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EL-18-1914Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address �m it Permit NO. E L-7-18-1' 914 Permit Type: Electrical -Residential Work Classification: Solar Permit Status: APPROVED Issue Date: 8/2/2018 Expiration: 01/29/2019 Parcel Number Applicant 230 NE 104 Street Miami Shores, FL 33138- 1121360130350 Block: Lot: JUAN HUMBERTO PEREZ Owner Information Address Phone CeII JUAN HUMBERTO PEREZ 230 NE 104 Street MIAMI SHORES FL 33138-2016 Contractor(s) Phone CeII Phone ANGEL ELECTRIC CONNECTIONS, IN (561)254-1764 Valuation: Total Sq Feet: $ 500.00 0 Type of Work: FINAL INTERCONNECTION - GRID TIED S Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.00 $0.00 $0.00 $0.00 $4.60 Pay Date Pay Type Invoice # EL-7-18-68244 08/02/2018 Credit Card Amt Paid Amt Due $ 4.60 $ 0.00 Available Inspections: Inspection Type: Final Review Electrical 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, DOORS, ROOFING and SWIM F4NVGpOOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and construction and zoning. Futhermore, I authorize the above -named contractor or ifl�esiarf€ 'n compliance with all applicable laws regulating o / AufiList 02, 2018 Authorized Signature: Owner / Applicant / Contractor gent Date Building Department Copy August 02, 2018 1 p 7.. DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ WO • 00 Type of Work: ❑ Addition ® Alteration BUILDING PERMIT APPLICATION ❑BUILDING ❑■ ELECTRIC ❑PLUMBING ❑ MECHANICAL JOB ADDRESS: 230 NE 104th Street 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 ❑ ROOFING ❑ REVISION El PUBLIC WORKS ❑ CHANGE OF CONTRACTOR RECEIVED JUL 17 64-11 FBC 2011 . lY- 1g1S El..l 4-f, l ❑ EXTENSION ❑RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-2136-013-0350 Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Juan H Perez Address:230 NE 104th Street Is the Building Historically Designated: Yes NO Flood Zone: BFE: FFE: Phone#: (305) 751-3424 City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Email: juan.h.perez@outlook.com Phone#: CONTRACTOR: Company Name: Angel Electric Connections, INC. Address: 400 Alemeda Dr. Phone#: (561) 254-1764 City: Palm Springs State: FL Zip: 33461 Qualifier Name: f —1 W Phone#: State Certification or Registration #: ��Cp Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work: ri New ❑ Repair/Replace Description of Work: t—HAa I `r ric +ion n Demolition Specify color of color hru tile: Submittal Fee $ -v Permit Fee $ O/ c7 0 CCF $ Scanning Fee $ Radon Fee $ Technology Fee $ Structural Reviews $ CO/CC $ DBPR $ Notary $ Training/Education Fee $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ L(. 6,6 Bonding Company's Name (if applicable) A n I e) E ie c4 r iC. norm e C l! t%n s, / k C- • Bonding QCompany's Address 7O0 A MAeca. Dr City Pa I fri Spr ys State f'' t Zip 3 3 L/ 41 Mortgage Lender's Name (if applicable) J l� a n N/ • P-ere Z Mortgage Lender's Address c � 30 J C, / o c7 ili 5 f2G4' City MIaIMl SV1bCeS State FL zip 33)3D 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: f W Signature l Signature 6f-0 V OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before Qm me this The fore oing instrument .�was acknowledged before me this �� day of .pig t ( , 20 ( O , by I "day of 3U , 20 t 0 , by -iL1c3 1 fi , I—C. reZ. , who is personally known to 1 L , who is personally known to me or who has produced f —C_ identification and who did take an oath. NOTARY PUBLIC: as me or who has produced Sign: Print: Seal: 411 1. ,Ayr rtrNotary Public State of Florida '6: Madelin Rojas 157509 r j My Commission GG w� Expires 1110512021 '� of identification and who did take an oath. NOTARY PUBLIC: as Sign: 7�if�ili Print: Seal: oogY Nis, Notary Public State Florida Madelin Rojas , j My Commission GG 157509 of of'Expires 11/05/2021 ************************************** /g APPROVED BY ��jL /6 .T4I)( Plans Examiner ******** Zoning (Revised02/24/2014) Structural Review Clerk Miami Shores Village 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. