PL-17-2213Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Permit NO. PL-8-17-2213
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: APPROVED
Issue Date: 9/26/2017
Expiration: 0312512018
Parcel Number
Applicant
1532 NE 104 Street
Miami Shores, FL 33138-
1122320320370
Block: Lot:
JUAN CAMILO SUAREZ RUBIO
Owner Information
Address
Phone
Cell
SANDRA MILENA GIRALDO BOTERO 1532 NE 104 Street
MIAMI SHORES VILLAGE FL 33138-
1532 NE 104 Street
MIAMI SHORES VILLAGE FL 33138-
Contractor(s)
ALL COAST BUILDERS LLC
Phone
(786)299-2807
Cell Phone
(305)934-6115
Valuation:
Total Sq Feet:
$ 2,600.00
0
Type of Work: NEW POOL PIPING FOR NEW POOL
Type of Piping:
Additional Info: NEW POOL PIPING FOR NEW POOL
Bond Return :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$3.38
$3.38
$0.60
$225.00
$3.00
$2.40
$239.56
Pay Date Pay Type Amt Paid Amt Due
Invoice # PL-8-17-65056
08/31/2017 Check #: 1135 $ 50.00 $ 189.56
09/26/2017 Check #: 1143 $ 189.56 $ 0.00
Available Inspections:
Inspection Type:
Main Drain
Final
Rough
Review Plumbing
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, WINDOW , DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing informa on accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore, I authorize the above-na ed ntractor to do the work stated.
September 26, 2017
Authorized Signature: Owner / Applicant / C tr- tor / Agent Date
Building Department Copy
September 26, 2017 1
BUILDING
PERMIT APPLICATION
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION
'PLUMBING ❑ MECHANICAL PUBLIC WORKS
JOB ADDRESS: /53 L N L /Oy £f
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
Master Permit No.
Sub Permit No.
❑ CHANGE OF
CONTRACTOR
RECEIVED
AU1 2017
By:
-th
FBC 20r
6PP/ 7 — /4786
PL1 i-22I3
❑ EXTENSION ❑ RENEWAL
❑ CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shores County:
Folio/Parcel#: /1— 22.32 - 032- 037 6
Occupancy Type:
Load: Construction T
OWNER: Name (Fee Simple Titleholder):c7' 1 61 L°
Address:
Miami Dade
33%
Zip: 33 8
Is the Building Historically Designated: Yes NO
e: Flood Zone: BFE: FFE:
krkt G2.
ry a Robi'o
Phone#:
City: %Y? TAW? / fho✓-eS
State: FL- Zip: 33 / 3 `b
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Ad LO41 &h / /e C , L 1--
Address: 6/7 ' /lv4" -*red
Phone#: 796 Z' 9 Z$67
City: den
Qualifier Name: n'?arn'ef Qe J6f r-o‘
State: FL Zip: 33/1-5
Phone#: '784' .2-94 2 gel?
State Certification or Registration #: G! re_ 14/2.10 7.7
DESIGNER: Architect/Engineer:
Address: City: State: Zip:
Value of Work for this Permit: $ ,2400
Ot
Certificate of Competency #:
Phone#:
e •
Type of Work: ❑ Addition ❑ Alteration
/V
Description of Work: .&tA) Aio
O 1 ' is nS
Square/Linear Footage of Work:
IA New
❑ Repair/Replace
c
n Demolition
Specify color of color thru tile:
Submittal Fee $ : CO/CC $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $ CCF $ •
Radon Fee $
Training/Education Fee $
DBPR $ Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1B'r. G
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
MortgageLender's Name (if applicable)
Mortgage Lender' Address
City • ' 1;". F �`� ti State Zip
(
1. a ,
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 permirwith 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 abs ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
2.. day of MA i , 20 /7 by
.TJ�N 01001..0 Sv�A-pt�- , who is personally known to
me or who has prod` eds-(0rt(o—di/t3" 749- £'2J 4as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
CONTR • TOR
The foregoing instrument was acknowledged before me this
�3 day of ltAle'a.Lr
Mn« vl.2- 14. J4R4
, 20 / 7 , by
, who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: Sign.
dird
Print: Print:
PV . v P,.."
