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DS-13-94Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184316 Permit Number: DS- 1 -13 -94 Scheduled Inspection Date: March 04, 2013 Inspector: Bruhn, Norman Owner: LIVINGSTONE, KERI Job Address: 1140 NE 100 Street Miami Shores, FL 33138- Project: <NONE> Contractor: CHAMPION CONCRETE Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: Addition /Alteration Phone Number (786)218 -0080 Parcel Number 1132050190430 Phone: (305)252 -8055 Building Department Comments driveway Infractio Passed Comments INSPECTOR COMMENTS False PasseV., Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments please check the elvation of the driveway, neighboor called and complaint about water dumping to his property March 04, 2013 For Inspections please call: (305)762-4949 Page 16 of 32 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 1 3-14 TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement 1. Legal description of property and street/address: 11111111111111111111111111111111 111 1 11111 1111 CiFN 2013R0127389 OR Bk 2€492 F's 1765► (1Ps) RECORDED 02/15/2013 1414 0o22 HARVEY RUVIN, CLERK OF COURT NIANI -DADE COUNTY, FLORIDA ' LAST PAGE Space above reserved for use of recording office iI'-I© lOv St,rr...e.h* MT .a>t 31.a✓e4 P , 33i3S? 2. Description of improvement: r^ )z..d ► s,,•+ P* r' -"-'s Co/ c v n 3. Owner(s) name and address: Ire -r, v,n S ;w Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone number. CMo.. s p i or, 11001 L tr 3 S jar rc 5. Surety: (Payment bond required by owner from contractor, If any) Name, address and phone number Avia- Amount of bond $ 6. Lender's name and address: Csftwee-i-t. 4- Pu4ers a3 0-1Y4-Q. 33.(• rs- P+- 33r7Y 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1Xa)7., Florida Statutes, Name, address and phone number. Cat 9 444+ -re--11 3o S - 2-41 Or 33 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number. 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN 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 WITHMAL4R-LUIDER AR AN ATTORNEY BEFORE COMMENCING WORK `cfeu QV OR RECORDING YOUR NOTICE OF COMMENCEMENT. f 1% • , r ,,'- - EBY(; qPv Y3 .a_ wir Signature(s) of Owner(s) o Owner(s)' Authorized Offlcer/Director/Partnet `del , r r . fal. ; , Prepared By _ Pre • v r �.. Print Name i -e,r. 4...r...trs-z.e— Print t liii- �� 4D k�� Title/Office TItle/O '�► i' . STATE OF FLORIDA ��j.ii ' ly/ •�/�5 iii COUNTY OF MIA I -DADE ; : The s� • ng instrr n di...,,; (edged before me this n 1 day of �V '�► By t ❑ Individually, or'19 as ❑ Personally known, or ❑ for 1 / am EIMIUMITailiiMILIMANG roduceci the fo owing type of identificatio Signature of Notary Public: Print Name: (SEAL) TO 1 • k - _ _ 2 _ • ' ID_ Y i -111 Under penalties of perjury, I declare that I have read the foregoing and that the facts stated In It are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer /Director/Partner /Manager who s 123.01-62 PAGES 3N0 .,.-� By it CLAUDIA V. CUBILLOS " Notary Public - State of Florida • E My Comm. Expires Sep 23. 2015 s • xt;. Commission # EE 12$810 nedfal ': Bonded Through National Notary Assn. Miami Shores Village Building Department 10050 N,E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBCi20 Permit No. OS 314 Master Permit No. Permit Type: UILDING) ROOFING JOB ADDRESS: 1 I t'I 0 11, N 113 J O© S City: Miami Shores County: Miami Dade Zip: 134.3e Folio/Parcel #: Is the Building Historically Designated: Yes NO t/ Flood Zone: OWNER: Name (Fee Simple Titleholder): L.\V %^ S C+4 °� kui Phone #: 484 L1' 0&O Address: I I yo 4 € Sfisee -t- City: /i WII i S%.,P % State: Fl Zip: ?3 Tenant/Lessee Name: Phone #: ZkcP" (3j " Email: /141 io\ �G ��h I i� ICS net CONTRACTOR: Company Name: Ch (.