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FW-14-859Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218842 Permit Number: FW -4-14-859 Scheduled Inspection Date: September 02, 2014 Permit Type: Fence/Wall Inspector: Rodriguez, Jorge Inspection Type: Final Owner: MARTINEZ, MARTA GAMALLO Job Address: 10528 NW 2 Avenue Miami Shores, FL 33150 - Project: <NONE> Work Classification: Wood Fence Phone Number Parcel Number 1121360020030 Contractor: MIAMI JGL DECO PAVERS CORP Phone: (786)286-5033 Bull WOOD FENCE SELF CLOSING GATE FOR POOL 5" HIGH I a„ INSPECTOR COMMENTS False `w Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-211495. North side higher than 5' Failed Correction ❑ I - Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 29, 2014 For Inspections please call: (305)762-4949 Page 24 of 25 66 Iy � -VI l0 BUIL INS M m 1ka- G PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS FBC 20 C- Master Permit No. -- Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL E&-tHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Ilii,57,0 AAJ *46 - City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: /Coo�lnsstruction Type: ,�/ Flood Zone: BFE: �p FFE: t� OWNER: Nam�ee Simple Titl holder): � /�f Ivo c, � �wej "r �Az" Phone#: 1' o� 6s3 -/57 ~� M Address: � /� � 16 ��L �Y/E 1� -pix City: State: Zip: Tenant/Lessee Name: Phone#: Email: 2f- s -5V,33 CONTRACTOR: Company Name: 4 04 ( � eZ- Phone#. Address:.4z c City: / l State: I Zip: Qualifier Name:Phone#: State Certification or Registration #: ell, Certificate of Competency #: DESIGNER: Architect/Engineer: one#: Address: City: State Value of Work for this Permit: $ CU 5:f) Square/Linear Footage of Work: _ Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work:, Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ CfF$ { , CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ r Notary $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ L "0a Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 whiq#9 occ s ven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app v d nd a sp tion fee will be charged. !r . Signature Signature l x, ` CTOR The foregdiAg instrument was acknowledged before me this day. 20 -I by Le0N'a ap (20-,-Foti (r)l NAo ii pe s o n a I I y known to me or who has produced Qrl6bR-1 90 ynI as identification and who did take an oath. NOTARY PUBLIC: Sign: ,I (AJ,1 Lk Print:�if l Seal: APPROVED BY (Revised02/24/2014) �.>a 1 :2 or 'PS The foregoing instrument was acknowledged before me this e30 day of I'k 1'� 20 t' , by _:LN4 k RIlz—l� `� �S. who is personally known to me or who has produced rA�-> C -C- L-A C-- as identification and who did take an oath. Plans Examiner Structural Review Zoning Clerk NOTARY PUBLIC: ,�``er6/ Sign: Print: Seal: Plans Examiner Structural Review Zoning Clerk in`a title insurance commitment vv issued by it. File Number: 120088 Folio Number: 1121360020030 LIMITED POWER OF ATTORNEY Know All Men By These Presents: That MARTA G. MARTINEZ has made, constituted and appointed, and by these presents do(es) make, constitute and appoint LEONARD MARTINEZ true and lawful attorney for and in name, place and stead, giving and granting unto said attorney full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises, including but not limited to the conveyancelencumbrance of said premises, execution of deed/mortgage, settlement statement and any related closing documents; said premises being limited to the following described real property: Lot 3, Shoreland Heights, according to the map or plat thereof, as recorded in Plat Book 43, Page(s) 85, of