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PIE-C` IO RECORD ____ _ QQ POSE' ON SITE
Permit NO. RC—J-15-2471
/yNUREr;v
Miami Shores Village Permit Type: Residential Construction
�c 10050 N.E.2nd Avenue
-_-�- Miami Shores,FL 33138-0000 Work Classification:Alteration
LEN res,e+5a Phone: (305)795-2204 Fax: (305)756-8972
�` Issue Date: 12/3/2015
�ZOttivExpires: 05/31/2016
INSPECTION REQUESTS: (305)762-4949 or Log on at https:libidg.miamishoresvillage.com/cap
REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOW -NBUSINESS DAY.
Requests must be received by 3 pm for following day inspections. = ,
Residential Construction - � � Parcel #:1122320300100
r
Owner's Name:KRISTINA GUILLEN Owner's Phone:
Job Address: 1298 NE 104 Street Total Square Feet: 113
Kam* Shores FI Total Job Valuation: $ 26,000.00
Bond Number: A
Y7 �' WORK IS ALLOWED MONDAY THROUGH SATURDAY,
a-- 7:30AM-6:OOPM.NO WORK IS ALLOWED ON
Gontractor(s Pho , ;'Pt Contractor SUNDAY OR HOLIDAYS.
HOME OWNER YNR
� BUILDING INSPECTIONS ARE DONE MONDAY
THROUGH THURSDAY. ROOFING INSPECTIONS ARE
DONE MONDAY THROUGH FRIDAY. NO BUILDING
INSPECTIONS DONE ON FRIDAY.
NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE+ ITIS
THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER
THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL
REQUIRED TO ALLOW INSPECTION.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
• f
INSPECTION RECORD
STRUCTURAL ZONING
INSPECTION DATE INSP INSPECTION I DATE-1 INSPI INSPECTION DATE I IN ,
Foundation Zoning Final
Stemwall ZONING COMMENTS Rough
Slab Water Service
Columns 1 st Lift 2"d Rough ,
Columns 2nd Lift Top Out
Tie Beam Fire S rinkle
Truss/Rafters Septic Tank
Roof Sheathing Sewer Hook-u 1`
Bucks Roof Drains a
Windows/Doors ELECTRICAL i Gas
Interior Framing INSPECTION DATE INSP LP Tank
Insulation Temporary Pole Well
Ceiling Grid 30 Day Temporary Lawn S rinklers
Drywall 1 j. 4 Pool Bonding Main Drain '
Firewall Pool Deck Bonding Pool Piping
Wire Lath Pool Wet Niche Backflow Preventor
Pool Steel Underground Interceptor
Pool Deck Footer Ground Catch Basins
Final Pool lab Condensate Drains
Final Fence Wall Rough HRS Final
Screen Enclosure Ceiling Rou `
Driveway Rough PLUMB G M S
Driveway Base Tele h ne Rou h
Tin Cap Telephone Final
Roof in Pro ress TV Rough
Mop in Pro ress TV Final
Final Roof Cable Rough
Shutters Attachment Cable Final
Final Shutters Intercom Rough
Rails and Guardrails Intercom Final MECHANICAL
ADA compliance Alarm Rough INSPECTION DATE INSP
Alarm Final Underground Pipe
DOCUMENTS— Fire Alarm Rough
Soil BearingCert Fire Alarm Final Rou h
Soil Treatment Cert Service Work With
Floor Elevation Survey ��/ Ventilation Rough
Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough
Insulation Certificate Pressure Test
Spot Survey Final Hood
Final Survey Final Ventilation
Truss Certification Final Pool Heater
STRUCTURAL COMMENTS Final Vacuum
MECHANICAL COMMENTS
L
SPECTION DATE INSP
nal Sprinkler
Final Alar
}
Miami Shores Village '
10050 N.E.2nd Avenue NE
� x
Miami Shores,FL 33138-0000
Phone: (305)795-2204
x: Expiration: 0613112016
Project Address Parcel Number Applicant
1298 NE 104 Street 1122320300100
KRISTINA GUILLEN
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
KRISTINA GUILLEN 1298 NE 104 Street
MIAMI SHORES FL 33138-
1298 NE 104 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 26,000.00
HOME OWNER
Total Sq Feet: 113
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::in Review Final PE Certification
Date Denied: Window Door Attachment
Type of Construction:KITCHEN AND BATHROOM REMO[ Occupancy: Framing
Stories: Exterior: Insulation
Front Setback: Rear Setback: . Drywall Screw
Left Setback: Right Setback: Window and Door Buck
Bedrooms: Bathrooms: Fill Cells Columns
Plans Submitted:Yes Certificate Status: Review Electrical
Certificate Date: Additional Info: Review Electrical
Review Electrical
Bond Retum: Classification:Residential Review Building
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Building
CCF $15.60 Review Planning
CO/CC Fee $50.00 Invoice# RC-9-15.57238 Review Plumbing
DBPR Fee $11.70 12/03/2015 Check#:5047 $877.00 $50.00 Review Plumbing
DCA Fee $11.70 09/28/2015 Check#:5043 $50.00 $0.00 Review Plumbing
Education Surcharge $5.20 Review Structural
Notary Fee $5.00 Review Mechanical
Permit Fee $780.00
Scanning Fee $27.00
Technology Fee $20.80
Total: $927.00
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: I certify t II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and nin . Fut ore,I authorize the above-named contractor to do the work stated.
