EL-17-1212 petmir)/d, L 17-, 212
Miami Shores Village PBi7?71f 7}rp8 EiBGtriC>� �+ReSidentia�
& 10050 N.E.2nd Avenue NE
pok 04 Additiof#Alterat!on
Miami Shores,FL 33138-0000
Pea Std APP, .
Phone: (305)795-2204
�t Rm� Issuei .511l2tii7 Expiration: 11/11/2017
Project Address Parcel Number Applicant
1009 NE 104 Street 1122320290140 LENILAN INVESTMENT LLC
Miami Shores, FL 33138-2655 Block: Lot:
Owner Information Address Phone Cell
7
LLENILAN INVESTMENT LLC 1009 NE 104 Street (305)608-9839
MIAMI FL 33138-
980 BELLE MEADE ISLAND Drive
MIAMI FL 33138-
Contractor(s) Phone Cell Phone Valuation: $ 3,000.00
SUNSHINE ELECTRICAL CONTRACT( (305)268-4958
__. Total Sq Feet: 0
Type of Work:REMOVE EXISTING WORK AND BUILD UNDE Available Inspections:
Additional Info:REMOVE EXISTING WORK AND BUILD UNDE Inspection Type:
Classification:Residential Final
Scanning:1 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
W.W.
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80
DBPR Fee Invoice# EL-5-17-63890
$2.25 05/15/2017 Check#:1290 $412.30 $0.00
DCA Fee $2.25
Education Surcharge $0.60
Penalty Fee $100.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $2.40
Work without Permit Fee $150.00
Total: $412.30
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 accurat dth t II work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above-named contractor o o t ork sta ed.
May 15, 2017
Authorized Signature:Owner / Applicant / Contractor / gent Date
Building Department Copy
May 15,2017 1
R Miami r ill RECEIVED
lt� MAY - 3 2017
• Building Department
10050 N.E.2nd Avenue,Miami Shares,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
CL4BB 1 (�
BUILDING aster Permit No. 9— L V _ - t 7—
IT APPLICATION Sub Permit No. V l t <Z 12-
F-]BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF F]CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1009 NE 104 ST
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-2232-029-0140 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):LENILAN INVESTMENT LLC Phone#:305-608-9839
Address: 1009 NE 104 ST
City: MIAMI SHORES State: FL Zip: 33178
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 1J CC4. Phone#: 2 1?(0 �6
Address:
r -7
City: omJlA.0 State: XY Zip: 7
Qualifier Name: AA ZtuEAW Z! YI Phone#: -2 b cl'f- 3 c7'S- 0
State Certification or Registration.#: e C f)U eSQ Certificate of Competency#:
DESIGNER:Architect/Engineer: JORGE D. MANTILLA (LIC# 14320) Phone#: 305-815-4649
Address:5901 SW 63 COURT City: SOUTH MIAMI State: FL zip: 33143
Value of Work for this Permit:$ 99 -i•cco• Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace F-1Demolition
Description of Work: F I Y ' $41 o e 000 . A ��
X. CJ!� ��?��£-12_ FB C
FIC e"J,A G!loll, �C7
Specify color of color thru tile: y.
-3
Scanning
®®f
Submittal Fee$ Permit Fee$ � �� CCF$ CO/CC$
I . -.,VScanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ C
TOTAL FEE NOW DUE$
[ (Revised02/24/2014)
w
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: 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.
"WARNING TO ER: YOUR FAILURE TO RECORDA NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING ICE 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 riinspection fee will be charged.
Signature Signature
0 R or AGENT CONTRACTOR
The foregoing i strumen was acknowledged before me this The foregoing i trument was acknowledged before me this
24) da of f I 20 �� ;by �day of 20 1 by
91i�Q.f P.tr1C� who is personally known to _ o 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-ai:�eath.
0.n., RAUL WARRO
NOTARY PUBLIC: NOTARY PUBLIC: �, My COMMISSION#FF972714
EXPIRES:MAR 20,2020
O�a� onded through 1st State Insurance
Sign: ���� Sign: F —.
Print- NATAUALARA AMN Print:
;Y
Seal: EXPIRES:Sq*mber30,2111 Seal:
APPROVEDBY �� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
e
SUNSHINE ELECTRICAL CONTRACTORS CORPORATION
LICENSE # EC 13005807
PHONE NUMBER 786 443 9590
Date;04 28/2017
COUNTY OF MIAMI SHORES VILLAGE
Building Department
Before me this day personally appeared Mariano Santiesteban who, been duty sworn deposes and says:
That he will the only person working on the property located at 1009 NE 104 Street, Miami Shores, FI
33178
Cordially:
Mar no Santiesteban
Sworn to and subscribed before me thisc�r�) day of 2�' 20 I�� by
Personally Know / —_
Orroduced Identification
p FAUL NAVARRO
Type of identification My G0MMiSS10N;,FF972714
9r o EXPIRES:MAR 20,2020
E-nded through 1st',ate Insurance
Print,Type or stamp sell of Notary
OR
®®el"
non Miami shores Village
Building Department
R 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
&E-r"'': 7 �7,
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 prqiect 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:
W_
®w
er
State of Florida V
County of Miami-Dade
The foregoing was acknowledge before me this day of 20A
By �affj( who is personally known to me or has produced
A as identification.
14ATAUA I ARA
Notary: ti� MYCOWS5101410FOM
EXPIRES:Svtember 30,2019
SEAL:
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