RC-13-2464Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 206825 Permit Number: RC -10 -13 -2464
Scheduled Inspection Date: February 10, 2014 Permit Type: Residential Construction
Inspector: Rodriguez, Jorge
Inspection Type: Final
Owner: PENDLETON, CAMILA & RYAN Work Classification: Alteration
Job Address: 166 NE 93 Street
Miami Shores, FL 33138- Phone Number
Parcel Number 1132060133090
Project: <NONE>
Contractor: HOME OWNER
tcunama uepartment Comments
KITCHEN REMODEL
INSPECTOR COMMENTS False
February.07, 2014 For Inspections please call: (305)762 -4949 Page 35 of 44
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re- inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February.07, 2014 For Inspections please call: (305)762 -4949 Page 35 of 44
IN Miami Shores Village
�} fJ v Building Department
1� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (3057 762.4949
BUILDING
PERMIT APPLICATION
Permit Type: BUILDING
OCT 31 2013
91Y
FBC 20
Permit No.
Master Permit Nok l
ROOFING
JOB ADDRESS: I ( G /U % 4re e
City: Miami Shores County: Miami Dade Zip: 3,31
Folio/Parcel#: — 37 067 —013- R f U
Is the Building Historically Designated: Yes
NO
Zone:
OWNER: Name (Fee Simple Titleholder): r 1 AA) Pi"s P D L, U-- 7G�J Phone #: 3() 5 -5 -0S�
Address: la Al C
City: MigAl )—i1&A,j State: L Zip: -33 / 3 Y
Tenant/Lessee Name: 0 I1 IV -L rL Phone #:
Email: I? L, PCN 9 Le 70&) 4,Q i�tJ�'� 1 L
CONTRACTOR: Company` Name: 0� Ai � 1 Phone #: 30S - 7' _UjS
Address: /� 16 6 /�' � 13 �nc _�
City: M dy M e S% V f State: F L— Zip: S3 3 9
Qualifier Name:
State Certification or Registration #: Certificate of Competency #:
Contact Phone #: 05_" (oh % el- fN_' mail Address: 49E0Le7T6,)j0_ _ ✓i►
DESIGNER: Architect/Engineer• .' K (_cl M k Phone #: — ��y 231 Y
Value of Work for this Permit: $ a Square/Linear Footage of Work:
Type of Work: ❑Addition II OAlteration ONew ❑Repair/Replace ODemolition
Description of Work: 9, T� iv tj 2 N o
Color thru d1e:
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Educadon Fee $
Double Fee $ Structural Review $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ VIC
Bonding Company's Name (if applicable) _ 0
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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.
S Signature
Owner or Agent
The forego instrument was acknowledged before me this 3L
day of , 20 , by 944,Qn �? h L I& af7
who is personally known to me or who has producedP 53 LI7a2,
As identification and who did take an oath.
NOTARY PUBLIC: r �►�t�uuuirn�,,
Contractor
The foregoing instrument was acknowledged before me this
day of .20 _, by
who is personally known to me or who has produced
as identification and who did take an oath.
My Commission Expires:
Structural Review Clerk
(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10 /2009 )(Revised 3/15/09 )(Revised 7/10/2007)
ELI
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: PtE2JPt.1 7O n) D A T E : 10 . 3 i 3
ADDRESS: P. r 13 �� r
Do hereby petition the Village of Miami Shores to act as my own contractor pursuart to the laws of the State.of Florida, F.S 489.103(7).
And I have read and undetaiood the. following disclosure s#atemeM, which eptitles 00 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 dorm 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 buiilding'must be for your own use and
occupancy. It may not b built for sale or lease: If yowseli or lease a building you` have built yourself within' one, year after the
construction isrcoWiplats ft tawwiiEpftun*th*you built for sale or lesse, which is=a violatiob of this'exe"Oon. You may not hire
an unlicensed person as a contractor. It Is you responsibility to make sure the people employed by you have lio roses required by state
taw 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 eniployee� all as pribed bylaw. Your construction crust comply with all applicable laws, ordinances,
buildings codes and zoning regcilatiorm
Please read and initial each paragraph.
