltng agency responsible for issuing the permtL A copy of the property owner's driver license,the
rotadzed signature of the property owner,or other type of verification acceptable to the Wool permitting egmncy Is required when
the permit is iced.
Was acknowledged before me this 1 _day of d9---200
gy who was personally known to me or who has
Produced there !cerise or ��•1�-to)Zs identification.
Ikus
OWNE CLAUDIA V. �Y
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My Comm.Expires Sep 23,2015
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