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PL-17-1025 Permit No. PL-4-17-1025 �sHO1S c,� Miami Shores Village ot Permit Type:Plumbing-Residential v 10050 N.E.2nd Avenue NEP lo Miami Shores,FL 33138-0000 Work Classification:Addition/Alteration Phone: (305)795-2204 Peffnit Status:APPROVED ficoRYVA Issueoate:6112/2017 Expiration: 12/09/2017 Project Address Parcel Number Applicant 289 NE 102 Street 1132060134970 ALFRED&NANCY DOWSON Miami Shores, FL 33138-2426 Block: Lot: Owner Information Address Phone Cell ALFRED& NANCY DOWSON 305 NE 91 ST MIAMI SHORES FL 33138-3129 Contractor(s) Phone Cell Phone Valuation: $ 750.00 EDDIE ROJAS PLUMBING INC 305-944-6788 Total Sq Feet: 72 Type of Work:REPLACE BATH FIXTURES Available Inspections: Type of Piping: Additional Info: Inspection Type: Top Out Bond Return: Final Classification:Residential Scanning: 1 Review Plumbing Underground i Fees Due jmnPay Date Pay Type Amt Paid Amt Due CCF DBPR Fee Invoice# PL-4-17-63682 06/12/2017 Credit Card $ 109.10 $50.00 DCA Fee Education Surcharge 04/12/2017 Check#:3503 $50.00 $0.00 Permit Fee Scanning Fee Technology Fee Total: 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 assum esponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRIC , L BING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFID erti all the foregoing information is accurate and that all work will be done in compliance with all lapplicable laws regulating constructio an F e ore, I author above-n dontractor do the work stated. June 12, 2017 Authorized Signature:Owner / Applicant / Contractor / Ygenf Date Building Department Copy June 12, 2017 1 -��-�-n— Miami Shores Village RE 8VVED Building Department APR 12 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 51)4 FBC 2019 BUILDING Master Permit No.gcxl — `CA,-e PERMIT APPLICATION Sub Permit No. 1� \U2S ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ( PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: G'\O F City: Miami Shores County: Miami Dade zip: Folio/Parcel#: ! Q ^0 Is the Building Historically Designated:Yes NQ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFFE: \\ OWNER:Name(Fee Simple Titleholder): (� Phone#: Address: 3 /._- -/ City: State: i .L_ Zip: Tenant/Lessee Name: Phone#: Email:� � dL( _ 2711 a �6 rh— CONTRACTOR:Company,Name:� b lt�.S n /`? Phone#: 3,OT— 9/ yy,odp Address:; 2 City: �_� �p ( State: 1�1 Zip: J�(� Qualifier Name: O I Phone#: State Certification or Registration#: Certificate of Competency#: ULJ (� DESIGNER:Arch itect/Engineer: 44 r- Phone#: /S (�7 Address: /i City: State: ip: 33 Value of Work for this Permit:$ (, o Square/linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ /Re lace Re air p p El Demolition Description of Work: z° IF Specify color of,co/or-thru tile: - dou Y"'f.i Submittal Fee$z *c-g , , r,,;• permit Fee$ CCF$ Scanning Fee$ _...__Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (C)9. 