the Public Records of Miami -Dade County, Florida. As fully, to all intents and purposes, as might or could do if personally present, with full power of substitution and revocation, hereby ratifying and confirming all that said attorney or substitute shall lawfully do or cause to be done by virtue hereof. IN WITNESS WHEREOF, I/we have hereunto set my /our hand(s) and seal(s) DATE: ., - 2 V - �) U / -2,- Seated Sealed elivered in the presence of Witness Name Printed tnes�''Name Printed: 1 +i11 1 i 1 STATE OF COUNTY OF ' l l 1 ARTA G. MARTIRE The foregoing instrument was acknowledged beforeye this ' ?V C, Z by MARTA G. MARTINEZ who is/are personally known to me or who has produced a S ; as identification. Notary Prrrlic Printed Name My Commission Ex (Notary Seal) MARCIAL R. PENA • Notary Public •g -State of Florida M y comm. Expires May y 3. 2016 Commission # EE 195' << ® DATE(MMIDONM) ac - CERTIFICATE OF LIABILITY INSURANCE 5/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificete holder Is an ADDITIONAL INSURED, the Pol"iesj must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the poky, certain pokles may require an endorsement A statement on this certificate does not confer rights to the certificate holder to lieu of such endorseme s). PRODUCER CONTACT NAME: ANDYS ASSURANCE AGENCIES PHONE (305) 642-8407 ^X 1441 W Flagler St No A/C Na:{305) 643-5969 Miami, FL 33135 ADDRESS:loreta8andysassuranee.Com INIKIR IS) WOROING COVERAGE NAICN INSURER A: GRANADA INS CO INSURED MIAMI JGL DECO PAVERS CORP INSURER B: INSURER C: _ 4485 SW 7th Strut INSURER O: 1 Coral Gables, F1 33134 INSURER E: INSURER F : COVERAGES CFRTIFICATF NIIURFRT RF:VLRIrw NtIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE AUM 141M wvD POLICY NUMBER POLICY EFF MMID t LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR PAMAGES1Ea oawrrenaei $ 100,000 MED EXP (Any one person) $ 5,000 A 0185FL00030051 10/03/13 10/03/14- PERSONAL & ADV INJURY $ 1s000,000 IGENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMB APPLES PER: POLICY 1 PRO- LOC PRODUCTS - COMPIOPAGG S 21000,000 i AUTOMOBILE LIABILITY €a aBINIED SINGLE ccident I $ BODILY INJURY (Per person) S ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY R+IJURY (Pel acadeM). $ MIRED AUTOS NON SVMNED AUT Per accideMS UMBRELLA LIAROCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ i DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/m ANY PROPRIETORIPARTFER&XECN1Vaw Olanda NI ARIEREXCLUDED? ❑ NIA WC 5 ATI- 0 TORY LIMIT E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE S .. _ (aanaaray In aaq to I yes, desabe under E.L. DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS below 1 Utbk;KIF' i IUN ur UF'I=KAI IUNS I LOCATIONS I VEHICLES (Attech ACORD 101, Addili nal Resnaft Schedule, if more apace is. required) PAVING CERTIFICATE HOLDER CANCELLATION i MIAMI SHORES VITrLrFICsE SHOULD ANY OF THE SCRIBED POL IES BE CELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION THE EOF, NOTIC BE DELIVERED IN, 10050 NE 2ND AVE ACCORDANCE E P CY ROVISIONS, MIAMI, FL. 33138 01988-2010 ACORD25(2010105) The ACORD name and logo are regis d marks of ACORD rights reserved. HIS IS NOT A BILL - DO NOT PAY 6582036 13USMESS NAME/LOCATION MMI JGL DECO PAVERS CORP 14485 SW 7 ST MIAMI FL 33134 11witeR AIAMI JGL DECO PAVERS CORA off 1"17 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2014 "52678 Must be d'splayed at place of business Pursuant to County Code Chaotet SA Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY BUILDING CONTRACTOR PAY"ENT RECEIVED 049-54 04, 7 4 BY TAX COLLECTOR $45.00 0 J-1/7777- --0040:17 FPPU05�)3 Local Stainoss Tax Rompt only confims peymW of the L Business Tax. Tto flocoipt is owto konse, rait, at a certifit'860" of the Wder"s gam!Iftsfiom to do busifte". 