WS-13-2434 ' Miami Shores Village ; -1
a - Building Department G 77
Oc-, 2 8 2o13 10050 N.E.2nd Avenue,Miami Shores,Florida 33138
c� Tel: (305)795.2204 Fax: (305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
\(� FBC 20
BUILDI G Permit No.
PERMIT APPLICATION Master Permit Nol' 113
Permit Type: BUILDING ROOFING
JOB ADDRESS: a% UG ` q4) SA
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): SO(_CA VU Phone#: y j g - '15l{-35'0
Address: ;) l0/ �X q94/
City: 14 k ann State: Zip:
Tenant/Lessee Name: Phone#:
Email: Sq non) Cam
CONTRACTOR: Company Name: W Phone#:
i
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: / Certificate of Competency#:
Contact Phone#: "Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ �.2 7f Square/Linear Footage of Work:
Type of Work: ❑Addition ❑Alteration ❑New *epair/Replace ❑Demolition
Description of Work: R 45,014AIC6/16
Color thru tile:
���>F��;F>F��>F>�><><><>z>E>F�>F><><�r><>F��><�r�>F><><>F�Fees�;k>ti����;�;F��������>F><>ti>F>F><�>ti����><��><�>ti��>F�><�><><�
Submittal Fee$ 50- 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$ 0
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. 1 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 The foregoing instrument was acknowledged before me this
day of (OC4. ,20 L,by �cz/� Ee w day of ,20_,by ,
who is personally known to me or who ha roduced who is personally known to me or who has produced
��O®�ill—��'�►s idents ication o did take an oath. as identification and who did take an oath.
NOTARY P NOTARY PUBLIC:
Sign: Sign:
Print: �� S� �" Print:
My Commission Expires: �otaw
�pr"' EDITH YSADA My Commission Expires:
Notary Public-State of Florida
• gMy Comm.Expires May 9,2016= Commission#E EE 177161
APPROVED BY �''s Plans Examiner Zoning
Structural Review Clerk
(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
10 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: 50 DATE: I OA A
ADDRESS: 1 41 . FL 3313 K
Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the taws of the State of Florida,F.S 489.103(7).
And I have read and unde�ood 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 We or lease.,If you°sell or lease a building you have built yourself within*one year after the
construction b`cbApleter tie taw wilt;presume that-you Wilt for sale or Was,which Is a violatioh 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.CA and with-holdings tax and provide workers'
compensation for that employee,all as'prescribed bylaw.Your construction must comply with all applicable laws,ordinances,
buildings codes and zoning regulations.
Please read and inNal 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 spedfift that I,as the miner of the properly listed,may act as my own
contrector with certain restrictions even though I do not have a license.
InftL,
2. 1 understand that building permits are not required to be sigrred by a property owner unless he or she Is responsible for the
construction and Is not hlring a licensed contractor to assume respansibllity.
In
3. 1 understand that,as an owner builder,I am the respo_ible party of record on a permit I understand that I may protect myself
from potential financial risk by hiring a Rearmed 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 its or license numbers on
permits and contracts.
initial
4. 1 understand that I may build or improve a one family or two-famlly residence or a farm outbuilding.I may also build or Improve
a commercial building lf the costs do not exceed$75,000.The building or residence must be for my use or OCCUPanccy.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 corstrucction 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 direr,onsite supervision of the construction.
initial_ G�
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.
r., ._ Initial
, a•. � la of
7. 1 understand that it Is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that s- •
erron ly h*W that the property owner is providing his or her own labor and materials.I,as an owner-buUclah'AAbe lod „A y
gable and sub*W to serious financial risk for any injuries sustained by an unlicensed person or his 4 emplo
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working on my property. My homeowner's insurance may not provide coverage for those injuries.I am wilBuliy acting as an •t r
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
r perform the work being done.Any Person working on my building who is not livened must work under my direct supervision
and must be employed by me,whitdn means that I must comply;;laws raquiiing 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 .
