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WS-14-786Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-219108 Permit Number: WSW -4-14-786 Scheduled Inspection Date: September 08, 2014 Inspector: Rodriguez, Jorge Owner: SFARA, VERONIQUE Job Address: 1080 NE 105 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: HOME OWNER Building Department Comments SEAWALL CAP AND DAVITS Permit Type: Retaining Walls/Seawalls Inspection Type: Final Work Classification: Repair Phone Number (305)799-2006 Parcel Number 1122320280090 INSPECTOR COMMENTS False September 05, 2014 For Inspections please call: (305)762-4949 Page 17 of 19 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 05, 2014 For Inspections please call: (305)762-4949 Page 17 of 19 BUILDING PERMIT APPLICATION Miami Shores Village Building Department APR 17 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 3313 Tel: (305) 795-2204 Fax: (305) 756-8972 $y° 2_S7_.___ INSPECTION LINE PHONE NUMBER: (305) 762-4949 FtB�C 20 Master Permit No. (Il -su) j ! —4-6 Sub Permit No., UILDIN ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS [:]CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: I ® ® N E to e't City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple City: Tenant/Lessee Name: Email: �. ! Qsv-f State: Zip: CONTRACTOR: Company Name: / Phone#: Address: City: -State: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Ad Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ of Work: ❑ New State: Zip: Footage of Work: 2 ® Repair/Replace ��C]Demolition 4 p 0 11A , A A C L B I AL ., A ° i] Pl � 4-3 Specify color of color thru tile: go lwecsfii 1 v(040 r 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 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. Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this I� The foregoing instrument was acknowledged before me this day of 20 141 byV14iN JUL S day of . 20 J by who is personally known tome or who has produced who is personally known to me or who has produced As identification and who did t�lt�'aii��fhU,�, as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY Plans Examiner �Zonx+�+�� ng ZR L, k tI Structural Review Clerk (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) jai Z/ NOTARY PUBLIC:%p�PP•. �,, '.,± Sign: 6" °• FF :' i,�IN Print: ' f7.3r� Jg \�.: ���1QF�FLO,�®`°�10\ My Commission Expires: NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY Plans Examiner �Zonx+�+�� ng ZR L, k tI Structural Review Clerk (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) FAI U (2) t `.P. /NO CAP "'�L" :ALC-r':'r_ 0, CON" PAVER I DP'VEWA,Y 15T:: LOT 8 BLOCK 1 4' METAL FTP OVERHEAD WIRE 75.00' s SEPTIC IANf; ^Q, i ?'P 0 2 `bm CLEAN ' V. O OUT mm \--STEP5 CLEAN 0 OUT TP WATER Irl .11A AC `DECORATIVE WALL LOT S BLOCK 1 UNDER] CONSTRUCTION POOL UNDER CONSTRUCTION n 42.4 UNDER CONSTRUCTION i ��LBOA r T1 00ill INOOD PpOICT 11U -6fA WALL CV PUIL17-Ur'' M. -- PPWICT LOCATION 627.75' .LP 112" 1050 NF 105TH 5TVFF T NO CAP MIAMI 5HOkE 5, FL 3508 LEGAL 12 5CI;1P110N LOT 9,131..00K I, MIAMI 5HOp�5 D5W' 5, ACCOPVING TO THS FLAT" TH�PEOF A5 f?