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EL-16-2506 * � o Miami Shores Village Pe", biii rlda R �ential 10050 N.E.2nd Avenue N e+ � � �t�.rlt'CI�isSttlCBttt�r'i Altt�r�tinr, Miami Shores,FL 33138-0000 Phone: (305)795-2204 # rrft� us ' '� 1ltl 5 Expiration: 04116/2017 NO ;E + 0120126 H Project Address Parcel Number Applicant 10090 N MIAMI Avenue 1131010210090 LUISA FERNANDA LUNA Miami Shores, FL 33150-1216 Block: Lot: Owner Information Address Phone Cell LUISA FERNANDA LUNA 10090 N MIAMI AVE (305)757-3133 MIAMI SHORES FL 33150-1216 Contractor(s) Phone Cell Phone Valuation: $ 700.00 ONLY ELECTRIC CO INC 305-785-6059 Total Sq Feet: 0 Type of Work:INSTALLATION OF TWO GFCI IN BATHROO Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# EL-9-16-61288 DBPR Fee $2.25 10/20/2016 Credit Card $ 109.10 $50.00 DCA Fee $2.25 Education Surcharge $0.20 09/09/2016 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated. October 20, 2016 A orized Sign ner / Applicant / Contractor / Agent Date Building Department Copy October 20,2016 1 Miami Shores Village [BYT IEP 0 .9 ZU16 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201 Q BUILDING Master Permit No. T-0 I G` 23 PERMIT APPLI TION sub Permit No � ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL []PLUMBING ❑ MECHANICAL Ej PUBLIC WORKS ❑ CHANGE OF r-j CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS:- 1009,Q /v , di.", A v e, City: Miami Shores County: Miami Dade Zip:3 .7 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): /-LA." 5-9-- Z,&-. Phone#: Address: i00qQ N. d:c,. ; Ave- City:. - kw-C3 State: Zip: Tenant/Lessee Name: Phone#: Email: !- I �,r CONTRACTOR:Company Name: `nn X W 1, �P�_7-�I C; �� Phone#: Address: 3 4 xf W ��."Z�Q I ii City:�t G.01 h State: � Zip: Qualifier Name: Y Q Cy Phone#: 65 7 e* �,cT-1 State Certification or Registrations#: Ca l 3Oo 2;1.3 Certificate of Competency#: DESIGNER:Architect/Engineer:l Atrc,,.G,i Phone#: 7 7 8 9-01(P Address: 662-T Ak-A.4 &-ka a Afr �-f/ Z City: R.Ce4v" State:'FY-,—Zip: .3301sc Value of Work for this Permit:S, Square/Linear Footage of Work: ii/ Type of Work: ❑ Addition D i Di-Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: af'+S''�^"�-fa- Specify color of color thru tile: Submittal Fee$ � '� Permit Fee$ CCF$ CO/CC$ XJ Scanning Fee$ 2- CX) Radon Fee$ DBBP/R�$ aS Notary$ �, Technology Fee$ • CEJ Training/Education Fee$ d'0`�1 Double Fee$ 0 Structural Reviews$ Bond$ r n0 C TOTAL FEE NOW DUE$ Opt (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 be approved and a reinspection fee will be charged. Signature �. -� "`�� Signature OWN or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of ,20 r� ,by day of ��20 0,64 by ��. `'d •� ,who is personally known to � at ;' � ,who is personally known to L 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: Sig Signer = ' Prim ` Print: • � = Seal: poop" BRENDA M DERI ;Par aid, BRENDA M DERI Seal: ••eot � �;,, Notary Public-State of