FW-06-1053 Miami Shores Village
(� Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fag:(305)756.8972
BUIL )ING � AN 2 5
.20�106' 3 PermitNo.T��
.
PERMIT APPLICATION aster Permit No.
FBC 2004 B Y.-
Permit
:Permit Type(circle): Building Electri Plumbing . Mechanical Roofing
s
Owner's N ame(Fee Simple Titleholder).dF,S(,1S Y-�Ll�� Phone# *J)O -' 9 Glte4l J4 9
Owner's Address
City
• State �� Zip J J` 3 A
Tenn ee Name Phone#
Job Addr (where the work is being done) M E, 10'52) Sk.
City Miami Shores Villa, Coupty . Miami-Dade Zip 3
FOLIO/PARCEL# `
Is Building Historically Des' ted YES
Contractor's Company N e : Phone#
Contractoris Address
City M State Zip
Qualifier. ame Phone#
State Cerhicate or.R tration No. Certificate of Competency No.
ArchitectlEn s Name(if applicabl Phone#
da k For this Permit$ Square/Linear Footage Of Work-
Type of V�ork: []Addition nAlteration New VRepair/Replace ❑Demolition
Descrlbe' ork:
4—H eq
Submittal Fee$ ermit Fee$ ������ CCF$ . MCC
Notary$ _ Train' ducation Fee$ C r E3 0 Technology Fee$ —7 • Z�.
Scanning$ - Q ' Ra on$ DPBR$ Zoning$
Bond$ f C e Enforcement$ Double Fee$
Structural Review.$ Total Fee Now Due$ .
• See Reverse side
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 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 wrm 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 aiceeding$2500, the applicant,rust
promise in good faith that a copy of the notice of commencement and construron lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the r r o c e of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the g is issued In the abs a of such posted notice, the
inspection will not be approved and a reinspection fee will
Signature Signature ,
Owner or Ag t Contractor
The foregoing`instrument was acknowled/ged,before me this The foregoing instnunent`was acknowledg before me this
day of 6I ,20&byt S lI L(a la _ _ , day of .20_,by
who is personally known to me or who has produced who is personally known me orr who has pro uced
As identification as i tification and who di take an oath.
'+DFFlCtALNOTARYBt:/y,
NOTARY PUBL : ° •�% AMA�VpR� NOTARYPUB
NSR
9� niDte�a
Sip: Sign'
Print` A i ya ii Z Print:
My Commission Expires: My Commission Exp' : v
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APPLICATION APPROVED BY: �T' Plans Examiner
Engineer
Zoning.
(Revised 02108/06
t
VILLAGE OF MIAMI SHORES
OWNER°BUILDER DISCLOSURE STATEMENT
NAME: f
DATE:
ADDRESS: l 33313.4
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 4$9.103(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 cominercial'building at a cost of$25,000.00 or less.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'Mat.licensed must work under your supervision and must
be employed by you,which means.thatyou,in�e°ts d ct F.I.C.A and with-holdings tax and
provide workers' compensation for that empl7' prescribed by law.Your construction
must comply with all applicable laws,ordinances, dings codes and zoning regulations.
Please read and initial each paragraph.
1. I hold title to the above property and I am planning on doing this construction
Initial
2. I understand that as an owner-builder I must abide by all zoning o es and
building regulations in effect at the time of permit application
Initial
3. .I have an understanding of the 2004 FBC & FRC and understand that this
department and its inspectors are there to help enforce and interpret the code.
There is a copy of the code in this office for rev'
4. I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code —. only if the structure meets the
minimum code.
Initial
r
5. I understand that as an owner-builder, that any contractor disputes with sub-
contractors.and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate'any contract disputes.
Initial
17
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed company-or person.
Initial
_4/
7. I understand that if any person gets injured on my construction project--they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy I could be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Initial
... ILI
8. I understand that under state-,,and local laws I can not do any Electrical,
Plumbing, Heating, Ai of work on my property with out first obtaining
the proper permits by li� ed contractors.
Initial
.acknowledged before me this `Z day of I L , 20 �
By C4F- J L-- who was personally known to me or who has
Produced there License or as identification.
.OWNER N Y
NOTARY pnLIC.On OF nORMA
*Yorlem He dez
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