1. I understand that state law requires construction to be done by a licensed contractor and have.applled for an owner- builder
permit under an exemption from the law. The exemption specifies that I, as the owner of the property Oft, may my awn
contractor with certain restrictions even though I do not have a license.
I
2. 1 understand that bulldbn pemdts are not required to be signed by a property owner unless he or she is responsible for the
corstruclioq and Is not h*g a fisted contractor to MM respo 9611ityy.
Initial
3. 1 understand that as an owner builder, I am the respWilble party of record on a pemdt. I understand that I may protect myself
from potential tmncW risk by hying a ticersed wntractor and having the permit filed In his or her name . bstead of my own
name. I. also understand {hat the cQrntracdor le required by law to be Weed to Florida are to list
h or
permits 8 contracts. lis
4. 1 understand that I may build or improve a one family or two-family residerree or a farm outbuilding. I may also build or improve
a mmmftW building If the costs do not exceed $75, 000. The building or residence must be for my use or OCCUPORCY. it may
not be built or substantially Improved for sale or lee. ff a building or residence that I have built or s Improved
myself its sold or leased within 1 year after the corstuction is compete, the law will presurrre tilt I y
improved it for sale or lease, which violates the exemption.
initial_
5. 1 understand that as the owner - builder, I must provide direct, onsite super of the construction. ✓J
Initial
6. 1 understand that I may not hire an unlicensed person th act as my contractor or to superft persons woddng on my buildhrg or
residence. It Is my resposibtiily to ensure that the persons whom I employ have the own required by law and by county, or
municipal ontineribe.
Initial
7. 1 understand that it Is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that
erronedusly Implies that the property owner is providing his or her own labor and materials. I. as an owner-wild Or,.may be Mid
Gable and subjected to serious financial risk for any Injuries sustained by an unlicensed person or his or emplf>yees�ahNe
working on my property. My homeowner's insurance may riot provide coverage for those injuries. I am willfully acting as an
ownsf-builder and am aware of the Gmile of my insurance coverage for Injuries to workers on my property.
Initial
I understand that I may not delegate the responsibility for supervising work to be a licensed s ed contractor who Is not licenses to
perform the wwork:being4one. Any person working on my building who Is npt,licensed must work under my direct supervision
and must be employed by me, whldh inoeti that I mug com* with laws kulAg the withholding of federal Income tax and
social am* contributions under the Federal Insurance Contributors Act (FICA) and must provide workers col on
for
the employee. I understand that my failure to follow these may subject to serious financial risk.
Initial,
i agreai that as the party legally and flnenclally responsible for this proper Construction ecfivity, I will abide by all applicable
W and requirement that govern owner- builders as well as employers. I also understand that`the
Construction mist comply with all applicable larva, ordfnertm, building codes, `and zoning regulations.
10. 1 understand that I may obtain more information regarding my obligators as an employer from the Internal Revenue Service, the
United Stales Small Business Administration, and the Florida Deparhr err of Revenues. I also understand that l may contact the
Florida Construction Industry Licensing Board at 850.487.1395 or J
!
11. 1 am aware of, and consent to; an owner- builder building permit applied for in my nanm and understands that I am the party
legally and financially responsible for the proposed construction ectivny at the 61lowing address:
mitt
12. 1 agree to notfy Miami Shores V!Ilage immediately of any additions, deletions, or changes to any of the lnforrrhatio
have provided bn the 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 Construuction Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you with any financial kiss that you sustain as a result of *ntrector may be in civil court. It is also I portent for you to
understand that y an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may
be held Gable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for
verifying arfether the contractor a properly GcensW and the status of the contractor's workers compensation average.
Before a building permit can be Issued, this disciosure statenicrd must be completed and signed by the pry owner and
retumed to the local permitting agency responsible for issuhg the permit. A copy of the proPerty ownbei'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 J day of OCT 20—Lf3,,._
ByV1 OA Pen A(� I W • who was personally known to me or who has
Produced there License or.12 0 73) -ALS l�"h.%,h�hhr11r11
310 612 0
OWNER C NIDTARY
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