14614or muv oomoy *ft any 60voraffmatal tojodatuty taws and i equirernuft which apply to the busift'evs btoot soc $4- on all ceim4of RE, al -NO. *hove *is o disonye Fat Mwe'fiftw"wia", Visit CTQB Construction Trades Qualifying Board JSINESS`CERTIFICATE OF COMPETENCY 09BS00624 IAMI JGL DECO PAVERS CORP LE S JAVIER G Is certified under the provisions of Chapter 10 of Miami -Dade County, ami Miami shores V Building Department XOR10050 N.E.2nd Avenue Miami Shores;Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner- workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: I . The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability.' BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contractor Print Name: L� . "��✓� PrintNamec Signature: m o o Signature:' • d ao� - m3oZ State of F da) n� o3,�c g 'T1 County o iami-Dade) to County of Miami -Dade } N �'• n N U P ' o Sworn and ubscribed before m this o o 9. day of o' s '20V -n ; s� By / ! w a MPATI f? i w (SEAL) Type oflTeintification produced AA n� State of Florida } 03 m County of Miami -Dade } N T g Sworn to and subscribed before me this day of 20 / o' s _-n By / ! w a MPATI f? i w 6/11/2014 JEFF ATWATER CHIEF FINMCIAL OFFICER Report Viewer s STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exemptfrom Florida Workers' Compensation law. EFFECTIVE DATE- 6/10/2014 EXPIRATION DATE: 6/9/2016 PERSON: LEYES JAMER G FEIN: 270958838 BUSINESS NAME AND ADDRESS: MIAMI JGL DECO PAVERS CORP 4485 SW 7 STREET MIAMI FL 33134 SCOPES OF BUSINESS OR TRADE:- CONCRETE RADE: CONCRETE OR CEMENT WORK - FLOO PRrsuant to Chapter 440.05(14), F.S., an officer of a corporation who elects eiertptim from this chapter byfiling a cerlMcate of electim order this serAm may not recover benefits or carponsation order he duper. Pursuant to Chapter 440.05(12), F.S., Certificates d elec im to be eserrpt_, applycrdyw thin the scope of it* business or trade listed on the notice d election to be enerrpt. Pursuant to Chapter 440.05(13 , F.S., Notices d election to be emrpt and certificates d election to be ermrpt shall be subject to rewcation it, at arryb7 after the filing d the notice a the issrwrce d the certificate, the persm named on the notice or catiflcale rp longer meets iha requirements d hs section for issuance d a certificate. The department shall re de a certificate at amytime tar failure of Ow Ixram named m the certlflCate to meet the requirenenb d this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 https://apps8.fldfs.comfcrreport\AewerlreportVievver.aspx?data=kd\pg i nc9D7Q3g H6TER6eP1 KMZ%2FSz5bXKYfBxlveksESoPVy1v4N POPN42XeirDRGXVWI) H ... 1/2 S � sr 1 ors: Tax Receipt • State , of Florida b' L — DO NOT FAY CC NO: 09bs00624 ' BUSt1VES5 IVANIE/E?QCATION �.-,., RECEIPT NO. EMPIRES MIAMI JGL DECO) PAVERS CORP NEW BUSINESS SEPTEMBER 302d'� �4 4485SW7ST• s 74526Q9` MIAMI, FL 33134 Must be displayed at place of business i Pursuant to County Code Sec 90-24 TYPE OF BUSINESS a OWMR __MIAMI JGL DECO PAVERS CORP � SPECIALTY, BIJlLI71NG CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR '18.75' 07,128/2014 0230-14-005081 a Restricted to - City of Miami Shores f + } r r c x 4 } . } r MIAM{ For more Information, visitlA1K31�C#QII�lIi�Lt��QQYlto�iCJiiiI�G9t u { Miami Shores Villag Building Departmen ri f0050 N.E.2nd Avenue, Miami Shores, Florida 331 Tel: (305) 795.2204 Fax: (305) 756.8972 B ILDING Pe; PERMIT APPLICATION Master