�C0P12�12 PLAT POOK 47, Wir- 58 OF THS PUPLIC C. ,lk kECOPT5 OF MIAMI-12AP� COUNT`(, FLOPVA / 3f"15 o LOT 10 N BLOCK I 5 N y1 coo sl 4' METAL /-PENCE ✓.1.P i/2" /806 pp0,.ECT LOCATION LOCATION MAP 1C U ATO ENGINEERING 10525 SW 77111 COURT MIAMI, FL 33156 19 541 260-8002 W W W.CUEYOENGLNEER ING.COM NESTOR A. CUETO, P.E. LTC#71988 SEAL 6K- GBN` 06"',�i O No. 71988 STATE OF % �U xsFss' 0NA% \\ VFOJI CT L�5TIWF-51`Ap.A M51MNC� 5�A WALL CA? I3UILI:2-LP 1080 NF 105th 5TMf MIAMI 5N01?�5, FL 35138 rv.,-r t913Y: NAC CWCrW r y V I.5 --D K V f7AT� 1F5CONON 0 5/2/I� ISSIEI7FOKCUNSi�1.:110N (5cu! N,f,5, -� 511��T TITLE 51Tc PLAN & LOCATION 5HEE T NO, �iV G -I 0 IN17FX OF RAWIN65 G-1 511 PLAN & LOCATION 6-2 6�Wk I. N01t5 b -I f9WLI110N PLAN �-AA,'-v1AAH%SCT1LPLLL& i n�1'AI b Ii P1 ROVED BY DATE ON1NG [S R 'CTURAL s FILI CTRICAL L MaING EC HAWCAL G. c 1 U '!*CT TO C :MPUANd WIi11 I'LL i .)ER `,L. T TE FM�I-VYIJr\1�R # IRECEIVED MAY 0 2014 BY; Sul C u Confidential Q 2014 Cueto Engineering, LLC. This document contains confidential information proprietary to Cueto Engineering, LLC that is not to be used, disclosed, or reproduced in any format by any party without prior written permission. All riahtc ---d FAI U (2) t `.P. /NO CAP "'�L" :ALC-r':'r_ 0, CON" PAVER I DP'VEWA,Y 15T:: LOT 8 BLOCK 1 4' METAL FTP OVERHEAD WIRE 75.00' s SEPTIC IANf; ^Q, i ?'P 0 2 `bm CLEAN ' V. O OUT mm \--STEP5 CLEAN 0 OUT TP WATER Irl .11A AC `DECORATIVE WALL LOT S BLOCK 1 UNDER] CONSTRUCTION POOL UNDER CONSTRUCTION n 42.4 UNDER CONSTRUCTION i ��LBOA r T1 00ill INOOD PpOICT 11U -6fA WALL CV PUIL17-Ur'' M. -- PPWICT LOCATION 627.75' .LP 112" 1050 NF 105TH 5TVFF T NO CAP MIAMI 5HOkE 5, FL 3508 LEGAL 12 5CI;1P110N LOT 9,131..00K I, MIAMI 5HOp�5 D5W' 5, ACCOPVING TO THS FLAT" TH�PEOF A5 f?�C0P12�12 PLAT POOK 47, Wir- 58 OF THS PUPLIC C. ,lk kECOPT5 OF MIAMI-12AP� COUNT`(, FLOPVA / 3f"15 o LOT 10 N BLOCK I 5 N y1 coo sl 4' METAL /-PENCE ✓.1.P i/2" /806 pp0,.ECT LOCATION LOCATION MAP 1C U ATO ENGINEERING 10525 SW 77111 COURT MIAMI, FL 33156 19 541 260-8002 W W W.CUEYOENGLNEER ING.COM NESTOR A. CUETO, P.E. LTC#71988 SEAL 6K- GBN` 06"',�i O No. 71988 STATE OF % �U xsFss' 0NA% \\ VFOJI CT L�5TIWF-51`Ap.A M51MNC� 5�A WALL CA? I3UILI:2-LP 1080 NF 105th 5TMf MIAMI 5N01?�5, FL 35138 rv.,-r t913Y: NAC CWCrW r y V I.5 --D K V f7AT� 1F5CONON 0 5/2/I� ISSIEI7FOKCUNSi�1.:110N (5cu! N,f,5, -� 511��T TITLE 51Tc PLAN & LOCATION 5HEE T NO, �iV G -I 0 SCOPE of wow I, REMOVE E4511NG 2AVIT5 AN2 2EMOLI5H EXI51N6CONDI TE 2AVIT FOUNDA11ON5, 2. EXTEND 51�AWALL CAP AT OL2 TEWACE LOCATION TO ALIGN WITH EXISTING TOP OF ADJACENT 5EAWALL CAP. GENMPAL NM5: 1. 1HE5E PLAN5 AP� FOP THE CON51RUC11ON AT Tl -E LOCATION 50 0K516NASP HUMIN. 