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FW-15-777Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-231710 Permit Number: FW -4-15-777 Scheduled Inspection Date: May 05, 2015 Permit Type: Fence/Wall Inspector: Rodriguez, Jorge Inspection Type: Final Owner: DE PASQUAL, EMILIANO Work Classification: Wood Fence Job Address: 67 NW 103 Street Miami Shores, FL 33150-1233 Phone Number Parcel Number 1121360131090 Project: <NONE> Contractor: HOME OWNER :Sul comments WOOD FENSING HORIZONTAL 5 FT HIGH INSPECTOR COMMENTS False Inspector Comments Passed tv Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. May 04, 2016 For Inspections please call: (305)762-4949 Page 9 of 40 Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 rroject Aaaress Parcel Number Applicant 67 NW 103 Street 1121360131090 EMILIANO DE PASQUAL Miami Shores, FL 33150-1233 Block: Lot: Owner Information Address Phone Cell EMILIANO DE PASQUAL 67 NW 103 Street MIAMI SHORES FL 33150- 67 NW 103 Street MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone HOME OWNER Approved: Denied: of Construction: Wood Fence ;ification: Residential Fees Due Amount CCF $0.60 DBPR Fee $2.04 DCA Fee $2.04 Education Surcharge $0.20 Permit Fee -Wire & Wood $136.00 Scanning Fee $9.00 Technology Fee $0.80 Work without Permit Fee $136.00 Total: $286.68 Valuation: $ 1,000.00 Total Sq Feet: 136 Additional Info: WOOD FENSING HORIZONTAL 5 FT I Scanning: 3 Pay Date Pay Type Amt Paid Amt Due Invoice # FW -4-15-55081 04/06/2015 Credit Card $ 50.00 $ 236.68 04/15/2015 Credit Card $ 236.68 $ 0.00 Available Inspections: Inspection Type: Final In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT rtify that all the fore g information is accurate and that all work will be done in compliance with all applicable laws regulating construction and z ing. Futh rmQrWl autho ' e the above-named contractor to do the work stated. 15, 2015 Authorized Signatur;�Mment er / Applicant / Contractor / Agent Building Dep a Copy April 15, 2015 1 Miami Shores Village DO Building Building Department APR 701� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 _ INSPECTION LINE PHONE NUMBER: (305) 762-4949 _FBC 2016 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING E]REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9:T /V k/ /0 ° ��—j City: Miami Shores County: Miami Dade Ziwa 3 to _ w Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder : Phone#: 344(2�P Address: / 1P City: 1.'1 �jState: Zip: r':�?;z Tenant/Lessee Name: Eos ( t i A,( ),-1 Phone#: Email: :1 l 0� k CONTRACTOR: Company Name: bAhv � Phone#: Address: City: State: Zip: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ fi ;� Square/Linear Footage of Work: I `JVD Type of Work: 11 Addition / ❑ Alteration F-1NewRepair/Replace F-1Demolition Description of Work: fi��o'JG H 0 tai Y--- -T � S ► i (0-H Specify color of color thru tile: Submittal Fee $� ° �� Permit Fee $� ' CCF $ CO/CC $ Scanning Fee $ 00 Radon Fee $ _ Qj DBPR $ 2-4- Notary $ Technology Fee $ 0 • a v Training/Education Fee $ -2-<Z)Double Fee $ I K - o k-� Structural Reviews $ (Revised02/24/2014) Bond $ 