1 _ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address _ City State Zip Mortgage Lender's Name(if applicable) s Mortgage Lender's Address E 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 commerice'nent 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 app ve nd a reinspection fee will be charged. I � _ r Signature Signature 4"� r OWNS or AGENT ' CONTRA TOR a The foregoin instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 31 St day of Qyc 20 J by 13day of Y 1 20 1--1 by i �v�UJ ✓ I \� ��n .who is known t• �il. who 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 an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1�44 Sign: OAkA `, Sign: 0MA Print: ��l C4 Print: (I Seal: ANA PARRILLA Seal: Notary Public-State of Florida' J`�« , - - ;'? .,.; ANA PARRILLA 4 +o;' My Comm.,Expires Apr 21,2017 ' Notary Public-State of Florida Commission# EE 86778 ':• -' M42%12 l Ommission#EE 867787 APPROVED BY 7 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) t EDDIE ROJAS PLUMBING a Date: I State of County of Before me this day personally appeared who, being duly'sworn, deposes and says: That he or she will be only person working on the project located at: F V' 607 Ividle;", Contractor ignatu a t.y t Sworn to (or affirmed)and subscribed before me thisday of^—�VAC .20 17 i t I Personally Know OR Produced Identification Type of Identification Produced Print,Type or Stamp Name of Notary .';si'v'a�'•.,, ANA LUISA PARRILLA ;c, Notary Public-StateofFlorida r t =•: Commission N GG 090452 9 ,Io.ar My Comm.Expires Apr 21,2021 t ''IF OF Fly`•' Bonded through National Notary Assn. i t RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION y CONSTRUCTION INDUSTRY LICENSING BOARD a " CFC049431 t ¢' The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018us' ROJAS, EDWARDO . EDWARD ROJAS PLUM ORP 880 NE 111TH ST � c:, - BISCAYNE PARK' X3161 ,. ` ISSUED_ 07/28/2016 DISPLAYAS REQUIRED BY LAW SEQ# L1607280001584 001869 Local sic ss Tax Receipt Miami—Dade County,State of FloridaLBT -THIS IS NOT A BILL-OO NOT PAY 5175658 BUSINESS NAMEILOCATION RECEIPT NO. EXPIRES EDWARD ROJAS PLUMBING CORP RENEWAL SEPTEMBER 30, 2017 880 NE I 1 I ST** * 2371250 Must be displayed at place of business BISCAYNE PARK FL 33161 Pursuant to County Code Chapter 8A-Art.9&10 t OWNER SEC.TYPE OF BUSINESS EDWARD ROTAS PLUMBING CORP 196 PLUMBING CONTRACTOR PAYMENT O BY TAX COLLECTOLLECTO R Workers) f CFC049431 $45,00 07/31/2016 CREDITCARD-16-044804 This Lccat Buslrmss Tax Receipt orsfy confirms psymeat of the local Business Tan.The Receipt is not a licaese, permit or a certification of the holder's gaafificali0as,ttt do business.Holder mart comply with any goveroareaatal or rm0stgovereuatatrtaE replator y lays acrd requiramettts which apply to tate busiaes. The RECEIPT N0.above rust be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-2/6. For more information.visit wmANAMamided%govitexcol 0r 09113/2016 14:12 TAX) P.0011001 CERTIFICATE °ATE,MM/DDrYYYY) �,,....� OF LIABILITY INSURANCE 09113/18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY ON NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT! If the COrtifioata holder Is an ADDITIONAL INSURED,the Bile p y(tee)must be endorsed. If SUBROGATION IS{NAIYED,xubjele to the corms and conditions of the policy,certain ponctee may require an endorsemont, A statement on this eartiticate does not confer rights to the certificate holder in lieu of such andorsemsnt(al. _. PRODUCER L— Estrella Accurate v DN 305)226-8727 +Na, (30S)226.8767 8300 West Flagler Suite 114 tudaetltAllatbolltaa,itr:n8t Miami,FL 33144 wsuRER($)Ain+CRtRNfCOVERAOE NAZCA Phone 305 226-8727 Fax (306)226.8787 iNSUR6 A. Aron S peclalty Insuranos Company INSURED JNBURER a: Edward Rajas Plumbing Corp INSURER C. 880 NE 111 St N g€30ayne Park.FL 33161- INSURERF; COVERAGlrS CERTIF€CATE