EL-16-99 Permit No. EL-1-19-99
�eµO'tFs LMiami Shores Village M Permit Type:ElectPerinl Workrical-Residential
10050 N.E.2nd Avenue NE Classification:New
Miami Shores,FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
F�ORiDp'
Issua patsy 2/1/2016 Expiration: 07/30/2016
Project Address Parcel Number Applicant
1420 NE 103 Street 1132050310030
Miami Shores, FL Block: Lot: MARC AND ANNE LITZENBERG
Owner Information Address Phone Cell
MARC AND ANNE LITZENBERG 1420 NE 103 Street
MIAMI SHORES FL 33138-
1420 NE 103 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone Cell Phone Valuation: =30,000.00QUINTANA ELECTRIC BROTHERS IN( (305)986-5893 (305)681-5317
Total Sq Fee
Type of Work:NEW HOME Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:3 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Underground
W.W.
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $18.00
DBPR Fee Invoice# EL-1-16-58326
$15.75
DCA Fee $15.75 02/01/2016 Check#:2539 $ 1,088.50 $50.00
Education Surcharge $6.00 01/13/2016 Check#:2537 $50.00 $0.00
Permit Fee-Additions/Alterations $1,050.00
Scanning Fee $9.00
Technology Fee $24.00
Total: $1,138.50
i
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
ccepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
VW'
ed for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
FFIDA IT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
con i zo ing. Futhermore, I authorize the above-named contractor to do the work stated.
February 01, 2016'
ho ' d nature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
4
February 01, 2016 1
-3 Miami Shores Village _
OjO ' Department p ; JAN 13 2a
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:
INSPECTION LINE PHONE NUMBER:(305)762-0949
. FBc 20jy �
BUILDING Master Permit No. fA__S�
PERMIT APPLICATION Sub Permit No. �! 125
[—]BUILDING C-N ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
[—]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CCONTRACTOR DRAWINGS
JOB ADDRESS: L 1`02� �,
City: Miami Shores County: Miami Dade Zip- 331 3Y
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood•Zone: BFE: FFE:
JJ
OWNER: Name(Fee Simple Titleholder): L i Phone#:�
Addr2 ?
sa
City:ess: h4? ✓' State: Zip: ) 1 J
M
Tenant/Lessee Name: Phone#:
Email: -�
CONTRACTOR:Company Name: t VIiO��A �I� j(�� rt� �Y1�� Phone#:
Address: "I"I I L a� �' TzGyh K�
City:lb_k�q State: C_10j Zip: 5) 5 -
Qualifier Name: DLA&, l •N U) Z `` Phone#:
State Certification or Registration#: l' 000;?5q h Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for_this Permit:$ '7� CJ/ it . ! Square/Linear Footage of Work:(9,COD 'ed- jW,
Type of Work: ❑ Addition ❑ Alteration ®'New ❑ Repair/Replace ❑ Demolition
Description of Work: AL') I o
..�� „ � )1 �•.Y � a�;�Ts?'Jw'TA N?bLP^ti5'DhT01i `t� ty�
Specify color df color thiu'tile l is���=�z:ga .�1F,S�, :, POS' f
+s-M�nps`` iiL�'t+w«tr ;?;: u'i:i t%4•�` 'd'
Submittal Fee$^�"� ' � �C3 Permit Fee$ l G_f';!9 CCF$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ C
TOTAL FEE NOW DUE$ 0 pv
(Revised02/24/2014)
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
u -
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 seMn (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appr will be charged.
Signature Signature
OWNER or AGEN CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
+r day of ;?L yi uil r j 120 1 Ur by 3 � day
of� DG YI uli M ,20�� by
A41a 4?T7� who is personally known to at V >=/-ht� y I/L� Y,who is personally known to
me or who has produced" / — as me or who has produced as
f\ation and who did take an oath. identification and who did take an oath.
NO UBLIC: \\ TARY PUBLIC:
Sign- Sig
Print: v Print:�0� (0I�n�n mb, ___
h• ER I OM MAN%-
Seal: ,r+� ''e ROBERT Qt11NTANA Seal: • ••; NOTARY KW C•STATE OF FLORDA
. NOTARY PUBLIC-STATE OF FLORIDA t
COWIMSSION 0 FF070112
_ COMMISSION#FF070112
EXPIRES 11/13/2017
EXPIRES 11/138017y'�� •
�P�.••'. BONDEOTHRU1-908-NOTARYI
APPROVED BY l3 Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
,
♦5�ORE'
logo Miami Shores Village
� �- ,�� Building Department
�OR1DA 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:
4
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 permif 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 ACYNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
State of Florida
r
County of Miami-Dade j-
1L
,The foregoing was acknowledge before me this 1 day of 1& ,20 J 6
� y;BI
�. ���� ' who i ersonally known t e or has produced_
as identification.