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 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 which occurs seven (7 , after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a rei ection fe will be wed. Signatu OWNER or AGENT The foregoing instrument was acknowledged before me this 3\p dayof mfg 20 S by I 4-1 , who is personally known to me or who has produced�as identification and who did take an oath. NOTARY PUBLIC: (Revised02/24/2014) Signature. CONTRACTOR The foregoing instrument was acknowledged before me this day of , 20 by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: as Plans Examiner l / Zoning Structural Review Clerk NAME: OWNER BUILDER DISCLOSURE STATEMENT Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 x.30.2�,r� ADDRESS: 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. 1 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. Initial,E 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. Initials 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. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction�_Olp 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 by law and eco mpunicipal ordinance. Initial (J'�� 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 US) P, 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. 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 http://www.myfloridalicense.com/dbpr/pro/cilb/index.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: 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 3-D day of M641�20 By tY-," 11 L4 A-" who was personally known to me or who has \\\\III I I III////// rrr///// identifira ty a -#;)�JapWf rtO�SI511 k-l®r50AAOJ IV. -1 CIA v ullvc� * Z 9,Yl pro v z ... . .. . . ... . . . •. . • . • . . . t , I 00 • ••• • • • • ••• I LOT 13 :�. :LOT 126. .60 BLOCK 124 .:6:CK j2F • f • • • • OP. • ;4cL6 S' •. F.I.P. 1/2" (NO /. D.) 3.95' °f �M•. PP 4.3' e, it ; CON C '• ®eI Z or rTAC cla. Id Elf LOT 16 `� BLOCK 124 '00' N', N APR 06MS F.I.A 112" 105.40' (NO 1.D.) &DNC 9.95' POOL c, ' °f 30,10' Ordered By: .!'�' ;'�► UNIVERSAL LOT 11 LAND TITLE BLOCK 124 tt E+ �1?r�lrr. lr rXrrpe�r F.I.P. 1/2" N (NO 0.) co 0' 10' 20' 10 CONC o tO r� N N 07.95, J � REMAINDER OF C111o.aa LOT 18 04 BLOCK 124 b LO ONE STORY CBS of < N A... , a RESIDENCE 0 N L.'.'.'. # 67 to 4:0' — 8•.. • 9 10.0in M AC o .•� •••• 1 17,80. 4 •• • *see PL '0,11.20' Dose•• 0908 sF " Y O • -10. 851' 'IT In , 0•••q••• • 00.0.0:: 4.4' 13.10' x I� i'• so** so 1.25' PL 0000 •0•• 5.15' 0000•• 0000 ' ..........'. ..'.'.'.'.'.'.'..'.. • • • • • .... .. .. o.'.'. ...... •• •• •• • .. 1.1.1.1...'.'.'.' '.'.'.'....1:.1.1..1... '.b'. • • • • • • • e... .......... ....... N. ... • • • • • • • � ..... ...... .....M'.... ... .- 0000•• In M V." ..'.'. d' • • • 0 .... .'. �i .....'.'.. o�� '"F.y P :1�2„ • .. • 01 ... .... .. • 5.0' 37.50. (NO 4D.) Of • e. 75.00' R&M)' csw e (NO 1, D) 8, 0 PARKWAY : O v a' •� '' �� ''n a •4 •. ...........7777 , ...... 0 ...1.1.' 5D' R/GNT--OF-WAY (BY PLA.T). : • • ' ...: ...' '. : 20:f ASPHALT PA DEMENT :.'... ' ... '.. . •.'... ....................... — .... y'I9......bl�'d0 :. , ..::':.........................0 :.'