MC-17-2211Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
1532 NE 104 Street
Miami Shores, FL 33138-
Owner Information
Address
Pe
m1t
Permit NO. MC-8-17-2211
Permit Type: Mechanical - Residential
Wort( Classification: Pool Heater
Permit Status: APPROVED
Issue Date: 9/26/2017
Expiration: 03/25/2018
Parcel Number
1122320320370
Block: Lot:
Phone
Applicant
JUAN CAMILO SUAREZ RUBIO
Cell
SANDRA MILENA GIRALDO BOTERO
1532 NE 104 Street
MIAMI SHORES VILLAGE FL 33138-
(305)934-6115
1532 NE 104 Street
MIAMI SHORES VILLAGE FL 33138-
Contractor(s)
LAR CONSTRUCTION INC
Phone
(561)853-6608
CeII Phone
Valuation:
Total Sq Feet:
$ 2,700.00
0
Tons:
Additional Info: NEW HEAT PUMP FOR NEW SWIMMING POOL
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work: NEW HEAT PUMP FOR NEW SWIMM
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$2.00
$2.00
$0.60
$100.00
$3.00
$2.40
$111.80
Pay Date Pay Type
Invoice # MC-8-17-65054
08/31/2017 Check #: 1135
09/26/2017 Check #: 1143
Amt Paid Amt Due
$ 50.00 $ 61.80
$ 61.80 $ 0.00
Available Inspections:
Inspection Type:
Final
Review Mechanical
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, DRS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informatio
construction and zoning. Futhermore, I authorize the above -name
is a
con
rate and that all work will be done in compliance with all applicable laws regulating
tor to do the work stated.
Authorized Signature: Owner / Applicant / Cont acto / Agent
September 26, 2017
Date
Building Department Copy
September 26, 2017 1
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
❑BUILDING ❑ ELECTRIC ❑ ROOFING
❑PLUMBING MECHANICAL ❑PUBLIC WORKS
JOB ADDRESS:
/53 Z
NE /oy-'t
AUG 31 2017
�..%44
S±h
FBC 201`1
Master Permit No. 1 PP/7_
Sub Permit No. 1 MCA-1- 2z I I
❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
City: Miami Shores County:
Folio/Parcel#: //— v2 e2,32 "0.32. — 0-370
Occupancy Type: Load: Construction Type:
Miami Dade
zip: 33/ 313
Is the Building Historically Designated: Yes
Flood Zone:
BFE:
NO
FFE:
OWNER: Name (Fee Simple Titleholder): JiJU' " SV A re Phone#:
Address: /S32- NE /Ds/ _ff
City: n? / 4 n4' �k bveS State:
FL.
Zip: 3.3/.3g
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 44W'1. C/T7b h 1411. E. Phone#: 561- ass -b6o8
.s
Address:3 Vm/
� air) eL )oocc C .
City: 6) T' h Ca A Q State:QQ Zip: -35 517 2-
Qualifier Name: 4ic4.J 4- / j QK ` 0 i` es:, - Phone#:
�.. C'9 e. 12-Sa
State Certification or Registration #: �•
Certificate of Competency #:
DESIGNER: Architect/Engineer: • . Phone#:
Address: City: State: Zip:
Value of, Work for this Permit: $ 02700 , Square/Linear Footage of: Work:
Type'of Work: ❑ Addition ❑ Alteration ,New ❑ Repair/Replace
! IDescription of Work:, Nerd . LfeA f /?)fl f9 1 r 4nP St.a,✓i)-- kv
❑ Demolition
t3o(
Specify color of color thru tile:
Submittal Fee $ 50.: .I<vl,...Permit Fee $ \00 a CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ dv
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City " e •E State Zip
• 1
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) 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.
ti
Signature
� % J
t „.. , :.,, OWNER or AGENT ,
The foregoing instrument was acknowledged before me this
2.3 day of AJ64)11- , 20 r' , by ; , day of , 20' /7 , by
Sim! 16D Sagl✓Q• , who is personally known to 'tars / kY Wt e •o�i�+6�S ,who isiOrsonally known to
me or who has produced aL^5 ^404—'�o�' % 1-0Z3 a�"
identification and who did
Si
Print:
Seal:
♦.-, .
Signature .
CTOR
Theforegoinginstrument was:acknowledged before me this
. (��ays;
me or who has produced as
-alto an narh id ntificati
gip'•..
`'11.P.... UB "•
_�;: CLARA E RODRIGUEN TARY
• MY COMMISSION #FF138588
EXPIRES July.5, 2018
FloridallotaryService.com
Sign
Print:
Seal:
did take an oath.
'_�
-;§! V \a
` ,<1;CLARA E RODRIGUEZ
u • MY COMMISSION #FF138588
'�Furn./ EXPIRES July 5, 2018
(407) 398-0153 FloridallotaryService.com
**********************************************************************************s**s*********************
APPROVED BY
t £P1s
Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
RICK SCOTT, GOVERNOR
STATE OF FLORIDA
KEN LAVVSON, SECNLTARY
DEPARTMENT Of BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
LICENZI: Ht.sr,f,t3f.14
The MECHANICAL CONTRACTOR
Named beforlS.CERTIFIED
'Under the,proveslorts of Chapter 489 FS
Expiration date: -AUG 31. 2018
FtODRIGUEZ,'LUIS ALEJANDR9
LAR CONSTAUCTION ING4
6341 LIKEWOOD m .141,44-4
, soyNTotoeActi
. _
ISSUED: 08/12J2018
4.„
4/-444. "jit•otA
444•• to,
74.