Notary: i
SEAL:
ROBERT QUINTANA
.f NOTARY PUBLIC•9rkM OF FLORIDA
,
EXPIRES 11/13/2017
,
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND'PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
i
MENDEZ, JUAN M
QUINTANA ELECTRIC BROTHER'S INC
660 E 60 ST
HIALEAH FL 33013
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 ;: " STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, �/ DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. 3,3 PROFESSIONAL REGULATION
Every day we work to improve the way we do business in order to EC0002546 ISSUED: 08/07/2014
serve you better. For information about our services,please log onto
www.myfloridaiicense.com. There you can find more information t CERTIFIED ELECTRICAL CONTRACTOR
about our divisions and the regulations that impact you,subscribe MENDEZ, JUAN M
to department newsletters and learn more about the Department's
initiatives. QUINTANA ELECTRIC BROTHER'S INC
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, IS CERTIFIED under the provisions of Ch.489 FS.
and congratulations on your new license! ExprcaCron date :AUG 31.2016 1.1406070002129
RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
EC0002546
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31,2016
MENDEZ; JUAN M •
QUINTANA ELECTRIC BROTHER'S INC
765 SW 101 CT CIRCLE %
MIAMI FL 33174 .
ISSUED: 08/07/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408070002128
9!212015 Report Viewer
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JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION h
"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.
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EFFECTIVE DATE: 8/13/2014 EXPIRATION DATE: 8/12/2016
I PERSON: QUINTANA ROBERT W
3
FEIN: 650973171
BUSINESS NAME AND ADDRESS:
QUINTANA ELECTRIC BROTHER'S INC }
6020 SW 8TH ST LOT C-306
MIAMI FL 33144
SCOPES OF BUSINESS OR TRADE:
t LICENSED ELECTRICAL -
? CONTRACTORPursumtloChRpter b
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may not nxw berte641o�a comppersation tilde this clWee.Rrslatto Ch�r40.Q5(12).torn F.s.cet'A 6�delecowfiCm to be exempt...apply only
vdtlin ale stape,=btakless a trade IlsW on the notice of election to beetempL Ptrsuert to Chapter 440.05(13).F.S.Notices of election to be
erengandcatificaksot lection to beexempt still bestgecttorevocationiLatarytimeartathefilingofthenoticeathelssuaweoftecatificafe•
1 the person raned an Via nofice or certificate no longer meets tha,re*irements of the section for issiAnce of a certificate,The department shall revoke a
DFS-F2-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED W13 QUESTIONS?(850)413-IW9
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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: 8/14/2014 EXPIRATION DATE: 8/13/2016
PERSON: QUINTANA RAMON
FEIN: 650973171
1 BUSINESS NAME AND ADDRESS:
QUINTANA ELECTRIC BROTHER'S INC
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s 4801 SW 6TH ST
MIAMI FL 33134
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
Punkt to Chapter 440.05(14),F.S.an cticer d a coWabonwho dere aernpaan tom this chapter bby�acing a ceraecale ddedlonuxler this section
may rpt recover benfi[s a ccmperis m ulda ahs chapter.PlrsVdt toChX to 44(105(12).F.S..Certifies dcsmb
deb:exempt..appy aty
I vol 'nae scope doe dainess or trade lislea an the route of election to beexeapt.Ptrsuart to Chapter 440.05(13),F.S.Notices of election to be
exempt andcatiacdes d cti
demto be exanpt shall be"ea lo revocation if,a any time saw the Marg dma notima to issuance dale cetiacam
tie person raneo on tie notice a cera6cate ro longer meed the requiremrres of this section for issuance of a araacale.The depaiment shall revoke a
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JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DMSION 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: 5/29/2014 EXPIRATION DATE: 5/28/2016
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PERSON: MENDEZ JUAN M
FEIN: 650973171
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BUSINESS NAME AND ADDRESS:
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QUINTANA ELECTRIC BROTHERS INC
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660 E 60ST
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HIALEAH FL 33013
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s` SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
Ptrstlai to Chapter 440.06(14).F.S.,an officer da corporation who dells exemption from this chapter bbyy filing a cadficate ddection oder tiffs section
may nal recover berefits o cam (e i vda IHs chapter.PusuM to Chapter 440.05(12),FS.,Cee Icates dilation to be exempt...apply only
within the scope d tie d8lress o trade listed on the notice ddectionto be exempt Pusuari to Chapter440.05(13),F.S.No ices d decian tote
{ exempt and certifieaans ddationrobeexempt shall be 5dject to revocation if.at arty time after tier filing d tin notice or the isstsome of to certificate,
f dhe persam mamedmahe ndioeaartifialerologer meets We repirenMa dais section for issuance of a certificsta The department shill revoke
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Local Business Tax Receipt
Miami—Dade County, State of Florida
-THIS IS NOT A BILL-DO NOT PAY
5863932 \� LBT/
BUSINESS NAMEMOCATION RECEIPT NO. EXPIRES n
QUINTANA ELECTRIC BROTHER RENEWAL SEPTEMBER 30, 2016
S INC 6115745 Must be displayed at place of business
19441 GULFSTREAM'RD Pursuant to County Code
CUTLER BAY, FL 33157 Chapter 8A-Art.9&10
OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED
QUINTANA ELECTRIC BROTHER S 196 ELECTRICAL BY TAX COLLECTOR
INC CONTRACTOR
45.00 . 09/16/2015
Worker(s) 2 EC0002546 0222-15-004456
This Local Business Tax Receipt only confirms paymentof the Local Business Tax.The Receipt is nota license,
permit,or a certification'of the holders qualilkathms,to do business.Holder must comply with any governmental
or nongovemmernal regulatory laws and requirements which apply to the business.
The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8e-276.
MIA'.. For more information,visit wwwmiamidede.gpvRaxcollector