2, NO 6HANGE5 IN THE PLAN5 5 -XL BE MARE WTHOUT PWIOP APPMOVAL FMOM THE ENGINEEP OF RMCM, 3. ANY COWFLICT5 BETWEEN DPAWING5 5HALL BE GOVKRNE2 BY fitMG5T 5iPIN2NT APPLICABLE. APPLICABLE..4. ANY AN12 ALL APPLICABLE 6012E5, ALL OR IN FW, APPLIED TO THESE 2PAWING6 SHALL BE IMPLEMENTED A5 RKQJIRE2, Al WEFEeNCE5 AND/ OR MQURKMENT5 5HALL APPLY A5 2ETAILW IN THE 2P.AWIN66. 5. ANY CHANGES MADE PI40P TO APPROVAL BY OWNER AN2 ENGINEER M 215ALLOWMD A5 MXTMAS AND T1 f CONTI ACTOR MAY BE MMQUIRMD TO PM%OPE TO PLANS 6, ANY EWOR5, OMI551ON5, ANI2 AMBIGUITIES IN TK 12MAWINC45 AN2/ OR 5PECIFIGA11ON5 5HALL BE I;F�FOM11~D TO T -IE %CAINEEP OF WECOW2 FOR COWWEC11ON5 PRIOR TO COMMENCEMENT OF WORK, 7. THE ENGINEER OF WECM SHALL BE INVITED TO PWCIPATE IN THK PRE -JOB BRIEF PRIOP TO IN5TALLAIION, 8, ALL WORK 5H&L BE PERFOPMW2 IN ACCO AN' E WITH THE LATE5T FLOWA BUILDING CODE AND LOCA, AUTHOPIT1E5 HAVING JURI512ICTION, 9, ALL MATEMIAL5 5HALL BE IN5PEC92 UPON ealPT FOP CONFORMANCE TO THE M516N DWAWNG5 AND ANY DAMAGE SHALL BK DOCUMENTED, 10, ALL LUMBER 5HALL BE 12E1`411FIE2 BYTHE 6 WE MOF, OR CEP1IFICATE OF IWI G110N 155LE2 BY, AN A'PPOVE2 LUMBEP GRADING OP IN511EC11ON Bl, AU OR AGENGY, 11, DECK SHALL NOT BE U5E12 OR 06CLPIEP UNTIL FINAL INSPECTION AND ApPMOV& 15 OXA192. 12, EX15T1N6 5EAWA,L 2EA2MEN 5HALL eMAN UN2151URBE2. DE51(AN CRITERIA: I. 2E516N LOA25: a. M%N WIND PRM55M = t45 PSF (175 MPH 3-5EC 6U5T, GATEGOPY Il, E)P051,9 2) b. LIVE LOAD m 40 P5F 2. CONCI:T�1R COVER SHALL BE 2" MIN. 3, FA511 NEWS AND CONNIECTOR5 EXP05E12 TO 5A,T WATER OR LOCATED WITHIN 300 FEET OF SALT WASP 5HOMILIN SHALL BE STANLE55 5TEEL (APV504 OP 316, 4. MAT IAL5 LISTED BELOW 5HALL CONFOPM TO TNM FOLLOW 5PMGIFICAAON5. a. NOMMAL wT, CONCRETE - ACI 318 -II, 28 -DAY COMPRM5`Aw 5TMNGTH f' c ® 4,000 P51( MIN.) b. REINFORCING 5TEEL - CARBON 5TEEL: ACI 31&II, A5TM A 615, fq m 60,000 psi TaERANCE5 1. UNLE55 NOTED OTNEPW15E, 5UPPORT MEMBER5 AND COMPON%T5 SHALL BE IN5TW2 ON TIE CENSQ49 OF 11f CONCRETE 5WPa WITHIN A TOLERANCE OF ty" . COATING/ FINI5HIN6 I. ALL 5UPFACK5 TO BE COATED 5HALL BE CLEAN, FRMS OF 21PT, 6MA5E, OIL, M015M AND OTHMP FOREIGN MATY. 2. CLEANING SNA,L BE PERFORMED AFTER A55EMBLY OF EACH COMPONENT HA5 BEEN COMPLETED. 3. 50JNLE55 5t1 L, GALVANIZED 5t1 L, AND 5UPFKC 5 EMBEDDED IN CONCRETE SHAI..L NOT P�CEIVE ANY TYPE OF COAI1%, CONTRACTGR' 5 RM5FON51BILM5: I. 1IE CONfWTOP SHALL BE KNOWLEDGEABLE, PPOPEPLY LICENSED A142 MU5T BE eLV19 UPON TO A'HIEVE PPOPEP IN5TALLA1ON OF MAtPIAL5, WEATHEP 5EAJK MA1I lk TPAN51T1ON5, SEPAPA11ON5, CONNECTi0N5, ffC 2, THE CONTWACTOP 5HALL PROVIDE FOP TK 5AFETY, PREVENTION OF INJI PY AT TIS JOB SITE TO ALL PES0N5 EMPLOYED ON THE WORK, PER50N VI5111NG 1H: WORK, AND THE GENEP& PUBLIC, CONMCTOR SHALL A.50 BE I?i5PON51BLE FOP TSE PPOPERTY AT THE 5111; OR Al2JAaNT TH�ITTO. 3, THE CONRACTOP. 5HALL EXEPCI5E CARE DUPING DEMOLITION AND REMOVAL TO A550 THAT ItM5 50-E2.lLE2 FOP 2WMOLMON AT; PROPERLY RMMO02 AN2 ISM5 TD MMAN AME PROMCTE2 FROM 2AMAGE. 