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SGN-16-1903 (2) Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795.2204 Fax: (305)756-8972 Inspection Number: INSP-262798 PermitNumber: SGN-7-16-1903 Scheduled Inspection Date:July 29,2016 Permit Type: Sign Inspector: Mesa,Michel Inspection Type: Final Owner: I Work Classification: New Job Address:9537 NE 2 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1132060133910 Project: <NONE> Contractor: OWNER Building Department Comments logo stickers&letters applied to windows&doors(white tnfractio Passed Comments letters) INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. I July 28,2016 For Inspections please call:(305)762-4848 Page 12 of 42 Or4 � L 3'1 P Miami Shores Village 10050 N.E.2nd Avenue NE �bIZ1fCj8�C3/3 M.,., Miami Shores,FL 33138-0000 Pe lit tu i t fit Phone: (305)795-2204 , ,, �•', ua pates 1 Expiration: 01118/2017 Project Address Parcel Number Applicant 9537 NE 2 Avenue 1132060133910 DVS LLC Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell DVS LLC 9537 NE 2 Avenue MIAMI SHORES FL 33138- 9537 NE 2 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 75.00 OWNER Total Sq Feet: 0 Type of Sign:Wall Sign Available Inspections: Electrical Sign:No Inspection Type: Height: Final Width: Review Planning Color: Elevation: Review Building Plans Submitted:Yes Additional Info: Classification:Commercial Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee Invoice# SGN-7-16-60524 $2.00 07/08/2016 Credit Card $50.00 $64.60 DCA Fee $2.00 Education Surcharge $0.20 07/22/2016 Credit Card $64.60 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 AFFIDAV I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructionand ni . Futhermore,I authorize the above-named contractor to do the work stated. July 22,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 22,2016 1 Miami Shores Village = = 1 Building Department JUL 08 2016 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�7��C;"1 PERMIT APPLICATION Sub Permit Nq. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS. 6 `7 `'J C� City: Miami Shores County: Miami Dade Zip: ( — Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �1 OWNER: Name(Fee Simple Titleholder): f�,S ALC_ Phone#:;j�—��I _IU4 Address: ��3 d�/ ALC f v � City: lc4�'19 � 5 �-- i/�State: 1Pk_ Zip: S/�'1,�� Tenant/Lessee Name: Z� p ��� Phone#: � (� `�. 1 Email: 4 C r 1 0 c '-10 CONTRACTOR:Company Name: 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:$ - Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:`IL�S� C..,OaCe � AS-2 (�QlC�i,�S m Specify color of color thru tile: - Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �U (Revised02/24/2014) 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 proved and a reinspection fee will be charged. I Signaturer/ / Signature OWER or AGENT CONTRACTOR a The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 %�o , by day of 20 by �IIQ�PSII l[I&i� r!i` ,who is personal v known to who is personally known to me 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: Sigh--.2 Sign: Print: ,'Z r'C Print: Seal: Seal: ELIZABETH ELORRUIQA y ••: MY COMMI8 M#FF953M EXPIRES 25.2020 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 1 Y Miami 5�!Oa, y Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 ltt Tel:(305)795.2204 Fax:(305)756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: LLC DATE: I ADDRESS: � 6�Z C97'sl kc 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 acjAvxiRy own contractor with certain restrictions even though I do not have a license. Initshe 2. 1 understand that building permits are not required to be signed by a property owner unlessnsible for the construction and is not hiring a licensed contractor to assume responsibility. Ini 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 ins t d y 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 p its an contracts. itial 4. I understand that I may build or improve a one family or two-family residence or a farm outbuildin .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 occ panty. It may not be built or substantially improved for sale or lease.If a building or residence that I have built or substantially improved self is Id or leased within 1 year after the construction is complete,the law will presume that I built or substantially improved it for sale r le se,whic violates the exemption. Initia 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the constr cti n. Ini 'al 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise per ons working on my building or residence.It is my responsibility to ensure that the persons whom I employ have the license required by la an b county or municipal ordinance. I itial 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 rp aware of the limits of my insurance coverage for injuries to workers on my property. lei Initi I 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 emplo .I understand that my failure to follow these may subject to serious financial risk. ` In' aal 9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,_1 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 regula Init I 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:/Iwww.mvforidalicense.com/dbar/pro/cilb/index.html Initia 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 th infor ation 1 at I have provided on this disclosure. Initia 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. i Was acknowledged before me this day of 20 By 7 .Wd M I"" who was personally known to me or who has Produced the a as identification. � �— ;•'0& ELIZABETH ELORRIAGA =': •'= MY COMMISSION 0 FF953536 R NOTARY EXPIRES Jarwsty 25.2020 �ooiisee•o•sa FWnd3N0ft7SWVft ear 2016 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED DOCUMENT#L10000129579 Apr 25, 2016 Entity Name: DVS, LLC Secretary of State CCO204796481 Current Principal Place of Business: 201 N.E.95TH STREET MIAMI SHORES, FL 33138 Current Mailing Address: 201 N.E. 95TH STREET MIAMI SHORES, FL 33138 US FEI Number: 80-0670481 Certificate of Status Desired: No Name and Address of Current Registered Agent: CACCAMISE,THERESA 201 N.E.95TH STREET MIAMI SHORES,FL 33138 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: THERESA CACCAMISE 04/25/2016 Electronic Signature of Registered Agent Date Authorized Person(s) Detail : Title AUTHORIZED MEMBER,MANAGER Title AUTHORIZED MEMBER,MANAGER Name CACCAMISE,THERESA Name CACCAMISE,RICHARD Address 201 N.E.95TH STREET Address 201 N.E.95TH STREET City-State-Zip: MIAMI SHORES FL 33138 City-State-Zip: MIAMI SHORES FL 33138 1 hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:THERESA CACCAMISE AUTHORIZED 04/25/2016 MEMBER/MGR Electronic Signature of Signing Authorized Person(s)Detail Date . . ... . . . ... .. .. . . . .. .. . x • . . . •• . . : : : . . . 00 . . . . . . . . oes 00 , . . . . . . jiw r 2 4 • • • _ _ t - f -. -------- -- - Al.___ cc ia tour �l m. ..-- �C� .�iR Pin� ,���� ��-}�`-►�'`- a�' �9c��. . . ... . . . ... ;; ��r� FrU�--� C�-��- ( (�c Stec• :•� :•' . . ... . . . . ... . . . . . . . .. . 110 a • • 0.0 • • • • • • • • • • •• . ` PRIVATESON M. CLASSES & TEACHER Moll; 1 • • • p305-917-5886