NUMBER. REVISION NUMBER, THIS IST F,RTIFY TWIT THE POLICIES F INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TEAM 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 OLICIES.t_IMMS SHOWN MAY.HAVE BEEN I Et)UCED BY PAIN CLAIMS_ JNT R TYPE OF INSURANCE POLICY numeen MOY EI F AWK LIMITS 0e118RAL 1.1A81LIlY _. S ACH OCCURRENCE 1 1,000,000.00.:. ® COMMERCIALGENERALLIABILITY oJO (It1i5RTF1T ❑ [1 CLAIMS-MADE © OCCUR P13 4tBt sl AJQWAM 1 :_110D.000-00 A Y : AGL0028426-01 MED EXP ata p.r>on i 6,000 00 08/08/2098 08/06/2017 PERSONAL a AINJURY. 1 1,000,000.00 ® LN GIWNERALAGGREGATE 3 1,000,000.00 c��ryN'POLICgEgATELUNIrAPPut;Loc PRODUCTS-COMProPAGc a 1,000,000.00 tJ POLICY ❑ �' ❑ Lo0 a AUTOMORIL[LIABILITY N LE LIMIT; ❑ ANY AUL tIW�D �D BODILY INJURY(Par person) i ❑ 01 RUT88 ❑ pN{+BWN BODILY INJURY(Para dent) S ❑ HIRED AUTOS C] AU708 - POPt213 '#AGE T.,._• 9f ❑ S 0 unleaeLLA Lwa E3 occuR EACH OCCURRENCE S j�} t!)CCE6S IJAB irw�.7l_a L]CLAIAES•MN]E R GtATE s 77 — WOIt)(Et16 COMPENSATION WG STATTH. AND DAPLOYEEW LtABtL" Y r N ANY PROPRIETOR)PARTNERlF.J OUTwE OPi,I ERJINEMta A EXCLUDEO7 NIA E.L.EACH ACCIDENT i U seE.L.DISEASE•EAEMEL $ O AERATIONS below E.L.DISEASE-POLICY LIMIT 'E. DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(Attach ACORD 101,Additional VOW"aehaalae,if men spaeo Is meshed) CFC049431 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRI9c, !L'5 8E CANCELLED BEFORE Mlaml Shores Village Tae EXPIRATION DATE THEREOF,NOE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY 10050 NE 2nd Ave AUTHORI7A6 REPRESENTATIVE Mlaml Shores,FL 33138 Lucca Estrella ACORD 25(2010103)QF ®1988.20 ORATION, All rights reserved. The ACORD nam and logo are registered marks of ACORD Report Viewer Page 1 of 1 3 " JEFF A'rWAMR •ryf`0":` , CµieF 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: 7/1212015 EXPIRATION DATE; 7/1112017 PERSON: ROJAS EDWARDO FEIN; 463073811 BUSINESS NAME AND ADDRESS: EDWARD ROJAS PLUMBING CORP 880 NE 111 ST BISCAYNE PARK FL 33151 SCOPES OF BUSINESS OR TRADE; PLUMBING NOC AND DRIVERS Pv'aa2,9i'gCh?'1tt 8<U 4jria},F;^a,936�v`f*i19Xd✓j.9 ifYry Mt?a?ftaf f.'�gbi(,�M4A4 WyF14//1iriy 92lC t91d-($+ i HUtN t(ffhR rafhof lftiraf411Ra fd"ffA'.j 2,'F,Oi4�DM14�NSh14f arts Pu}Ira{96Afj1fl<9�afi1{1�fr.t�,Q.f�!.F.�,ba9l fstii'1f9 fu ff4 S Oiv:'yMtf e�`.�'41H9 ai0pf d11R!SLf4s(t(9f ti?fId Mtfd ft4 L`,a CG1+G0 sr Nft�J@t?✓Sb»f-I'".4�L t�a`t td E�t2FN RtlJ�S(4�St,RT,M,1:2f f!tii-at t?tP. ere°,�5?.afa!d:afaa9!efsf4ai??oe ceam�`.aha*tE6 r�°sdstlf?rar9da?=2 t4a.7 f.rosai(:^,d l�+'pettae Catty art}fs kssli:.ta fli scar.^.esra,. � r.�€Ht9n name99n iR9 na5(a Yi dan.A6t:a fate+yf�traata�a+a.p��(Nd'=;4�S?W.sti`.,>x7 tat hisiata of,�iN'-f>6t'?�,a tr¢iArvn,f4l°f tfrfta?... 3 1)PS•F2,0WC-252 C ERTIFICATE OF eLECT10N TO a8 F-WAPT REVISFO 0513 OUEST+ON57(850}4+3.1809 f I a I r file:///C:/TJsers/RUTHL/AppData/Local/Temp/5PNQSAIC.htm 6/30/2015% a `SVoREs GQ goal 11111M Miami shores Village - Building Department ��ORtDP' 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 f: 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 OU ACKNOWL THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND, ITS CONTENTS. Signature 1 Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 1 day of 2 t(� ,20 who is perso 1 kn e or has produced as \�N�� Notary: SEAL: _cam• T °'o:�_ T N i :GN a: ii0RI D ��N\\\\\`\\\ f :�� .p,�i'�V t�C" . p. f 6 + a 4 {