DS-17-895 Pyr nr ���-4_17-835
Miami Shores Village Permit Type;Driveways(Sldew;`a1kslStabs
�S. 10050 N.E.2nd Avenue NE
O* a:�catfo N
Miami Shores,FL 33138-0000
hrPN ` Phone: (305)795 2204 Permit States:APPROVED
�'4ORtA�'
Imo ,41712017 Expiration: 10/04/2017
Project Address Parcel Number Applicant
1295 NE 105 Street Number: TH 8 11-2232-087-0080
Miami Shores, FL 33138-2111 Block: Lot: ADAM&RORIE ROTH
Owner Information Address Phone Celt
=ADAM& ROTH 1295 NE 105 Street (305)333-2084
MIAMI SHORES VILLAGE FL 33138-
1295 NE 105 Street
MIAMI SHORES VILLAGE FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 3,500.00
ALES GROUP GENERAL CONTRACT( (305)545-6950
Total Sq Feet: 380 ;.
Approved:In Review Available Inspections:
Comments: Inspection Type:
Date Approved::In Review Final
Date Denied: Foundation
Type of Work:PATIO REMODEL PUT IN CONCRETE PAb Additional Info:PATIO REMODEL PUT IN CONCRET Review Planning
Bond Return: Classification:Commercial Review Building
Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40
DBPR Fee Invoice# DS-4-17-63534
$2.00 04/07/2017 Credit Card $ 119.40 $0.00
DCA Fee $2.00
Education Surcharge $0.80
Permit Fee $100.00
Scanning Fee $9.00
Technology Fee $3.20
Total: $119.40
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 AFFI AVIT: I certify t a e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction z ng. Futh or uthorize the above-named contractor to do the work stated.
April 07, 2017
Au o e Si a caner / Applicant / Contractor / Agent Date
Building Department Copy
April 07,2017 1
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Miami Shores Village
APPROVED BY DATE
ZONING DEPT '
SITE PLAN
BLDG DEPT
SUBJECT TO COMPLIANCE W rH ALL FEDERAL
STATE AND COUNTY RULES AND REGULATIONS
Miami Shores Village RECEIVED
Building Department `APER 04 78F
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 201
3UILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
*BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING F—] MECHANICAL ❑PUBLIC WORKS [—] CHANGE OF CANCELLATION ❑ SHOP
n1 CONTRACTOR DRAWINGS
JOB ADDRESS: I -C-) E [V JAS %
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: � l�
Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): A&II � �V1 Phone#:
Address: Ms N-'i e 1C)s 51
City: t&)l f GQ1 State. Zip: �� )
Terant/Lessee Name: Phone#:
Email: ( �;��,
CONTRACTOR:: /
/1 Company Name: C�C fl.l�� Phone#: 5015 Cl 5 21�L
Address:
City:. Stater Zip: I y
Qualifier Name: I (� (D oil Phone#: X)5 ?IQ 'Q�GCO
State Certification or Registration#:r�-1 ( 5 -;5 .�4 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �D 566 Square/Linear Footage of Work:
ype of Work: ❑ Addition ] Alterart�io-nI 1:1 New , ❑ Repair/Replace ❑ Demolition
Description of Work: �JTic4 /' A.a P'
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$
(Revised02/24/2014)
t
Bor ding Company's Name(if applicable)
Bording 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.
dWARNING 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
OWNER or AGENT CONTRACTOR
i he foregoing instrument wasa knowledged before me this The foregoing instrument was acknowledged before me this
day of /� ��^ 20 J by day of I-ACI 20 I ,by
_ �, ' 1 M • ®(1� V `,who is personally known QkW1
lto � t—)6 n-J6 �!Cq ,who is personally known to
IrlIJ
me or who has produced
o�®Q� -U/ `�f/_I `0 me or who has produced as
identification and who did take an oath. ''1un aQ identification and who did take an oath.