Florida `I Notary Public-State of Florida d• s • ••s My Comm.Expires Aug 19,2017 =' My Comm.Expires Aug 19,2017 "4121 � Qy,�o Commission#FF 046731 '%,, ¢� Commission#FF 046731 w** * *a»* '' *s 6l Rl oaal sa*� *�eres s•*asw �' seg N60 AM axu *w* APPROVED BY ��C`j/®'�l'/G Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. ~ ' PROFESSSf. .. L__ GULATION Every day we work to improve the way we do business in order ., EC13002313 '.; : 08/17/2016 to serve you better. For information about our services,please log onto wwwmyfloridelicense.com. There you can find more. CERTIFIED ELE CQ -TOR information about our divisions and the regulations that impact AD1KA,YOAV. _ ' You,subscribe to department newsletters and learn more about ONLY ELECTRICI�� the Departments initiatives. �. .• Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.488 FS. and congratulations on your new license! Expirsuondate:Auc31.2018 LIW817DM3047 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARb r, EC13002313 9 at,, The ELECTRICAL CONTRACTOR Named below IS CERTIFIED 'a Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2018 ADIKA,YOAV ONLY ELECTRIC COMP 348 NW 102ND TERRA PLANTATION ISSUED: 08117 b ti PLA ^S R UIR SEQ# L1608170003047 002836 Local Business TaxReceipt ., f�. Miami-Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6877196 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES ONLY ELECTRIC COMPANY INC RENEWAL SEPTEMBER 30, 2017 DOING BUS IN DADE CO 7151259 Must be displdyed at place of business MIAMI FL 33000 Pursuant to County Code Chapter BA—Art.9&10 OWNER SEC.TYPE OF BUSINESS ONLY ELECTRIC COMPANY INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED EC13002313 BY TAX COLLECTOR Worker(s) I S75.00 08105/2016 ECHECK-15-159113 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a ficense permit,or a certification of the holder's qualifications,to do business. Halder must Con}pty with any gOvermnental or nongovernmental regulatory saws and requirements which apply to the business. The RECEIPT NO.above must he displayed on all commerciat vehicles-Mlami4ade Code Set;8a-176. For more intormation,visit www.mianadade.taovttsxcOUector Ll. 5. 2616 11:23AM KAVA INSURANCE No- 9020 P. 1 CE QF LIABILITY INSURANCE °"�°`' "' ERTIFIATS �.�•^ � MAWS THM CURTWICAW IS WSM AS A MATTER OP INFORMATION MY=MEN NO Rlfitff$UPON 7l1E T= CERTIFICATE DOES NOT AFF MATM MY OR NEGATWELY AMEND,NXTOW OR ALTER THE COVERAQE AFFORD®13Y TIS POLICIES >tELOW.THIS CERTMAU Of INSURANCE DOES NOT COLWITIM A CONTRACT BETWEEN THE ISSUNG MI IM"),MINOMMI REPRESENTATIVE OR PIER,AND THE C6RTFICATE HOLDER. Waffw- hotrtis Is as 1�it AoYt�)1ltttatL�a eNQdlsad E .SII m 806mps and rats one On PUCYmlain pogdes=Y MWAIT an 9naouel UM A etaLtmdrd ontlda catAtkete does not aatitar rMnq m ato • Cert�ealhe haldar isI 8at1 ott4eit eadoraamanl(a1. IM10GtiC.7COWAM VLADW L✓ AHADDOR6fM Kava 1118Umm And Fkww l Src Na L54 727MW 1247 N W AM Ave MA ADPWAVAI18URANW.COM Laide