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PL-17-704Amt Paid Amt Du1 e $ 360.60 $ 50.00 $ 50.00 $ 0.00 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -3-17-704 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 4/3/2017 Expiration: 09/30/2017 Parcel Number Applicant 77 NE 95 Street Miami Shores, FL 1132060130720 Block: Lot: PABLO NUTA Owner Information Address Phone Cell PABLO NUTA 77 NE 95 Street MIAMI SHORES FL 33138-2706 77 NE 95 Street MIAMI SHORES FL 33138-2706 Contractor(s) DOCTORS PLUMBING INC Phone Cell Phone (305)602-0400 Valuation: Total Sq Feet: $ 380.00 0 Type of Work: REPLACE KITCHEN SINK Type of Piping: Additional Info: REPLACE KITCHEN SINK Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $0.60 $3.00 $3.00 $0.20 $200.00 $3.00 $0.80 $200.00 $410.60 Pay Date Pay Type Invoice # PL -3-17-63325 04/03/2017 Check #: 187 03/16/2017 Check #: 992 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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, P UMBIN' ECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I c:/ir, - I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. F ft authorize the above-named contractor to do the work stated. ///1 Authorized Sig April 03, 2017 wner / Applicant / Contractor / Agent Building Depa ment Copy Date April 03, 2017 1 BUILDING PERMIT APPLICATION ❑ BUILDING %PLUMBING Miami Shores Village 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 ❑ ELECTRIC ❑ ROOFING ❑ MECHANICAL ❑ PUBLIC WORKS JOB ADDRESS: 71 i * el 95 S'r7- Master Permit No. Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL AR 15 Z017 Fec Zoi 61-11 gck - 3s66 PL L7-704 ❑ CHANGE OF CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Folio/Parcel#: Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Address: 11 c-) 5 Miami Dade Zip: 33\ 3f, Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: ate\ c-3 jJ Jt� Phone#: City: NNtAk State: �-.•9 Tenant/Lessee Name: Phone#: Email: Zip: 7✓'-� 1 �i b CONTRACTOR: Company Name: Address: City: AS\ o. �� o c—Vo S � �` S_i i P1 l� 1►S+ C� 2_31:71 V1 Op S\ - State: --f".1.oR-•9 6. Phone#: (3os> (oo2.-C..) Qualifier Name: r,.,1/41+9° Phone#: Zip: 3'5ol to State Certification or Registration #: CR-( t 425) X44 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: (� City: State: Zip: Value of Work for this Permit( 2 D _ 496 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: Q�o��c SAQ ti �rvhU Repair/Replace ❑ Demolition t ; 9 Specify color of color thru tile: 1:1" '14 Submittal Fee $ Permit Fee $ �, U Scanning Fee $ 3 Radon Fee $ S DBPR $ 3 Technology Fee $ ' WO Training/Education Fee $ ° 2-0 Double Fee $ WO Bond $ t.O CCF$ tl90 CO/CC $ Notary $ Structural Reviews $ (Revised02/24/2014) TOTAL FEE NOW DUE$ (00 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) da s after the building permit is issued. In the absence of such posted notice, the inspection will not be a. 'roved and a reinspe '•n fee will be charged. r ., , Signature �:. `.,���� Signature OWNER orA The foregoing ins X11 ent was acknowledged before me this } day of d.t4 , 20 VI , by CONTRACTOR The foregoing instrument was acknowledged before me this S day of teA., 20 V' , by , who is personally known to i3(V c.VC O 11\`cy.,,S , who is personally known to me or who has produced as identification and who did.take an oath. =NOTARY PUBLIC_ me or who has produced as identification and who did take an oath. NOTARY PUBL Sign: Sign: Print: J — Print: •�;'d r6�a,, JAVIER PEREZ Seal: ; °.-`c�'% Notary Public - State of Florida Seal: Commission # FF 958026 My Comm. Expires Feb 7, 2020 Bonded through National Notar A co APPROVED BY (Revised02/24/2014) 3 -- (7—l? Plans Examiner Structural Review JAVIER PEREZ Notary Public - State of Florida Commission # FF 958026 ,My Comm. Expires Feb 7, 2020 Bondedthrow, iAa)to * Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 ARIAS, FERNANDO JR DOCTOR'S PLUMBING INC. 7530 SW 36 ST MIAMI FL 33155 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT -OF BUSINESS AND PROFESSIONAL. REGULATION CFC1429344 ISSUED; 08/16/2016 CERTIFIED PLUMBING CONTRACTOR ARIAS, FERNANDO JR DOCTOR'S PLUMBING,!NC:-1 IS CERTIFIED under the provisions of Ch.489 FS. Expiration date . AUG 31, 2018 L1608160002302 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CFC1429344 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 1 ARIAS, FERNANDO JR DOCTOR'S PLUMBING,ItIG. 11316 SOUTHWEST185,TERR' MIAMI FL 33157, 007355 -Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 6106371 BUSINESS NAME/LOCATION DOCTORS