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EL-16-3252Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number APPROVE Expiration: 06128/2017 Applicant 1226 NE 100 Street Miami Shores, FL 33138-2604 1132050090060 Block: Lot: VALDIVIA HOLDINGS LLC c/o M Owner Information Address Phone Cell VALDIVIA HOLDINGS LLC c/o MELLAW 2601 S BAYHORE Drive --- - -- -- - COCONUT GROVE FL 33133- 2601 S BAYHORE Drive COCONUT GROVE FL 33133- Contractor(s) SOUTH DOM ELECTRIC INC Phone CeII Phone (305)626-5904 Valuation: Total Sq Feet: $ 8,900.00 0 Type of Work: ELECTRIC REPAIR AND UPGRADE FOR EXT Additional Info: Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $5.40 $4.66 $4.66 $1.80 $5.00 $311.15 $9.00 $7.20 $348.87 Pay Date Pay Type Invoice # EL -11-16-62215 12/30/2016 Check #: 6703 11/30/2016 Check* 998 Amt Paid Amt Due $ 298.87 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Review Electrical 1 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 :LECTRICAL, PLUMBINGCHANIC, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS FI • • VIT: I certify that constructi n and ; ening. Futhermor ill t e fo egoiri inf I a tho a the ab• ation is accurate and that all work will be done in compliance with all applicable laws regulating e -named contractor to do the work stated. uthorized Si s nature: Obuner " / Applicant / Building Department Copy Contractor December 30, 2016 Date December 30, 2016 1 Questions/Comments/Concerns ? Miami Shores Village Monique Smith, 786-253-2869 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING XELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS JOB ADDRESS: 122-4 /k/k./b 0 S ,. NOV 3 0 2116 FBC��20N Master Permit No. 1U' / //r/ Sub Permit No. T — & 25 2- ❑ REVISION ❑ EXTENSION []RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: zip: 33 / (' NO V BFE: FFE: OWNER: Name (Fee Simple Titleholder): I V IA- A.° L'D% AI f Phone#: 704,- 26 3 Q-061 1142/4//61,/8" sr, m Address: g2 EA'As A'60 ✓tT City: State: Zip: Tenant/Lessee Name: Phone#: Email: /i D/U1CQ(!U /tet' d7 vC'/-ib awl e x yz CONTRACTOR: Company Name: Address: a00 ACa / c City: / v' 1 isrt\ 1 State: 4F 1 Qualifier Name: To S A'7/ TO.S Phone#: ,_,11 ,54. State Certification or Registration #: /3 09 6-62/ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ g q0 Q i ©Q Square/Linear Footage of Work: Zip: 50 State: Zip: Type of Work: ❑ Addition Description of Work: Alteration ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ 3 `4 -6 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ • DBPR $ ' Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 2..C1 ' (Revised02/24/2014) c. 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 firsinspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection ill be approved and ojreinsp ti n f will be charged. Signatu JAL,/ OIER0 The foregoing instrument was acknowledged before me this Z 2 day of NOV , 20 1, CD , by 4—tO f 9 U C f to ith , who is personally known to me or who has produced I�r k d 0 [ A) Jt S as identification and who did take an oath. NOTARY PUBLIC: Print:L-?Gtl' \ rQ' ioI�ZI/f1� Z Seal: MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 ' > `1Nititt1b AIMI'INS IPI APPROVED BY (Revised02/24/2014) Signature CONTRACTOR The foregoing instrument was acknowledged before me this Z.. day of N©'J ,20`� , by JO � DCI rI o`er vbho is pe sonallyTcnown to me or who has produced fi®r l d c ` N ryt identification and who did take an oath. NOTARY PUBLIC: • h�� Sign: Cc_! r Print: 111-190 rQ✓Gr 1 so n Ea r e-2 r Seal: ******************** 6A9we f Plans Examiner Structural Review MAHARAI K GONZALEZ MY COMMISSION # GG 044602 .***nub„** .,o ;; R•� Bonded Tiw Notary Public Undarwv ters ********** Zoning Clerk i Miami Shores Village 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' mpensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIG s BELOW YOU ACKN• EDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENT Signator;- /AL,' 0,414 4 c cw r State of Florida County of Miami -Dade The foregoing was acknowledge before me this Z Z. day of 1�I 0`v , 20 By %-- on igUe. SVY \ ltV, who is personally known to me or has produced �corid�l &wrrS Not as identification. SEAL: % MAHARAI K. GONZALEZ 4.4?- „ MY COMMISSION # GG 044602 EXPIRES: November 2, 2020 Bonded Nu Notary PebUo Underwriters 4 southdom electrVc 5860 NW 192nd St Hialeah, FL 33015 (305) 335-9124 Date: State of Lo ¶i is County of MIP 1 P b Before me this day personally appeared A4 fri 0 S who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: [2-2--C, /fit Sworn to (or affirmed) and subscribed before me this ZZ day of N 0 \) 201(0 by JOSC. ClQ,1 CYrncn rrocto5 Personally know -r Or produced Identification POT )dCira i\) e_y3 Type of Identification Produced MAHARAI K GONZALEZ MY COMMISSION # GG 044602 EXPIRES :November2, 2020 or ' Bontlec Tnru notary Public Underwriters rint, Tipe or Stamp Name of Notary