ol,PL33919 wm Pfau 563-5377 Pail 727AIm im"qgAz S(OTTSOSALE IN9t3RAFiCE COMPANY 41297 atlmml) gUM 5• TITAN INSURANGCtAMPOLICY ONLY ELEO•TRIC.Cd INC 348 NW 102nd Twos Pkift an,FL 33324• (954)817-W17 "($U I1 e, COVotAsgs aMf PUT-9 NUMMK- REVISION NUMBER: THIS 19 TO CERTIFY THAT THE ROUCI LIBM BELOW MANE SM MM TO THE MIRED NAMEDABOVE FOR THE AOLICY P INDICATED.NOTIAITMANINNG ANY RECUIREINNT•.TERM OR CONI)ITION OF ANY CONTRACT OR OTHER WCLI E.NT WM REWWT TO WK*i THIS CERTIFICATE MAYBE ft=OR MAY PERTAIN.THE MAWME AFFO MED BY THE POL30EG DESCRBED HEREIN L9 SMeQT TO ALL THIS TIMI EXCLUSIOW ANO CONOMONS OF SUCH POLDES.LIMITS SHOWN MAY HAVE RON REDUCED BY PAD CLAM. rrae ap sumNal 0 PoLcY Numm umtmlLIINf$ GE14MAt.IdJLW" EAC1t S 11,000,010.00 ® I?C►AL tdRIN L1A6GTY I nr t 1.0OO,IH10.00 A 110 CIANAI' pDa Fo 1 CAS2385a959 04NtQf24It3�tJ4l14@01? IY�filo`HW n we own" ! &!P�! PHRSONAL3 App hAEv t 1, Oi.NHM .00 QIeTPLAAaR6f9ATEULdTRPP1 SPPR 1 PR0MJM3.00MPWAGO a 4,OO OM-00 ❑PG= ❑ d Loc S xsitoeweua L1ASN.ITY s area Aero arxstY NavRy 1lgr aeiuo+u a 100 000.00 9 ❑ NJ= © Asn Y 7 09Y28l2S115 08V7712016 Llot>rLY InwtJltY tPo,.o Ail t 300 000.00 ❑ mm AUTO@ ❑ It 100,WO,OD s IJ- �a11a61.U1 LJAB [�ecxlae cAa10 s RiSCBaa LIA< I AATI: S norm S ,aaoRlcota GOtArHitaAT10N � A An EIYLOYEW I.Ai llwy TNtE I N aL eAw tCCOanrr s I Nm yy � r7, ,B.L c .RkA EMPLOY% s OF ATION9 fmtOW SA.cook 6•Pmcv LNAR S i ggaCRS�TIQN 8r Op@RATIONa I LOQATI t V19 LT'e(AlfMM ACM 19'1,Aetl{COR91 ReClitie bal B,M0f01Q 6pS0Y m OkgYiloO) ELECTRICAL WORK ON 9UILDING 00MVICATE CANCELLA ON SHOULD ANY OF THII AWW WMW POL,ICM U CANCRAM Off-OW MVM SHORIE WILLAOE TL41L L MTLOA DA11tTt ,NOTNZLW"U ACCORDANCR V M THB POLICY PROVILIICNLI. 10050 NORTHEAST 2NO AVENUE PAIAMISHORES,FLORIDA AUrplORIZ10REPRRUWATIVE I 93198 ) i VLAoloft LALSHADOORSINGH 3 0 19118411110 ACORD CORPORAPM A dghk rasarved. ACOFW 26(2010166)QF TM ACORD ItAlila and logo are ragWwad nlarka of MM Only Electric Company Inc 348 NW 102nd Terrace Plantation, FL 33352 Date: 08-23-16 State of County of /9 Before me this day personally appeared Y®eWU who, being duly sworn, deposes and says That he or she will be the only� 4 perssogn working on the project located:orad Gwa; fI cfi k � Sworn to (or affirmed) and subscribed before me this qday of , 20 , by Personally know OR Produced Identification Type of Identification Produced �ataa'r'"n"''•.,, BRENDA M DERI Notary Public-State of Florida ?'• •e My Comm.EXPlres Aug 19,2017 �•±� ?;� Commission#FF 046731 fill Borst l RK0 M tlo W Notary Awn. Print, Type or Stamp Name of Notary •� ,5��s Miami shoresVillage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: (/ caner i State of Florida County of Miami-Dade The foregoing was acknowledge before me this 423 day of ,20 11 . By `^� Jam' �� - who is personally known to me or has produced as identification. w Notary: `c+t Notary Public-State of FlOfitla SEAL: :o My Comm.Expires Aug 19,2017 Commission#FF 048731 Nndednn0RftdN0WyA=L1