PLUMBING INC OPERATING IN DADE COUNTY MIAMI FL 33999 OWNER DOCTORS PLUMBING INC Employee(s) 1 RECEIPT NO. RENEWAL 6369276 SEC. TYPE OF BUSINESS 213 SERVICE BUSINESS Not a Contractor Receipt 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 holder's qualifications, to do business. Holder must comply with any 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-276. For more information, visit www.miamidade.goy/taticollector LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/28/2016 CHECK21-16-104774 A RCr CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/15/2017 r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Jvs Insurance Agency 9600 SW 8th St, Suite 27 Miami, FL 33174 Phone (305) 552-5250 INSURED DOCTOR'S PLUMBING INC. 11316 SW 185 TERR Fax (305) 552-5292 Miami FL 33157 CONTACT NAME: PHONE FAX PHONE No. (305) 552-5250 E-MAIL (NC. NNo(305 ) 552-5292 ARDBESs.. sergiodelgado©jvsins.com ILIANA CASTANEDA INSURERS) AFFORDING COVERAGE _i- INSURER A : SCOTTSDALE INSURANCE COMPANY INSURER B : NAIC A INSURER C : INSURER D : INSURER E : , INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR TYPE OF INSURANCE ADDLiSUBR I POLICY'EFF POLICY EXP LTR POLICY NUMBER f (MMIOD/YYYYJ (MMIDDIYVYY) LIMITS El COMMERCIAL GENERAL LIABILITY A ;❑ ❑ CLAIMS -MADE ® OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: D POLICY ❑ JE ❑ LOC ❑ OTHER h1 AUTOMOBILE LIABILITY i ❑ ANY AUTO ❑ALLTOS OWNED AU HIRED AUTOS II ❑ UMBRELLA LAB 4 ❑ EXCESS LJAB DED ❑ RETENTION$ CPS2293426 08/10/2016 SCHEDULED AUTOS NON -OWNED AUTOS ❑ OCCUR ❑ CLAIMS -MADE 08/10/2017 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea oc,4vrrence) MED EXP (Any one person) $ 1,000,000.00 $ 100,000.00 $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ 1,000,000.00 —1 COMBINED SINGLE LIMIT (Ea accident _ BODILY INJURY (Per person) BODILY INJURY (Per accident PROPERTY DAMAGE ,Per accident) EACH OCCURRENCE AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE----- I OFFICER/MEMBER EXCLUDED? i (Mandatory In NH) if yes, describe under DESCRIPTION OF OPERATIONS below NIA ❑ $T TUTS ❑ 24H. EL. EACH ACCIDENT $ EL. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) PLUMBING CONTRACTOR CFC1429344 r CERTIFICATE HOLDER CANCELLA ION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 333138 ACORD 25 (2014/01) QF SHOULD THE EXP ACCORD AU OF THE AB ON DATE EWITHTH E DESCR BED POLICIES BE CANCELLED BEFORE REOF, N r TICE WILL BE DELIVERED IN UCY PR VISIONS. CORPORATION. All rights reserved. ogo are registered marks of ACORD 03/15/2017 4:06PM FAX JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW " * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/13/2015 EXPIRATION DATE: 8/12/2017 PERSON; ARIAS FERNANDO JR FEIN: 204464688 BUSINESS NAME AND ADDRESS: DOCTOR'S PLUMBING INC 7530 SW 36 ST MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440,06(14), F.5„ an officer of a corporation who elects exemption from this chapter by fling a ce,14ircate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. appy only within the scope or the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of median to be exempt and Certificates of election to bo exempt shall be subject to revocation it, at any time after the filing of the notice or the Issuance of the certificate, the person named an Me notice or certificate no longer meets the requirements of thls section for Issuance of a certificate, The department shall revoke a DFS-F2-DVVC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08.13 IJ0001/0001 QUESTIONS? (850)413-1609 DOCTOR PLUMBING INC. PLUMBING CONTRACTOR 2357 W 80 ST BAY 4 Hialeah FL 33016 LIC: CFC 1429344 Licensed & Insurance Fax: (305) 602-0481 Phone: (305) 602-0400 Date: March 15, 2017 State of Florida County of Miami -Dade Before me this_day persorially appeared Fernando Arias who, being duly sworn, deposes and says: That he will be the orily..pers'on working on the project located at 77 NE 95 ST Sworn to;(or affirmed) and'stabscribed before me this 15 of March 2017 by Personally know Notarvl Javier Perez JAVIER PEREZ Notary Public - State of Florida Commission # FF 958026 /;:' My Comm. Expires Feb 7, 2020 Bonded through National Notary Assn. Miami Shores Viiiage 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 BEL ;W YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this afS day ofdie c,� , 20 Vr. By q\---1\0 0 Owner Notary: SEAL: NDO ARIAS JR ry Public - State of Florida y Comm. Expires May 19, 2018 Commission # FF 106782 who is personally known to me or has produced ification.