December 03,2015
Autho Ignature:Owner / Applicant / Contractor / Agent Date
Buildin epartment Copy
December 03,2015 1
, je,-t"0c� Miami Shores Village
SEP 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_(�I
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
F-IPLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1298 NE 104 STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-223�2_-030-0100 Is the Building Historically Designated:Yes NO X
Occupancy Type:4^iUL Load: Construction Type: / Flood Zone: NO BFE: FFE:
OWNER:Name(Fee Simple Titleholder RISTINA GUILLEN Phone#:305-975-1070
Address:1298 NE 104 STREET
City. MIAMI SHORES State: FL Zip: 33138
Tenant/Lessee Name: NOT APPLICABLE Phone#:N/A
Email: KRISTIGUILLEN@GMA-IL.CrOMn
CONTRACTOR:Company Name: 0 VV/k-e4 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:$ . 0V k)Square/Linear Footage of Work: 113 ,
Type of Work: ❑ Addition V Alteration ❑ New �❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ "�`� Permit Fee$q�)0 , CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ U r
(Revised02/24/2014)
Bonding Company's Name(if applicable)
NOT APPLICABLE '
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) SPACE COAST CREDIT UNION
Mortgage Lender's Address 15900 MIRAMAR PARKWAY
City MIRAMAR State FL Zip 33027
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 a d a reinspection fee will be charged.
Signature Signature
NER or AGENT CONTRACTOR
The foregoin •nstru ent was acknowledged before me this The foregoing instrument was acknowledged before me this
:29q-'`day of 20a 15,by day of 20 ,by
Kr St 1�)o- Gj W ��eYlwho is personally known to ,who is personally known to
m]or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
N
�'DD
Sign: Sign
Print 40A-10— c Print:
Seal: ,,,a Nq Notary Public State of Florida Seal:
Maria Carballelm
Q My Commis i EE131472
E 1 211 41201 5
s�x�ra•s**s**s * � rs�x�x*��*oaat�***ss�x�r�or�o*o*x�**s*s*�aa�*m+x*s��xoa��a****a�sae�as•sr�s�
() Za) 1v/
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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: KKj�chna (71/I/k 1 DATE: S (f 2B, 2✓�
ADDRESS: 12 qtq MC 1 D L) h,- J7 r--r—'06 L A414 ) OU/6'1 f'L -33138
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 1,as the owner of the property listed,may act as my own contractor with certain
restrictions even though 1 do not have a license.
Initial
2. I understand that building permits are not required to be signed by a property owner unless he or s e is responsible for the construction and
is not hiring a licensed contractor to assume responsibility.
Initial
— 14
3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understan4Jat 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.
Initial
4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I m 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
J
S. I 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 by law and by county or municipal ordinance.
Initial
d
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.
Initial
8. 1 understand that i may not delegate the responsibility for supervising work to be a licensed contr ho 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,II lde by all applicable taws and
requirement that govern owner-builders as well as employers.l 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 Inter-JI 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 htto://www.mvfloridalicense.com/dbor/oro/Cilb/index.htmi
Initial
11. 1 am aware of,and consent to,an owner-builder building permit applied for in my name and understand4at I am the party
legally and financially responsible for the proposed construction activity at the following address:
/2-9$ Ale 10q hz JtKeef
Initial
12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of t nformation 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 w o 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 c-P- 8 day of X20 1
By ��I NA GU I LA-A-Ciy who was personally known to me or who has
Produced there License or t_—pe(l/F op— Com(' 'cJ S=�: as identification.
Notary Public State of Florida
W N ER NOTARY `: sindia Alvarez
'T My Commission FF 158750
p Expires 0 9/0 312 01 8