Seal: o<.... e4:, LARA E RODRIGUEZ '?.. `°`"
Seal: `_°' it ��`= CLARA E RODRIGUEZ
MY COMMISSION #FF138588 MY COMMISSION #FF138588
EXPIRES July 5, 2018 ;�o,n EXPIRES July 5, 2018
15 Florida NotaryServiCe.com (407) 398-0153 FloridallotaryService.com
******************s�41I13J*� 5 r W *wv i i t. as***%********* 4,.,.,.,..'.
APPROVED BY
Plans Examiner
* * * * * * * * * *
Zoning
Structural Review Clerk
(Revised02/24/2014)
JEFF ATWATER
CHIEF FINANICAL 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: 2/16/2017 EXPIRATION DATE: 2/16/2019
PERSON: JARA MANUEL A
FEIN: 205844892
BUSINESS NAME AND ADDRESS:
ALL COAST BUILDERS, LLC
6467 SW 16 ST
MIAMI FL 33155
SCOPE OF BUSINESS OR TRADE:
Licensed Plumbing Contractor
IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate 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... apply
only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be
exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the
person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate. The department shall revoke a
certificate at any time for failure of the person named on the certificate to meet the requirements of this section.
RICK SCOTT, GOVERNOR '
.µa . . STATE OF FLORIDA
DEPARTMENT"OF BUSINESSSAND PROFESSIONAL. REGULATION
_CONSTRUCTION INDUSTRY LICENSING BOARD
KEN LAWSON, SECRETARY
LICENSE NUMBER
": CFC1429677 u
The PLUMBING CONTRACTOR;.
I Named below IS CERTIFIED
:..Under the provisions of Chapter 489 FS.
Expiration dater-AUG 31, 2018
JARA,- MANUEL A
ALLCOAST BUILDERS, LIM1_ D LIABILITY COMPANY,
6467 SW 16TH STD
MIAMI AFL 3315
ISSUED: 11/13/2016
DISPLAY AS REQUIRED BY LAW
SEQ # L1611130000825
Scanned by CamScanner
Local Business Tax Fbceipt
m iarni -Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY
7218792
BUSINESS NAM EILOCA TION
ALL COAST BUILDERS LLC
6467 SW 16 ST
MIAMI, FL 33155
OWNER
ALL COAST BUILDERS LLC
C/O MANUEL A JARA MGR
RECEIPT NO.
NEW BUSINESS
7503097
SEC. TYPE OF BUSINESS
196 PLUMBING
CONTRACTOR
Worker(s) 1 CFC1429677
This Local Business Tax Receipt only con"rms payment of the Local Business Tax. The Receipt is not a license,
perrrit, or a certi "cation of the holder's quail "cationsto do business. Hol der rrust conply with any governmental
or nongovernmental regulatory laws and requirerfents wt)ich apply to the business.
The REC8 FT NO aboNie must be displayed on all commercial vehicles - Miami -Code Code Sec -276.
Fcf more infornvtidn. visit YLVA.M.:4Bid...40e4101itaXrdie0X
EXPIRES
SEPTEMBER 30, 2017
must be displayed at place of business
Pursuant to County Code
Chapter 8A - At. 9 & in
PA YM ENT RECEIVED
BY IAX COL LEC1 OR
45,00 02/14/2017
0206-17-000717
Scanned by CamScanner
ALL COAST BUILDERS, LLC
6467 SW 16 ST. CGC 1514432 CFC 1429677 786 299 2807
MIAMI, FL 33155 allcbllc@gmaii.com
Date: August 24, 2017
State of 1414,ar''''
County of fiOri etA
Before me this personally appeared /Ohlid a. Ja who, being
duly sworn, deposes and says:
That he she w'll be the only person working on the project located at:
is32 Ogg' lit..`•, .tic 1 Shore . ,
Contractor Si nature
Sworn to (or affirmed) and subscribed before me this 23 days of
Auiwsr .2017
STATE OF-RUgo,A" COUNTY OF `';
On this • day of PJbas i ,2017, Before me, a Notary Public in and for the
above state and county, personally appeared M AN— 4, .SgRpr know to me or
proved to be the person named in and who executed the foregoing instrument, and being first duly
sworn, such person acknowledged that he or she executed said instrument for the purposes therein
contained as his or her free and voluntary act and deed;
SEAL
My Commission Expires
` `"°( : CLARA E RODRIGUEZ
MY COMMISSION #FF138588
op? EXPIRES July 5, 2018
(407) 398-0153 FloridallotaryService.com
1
Miami
hores
illage
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 fall -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:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this Z( day of A1/4u*- , 20 0.
Byd" ea. t L SKI who is personally known to me or has produced
Dl S-646-10.3-f, D 1-3-0 as identification.
Notary:
SEAL:
14:.°`'�'`4�; CLARA E RODRIGUEZ
MY COMMISSION #FF138588
EXPIRES July 5, 2018
FInrirlaa\InfaryG+niira rnm