PE FBC SW 10 - Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder) /)OP -3 t JF Phone Owner's Address /0603 IVIJ �2 44rL.. City tLk4, �-dj State f-(— Zip 5 !; Tenant/Lessee Name Job Address (where the work is being done) 105 Z? AAJ City Miami Shore. Village County FOLIO / PARCEL # Is Building Historically Designated YES NO Phone # Contractor's Company Name (A ),a Phone Contractor's Address City Qualifier Name _ State Certificate or Certificate of Competency No. Name (if applicable) Phone Value of Work For this Permit $ g 00- 00 - Square / Linear Footage Type of Work: ❑Addition []Alteration Otew ❑ Describe Work: /"]�P/r( to X 1-F Z r/ -Ir) ,' Submittal Fee $__670 400 Permit Fee S CCF $ Notary S Training/Education Fee $ Techne Scanning S Radon $ DPBR S Bond S Code Enforcement $ Double Fee S Structural Review. S Total Fee Now l ^3316-o air/Replace ❑ Demolition CO/CC Fee S Zoning S See Reverse side -a Bonding Company's Name (if applicable) Bonding Company's Address _ City State Mortgage Leader'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 neet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for EL CTRICAL 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 thata 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 alue exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien lai P brochure will be delivered to the person whose property is subject to att hm nt. Also, a certified copy of the recorded notice of co mencement must be posted at the job site for the first inspectio whit s even (, days ater the building permit is issued In the absence of such posted notice, the inspection will not pr a nd a inspection fee will be charged. Xignauffme Signature wneror Agent Contractor The forego g 'Le7 t was acknowledged before me this � The foregoing rostrum t was acknowledged before me this day of day of 20 ___, by who is personally known to me or who has producedA�*who is personally kno to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign- &; --7 < Print: My Commissio kNiotaary Public State of Florida My Commissi0 Expires: Joann ************# *�t*'M`�`li0M F V& ii` vrw Expircs01/1Y/2018 APPLICATION APPROVED BY: /� t Plans Examiner Engineer Zoning (Revised 07/10/07) Miami Shores Village _3 Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: ��!J�'+�Z, DATE: ADDRESS: /057ZYAJ4) f1�AJC l'Q�'T('.!'�`� 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.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. &I 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 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 license numbers on permits and contracts. 1-4 Initial 1 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, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial 5. 5. 1 understand that, as the owner -builder, I must 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 county or municipal ordinance. , Initial 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 willfully acting as 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 compensation for the employee. l 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 v ' 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 http://www.myfloridalicense.com/dbar/pro/cilb/index.html Initial 1J f I 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: [05N AW 2� 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 maybe 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 Aq_day of 20 20� ByZ=,O_n /- Q Ha,,/iidP7 who was personally known to me or who has Producedl e L e or�/�IdS � LC �� S as identification. a OWNER Notary Public State of Florida Joanna M Feliciano M My Commission FF 082753 Expires 01112/201 EMAP OF BOUNDARY SURVEY SCAL.E:1°=20' WEST MIA I SHORE P.B. 43, PG.85 SECTI N B LOT 8 (P.B. 46, I PG.35) LOT 7 Abbreviations FOU ND (NORp 1/2" N90.00'00 "W PILI 70.00' FOUND I.R.1112* A Arc .