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EL-16-3195Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Na. -1 1-'1 641.9 Permit Type:.E�ELtrlcai - Resident work as$+ cetion: P001- Private P 1n7it Status: APPROVE© Expiration: 2 op/ 17 Parcel Number Applicant 1060 NE 105 Street Miami Shores, FL 33138-2106 1122320280070 Block: Lot: Owner Information DUPLEX 900 LLC DUPLEX 900 LLC Address 44 W FLAGLER Street MIAMI FL 33130- 44 W FLAGLER Street MIAMI FL 33130- Contractor(s) Phone SUNSHINE ELECTRICAL CONTRACT( (305)268-4958 CeII Phone Phone CeII Valuation: Total Sq Feet: $ 1,000.00 0 Type of Work: ELECTRIC WORK FOR POOL Additional Info: ELECTRIC WORK FOR POOL Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Amount $0.60 $4.50 $4.50 $0.20 $300.00 $3.00 $0.80 Total: $313.60 Pay Date Pay Type Invoice # EL -11-16-62152 12/22/2016 Check #: 371 11/22/2016 Check #: 303 Amt Paid Amt Due $ 263.60 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Light Niche Bonding Review Electrical Alarms 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 AFFIDAVI construction and certify tha he Hing. all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating I authorize the above-named contractor to do the work stated. Authorized S' Building December 22, 2016 / Applicant / Contractor rtment Copy / Agent Date December 22, 2016 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION UNE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ErELECTRIC ❑ ROOFING ['PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS REC NOV 22 2016 FBC 201 ef Master Permit No. SPP 1 — 2400 Sub Permit No. -a,11— 16 —3 l qs ❑ REVISION ❑ EXTENSION ❑RENEWAL 5I+ ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1060 NE 105th St, MIAMI SHORES, FL 33138-2106 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): DUPLEX 900 LLC Address:44 W Flagger Street - Suite # 2300 Phone#: (305) 440-7651 city: Miami state: Florida Tenant/Lessee Name: None Email: mariea.berthon©gmail.com Zip: 33130 Phone#: CONTRACTOR: Company Name: 0 Y2 5 rui "` fled 1 cO 14l • Phone#: Address: 1-5 I3 0 0 S I/0 2 5 COV Y'f City: t' I jQ,YY1 f State: ` Zip: 3--/ ¥ Qualifier Name: rig Cc Y l a-`(7 0C1L'11�Ly��s.�Q16 cry) Phone#: State Certification or Registration #: G r C i / 3 00 p 23-) Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ (f r 0'0 C) 7 26 543' rPO Type of Work: Description of Work: ❑ Addition n ❑ Alteration State: Square/Linear Footage of Work: ❑ Ne ❑ Repair/Replace rl Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ 7e7,6,°®p Scanning Fee $ \ 3 Radon Fee $ 411 SC) Technology Fee $ ` 80 Training/Education Fee $ Structural Reviews $ (Revisedo2/24/2014) CCF $ CC, CO/CC $ DBPR $ I • SO Notary $ 0 Double Fee $ Bond $ TOTAL FEE NOW DUE $ 001 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 instailationc as indicated I certify that no work ar 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 pe,aile9oo OWNER or AGENT Signature The foregoing instrument was acknowledged before me this 26th day of Septem��bJJer 20 16 by rllo is personally known to me or who has roduced as identification and who did take an oath. NOTARY PUBLIC: -441111410 sir! `. Sign: Print: Seal: APPROVED BY (Revised02/24/2014) CONTRACTOR The foregoing instrument was acknowledged beforeme this 12-- day of , 20 16 by M Q �'(OrY7V Gq)Y— aka, is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: /���Plans Examiner RAUL NA`. 2RO MY COMMISSIO' ::1:972714 EXPIRES: MP 2020 Bonded through 1s (nsurance Structural Review Zoning Clerk Caibai Construction 10876 S.W. 24 Terr. Miami, FL. 33165 Date: December 20, 2016 State of Florida County of Miami -Dade Before me this day personally appeared Jose Losa who being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 1060 N.E. 105 St. Sworn to (or affirmed)nd subscribed before me this 20 day of December 2016 by 0 0C . W (COY( Personally know OR Produced Identification Type of Identificatio roduced OM/4 / 1‘1!, of rr mna��un\.iu�,•i Print, Type, or Stamp Name of Notary 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' 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 By J j r 1i SEAL: dayofDa i1 60,20 ! (. who is pew e or produced • e• ca . o '_° A r' MS SANC 1EZ ' MY COMMISSION #FF158432 `y'p• °'FOF rti� EXPIRES September 9, 2018 (407) 388-0153 Floridallotary$ervice.com