¢9Nq.r <. Phone #: 3 r vsL SoS� Address: LI 001 ik) uJ 33 sr -su 67 03 City: .,0 0� _ State: Zip: 13 V) r Qualifier Name: J 4ji`e- 4 rS Phone #: 2(0)-11 State Certification or Registration #: Certificate of Competency #: CLO.l&S QntrQ Contact Phone #:425 22? �O $ Emil Address: C� �It1 w►f'� 4'4 Y/j�'11a�o -a DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ S 15 o Square/Linear Footage of Work: Type of Work: ❑Addition Description of Work: ❑Alteration ❑New ►' +' epair/Replace i n s r-2 i 14 -+tip. c:4 e rs vs/ dnnr:or.0 ❑Demolition Color thru tile: ******* ******** ********* *** ****** ** /,�*** pees*** * **** * * ** �+ �s��x, x ,�a�***** *** * ***e��x** ** ******* Submittal Fee $ Permit Fee $ 1S0 ®� CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) rl �► Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) I d 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must ' e posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The fo oing jnst ent w s a owledge before m ss �I day o r 20 j Signature Contractor The foregoing instrument was ac day of 1" ' , 20 l 1, by w is p rsonngally known to me or who has producedf U L I° I V As identification and who did take an oa NOT Y PUBLIC: Sign: Print: My Commission Expires: o ledged before me this who is personally known to me or who has produced f'i't as identification and who did take an oath. NOTARY PUBLI Sign: Print: My Commission Expired ; Q,� \9p \ }..`��+\ **** ** ********* ***** * **************** ** ***** *********** **** *******+x********** * * *** ***Mott �`��`��`►'� ��$�** ** **** ** APPROVED BY Plans Examiner Structural Review (Revised 5 /2/2012)(Revised 3/12/2012) )(Revised 06 /10/2009)(Revised 3 /15 /09)(Revised 7/10/2007) Zoning Clerk IVI lami Shores Vinage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) 77.42r h rr i n� 5°�a )41 hereinafter referred to as the owner of the following described property (address): // Ye a c.. /®® 54- Legal Description Lot 7 Block tie Subdivision kltrnn ; �, ,,,� So, $ Follo# /14 3 . ? -0/4/ - # 136 Requests permission to install (describe work): Js iii"' eu Q L Within the public right of way of (address) / / YY0 L'. --€. /CrPS) IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 1 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this I CP clay of ;:$ ,tip ��� `: •_ SIGNED, S D, AND DELI EREDiti tt �rdf_o %,,n.BTA` *1 ** 2 Lam, ,201'S (Owner's Signature ) 17VHdSV T.6 co '� 22.77' 8 r 79 0.55'ENC, 30.00' v G 9 20.05' g 6 CONC. 14.65 ,6,1.9=7-414 22 9.35' 12.55' l0 o� �;. 4 2625' 50.00' 8 27.80' 4' C.L. F. 119.12' (R&M) Elke I )9 s )7.I4 - )6),,Cc u- v'.2 1410 h m elS4 drys, e crC %i a�i1 3 'Car+ c.•e.da.. 4,'4 rr ' net) >1 s o l ( Pa ('V s• NOT VALID UNLESS EMBOSSED WITH SURVEYOR'S SEAL REVISED: 10/18/06 3 D ��: 0G T EPT 1 50.00' rri 3 ® 1200' \. /SURVEY FOR: RAYMOND MATEO AND DAMARIS RIVERA, ac 33138. LOCATION s SCALE: N 1 1 i ABBREVIATIOPdS; Uo.;ECT 10 CC HPI.If`MCE WI UH ALL FEDERAL SWK= SIDEWALK. CBS= CONCRETE BLOCK STRUCTURE. CLF =CHAIN LI K FENCE, PLL =PR0LPprRT'YI LINK, 1.1 t J'A > . IP=IR PIPE, F= FOUND, A/C=AIR CONDITIONER PAD. P /C=PROPERTY CORNE 4)46IEITHOI.E. N1�F =W EEric ES RESI9ENeE, RB=REBAR, UE =UTILITY EASEMENT. CONC' CONCRETE SLAB, RNd= RIGHT OF WAY, DE =DRAINAGE EASEMENT. C/L= CENTER LINE, O= DIAMETER, TYP=TYPICAL, M=MEASURED, R= RECORDED, ENCR=ENCROACHMENT, COMP = COMPUTER, ASPH=ASPHALT, WD =NAIL & DISC, S =SET, F.F;E =FINISH FLOOR ELEVATION, 0/S =OFFSET. P/P =POWER POLE, OHP= OVERHEAD POWERLINE, WM=WATER METER WOOD FENCE= • MASONRY W ELEVATION BASED ON LOC. # 3250 S L= caNCRETE =`�• • •::v.1 DCBM# B-62 ELV. 8.74 TYPE OF SURVEY: BOUNDARY SURVEY MAINTENANCE & DRAINAGE EASEMENT= M & O.E. SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFESSIONAL LIABILITY INSURANCE. 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 51 UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM OF 1929. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL. RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 9' CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY,AFFECTING THIS PROPERTY, BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB PAGE [ 1 1 1 1 1 1 I I I LEGAL DESCRIPTION: LOT OF ACCORDING TO THE PLAT THEREOF AS RECORDED IN F OF THE PUBLIC RECORDS MIAMI -DADE Cot 7 MIAMI SHORES SECTION 8 i HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 Er (305) 665-1201 FLOOD ZONE: PANEL: O09 DATE: S' 7 100 1' Gem Paver Systems 305.805.0000 Page 1 of 1 HOME GEM PAVER SYSTEMS Manufacturers of Interlocking Brick Pavers ABOUT PRODUCTS COLORS FEATURES GALLERY 305.805.0000 9845 NW 118th Way, Medley, FL 33178 CONTACT PRODUCTS ,s Mini -Erick Ek Pd2,,r Oid Miami 6X'3 f:.b Lam.. Dc: Canada 4..4 Stone PIa :a 5332 St2n.e ?laza 5:x:8 Stc;;e '1333 Stonie. 