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this By J�AOIi'1 H . IftreZ FLL Notary: SEAL: Ito day of ,20 who is personally known to me or has produced as identification. apd'Y Poo Notary Public State of Florida Madelin Rojas a My Commission GG 157509 �100 Expires 11/05/2021 Goldin Solar, LLC Certified Florida Solar Contractor, License number: CVC56965 Cell #: (305) 469 9790 dgoldin@goldinsolar.com www.goldinsolar.com ‘.."6))P GU • t . LAR Date: 03/12/2018 State of RCIO County of ).-4-I0n1— ale. Before me this day personally appeared and says: Arce1 L (.pez That he or she will be the only person working on the project located at who, being duly sworn, deposes a30 L E IGA r-Tt PincY)1 Sk rF PL 3 338 i Contractor Signature Sworn to (or affirmed) and subscribed before me this (V day of al . 20 r' b . By 7 _ l Personally known I — Or produced identification Type of identification uq` Notary Public State of Florida Madelin Rojas c. , A My Commission GG 157509 of Boa Expires 11/05/2021 ANI,O" --v-. riot, type, or stamp name of Notary Regards, Signatures: Angel Lopez Electrical Contractor EC13006530 JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION •' CERTIFICATt Or 'ELECTION TO"8EEX MPT,FROM'FLORIDA WORKERS' COMPENSATION SLAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 7/28/2017 EXPIRATION DATE: 7/28/2019 PERSON: LOPEZ ANGEL A FEIN: 20E262320 BUSINESS NAME AND ADDRESS: ANGEL ELECTRIC CONNECTIONS INC 400 ALEMEDA OR LAKE WORTH FL SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor 33461 IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by fling 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 fis ,. person on the nohceor at any time for ure�fie person Ionger Meets the ��eet the requtrementaof this sectio��� The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 • DRIVER LICENSE CLASS E L120-001-53-266-0 ANGEL ARNULFO LOPEZ 400 ALEMEDA DR PALM SPRINGS. FL 33461-0000 Doe 07-26-1963 SEX M tSSLIED 0842-2017 NGT*5-011 ExPOREs 0T-26-2025 REST ENDORSE SAFE DRIVER a re4VOr ttYrytturray cbreyertt *by a.c.twlety tell '..:would by lam STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 LOPEZ, ANGEL A ANGEL ELECTRIC CONNECTIONS, INC. 400 ALEMEDA DRIVE PALM SPRINGS FL 33461 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. 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, and congratulations on your new license: RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EC 13006530 ,ISSUED 07/14/2016 CERTIFIED ELECTRICAL,CONTRACTOR • LOPEZ, ANGEL ANGEL ELECTRIC CONNECTIQNS, INC. IS CERTIFIED under the provisions of Ch.489 FS. Ezp:rativr,data • AUG 31.201a L1&S9t4000:2,35 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD CICENSE'NLJMSEA' EC t 3006530 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 LOPEZ, ANGEL A ANGEL ELECTRIC CONNECTIONS, INC. 400 ALEMEDA DRIVE PALM SPRINGS .FL 33461 ANNE M. GANNON CONSTITUTIONAL TAX COLLECTOR Serving Palm Beach County Serving you. TYPE OF BUSINESS P.O. Box 3353, West Palm Beach, FL 334023353 www.pbctax.com Tel: (561) 355-2264 "LOCATED AT" 400 ALEMEDA DR PALM SPRINGS, FL 33461 OWNER 23-0169 ELECTRICAL CONTRACTOR This document Is valid only when receipted by the Tax Collectors Office. LOPEZ ANGEL ANGEL ELECTRIC CONNECTIONS INC • ANGEL ELECTRIC CONNECTIONS INC 400 ALEMEDA DR PALM SPRINGS, FL 33461-1504 CERTIFICATION 0 EC13006530 RECEIPT OIDATE PAID 1317.510448 - 09/19/17 AMT PAID 327.50 BILL 0 840138840 STATE OF FLORIDA PALM BEACH COUNTY B2 -1301 2017/2018 LOCAL BUSINESS TAX RECEIPT LBTR Number. 201002412 EXPIRES: SEPTEMBER 30, 2018 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and In such a manner as to be open to the view of the public. L