PL-16-2772 Miami Shores Village ? Pehm 7yB ( 1t�1 �dential
10050 N.E.2nd Avenue NE
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�` � ass�cat/vr Ad 10W did
Miami Shores,FL 33138-0000o
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�— � Phone: (305)795-2204
Pew O#l0:APPROVED
�"oivP
4012112014 Expiration: 04/19/2017
Project Address Parcel Number Applicant
9029 NE 4 Avenue Road 1132060460150 C/O LA PLAYA PROPERTIES
Mia11 mi Shores, FL Block: Lot:
Owner Information Address Phone Cell
C/O LA PLAYA PROPERTIES 2275 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
2275 BISCAYNE Boulevard
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 4,000.00
LUIS QUALITY PLUMBING INC (786)256-2210 (786)444-2945
....._....__..______ ._ _. Total Sq Feet: 0
Type of Work:INSTALLATION OF 2 BATHROOM 1 SINK 1 Available Inspections:
Type of Piping:
Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $2.40 Invoice# PL-10-16-61631
DBPR Fee $4.50 10/21/2016 Credit Card $323.40 $0.00
DCA Fee $4.50
Education Surcharge $0.80
Notary Fee $5.00
Permit Fee $300.00
Scanning Fee $3.00
Technology Fee $3.20
Total: $323.40
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 AFFIDAVIT: 1 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 21, 2016
Authorized Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
October 21,2016 1
Q0 , Miami Shores Village
® a� Building Department
\ �
, 1 3 Nib
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 4S
BUILDING Master Permit No. ^fZ354
PERMIT APPLICATION sub Permit No.j�(6 2q�2-
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: Cto Z 9 w2 . 4TIck Q4as::>,
City: Miami Shores County: Miami Dade zip: 331--_58,
Folio/Parcel#: W320)&'04160 l5® Is the Building Historically Designated:Yes NO ><
Occupancy Type: Load: Construction Type: Flood Zone: BFE//: FFE:
0
OWNER:Name(Fee Simple Titleholder): ��� ��� �� � Phone#: (-5-05)
l 342454 Z
Address: ew-z 1 -A-rkk C . qaewto9 :s W 1T *N--&1-C2�
city: -�AkAFt ®\ —State: -� ®'�� zip:
Tenant/Lessee Name: Phone#:
Email: �`
CONTRACTOR:Company Name: ��d.� �vQ L / J �� �� Phone#: 2,f4,-? 4 2210
Address: t� �✓✓w
City: zz A4 State: Zip:
Qualifier Name: '2(4 Lr Alelzlvlo Phone#:A,*,� 0% 2 2 O ZN
State Certification or Registration#: /� �O 3 Oma( Certificate of Competency#: ®y'b a'lJD
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ �' �— Square/Linear Footage of Work:
Type of Work: ❑ Addition
s❑ teration New Repair/Replace ❑ Demolition
Description of Work: d b �1 e-71 a ;u AP6_.01,
Z 12-&ApZo[ c' 3"(f es7,-1IIa ,j ✓ b, G jo!�°L_
Specify color of color thru tile:
Submittal Fee$ 2 Permit Fee$ ��//a1 CCF$ z •e co/ccs-
Scanning
�(/
Scanning Fee$ ] Radon Fee$ •50 DBPR$ (4 • �®Notary$ ,
Technology Fee$ W Training/Education Fee$ 030
80 Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ .2-11 7_
(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 u.✓`
OWNER or AGENT ON RACTOR
The foregoing instrument-was acknowledged before me this The foregoing instrument was acknowledged before/me this
P
day of 11011 GTVb' f r- 20 � 0 by day of CL 20�lo by
ltc� 1-1 GcG[(�G !°` who is personally known to S GD is personally known to
me or who has produced V AA Z(f&4 06 l()4 as me or who has produced R,DQA 2 Gs,r � as
identification and who did take an oath. identification and who did take an oath.