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 governowner-twgders as well as employers.I also understated 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 Licerafng Board at 850.487.1395 or httpl www.mvfioridalioense.cmWdborbWdibrndex html
Initia��
11. 1 am were of,and consent to,an owner-builder building permit applied for in my name and understands that I am the party
legally end financiatly responsible for the proposed construction activity at the folldving address:
1AA1/ 03'/--W
Initial
12. 1 agree to notify Miami Shores Village immediately of arty additions,deletions,or changes to arty of the info on that I
have provided on the disclosure.
infti
Licensed contractors are regulated by laws designed to protect the public.ff you contract with a person who does not have a
license,the Corstr4ucgon Industry Licensing Board and Department of Business and Professional Regulation may be unable to
assist you with any finenclal loss that you sustain as a result of Contractor may be in civil court it Is also Important for you to
understand that,I an unlicensed contractor or employee of an Individual or firm Is Injured while working tin your property,you may
be held liable for damages.If you obtain an owner-builder permit and wish to hire a goersed contractor,you will be responsible for
veffft 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 hued.
Was acknowledged before me this 10 day of OcAokc 20 3
By— LO�C- who was personally known to me or who has
Produced there License or /7:?<' an' ca on.
OWNER NOTARY
EDITH YSADA
Notary Public-State of Florida
'•= My Comm.Expires May 9,2018
�=• aS' Commission B EE 177181
-�a� 4`� Bonded Through National Notary Assn.
Property Search- Report Page 1 of 2
'l JFJf l\ MUM
OFFICE OF THE PROPE
PROPERTY SEARCH SUP
Property Information:
d
FOLIO 11-3205-009-0140
Property Address 1296 NE 99 ST e.
Owner Names) SORAYA FAYS
Mailing Address 1296 NE 99 ST
MIAMI SHORES FL 33138
Primary Zone 1400 SGL FAMILY-3001-3250 SQ
0101 RESIDENTIAL-SINGLE FAMILY:
Use Code 1 UNIT
e �.'��"
l'
Beds/Baths/Half 3/2/0
Floors 1AN ?
r 3
Living Units 1
Ad].Sq.Footage 2,346
Lot Size 10,932.70 SQFT ,
e 1
Year Built 1951
Full Legal Description 5 53 42
EARLETON SHORES PB 43-80 Aerl
LOT 1 &E25FT LOT 2 BLK 2 N
LOT SIZE IRREGULAR
OR 18686-1393 07 1999 1 Taxable Value Information:
COC 22759-4407 10 2004 1
Assessment Information: Current Previous
Current Previous Previous 2 Year 2013 2012
Year 2013 2012 2011 Exemption/ Exemption/
Taxable Taxable
Land Value $199,229 $189,950 $158,292
County $0/$375,519 $50,000/$287,
Building Value $176,290 $188,372 $189,557
School Board $0/$375,519 $25,000/$312,
Market Value $375,519 $378,322 $347,849
Assessed Value 1 $375,519 $337,314 $327,490 City $0/$375,519 $50,000/$287,
Benefits Information: Regional $0/$375,519 $50,000/$287,
Current Previous Previous 2 Sale Information:
Benefit Type 2013 2012 2011 Date Amount OR Book-Page Quail
Save Our Assessment 07/17/2012 $560,000 28215-3879 Qual
Homes Reduction $0 $41,008 $20,359 10/01/2004 $540,000 22759-4407 2008
Homestead Exemption $0 $25,000 $25,000 QualI
Second Exemption $0 $25,000 $25,000 07/01/1999 $215,000 18686-1393 2200a81
Homestead
Note:not all benefits are applicable to all Taxable Values(ie County, 12/01/1998 $175,300 18415-4283 2008
School Board,City,Regional), Qual
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http://gisweb.miamidade.gov/PropertySearch/printMap.htm 10/28/2013