PL-16-575 Pe
mt neo.PL-3-16416
,SgRns�� Miami Shores Village 3B�T IPl#mbing-;Rasidential
10050 N.E.2nd Avenue NErl"td
"'• Miami Shores,FL 33138-0000
A,J"f3VE13
Phone: (305)795-2204 1� �:
oxtvt`
4 lwle ate.412 !201 Expiration: 10125/2016
Project Address Parcel NumberApplicant
9350 NE 9 Place 1132060070040
Miami Shores, FL 33138- Block: Lot: LUIS ARTIEDA
Owner Information Address Phone Cell
LUIS ARTIEDA 9350 NE 9 Place
MIAMI SHORES FL 33138-2972
9350 NE 9 Place
MIAMI SHORES FL 33138-2972
Contractor(s) Phone Cell Phone Valuation: $ 800.00
La Casa de las Piscinas Inc (305)633-9699 (305)216-3907
Total Sq Feet: 0
Type of Work:POOL PIPING Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Main Drain
Bond Return: Final
Classification:Residential Scanning:1 Rough
Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# PL-3-16-58888
DBPR Fee $3.38
DCA Fee $3.38 04/28/2016 Check#:1449 $ 186.36 $50.00
Education Surcharge $0.20 03/03/2016 Check#:2051 $50.00 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $236.36
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,MECHAN WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNER FI IT: I certify that the f regoing ' for
is accurate and that all work will be done in compliance with all applicable laws regulating
construction a oning. F ore,I above-named contractor to do the work stated.
April 28, 2016
Aut� rized Signature:Owner / Applicant / Contractor / Agent Date
Building artment Copy
April 28,2016 1
Miami Shores Village C FI 1�D
Building Department MAR 0 3 2016
BY:7i�4--
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 y
BUILDING Master Permit No. Yf? J 72,
PERMIT APPLICATION sub Permit No. PL C 5
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 4RJPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
/� COcNTRACTOR DRAWINGS
JOB ADDRESS: T-3 -6-0 /v - E / (-z'�c�� IF—
City: Miami Shores County: Miami Dade Zip: �1
Folio/Parcel#: -7CsC' 54� Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Z ne: BFE: FFE:
�
OWNER:Name(Fee Simple Titleholder): Phone#:7 6 �
Address: cc�` . lam CP—
Zi
L � �
City: � State: p: 25
Tenant/Lessee Name: Phone#:
Email: 4 .
CONTRACTOR:Company Name: '� ` ��` FSlione#: -5
s4 _49
Address:
.r
City: , State: Zip: f-�
Qualifier Name: �J C -'�/ Phone#:
State Certification or Registration#: C�G/ �� / Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alterat' n ,, New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color o�fcolor
rt�hru tile: t�1
Submittal Fee Permit Fee$ �� CCF$ J' (01S CO/CC$ 0
Scanning Fee$ Radon Fee$ ���� DBPR$ Notary$ ,0
Technology Fee$ U0 Training/Education Fee$ Double Fee$
Structural Reviews$ 70 Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
BondinklfCompany's Name(if applicable)
Bondigg 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. 1 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
WNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoingnstrument was acknowledged before me this
-< day of -��h .20 '� ,by �� day of ��`"'`� .20 j i ,by
who is personally known to ,who is personally known to.
me or who has produced at me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: v ``�- Sign:
Print: r f : � G' jFlorida
Print: "/Iy a is
Seal: .•`'a�P''% VIVIANA BARCIA
io,P y;`c�'' Notary Public-State of Seal: °"'11., VIVIANA GARCIA
,,��r°yea,
•i
My Comm.Expires Jun 2 _.�° tiotary Public-State of Florida
F Com�ion N EE 21 . My Comm.Expires Jun 27,2016
iq =;,� Commission#EE 212108
sssssssssss sssssssssssssssssssssssss s� ` s1ss sss
APPROVED BY `�Y O Plans Examiner Zoning
Structural Review Clerk
(Rv4lW02/24/2014)
2/'19/2016
LA CASA DE LAS
PISCINAS INC.
2601 NW 18 TERR.MIAMI,FL.33125
STATE OF FLORIDA C 5-633-996
305-633- 9
901 9
COUNTY OF DADE
Before me this day personally appeared Maria C. Rodriguez who,being duly sworn,deposes and says;
that she will be the only person working on the project located at: 9350 NE 9 Place, Miami Shores, FI.
Sincerely,
M ria C. nguez
ES/,QUALIFIER
Sy► m to�or affinnd Subscribed before me this day of 20>�,by
G• ra
PERSONALLY KNOW_✓
Or produced ID
Type of ID
,ename of notary]
11 V),A
o,�aYto%, VIVIANA GARCIA
♦SP VA'
cr°. .`c: Notary Public-State of Florida
' ie My Comm.Expires Jun 27,2016
�= Commission#EE 212108
Bonded TMougA NedOnal Notary Assn.
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Nilami Sures, Florida 33138
Tel: (305)795.2204
Fax:(305)756.8972
Notice to Owner-Workers' Compensation Insurance Exemption
Florida Law requires Workers, Compensation mance coverage under Chapter 440 of the Florida Statutes. Fla.•Stat. § 440.05
allows corporate officers in the construction industry to mempt themseives from this regnir�ement for any=siruction project prior to
obtaining a building permit, Pmsrrarrt to the Florida Division of Workers'Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more parttime or full-time
employees,including the owner,must obtain workers'compensation coverage. Corporate officers
or members of a limited liability company (LtC) 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 mwrds 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 cm oration 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,parttime 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 thew circumstances,119iiarni Shores Village does not require verification of
workers'commotion insurance coverage from the contractor's company for day labor,part time employees or sabcontractors.
BY SIGNING BELOW OU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner .0009 m
r
State ofFlorida c o N
y $ N
County of Nam i Dade ��� awl
The foregoing was admowledge before me this IP dayof
By 1�-� �/. e. s�
who is personally known to me or has produc e dAh a
as identification.,,a.--
Notary' '�'`.�.' �a tv�ta ; Dutu. ' F!Orlda °a
4 �•
n My Comm.Expuer.
SEAL: ', er Commission#EE 21
Boom.�
jigo*Mao"Notary Ass 11