NOTARY PURL C: NOTARYJC:
Sign: Sign:
� n
Print: Z � Print:
Seal: ANDRE GONZALEZ
a p` Notary Public,State of Rodda Seal: •
Commission#FF149307 ro,,01 Pya, Notary Public State of Florida
My comm.expires Aug.10,2018 � Sindia Alvarez
o My Commission FF 156750
APPROVED BY �°� "(� Plans Examiner L Zoning
Structural Review Clerk
(Revised02/24/2014)
RICK SCU 1 I, UL)VtKNUK KtN L.AVVJUN,JtUKt IAKT
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION s
CONSTRUCTION)NDUSTRY LICENSING BOARD
_
RF0037205
The PLUMBING CONTRACTOR
.6rhed.be[ow HAS REGIST€RED'
1lfrder the prgvisions`of Ctrapter 489 FS._.
Expiration date.ALIG 31,120 7
C,t1VDTVIDU L MUST MEET
ALL WcAL,L,IC�NSING
RE@UltEllllENPRIC3R T.O-C-ONTRACTtNG 1N ANY AREA}
.� Nil 9
QE
HERNANZ4UtS
QJALITY PLUMBINIIStC: _ _ ` , ^° �
A-.245 NW.59Th1'COORT = "*
FL33126
.�.��•.�..�+<'r' ..,,'-'r.� ;:�: aas � ,�, /�'a.. �a��'��`" ,: � .>.. '-� . Y x_. '4 - e*'^"� ��,+y `tee •,".�`e, R *..";. - 'w
ISSUED: 08/16/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1508160002062
Local Business Tax Receipt
Miami-Dade County, State of Florida
—THIS IS NOT A BILL—DO NOT PAY LBT
503178
.IF
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
LUIS QUALITY PLUMBING INC RENEWAL SEPTEMBER 30, 2017
245 NW 59 CT 503178
MIAMI, FL 33126 Must be displayed at place of business
Pursuant to County Code
Chapter 8A—Art.9&10
OWNER SEC.TYPE OF BUSINESS
PAYMENT RECEIVED
LUIS QUALITY PLUMBING INC 196 PLUMBING BY TAX COLLECTOR
C/O LUIS HERNANDEZ CONTRACTOR 45.00 09/23/2016
Worker(s) 10 04P000065 0225-16-003195
This Local Business Tax Receipt only confirms payment of the Local Business Tax The Receipt Is not a license,
permit,or a certification of the holders qualifications,to do business.Holder must comply with arty 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 Sec 8a 278.
MAM i For more information,visit www.miomidoda govilaxcolleewr
Muni ci pal Contractor's Tax Fbcei pt
M iaml-Dade County, State of Florida
—THIS IS NOT A BILL—DO NOT PAY
CC NO: 04P000065 _ M C
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
LUIS QUALITY PLUMBING INC
245 NW59 CT 7493394 SEPTEMBER 30, 2017
MIAMI,I'L 33126
Pursuant to County Code
See 10-24
OWNER TYPE OF BUSINESS
LUISQUAUTYPLUMBING INC PLUMBING CONTRACTOR PAYM ENT RECEIVED
C1 LUISHERNANDEZ BY TAX COLLECTOR
200.00 09/23/2016
0225-16-003195
`SgOREs 6�
s� Miami shores Village
aisin u"'11'
Building Department
artment
10050 N.E.2nd Avenue
`'filpy 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:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this �3 day of ®�0'� ,20 JPO
By -�3 L �� � D _Q l P who is personally known to me or has produced
as identification.
Notary:
SEAL:
ypgY D60 Notary Public State o4 Florida
R G^ Sindia Alvarez
e M,Commission FF 156750
oc W
V�°t,J4a,� +fe"h�ht
LUIS QUALITY PLUMBING
Date: a 0i
State of
County of
Before me this day personally appeared S�6M(N Q64--ho being duly sworn, deposes and
says:
That he or she will be the only person working on the project located aJ10 ZI IjE
M IAM I !E�31O9ES, FL 331
Sworn to(or affirmed)and subscribed before me this 1 day of GenMEZ . 20((o
by
�ls 70MIN G6��A�
Personally know
No.5ind a Alvarez ic to of Florida OR Produced Identification
a &AAV Commission FF 156750
Expires 09M312018 pe of Identification Produce
Pri t,Type or Stamp Name of Notary