. N.W. 16rd STR� 0.0.;.0.0.. ::..... , 0 0.10 �0r�ING SEPT Notes: NO VISIBLE ENCROACHMENTS ON THIS PROPERTY. Property Address: 67 NW 103 STREET MIAMI SHORES, FL 33150 �k fy Vi�xs; hal �..' "SURVEYORS, 0000•• • 0000•• %fee• • • •••e• 0000• •8•e•• •• • •Does• e • •0000• � f --A DTEPT �= 1 TT n `„(,jVR,�y46E IAUTH ALL FEDERAL AND CORRECT RRPR SENT TIQNGRy ERVT�IF�YpT�H�ApTTHISB�O�UN�DAgy�$uf�V�I COMPLIES WITH TI{E£ '� NlhAiib$ iCS R�l1 7-B, F FLORIDATE FLORIDA BOARD OFP I CHAPTER 61G77 8, ORID ADMINISTRATIVE ` UAI� jQ�7 . �F L�RIDA STATUES. lit vv �� •, tt• ` ni D 521�J,�_.t--fir• 7J�WUATE OFq LORIDA SIGNED ;� � FOR THE FIRM FERNANDO V. 60k&R P.S.M. No. 5259 STATE OF FLORIDA l "' "' NOT VALID WITHOUT AN AUTHENTIC ELECTRONIC SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL, AND/OR THE SIGNATURE AND/OR THE ORIGINAL RAISED SEAL OF A LICENSED SURVEYOR AND MAPPER. THE SEAL APPEARING ON THIS DOCUMENT WAS AUTHORIZED BY FERNANDO V. GOMEZ, P.S.M. NO. 5259 ON THE SURVEY DATE NOTED Survey Date: 2/7/2012 Survey Code: 0-6307 Page 1 of 2 Not valid without all pages. L O C A T I O N M A P • • ••• • • . •.. •• •• • • • •• •• • • • • • • • • • • • F O N T I W CERTIFIED TO: Community Number: VILLAGE OF MIAMI SHORES EMILIANO DE PASQUAL 120652 UNIVERSAL LAND TITLE Panel Number: 12086CO302 FIDELITY NATIONAL TITLE INSURANCE COMPANY TBD Suffix: L KEYES TITLE SERVICES Date of Firm Index: 9/11/2009 ITS'SUCCESSORS AND/OR ASSIGNS AS THEIR Flood Zone: X INTEREST MAY APPEAR. Base Flood Elevation: Date of Survey: 2/7/2012 Legal Description: LOT 17 AND THE WEST 1/2 OF LOT 18, IN BLOCK 124, OF MIAMI SHORES SECTION FIVE, ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 10, AT PAGE 47, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA. Surveyor's Legend •�•• — PROPERTY UNE i3 STRUCTURE ® CONC. BLOCK WALL TREE L.M.E. LAKE or LANDSCAPE MAINT. ESMT. & ESIAT. EASEXT • & • • X CHAIN-LINK or HIRE FENCE P.P. POWER POLE R.O,E. ROOF OVERHANG EASEMENT • • • 41L• DR19•" EASEMENT • • • • • • P.P. POOL PUMP �,. .. LANDSCAPE BUFFER ESMT. ®P.B. CATCH BASIN • • • .+ +v WOOD FENCE PL PLANTER OR PROPERTY UNE �..k UMITED ACCESS EASEM�i= • C.V.E. COUNTY UTILITY • • • • IRON FENCE I.E./EE. INGRESS/ EGRESS ESMT. S ES I.D. IDENTIFICATION • • •T1V.. TEL�T�' B.C. BLOCK CORNER • U.P• L TIT PDFLE• T"In U.E. UTILITY EASEMENT B.R. BEARING REFERENCE • • • • • -- — — --- EASEMENT • • E•1.8. ELEOiy10)I+7IUTY BOK FND. ORF FOUND IRON PIPE/ — — Q CENTRAL ANGLE a DELTA SEP. SEPTIC TANK CENTER LINE PIN AS NOTED ON PLAT R RECORD OR RADIUS • • • � DRAM"& • • • • • • LLICENSE 6 - BUSINESS • • C ITI ER RAD. RADIAL • • LS# S8 LICENSE N -SURVEYOR WOOD DECK • • • • • • CALC CALCULATED POINT N.R. NON RADIALTYP. • TYPICAL • • • • DRIVEWAW • SET SET MONUMENT • •SCFb SCREEN • CONCRETE ♦ CONTROL POINT I.R. IRON R00 & I.P. IRON PIPE GAM GRiAGE • • • • •CONCRE• • MONUMENT N&D NAIL & DISK CL• � • E. ELEVATION & .'.'..'.�'.'.'.•'.'.. �'•.'•.'.',.'.'.'.'