NOTARY PUBLI NOTARY PUBLIC:
•• �':! MAHARAI K GONZALEZ
MyCOMMISSION
Sig = = Sign:
' Bonded Tluu Notary P.M.6;"t..Print: Print:
Ap �� AALIYAH MERCEDES ALVARADO
Seal: Seal: "} MY COMMISSION#FF075410
ov
`:�o��o"• EXPIRES December 10,2017
(407)398-0153 Floridallot"Service.com
17
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Rev sea02/24/2014)
VILLAGE DEL MAR CONDOMINIUM ASSOCIATION
VILLAGE DEL MAR CONDO ASSOCIATION
Village Del Mar Condo Association approves Adam Roth of 1295 NE 105 Street, Miami Shores
FL 33138 to install pavers in the backyard.
Approval is hereby granted:
3la!A & g
Date:
Rach'm
Board o Directo
777A
Boar of Direct rs Signature:
`TIS mCAq-i WQS ac V,noUD►C d d bar-
��� has prodvtQ,d a Soo- 0 (0--� -qZ1 , -® �Aer dCk
�^us'••,, MAHARAI K GONUIZ
°•= MY COMMISSION#GG 044602
EXPIRES:November 2,2020
•~Fo t Bonded Thru N Public Underwriters
1200 NE 105 ST Miami Shores,F133138
Detail by Entity Name Page 1 of 2
n lorida Department of State Diy:s ou or ConPot AT!(:�NS
23 + rg
Department of State / Division of Corporations / Search Records / Detail By Document Number/
Bail by Entity
Florida Not For Profit Corporation
VILLAGE DEL MAR CONDOMINIUM ASSOCIATION, INC.
Filing Information
Document Number N03000002434
FEI/EIN Number 11-3717545
Date Filed 03/19/2003
Effective Date 03/19/2003
State FL
Status ACTIVE
Last Event AMENDMENT
Event Date Filed 11/12/2008
Event Effective Date NONE
Principal Address
1200 NW 105 ST.
MIAMI SHORES, FL 33138
Changed:09/26/2008
Mailina Address
1430 NW 15 AVE
MIAMI, FL 33125
Changed: 11/12/2008
Registered Anent Name&Address
PAUL A. MCKENNA&ASSOCIATES, P.A.
1360 S Dixie Hwy
#100
MIAMI, FL 33146
Name Changed:01/11/2012
Address Changed:02/22/2017
Officer/Director Detail
Name&Address
Title P
ROTH,ADAM
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/3/2017
Detail by Entity Name Page 2 of 2
1430 NW 15 AVENUE
MIAMI, FL 331'25
Title Secretary
SUMMERS,TOM
1430 NW 15 AVENUE
MIAMI, FL 33125
Title Director
Roghi, Francois
1430 NW 15 AVE
MIAMI, FL 33125
Annual Reports
Report Year Filed Date
2015 04/17/2015
2016 03/25/2016
2017 02/22/2017
Document Images
02/22!2017--ANNUAL REPORT View irnage in PDF forma4
012916--RAgggt,Qhange View image in PDF format
03125!2016--ANNUAL REPORT View image in PDF format
04/1712015--ANNUAL REPORT View image inPDF formai
03!2612014--ANNUAL REPORT View image in PDF torrnaY
02!18/2013--ANNUAL REPORT View image in PDF format
Pj-/j1/2.Q.j?_.:.._ NNl�9l4_@E:F...Q.C3.T. View image in PDF format
04101!2011--ANNUAL REPORT View image in PDF format
03105/2010--ANNUAL REPORT View image in PDF format
02!1012009 -ANNUAL REPORT View image in PDF format
11/12!2008--Amendment View image in PDF forma4
paam,_mo....:.:..nNNyl l R�P�T View image in PDF format
01103!2007--ANNUAL REPORT View image in PDF format
10113/2006--REINSTATEMENT View image in PDF format
09/0712005.-ANNUAL REPORT View image in F'DF forma4
04/30/2004--ANNUAL REPORT View mage in PDF forma4
{!4!0212003--Aq l -Qrrg_tC ion View image in PL7F format
03120!2003--Domestic Non-Profit I View image in PDF format
http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/3/2017
Miami shores Village
�z- P01 Building Department
ACpgYDA 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305)795.2204
Fax: (305)756.8972
Notice to Owner® Workers' Compensation Insurance Exemption
11
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 tune
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.