4, TIE CON112ACTOP 51ALL CHECK AN2 VERIFY ALL 21MKN5101\15 AN2 CONMON5 OF THE JOB STYE ANP REPOPT ALL 2150VANC{E5 O2 CONDIT10N5 THAT ARK UNSAFE T0 11 -E PROJECT %6INEEM, 5, TIE CONVACTOP 5H&L 20 ALL WORK IN 5f0CT CONFOPMANGE TO T -E PLAN5, 5TAN2ARP BUIL2lNG CO2E, LOCA, COM 5 & OP1211ANCE5, MANUFACTURER' 5 1;T-.1'-1OMMKN2AT1ON5, AN2 ACCEPTABLE TM PRfCTIGE5, FOP ANY GONFLIGT5 BEfm% Tl -E ABOVE MEN110NE2, THE M05T STRINGENT REQUIREMENT5 5H&L GOVERN TIE 2E516N. 6. CONTP•A;TOR 9-I&L NOT SCALE 2MAVAN65, ANY INFORMA110N THAT CANNOT BE OBTANWD FROM Tl -E 21MENSION5, 2ETAL5, OR 5CHWULE5 SHALL BE OBTAINED FROM THE ENGINEEP OF 1 E(COV. 7. CONTp.A; TOP SHALL FURNISH ALL 5UBCONfWTOP5 WITH A COMPLETE SET 9 PLAN5. 8. THE CONIVACTGM 5HALL COMPLY WITH ALL FEL2 5TOMM Z, HANPLING, IN5TALLA11ON, BP.ACING, ANCHOPA2, AN2 FIEL2 A55EMIV RKQUIREMENT5, 9, THE CONTMACTGP 15 RE5PON51BLE & 501, -ELY AC,'OUNIVPLE FOR ALL CON511WION MEAN5, MKTHO25, TECHNIQUE5, SKQI.ENGE5, PPO09URE5, ANP COCWINAI1ON OF ALL WOW\ PERFOWMED, 10. ALL WORK PERFOPME2 SHALL CONFORM TO THE 2010 FLOP 12A BUILPING CODE AN2 ALL APPLICA3LE MIAMI-2AM GOI N1Y OW2INANCE5, AND SHALL BE COMPLETE2 TO THE 1-1I6HE5T STAN19ARf25 OF CRA WAI\15HIP BY JOWYMEN OF THE P�5PKCTIVE TPVI 5, CEMTIFIGATE OF COMPLIANCE IT 15 (EPTIFIED THAT TH. UNDER516W HAVE REVIEWED THM51� DESIGN DOCUMENTS AND IT 15 DESIGNED IN ACC.OWANGE WITH Asa 7-10 AND THE 2010 FLO IPA BUILDING CODE. D15CLAMEP THE INFORMATION COdTA02 HKREIN 15 RMLIABLE, GENERALLY A:CURAt FOP THE PUWO5E I MNDEI, AN215 IN A;CMANa WITH APPLICABLE IN2U5TPY CODE5 AND 5TANDAP95. ALL M516N DOCUMENT5 ARE 0PYWHS19 BY CUETO ENGINEERING, LLC AND MAY NOT It 50LD OP REPRODUCED WITHOUT EXPWE55 W21 tN PE1&115510N. NO 19PAWIN65 AND/ OP POLICAT10N5 SHALL BE CONSIDERED FULLY ENGINEERED WITHOUT TK 5EAL AND N(ANATL9 OF A LIGEN5E2 FOW5510NAL ENGINEER ak IFIE2 BY Tl't 5TATE IN VVHCH THE WORK WA5 PERFORMED, THEREFORE, ONLY 5TAMPED AND 516NE2 COPIE5 SHALL BE CON5I7ERED FULLY ENGINEERE2 PLAN5 AND/ OR POLICATION5. iw� C U ET"O ENGINEERING 10515 SW 771H COURT WANM P1.33755 (954) 250-8002 W Ww.Cu7?rOENCLNFFRINC.COM NESTOR A. CUFrO. RE UC#71988 no.>ecr AB13REVIA11oN5 ALT ALTEI�IATE MLWL MEAN Low WATEP L:VEL 1,�5112Af?�-S�APA �511?�NG� SQA WALL GAP PUL194 P BM BEAM O.C. ON CENTER LINE EA EACH It PWoPEMTY ([180 Ply IOStFi S SI E.F. EACH FACE U.N,O. UNLW55 NOTED OTH'- WI5E MIAMI 5HM5, PL 53138 MIN MINIMUM W/ NTH MHX MEAN HIGH WASP LEVEL vvv W002 mrmy Py' NAG atcep Vr; VI,5 'WV VAM M50WON 0 512/16 1551Ef7FMCON9ttWWN N/ A st�Ttht>; GZW& NOTe5 Confidential ® 2014 Cueto Engineering 5N,�TNO, V LLC. This document contains confidential Information proprietary to Cueto Engineering, LLC that is not to be used, disclosed, or reproduced in any format by 6-2 0 any party without prior written permission.All rights reserved. AA C U ETO ENGINEERING 10525 SW 771H COURT