7137.3 Dec ;,tone COODieStcne e , 2c;hop Dade Pool i:opi33 TOrtb'ock Ec� �b .13LED 1, '525ERS PRODUCTS: OLD MIAMI 2 3/8" SPECIFICATIONS SF X PALLET: 101 PCS X PALLET: 336 PCS X SF: N/A INSTALLATION GUIDE Stack Bond 90"11 rringbone DESCRIPTION Unique in ihape, the Old Miami paver is designed and based on the New Orleans cobblestone streets. The amazing 'Old World" look enhances any project, http: / /gempavers.com/ products two inch old miami.html 1/4/2013 PERMIT # 1 J — 9 1. CONTRACTOR: _ 2 SUBMITTAL DATE: Z ADDRESS: !'l 01..._ \ CC). ` j NAME: fi q Nile:, --FO-C— RESUBMITAL DATES: PROJECT TY : – gift 'ti (C l `/ /// ZONING FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL BLD 0 9I 42-)i -b1icAt Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: l I qt) /J £ /00 S City: Miami Shores County: Folio/Parcel #: /1— 3105.- 011 C7 q5 d Is the Building Historically Designated: Yes Permit No. Master Permit No. FBC 201 'DS \ ---cH . 3,/V NO r; Zone: OWNER: Name (Fee Simple Titleholder): k .or. h o v a et G1 54 0 'ti. Phone#: 951'6 -u O ® to Address: / 14 0 li%„ c,- /00 5- ' City: f Vitt j 2, ®r FS State: 1 I Zip: 3 ?/99 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Phone#: Address: City: State: Qualifier Name: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Zip: Phone #: Value of Work for this Permit: $ 9160 0 1-* 4. Square/Linear Footage of Work: 1 b 8 �, k Type of Work: OAddition OAlteration Jf,7New ORepair/Replace ODemohtion Description of Work: ..174,s4-a Wt, d G lc- No 1e �i'�i�tr�✓ Color thru tile: ece, yet. //7 y',/ ("ea; ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** gees * * * * * * * * * * ***** *** ,x******* ******** * * ** x **** Submittal Fee $ 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 $ 1 A3' 50 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 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 occuis 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 fore ping instrument was acknowledged before me this 1 c The foregoing instrument was acknowledged before me this day of illiNi , 20 '3, by 9 u kii rte' 7 day of , 20 _, by who is personally known to me or who has produced R----1 who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: \���a�`��.jlveta�°P,,� ✓� NOTARY PUBLIC: . 916' • Sign: 93 Sign: Print: _ "DI®tRy 15 � ogn 1.I: = Print: EE11309.. c Q 6%* . My Commission Expires: APPROVED BY A/6"" 4,.,I Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) My Commission Expires: NAME: ADDRESS: 1 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 irN t 1 Q £'& .o Sr DATE: II o61 e, 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. Yqu 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. 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 p'operty listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial ts.,.o 2. I understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial ma." 3. I 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 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. I understand that I may build or improve a one family or two-family residence or a farm outbuilding. 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 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. 5. I understand that as the owner- builder, I must provide direct, onsite supervision of the construction. Initial +u Initial w.-, 6. I 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 to- 7. I 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 and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I 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 employee. I understand that my failure to follow these may subject to serious financial risk. Initial i. 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial EA.. 10. I 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://www.myfloridalicense.com/dbor/oroicilbAndex.html Initial - - 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party Malty and financially responsible for the proposed construction activity at the following address: 11%.10 1,1S K S smr, Initial Iw 12. I agree to notify,Mlamt Shores Village immediately of any additions, deletions, or changes to any of the information 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 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. Was acknowledged before me this 1 ' day of , 20 By � (V1 ^��C� who was personally known to me or who has Produced there License or 1 1D OWNER ,Nino11 /W,//,, \ Q-; .•0A) res q:I06120 613\ itzi. .���/411/ ,'I 0 F' i71C4 \\\\\