PLC-17-2627 (2)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
BUILDING
PERMIT APPLICATION
El BUILDING ❑ ELECTRIC ❑ ROOFING
']PLUMBING ❑ MECHANICAL El PUBLIC WORKS
JOB ADDRESS: 7 25 I 5-"\-V-t-F----k.
FBC 201q
Master Permit No. 'LC__ `
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑ CHANGE OF
CONTRACTOR
City: Miami Shores County: Miami Dade
Folio/Parcel#: Is the Building Historically Designated: Yes
Occupancy Type: Load:
Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): SAIroats3 ?fit Z -T c_tio Phone#:
Address:
City:
❑ CANCELLATION
❑ SHOP
DRAWINGS
Zip: 331385
NO
FFE:
'1 Sttate: r-,
Tenant/Lessee Name: t A L ilk
Email:
Phone#:
Zip:
CONTRACTOR: Company Name: �✓i � ((/iW P.�/2�C Phone#: 4S1% 144 S�3
Address: 3?O/ ti LA/(41 (cp -
City: i -C� cc State:
Qualifier Name: /372..J /='x60
State Certification or Registration #: Cr( / t72—_q-43
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $
ZOO 94—
Type of Work: ❑ Addition ❑ Alteration
Description of Work: `OAS
Phone#:
Certificate of Competency #:
CANCErtEP .City: Zip:
Square/Linear Footage of Work:
Zip: 370(3
❑ New Repair/Replace ❑ Demolition
LA A —I t- F-24 -11/4 VAt--Tt-a-- 1` 3 vk.A S ‘ bk_ of 8 qu,b pssca
1142-123 i yt uJM.I- 2)i~N-1N o �c t�xN� aS-4 B wic# evAtt.its STDJ-
Specify color of color thru tile:
Submittal Fee $ M , CO Permit Fee $ /;2 CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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
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 at a)cceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien kir`e 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.
Signatu
OWNER or AGENT
The foregoing instrument was acknowledged before me this
l / day of OC- faze-2 , 20 / r% , by
G^ 7, . L4VCR/a who is personally known to
�or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
*************
APPROVED BY
*
Signature
CAA
CONTRACTOR
in ins�rum n g e t was acknowledged before me this
!
j� 7 day of OC 7,4 , 20 ( 7 , by
VGA ivh t2 P t, v S2 / 0, who is personally known to
3or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
as
OS'c
4' '
opr" Ne, Notary Public State of Florida
? Oscar M Zaragoza
�ra My Commission FF 939287
��f Expires 12108/2019
************************
(01 % Plans Examiner
*******************
************
Zoning
Structural Review Clerk
(Revised02/24/2014)
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Local Business Tax Receipt
Miami --Dade County, State of Florida
ltIlS IS NOT A BILL- D0 NOT PAY
7165547
BUSINESS NAME/LOCATION
QUINTERO GENERAL CONTRACTOR CORP
8801 NW 112 TERR
HIALEAH GARDENS FL 33018
RENEWAL
7441936
EXPIRES
SEPTEMBER.30, 2018
Must he dlspiay'e!d'at Ple00 of business
Pursuant to County Cole
Chapter BA - Art. 9 8/ 10
OWNER SEC. TYPE OF BUSINESS
• QUINT'ERO GENERAL CONTRACTOR CORD 'Pt.UMB{NG CONTRACTOR.
C/0 BERNARDO'QUINTERO PRES CFC1428973
Worker(s) 1
PAYMENT RECEIVED
BY TAX'COLLECTOR
$45.00 07/11/2017
CRED TCARD-17-046558
This Local Business TexReceipt only confirms payment of the Local Business Tex. Ths Receipt is not a license.
permit, at a cartifcetion of the blades gratification to do Mainsail. Holder must comply with any governmental
er ntngovemrnitabd rtguiatsty lava sndraquiremertts which volt(' y to the business.
Ths Ramp -rug. above must be displayed on all commercial Indictee - Ntiouti -Osde Code Sec 6e-2V8.
For more itetormatios,visit wyyw•miateidede.00altte oifectp[
November 2, 2017
AFFIDAVIT
I Rene Medina, owner of Apartment 3D at 725 NE 91 Street,
Miami Shores, FL. 33138, fully authorize Quintero General
Contractor Corp. and the Shores Plaza East Condominium Asso.,
with office at 74 NE 91 Street, Miami Shores, FL 33138, to
perform inst. Iati • n of a "natural gas" line which will run from
the Tev g.. eter into my unit.
Signature
The foregoing instrument was acknowledged before me this
(2at' day of /Vo 1vc / e , 20 / 7 by
Rene Medina who is personally known to me and did take an
oath.
Notary Public:
Sign:
Print: ascieic 44Ac-,0 4
Seal:
•
= .17 . . ; _
A ••
Slate Plaga Sewe eaud4Nti.t4 x A24t eiettIo., Tee.
745 North East 91 sc Street
Miami Shores, FL 33138
305-759-9069 / FAX 305-759-2101
E-MAIL spel23@att.net
November 2, 2017
Miami Shores Village
Building Dept.
10050 NE 2nd Avenue
Miami Shores, FL 33138
Dear Sir / Madam:
This letter will serve as your confirmation that "Quintero General Contractor
Corp." has been contracted and is authorized by the Shores Plaza East
Condominium Association, Inc. to install a "natural gas" line pipe in
apartment 3D at 725 NE 91 Street, Miami Shores, Fl. The gas line will run
from the Teco gas meter unto unit 3D.
Should you have any questions regarding the enclosed, please feel free to
contact our office at your earliest convenience.
Sincerely yours,
Carlos Talavera
Vice -President
cc: file
,,,,,,,,,,,,,
l MV
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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signatur —"
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
By
Notary'
SEAL:
day of 0 20 R .
who is personally known to me or has produced
as identification.
Notary Puhlir. State of Florida
Siilila Alvarez
`.. My Commission FF 1515750
of e.ar Expires 0910312018
a, a, z .a. A. p; ,L.M _A J4.F4.",t..•.
IQuintero
General Contractor.
QUINTERO GENERAL CONTRACTOR CORP
Bernardo Quintero 8801 nw 112 terrace
Hialeah Gardens fl 33018
Date: 11/04/2017
State of Florida
County of Dade
Before me this day personally appeared Bernardo Quintero who, being duly sworn, deposes
and says:
That he or she will be the only person working on the project locate at: 725 ne 91 St # 3d
Miami shores FL 33138
Contractor Signature
Sworn to (or affirmed ) and subscribed before me this 04 day of November 2017
by /e/L.J 4 a t\'5:6it,
Personally know f)i e""
OR produced identification
Type of identification produced
ii/Of P/7
Print, Type or Stamp Name of Notary