WAAR EL 33156 S" 260-8002 WWW.CUFMINGINIM NG.COM NESTOR A. CUETO. P.E LTCU7L488 SEAL .71 gTWEOF ;'&V ; aw NAC�``�� azo'ecr V5W�'5PAIZA M51MNa 5�A WALL CAP 13UIL12-UP 1080 It 105th 51WI�r MIAMI 5HOM5, F1,55158 paten Pr: NAC aTmtgver, VI5 V PAT, R50WON 0 51111A 15MPOR cad5m ION 5'r�.H' 1111,E MMOLITION PIAN 5HMf N0, ev n'I 0 N a �4511NCA 5�A WXL X/VV` L- (Iff i v vr. rxi P\VW) A �e E (51 #q LOVE. 3'-V' M) f4V NEW AWV.CN' T-9 &VO4 10 M-1 ; a • RO.Yki;N 5NAahV c AMY[J'.G9N MA W F60R f0 F(M\,6 \PW CONO" 5'AWA, CM' . M AN9MY 4UVOF5 WALL (U a 012 Of.ATEF, LlI%HL IHY-I MU e4, , A1fIN1 (I,OCIUf01' 012 sOJA,) A Sm&I, CAP wAL Pl AN VIEW _ 5W: Vb, NOM: 5EAWA.. COP D ILP -LF VOf 0 EXl-.W OWR WAI--E Confidential © 2014 Cueto Engineering, LLC. This document contains confidential information proprietary to Cueto Engineering, LLC that is not to be used, disclosed, or reproduced in any format by any party without prior written permission. Ali rights reserved. C U ET(::) ENGINEERING 10525 SW,771 COURT MIAMI. FL 331.56 19541 260-8002 W W W.CUE MENGL%TE MING.COM NESTOR A. CUBTO, RE LiGCI 988 wo.:Cf 1,1�5 -5fARA M51MNa 51�A WALL CAP 13UIL12-UP 1080 NP 1054 5fmEf MIAMI 5HOW5, PL 3W58 McPA n VY,- NAC cWaw rev, VL5 V PACE MCOMON 0 5/2114 MEP FOR CON91laJ PON 51�A WALL CAP PLAN & MfAlL5 5HW NO, V A-1 O 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: 1) VATE:1 *15 . ADDRESS: ko ®® NF— I®s rt 1 t I 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.C.A 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 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. 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that 1 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 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, thelaw will presume that I built or substantially improved it for sale or lease, which violates the exemption. f r Initial 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial Y 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 county or municipal ordinance. Initial t 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 properly 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 willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial VG'S 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 compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial -"L_ I 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_h_ttp://www.myfloNdalicense.com/dbor/aro/Ciibriindex.html InfialV.S_ 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the parry legally and financially responsible for the proposed construction activity at the following address: 1020 f.) t ) 49's --s I', - Initial 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 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 /1 , 20 By ° d � J '` who was personally known to me or who has Produced there License or as identification. OW ER 5EE- c State of Florida Feliciano sion FF 082753