WS-18-2061Permit NO. WS-8-18-2061
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
e '
P • Permit Type: Windows/Shutters
IYork Classification: Window/Door Rep!seem
Pemait Status: APPROVED
Parcel Number
Issue; Date: 8/7/2018
Expiration: 02t03/2019
Applicant
49 NE 110 Street
Miami Shores, FL 33161-7043
1121360040270
Block: Lot:
CANDITA RODRIGUEZ
Owner Information
Address
Phone
Cell
CANDITA RODRIGUEZ
49 NE 110 Street
MIAMI SHORES FL 33138-
49 NE 110 Street
MIAMI SHORES FL 33138-
Contractor(s)
HERDIZ CONSTRUCTION INC
Phone
(305)479-4783
Cell Phone
Valuation:
Total Sq Feet:
$ 6,000.00
0
Type of Work: REPLACING 14 WINDOWS
No of Openings: 13
Additional Info:
Classification: Residential
Scanning: 5
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$o.00
$o.00
$0.00
$0.00
$230.00
$0.00
$0.00
$230.00
Pay Date Pay Type Amt Paid Amt Due
Invoice # WS-8-18-68412
08/07/2018 Credit Card $ 230.00 $ 0.00
Available Inspections:
Inspection Type:
Window Door Attachment
Final
Review Building
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 SWIMMING POOL work.
OWNERS 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 zoni Futhermore I aut' .ze the above -named contractor to do the work stated.
August 07, 2018
Date
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
August 07, 2018 -1
Miami Shores Village
`\/D-° Building Department
6P° 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 1A-
INSPECTION LINE PHONE NUMBER: (305) 762-4949 b,Y^
FBC 201"1
BUILDING Master Permit No. l .5— (t(0)2.;
PERMIT APPLICATION Sub Permit No. .� -2ao
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION
❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR
RECEIVED
JUL 311018
2JL-
JOB ADDRESS: 4Ct NE 11.0 3 1 vP_Qk
RENEWAL
DRAWINGS
City: Miami Shores County: Miami Dade Zip: 231 (O
Folio/Parcel#: Is the Building Historically Designated: Yes NO
1
Occupancy Type:O JYIQV Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): CoWtol kern P"t• R, d
Address: LI RI .NC l t O Si-r¢.RY
City: IM , 5t-to-it
State: F(--
Phone#:
Zip: 3 3 I (o I
Tenant/LesseelName: L Phone#: 1 FS (o q y 3- q18 ci 7
Email: 1r)ecka23 @0.tt'. NISI-\
CONTRACTOR: Company Name: tkare1 0"-th""d`APhone#: S—y Sk 7)4311
Address: 1344f 9 S L1.) Z St
City: NLn.w=�,., State: FL -Zip: 33 193
Qualifier Name: 1'�`^naNtA1A-- 'a'Phone#:
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ a 000 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration E New❑ Repair/Replace ❑ Demoliti
Description of Work: . 1 a IV s n O�oat1 S' C/ /e_ a c e �%� ' n Gy w S j
-ZS 2 (_,pcG uS l3 - 1 G1
3
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 3b • Q CCF $ CO/CC $
Scanning Fee $ - Radon Fee $ DBPR $ Notary $
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ vD- • CO
Technology Fee $
Structural Reviews $
(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 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.
Signature
(LIA
OWNER or AGEN
The fore oing instrume - as knowledged before me this
day of v/ 20 iorc) , by
('iNI1d,�i9 !V '/g who is per ovally known to
U as
me or who has produced r/ o &, (L,4
identification and who did take an oath.
NOTAit:tiLLCE '''''
`\G * OTRY /(
4�
n: REG. #70061
P ' MY
Se•l 10 31i9 r2
, LTH OF
APPROVED BY
t,
Signature
The foregoing instrument was acknowledged before me this
day of
,201S• ,by
P1/4•6OVp•,l' Z, who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
1
V.6(179-.0
as
MY COMMISSION # GG009157
EXPIRES July 06, 2020
**********************************************************************
Plans Examiner Zoning
(Revised02/24/2014)
Structural Review
Clerk
Herdiz Construction Inc
General Contractor
CGC 1511859
13444 SW 62 ST F1O1
Miami FL 33183
7/31/18
State of Florida
County of Miami Dade
Before me this day personally appeared Angela Hernandez- Diz who, being duly sworn, deposes and
says:
That she will be the only person working on the project located at:
49 NE 110 St Miami Shores, FL 33138
Angela Hernandez - Diz
CGC-1511859
Sworn to and subscribed before me this3' day of. 2018 By
sP • ,�` ; PATRICIA FESLES
•MY COMMISSION # GG009157
Q„ EXPIRES July 06, 2020
Print and signature or stamp name of notary
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 day of
By
Notary: Q(LAk;el Cecvo
SEAL:
, 201B• .
who is personally known to me or has produced
as identifica
;0�*��";, PATRICIA FEBLES
•': MY COMMISSION # GG009157
.74, M1 EXPIRES July 06, 2020