. ASPHALT � NET TO SCALE • • PK NAIL PARKER-KALON NAR • • • �• P.T. POINT OF TANGENCY • • • • • • II�P.P. POINT OF CURVATURE D.H. DRILL HOLE & • T.0.8. TSPFINJ,H & • � BRICK/TILE P.R.M. PERMANENT REFERENCE MONUMENT WAVER FIRE HYDRANT E.O.W. P.C.C. POINT OF COMPOUND CURVATURE OOF P.R.C. POINT OF REVERSE CURVATURE O M.H. MAN HOLE E/P E.O.P.EO.P. DG / MENT VALLEY WATER P.VRP.CRETE CUTTER P.O.B. POINT OF BEGINNING O.H.L OVERHEAD LINES P.O.P. POINT OF COMMENCEMENT TX TRANSFORMER B.S.L. BUILDING SETBACK UNE CAN CABLE TV. RISER S.T.L. SURVEY TIE LINE APPROXIMATE EDGE OF WATER P.C.P. PERMANENT CONTROL POINT M FIELD MEASURED W.M. WATER METER q CENTER LINE P PLATTED MEASURMENT PIE POOL EQUIPMENT R/W RIGHT OF WAY CONCRETE SLAB R.O.E. PUBLIC UTILITY EASEMENT ®CONC COVERED AREA D DEED C.M.E.. CANAL MAINTENANCE EASEMENT C CALCULATED A. I- ANCHOR EASEMENT General Notes: 1) LEGAL DESCRIPTION PROVIDED BY OTHERS. 9) BEARINGS REFERENCED TO LINE NOTED AS B.R. 2) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO 10) BOUNDARY SURVEY MEANS A DRAWING AND/OR GRAPHIC REPRESENTATION DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING PROPERTY. OF THE SURVEY WORK PERFORMED IN THE FIELD, COULD BE DRAWN ATA SHOWN 3) THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR EASEMENT OR OTHER SCALE AND/OR NOT TO SCALE. RECORDED ENCUMBERANCES NOT SHOWN ON THE PLAT, 11) NO IDENTIFICATION FOUND ON PROPERTY CORNERS UNLESS NOTED. 4) THE PURPOSE OF THIS SURVEY IS FOR USE IN OBTAINING TITLE INSURANCE AND 12) NOT VALID UNLESS SEALED WITH THE SIGNING SURVEYORS EMOSSED FINANCING AND SHOULD NOT BE USED FOR CONSTRUCTION, PERMITTING DESIGN, OR ELECTONIC SEAL. OR ANY OTHER PURPOSE WITHOUT THE WRITTEN CONSENT OF ONLINE LAND 13) DIMENSIONS SHOW ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN. SURVEYORS INC. 14) ELEVATIONS IF SHOWN ARE BASED UPON N.G.V.D. 1929 UNLESS OTHERWISE 5) UNDERGROUND PORTIONS OF FOOTINGS, FOUNDATIONS OR OTHER NOTED. IMPROVEMENTS WERE NOT LOCATED. 15) THIS IS A BOUNDARY SURVEY UNLESS OTHERWISE NOTED. B) ONLY VISIBLE AND ABOVE GROUND ENCROACHMENT LOCATED. 16) THIS BOUNDARY SURVEY HAS BEEN PREPARED FOR THE EXCLUSIVE USE OF 8) FENCE OWNERSHIP NOT DETERMINED. THE ENTITIES NAMED HEREON, THE CERTIFICATIONS NOT EXTEND TO ANY 7) WALL TIES ARE TO THE FACE OF THE WALL. UNNAMED PARTIES. SURVEYOR'S CERTIFICATION: I HEREBY CERTIFY THAT THIS BOUNDARY SURVEY IS A TRUE AND CORRECT REPRESENTATION OHF�JA�SURVEY PREPARED UNDER MY DIRECTION. THIS WITH THE STANDARDS, AS SET BY STATE OF FLOMPLIES OR DA BOARD OF ROFES�i1dNEAL LA90 $YRVE ORS IN CHAPTER 6IAL 11GT7-BHFLORIDAE ADMINISTRATIVE CODB%,4I T../472 Q Y,fLORIDASTATUES. i nlneLand q '�'N' SuRVEiORS INC. 5259 b STATE OF Q SIGNED s FOR THE FIRM Online Land Surveyors Inc. -�-�-- ' 7925 Coral Way, Suite 101 EZ..... FERNANDO VMPJ STATE OF FLSURV�'1��,�`� P•S.M. No. 5259 Miami, FL 33155-6524 NOT VALID WITHOUT AN AL/riliEwlirp r► &d O'NIC SIGNATURE AND AUTHENTICATED Tel.: (305) 910-0123 ELECTRONIC SEAL, AND/OR THE SIGNATURE AND/OR THE ORIGINAL RAISED SEAL OF A Fax: (305) 675-0999 LICENSED SURVEYOR AND MAPPER. THE SEAL APPEARING ON THIS DOCUMENT WAS 1_13*7904 AUTHORIZED BY FERNANDO V. GOMEZ, P.S.M. NO. 5259 ON THE SURVEY DATE NOTED HEREON. Survey Date: 2/7/2012 Survey Code: 0-6307 Page 2 of 2 Not valid without all pages.