DS-15-1967 Miami Shores Village
AUG U 2015
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
FBC 20 �({ '`�
BUILDING Master Permit No.��1 lC r
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
/ �� Q CONTRACTOR DRAWINGS
JOB ADDRESS: j Lt i N
City: Miami Shores CountV: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFFE:
OWNER: Name(Fee Simple Titleholder): h{ � G o��1 U t Phone#:
Address: 141
City: 12t S State: �P� Zip: 33 1 3
Tenant/Lessee Name: Phone#:
Email: u .�
CONTRACTOR:Company Name: Phone#:
Address:
City: S rc AS. ► ,i( State: Zip:
Qualifier Name: AA a Phone#:
State Certification or Registration#: i t mpetency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: Q)ro Q k
Type of Work: ❑ Addition ❑ Alteration ❑ New <`� Repair/Replace ❑ Demolition
Description of Work: �d�.� — �� H: —C' I S —
Specify color of color thru tile: rr��
Submittal Fee$ Permit Fee$ W ' CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ r
TOTAL FEE NOW DUE$ L4 bc)
(Revised02/24/2014)
aw
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 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) 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
b
NEr AGENT CONTRACTOR
The
ee)foregoing instrume t was cknowledged before me this The foregoing instrument was acknowledged before me this
�✓ day of �A1UGU 20 r by day of 20 , by
M \IZ J G ( yU--QJ.�6who is personally known to who is personally known to
me or who has produced�L �r Ltd`t-'G�s me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: z,�. Sign:
Print: Print:
Seal: �,arr a 'Woh&Public State of Florida Seal:
larez
y7� RFF 156750
OF F� qmAMV,, ,,n
09/03/2018
*********** * * * * * * * * * * * ******************************************************************
511
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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.1,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.
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8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenseto
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.
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9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide by all Jlilble
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.
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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 htta://www.mvfioridalicense.com/dbor/pro/cilb/index.html
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11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the pa
legally and financially responsible for the proposed construction activity at the following address:
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12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information ythl
have provided on this disclosure.
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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 Boar rtment of Business and Professional Regulation may be unable to
assist you with any financial loss that you sustain r ay lull court.Itis also important for you to
understand that,if an unlicensed contractor or em u it red while working on your property,you may
be held liable for damages.If you obtain an owner-builder perms an ensed 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 Q 'J day of -\U G-02 , 20
By k-IAVGa 21 �- who was personally known to me or who has
Produced there License or tL_ -DO as identification.
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OWNEJ NOTARY
E'A�n Nniary Pubh;State of Florida
Sindia.Alvarez
X04 My Commission FF 156750
F coo Expires 09;03/2018
ORES Miami Shores Village
Building Department
some �,,.�
--�- 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
ORmp► Tel: (305) 795.2204
Fax: (305) 756.8972
OWNER BUILDER DISCLOSURE STATEMENT
NAME: A tt a..P c2. 1n DATE:
ADDRESS: �g r Sri lA�,t UZc� :PC 3313
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.ft 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.
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2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responWleorhe
construction and is not hiring a licensed contractor to assume responsibility.
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3. 1 understand that,as an owner builder, I am the responsible party of record on a permit.I understand that I may prot t yself
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 lice se numbers on
permits and contracts.
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4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may also buildi
prove
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 bu' or substantially
improved it for sale or lease,which violates the exemption.
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5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction.
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6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on mWil 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.
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PRRN HOLDINGS ••
18085 SOUTH DIXIE HIGHWAY TALMF;1-1Y>,BAY FL '33157
E-Mail CARLOSRODBARR«YAHOO.C()M
Date: 9/14/15
Sindia Alvarez
Permit Clerk
Miami Shores Village
Dear MRS. Alvarez
I have an expired permit# E1,5-06-1305 since 2006. 'hhis permit was for a'l'raiislcr Switch."hlie work was never
perlormcd. I need to close this permit out on the property located at 1116 N.E. 92 ST. Miami Shores, FL. 33138
Sincerely,
Carlos Rodriguez
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Managing Member ol'PRRN Holdings LLC
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