ti1. 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:
Ow er
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of ,20
By MGM M k�r " who is personally known to me or has produced
�r�i9 G icer
No
`jay is MAHARAI K GONZALEZ
SEAL: ;r MY COMMISSION#GG 044602
v P�oPo EXPIRES:Nbvemt�t 2 2020
U..,�.v Bonded Thru Notary Public Undo Ti
Ales Group General Contractors
896 SW 701b Ave. Miami, FL 33144 State of Florida Certified General Contractors
Tel: 305-545-6950. 305-219-4806 CGC# 1522537
Fax: 305-262-1389
April 7, 2017
State of Florida
County of Miami Dade
Before me this 7th day personally appear David Gonzalez, who being duly sworn,
deposes, and says:
That he will be the only person working on the project located at 1295 NE 105th Street,
Miami Shores, FL 33138
Sworn to (or affirmed) and subscribed before me this 7th day of April, 2017 by David
Gonzalez.
David Gonzalez
Personally Known
KGs produCQd. G� .s2U - 1Coo-�U-2Cv5- .
Notary Name Q �-
Notary Signatur
(Seal)
FL;: �°� ,; MAHARAI K.GONZALEZ
:# *: MY COMMISSION#GG 044602
`:: :;` EXPIRES:November 2,2020
':Fob���p Bonded Thru Notary Public Underwriters
STAT :OF FLOIZIOA
D>rpART[�ENTDE-BU$INESSAND i
+ PI (
Sib NAL#tEGU ;ATION
CGC22 7 ° SD Gl %21f20'16`
i�
CERTIM-D GI�M1I �2AL t C3 {TRACTOR t
GONZAI~ Z,flA'i/iD '
ALES'GROUPGI:t4=F7AL CONTRACTORS
15 G`EFt7wjt- under the-provisions of GhA89 FS.'
£xptr lan cite.,AUC 3� 2096 tIO072100f11260
K =;f 0 '. GOVERNOR KEN LAWSON. SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD � �
f
V
G'r._
NERAL CONTRACTOR
a ,amu below IS CERTIFIED �
r der ,,ne provisions Cf Chapter 489 FS.
Expiry ion date AUG 31. 2018
GONZALEZ DAVID Y
ALES GROUP GENERAL CONTRACTORS
9725 SW 73RD STREET
P�!IPv11 FL 33173 #.
ss(..:: :; 07:21 2,^6 DISPLAY AS REQUIRED BY LAW SEQ# L160721C001260
Local Business Tax Receipt
Miami-Dade County, State of Florida
7196595
BUSINESS NAMEILOCATION RECEIPT No. EXPIRES
ALES GROUP GENERAL CONTRACTORS RENEWAL SEPTEMBER 3Q, 2017
896 SIN 70 AVE 7478893
M
MIAMI FL 33144 jst be disp.ayed at placeof business
Pers,ant to Count,,,coaG
Coapter 8A-Art,9&10
OWNER SEC.TYPE OF BUSINESS
ALES GROUP INC 19f, GENERA-BJ*::_D1NG CONTP,,aCTCR PAYMENT RECEIVED
C,J)DAVID GONZALEZ CGC1522537 BY TAX COLLECTOR
.%crker(s: 9 S75,00 09/07/2016
ECHECK-16-175623
This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license,
Perm(!.Ora certification of the holder's qualifications,to do business. Holder mustcotylply with any governmental
Or nongovernmental regulatory laws And requirements which apply to the business
The RECEIPT NO above must be displayed on all commercial vehicles-Miami-Dade Code Sac Sa-276,
For more ifliormation,visit wAvjm.wj g&.q ax;gl(e�ggr
WE
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION
**CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW"
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law.
EFFECTIVE DATE: 1/3/2016 EXPIRATION DATE: 1/2/2018
PERSON: GONZALEZ DAVID
FEIN: 592157712
BUSINESS NAME AND ADDRESS:
)LES GROUP INC
ALES GROUP GENERAL CONTRACTORS/ALES GROUP ELECTRICAL CONTRACTORS/PROLOCK AND SAFE
896 SW 70 AVENUE
MIAMI FL 33144
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL LICENSED ELECTRICAL DOOR AND WINDOW
CONTRACTOR CONTRACTOR INSTALLATION
Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section
may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only
within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,
:he person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609