- (NO ID. FND Found U.E. Utility Easement :1.4 " WOOD FENCE 5' 0.3' �' IP Iron Pipe 12.0' 10.2, IR Rebar N&D No! N 'a 4c1 N B. t e k C8 �O t— wa a _ 12.0 10.0 me u a � g � T e o r' � qt` 41 "00 W/ ater Pump O 1 `O 0 PWY Parkway 90NCRETE +,moo tf7 = L) N ,Q � CiF K O ' C N (/? 9-, 1— Le end Oo �� ; t' , r Unknown ManholeLl l GljTE C D 00 ® Electric Box (Z rGA - MLP S 0.2' +'' r'11a 441) GATE a = C� , Light Pole z {Z ANK ��s;JO. O Cl - Property Corner Q d . ONE S'a Fire Hydrant A/C '� 0 t RESIDENCE I Q d- »o" Catch basin � 0 LO NO. 10528 w "' 0 TI � J a� ® Water Meter i17 ' o' F.F.E.=12.75' a �_ r m 41 Water Valve41 wv N 10 10:6' 1 ' =O 0 o Utility Pole b 26`3' O 0 CLPConcr to Li O l �. « POR "`� O - Concrete Light Pole Z r ''� ry'A - x--- Chain Link Fence 15.0' ID —�� — Wood Fence qA S64 E -0 Metal Fence —11U�. ,- verheod Utility line <PCotic"RETE DRIVEWAYo,`'j v CN meq' ro9 N z FOUND I.P.01/2" 0 61Q1 o. 70 FOUND i.P.01/2" o 10 VL ER NO ID. '.q' �q' 1q' '.q' NO ID) _ c 141.99' 490°00'00'W Rl 70.00 ,07�1^^ rr5' SIDEWALK o 41 `� o .�o�O �qh ONCRETE 11' PARKWAJCQN �o� '.q' o CRETa0`�~°DRIVE �� SOD tiDRIVE `1tiN meq•' tiq' O}} W r i]0 s � "� c 4� o (n . 1 tCJ • '� 12.5' ASPHALT PAVEMENT 6 v L? � Lu w p _ _ 11.6' MEDIAN GRASS ELECTRIC coq'. O o P- -i- ¢ 4P .b`L TRANSFO MER Q o Paver 03-474010 � �q°` N.W. 2nd AVENUE -,qy� Job No.13-0506 'bt 0 ~ i tig Page 2 of 2 Q� o0 �►��' �` aQ�eofi �'� 1$e�t `e ok to gp�6' e& o t a� r o ,a 60 So o`N L i MAP OF BOUNDARY SURVEY 10528 N.W. 2nd Avenue, Miami Shores Miami -Dade County, Florida, 33150 Folio # 11-2136-002-0030 SURVEYOR'S REPORT: 1. MAP OF BOUNDARY SURVEY, Dated May 7, 2013. This Survey Map and Report are not full and complete without th�,jtief. 2. LEGAL. DESCRIPTION: KI , y�. ��- '�'° LOCATION SKETCH Lot 3, of SHORELAND HEIGHTS, according,,,ko Ili&-pfat' thereof,, as. recorded NOT TO SCALE in Plat Book 43, at Page 85, of the Public,>t ec3owtls V Miami, 'Pod*` County, Florida. t.� Y , 3. AREA: �A,4q.1� Containing 8,750 Square Feet, or 0.20 41cres rinolrefor' Idss by pq),Wlations. 4. ACCURACY: The accuracy obtained by measurement and calculations of a closed geometric- figure was found to exceed this requirement. 5. DATA OF SOURCES:,._ HORIZONTAL CONTROL: -The Legal Description was furnished by client. . -North Arrow and Bearings refer-tb an as§limedvalue :of N90-00'0GN',wdlong the Easterly Boundary line of the Subject Property. VERTICAL CONTROL: - Elevations are referred to N.G.V.D. 1929. Benchmark used: -Miami--Dade County Benchmark # N-567, Elevation 10:54'. 6. FLOOD INFORMATION: NFIP Community Name: Village of Miami Shores and Community Number 120652 Map/Panel Number 12086C0302, Suffix: L, FIRM Panel Effective/Revised Date 09-11-2009, Flood Zone X. 7. LIMITATIONS: No research was made for other instruments than the existing in the plat and provided by client. No determination was made as to how the site can be served with utilities. SURVEYOR'S CERTIFICATION: - — - I certify. This Map of Boundary Survey meets all applicable requirements of the Florida Minimum Technical Standards as contained Chapter 5J-17. Unless indicated to the contrary, the measured distance and directions shown on the Map of Boundary Survey are the some as the deed distances and directions. No valid without the signature and the original raised seal of Florida Licensed Surveyor and