DISPLAY AS itE0bIRED BY LAW
-4.404 444.44444**40444.4•44.64.4..4.4•4444.40..A.A..H0.4-,..A4,.
STATE Of FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAeREGULATION
CMC1250265 0:1c--",
UE0'106/1212016
66i-ftpaoR
4 'ft
t
;4, 4,1144 Ar
00.W-4
tS CERTiFiSO tirsdlit provisicts ot Ch,40 FS,
exisintr00 O MJ II,2011 Lietyriocel 704
CERTIFIED MECK
RODRIGUE2 LUIS
LAR CONSTRUCTI
SEO 0 11606120001704
•
. A
- •
,>IEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
• a CER� uFFIIC�ATTEEyOF ELECTION TO BE EXEMPT FROM FLORIDA YIIORICERs' COMPENSATION LAW • •
CONST
TION
XEMPTION
This
aeries
INDUSTRY �E Florida�y.{,.�.,.
T, W iiTh individual Iited � to be Florida %%bikes' Cortpensation law.
EFFECTIVE DATE: 81912016 EXPtRATTON DATE: 819f2018
RODRIGUEZ LUIS A
FEIN: 4633211773
BUSINESS NAME AND ADDRESS:
LAR CONSTRUCTION INC
5341 UUEWOOD CT
BOYNTON BEACH FL 33472
SCOPES OF BUSINESS OR TRADE
LICENSED GENERAL UCENSED ROOFING HEATING. VENTILATION.
CONTRACTOR CONTRACTOR AIR -AND
RarataaabOmahraaQa5414LF8.endeardacorpsmandlbMatesearapontamt&duels Illes aomtlCaladMaaonwar Ifs maw
may rat dorm biallsatmaapaeadfeaangst di.~lc PaaanaatbChador NnA6t/21.FALCwat calasatdadkabEadmpl--reps My
+r/hYathaadd* albbananas atVale IOW sataanabs dMelon bbaarm* Puma* bCJaplrAIDA 0).F8.aaellaaadatatWItoas
oaamRmdrrtOedasaldelbtOttawas! shill Ma sited navonsisi N env One slat tntlogNibs adeaoraularnoesono aedinsea.
Rapawn named anMe nags arnanne their The daplardal She dada a
OFS,FACKA G2E2 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 06.13 QUESTIONS? 13.1609
ANNE M. GANNON
C.NSTtnniONAt TAX OOta[CTOA
Srn+ing Paul Broth County
Serving you.
P.O. Sox 3363. West Pmn Beads. R 33402-3383 **LOCATED AT"
wew.abctax.Cds► Tot 0611 3 6-226a
5341 LIMEWOOD CT
BOYNTON BEACH, FL 33472
7YPE OF WSit €ss
23406 IYECKANCAL CO teRACTOA
*MCA
ROofuO1*F2 tun ALEJaMORO
This document is veld only rdhen moeiptod by Cho Tax COleCEOPs Moe.
LAR CONSTRUCTION INC
LAR CONSTRUCTION INC
5341 UMEWOOD CT
BOYNTON BEACH. FL 33472
r�llrrrllrelullurluhl
Ct= nscAnoN
ttaC‘»otos
RECENT ubaTE ►At0
u+asoeott -anoint
MIT NM
sn.so
Bai •
e.aiso.tO
STATE OF FLORIDA
PALM BEACH COUNTY
2017/2018 LOCAL BUSINESS TAX RECEIPT
LBTR Number: 201362851
EXPIRES: SEPTEMBER 30, 2018
The receipt pates the privilege of .rgsgn6., or
managing any business pi on of oocope ion
*win es m/diotaon and MUST bo ooncpiarausty
displayed al the place of bu3inese and in such a
Wm* as to be open to Ow view of the public.
•
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 ofl++..tthe Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requite?nent 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:
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this
By 010AN C.*MIIA S✓rtR�
DL- .504- Yd4 - 74. OZ
Notary:
SEAL:
21 day of Au .'ar , 20 /7 .
who is personally known to me or has produced
as identification.
,�,CLARA E RODRIGUEZ
;•_ MY COMMISSION #FF138588
p+ °` EXPIRES July 5, 2018
(407) 398-0153 FloridallotafyServte.com
LAR CONSTRUCTION, INC
534 Lime Wood Ct.
CMC 561 853 6608
Boynton Beach, FL 33472 alejandro@a,larconstruction.com
Tate: septevu.ber 23, 2017
state of 1 10 ri d 6\
couwtu of Dadk
ge fore v to this persoo.aLLu appeared+ S 41g'"614 "o«H wko, bei-vLg oltAU
sworvi,, deposes av401 SA US:
That he she will, be the ovtLu persoo, wor{-zivt,g ov the roject Located at:
/.53), loci s-f g,'olnA•; z) Ft, 3313
sworvt to (or a f firvu.ed) avt,d subscribed before v to this �-3 daus of
c�e. (J'�' . .2017
sYAY>✓ OF tI A COIANT( of Da.
ow this a23 dal of Seee(4V 27, Beforpee vi&e, a Notary PubUc i,w avt,d for the above
state al/La couwtl, personalll appeared h1A I2vww to ke or proved to be the
person navied 1,n, and who executed the foregoi 1,nstruvu.en , avid bei,ng first dull sworn, such
person, aclzzv owledged that he or she executed said iwstruvu.etnt for the purposes therewn coastal, ed as
his or her free and voluntarl act avid deed;
SEAL
NO • R. PV .LJC
n ll Cov hkissiow Expires
P,;ac; CLARA E RODRIGUEZ
MY COMMISSION #FF138588
?Far f oe: EXPIRES July 5, 2018
(407) 398-0153 FloridallotaryService.com