Mapper. Additions or deletions to Map of Boundary Survey by other than signing party or parties is prohibited without written consent of the signing party or parties. EU NIA L. FORMOSO Professional Surveyor and Mapper State of Florida License No. LS 6660 2243 S.W. 153rd Path, Miami, Florida, 33185 Phone: (786) 443-0285 Email:eugeniallosas@gmall.com Date: 05-07-2013 SEAL Job. No. 13-0506 Page 1 of 2 N.W. 106th STREET 6 sx 7 4 w O U (46-35) 3 N (43-85) cv s 2 3 z z 10 t N.W. 105th STREET 2. LEGAL. DESCRIPTION: KI , y�. ��- '�'° LOCATION SKETCH Lot 3, of SHORELAND HEIGHTS, according,,,ko Ili&-pfat' thereof,, as. recorded NOT TO SCALE in Plat Book 43, at Page 85, of the Public,>t ec3owtls V Miami, 'Pod*` County, Florida. t.� Y , 3. AREA: �A,4q.1� Containing 8,750 Square Feet, or 0.20 41cres rinolrefor' Idss by pq),Wlations. 4. ACCURACY: The accuracy obtained by measurement and calculations of a closed geometric- figure was found to exceed this requirement. 5. DATA OF SOURCES:,._ HORIZONTAL CONTROL: -The Legal Description was furnished by client. . -North Arrow and Bearings refer-tb an as§limedvalue :of N90-00'0GN',wdlong the Easterly Boundary line of the Subject Property. VERTICAL CONTROL: - Elevations are referred to N.G.V.D. 1929. Benchmark used: -Miami--Dade County Benchmark # N-567, Elevation 10:54'. 6. FLOOD INFORMATION: NFIP Community Name: Village of Miami Shores and Community Number 120652 Map/Panel Number 12086C0302, Suffix: L, FIRM Panel Effective/Revised Date 09-11-2009, Flood Zone X. 7. LIMITATIONS: No research was made for other instruments than the existing in the plat and provided by client. No determination was made as to how the site can be served with utilities. SURVEYOR'S CERTIFICATION: - — - I certify. This Map of Boundary Survey meets all applicable requirements of the Florida Minimum Technical Standards as contained Chapter 5J-17. Unless indicated to the contrary, the measured distance and directions shown on the Map of Boundary Survey are the some as the deed distances and directions. No valid without the signature and the original raised seal of Florida Licensed Surveyor and Mapper. Additions or deletions to Map of Boundary Survey by other than signing party or parties is prohibited without written consent of the signing party or parties. EU NIA L. FORMOSO Professional Surveyor and Mapper State of Florida License No. LS 6660 2243 S.W. 153rd Path, Miami, Florida, 33185 Phone: (786) 443-0285 Email:eugeniallosas@gmall.com Date: 05-07-2013 SEAL Job. No. 13-0506 Page 1 of 2 Popp, AccesssGgat REQUYR�;�IElV'1'S: away "oust ope outward from the pool are*, be self -clo device located o �/self-lacking, and locates} no '4d* of the late from of �st than 54"F9C 424 2,17. ate. SELF C 00 IVL*vu1"VWE� ENTS., FENRING/ 49141 -LO TES REQUIRCKING CEAND ; 4' HIGH IF NEIGHBORS CL IMBABLE WALL, OWNER MUST REPLACEVE OWNER'S I'ROPEROTY CE X Shadow)BOX o Vertical Picket o - Board on Board Miami. Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel; (305) 795.2204 Fax: (305) 756.8972 WOOD FENCE DETAIL 4x4 Post Spacing Fences <= 5! high posts spaced at Yon center maximum Fences <= 4' high posts spaced at 6" on center maximum Fence must not exceed Sin height --1 F-1 F -I F -I , F -I -E= - 4x4 pressure treated posts embedded Tinto concrete footing 10' diameter x 2'deep ALL wood must be pressure treated All fasteners, must be corrosion resistant No, less than two fastener's in any connection b with two corrosion resistant fasteners per connection ;2x4 horizontal pressure treated wood members with two corrosion resistant fasteners per connection