DEMO-17-2731 (3)BUILDING
PERMIT APPLICATION
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
REc
SEP
13Y:
FBC 20
Master Permit No C1 1O Zi 3
Sub Permit No.
❑ B,JILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: L rN NE' b01,F1 A --
City:
Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
[OWNER: Name (Fee Simple Titleholder):11x4rAe I OSee7rc&QQ0 Phone#: 424 F341 't530
Address: ZOO �LSGoCkyA)e $Lv� Way *clog
City: 1'4((4at,( State: FL Zip: 33 t a (
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: y\1 { fuC+.c-+r) Phone#:
Address: (0 9 c 5 '�.u..) ni A .r Q S 1�
City: YYt t Orr) r t State: I t Zip:'b 1 L io
Qualifier Name: so L r,(e- Phone#: �'?�io �14 �`��`c't'J
$?: CPC l�( SZB� 11� 3$�3reso
itState Certification or Registration #: �rs Z Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $' 7 d0 • b 0 CSquare/Linear-Footage of Work: 1
Type of Work: ❑ Addition ❑ Alteration (❑ New
Work:- l
Description of WorkG U rJ1 �) f•I %" d
❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ 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 . •nditr• to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a • y o e notice of commencement and construction lien law brochure will be delivered to the person
whose prop= su•'ect to attac • en Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the fir t insp:cti•n hich o••rs v.n (7) days after the building permit is issue•. In the absence of such posted notice, the
inspecti • n wil o be • p • v• V• reins • ction fee will be charged.
Signature
NER or AGENT
CONTRACTOR
The foregoin strument as acknowledged before me this The foregoing instrument was acknowledged before me this
day of
t"who is personally known to Fi t o luvG (o. , who is personally known to
me or who has produced as
identification and who did take an oath.
(NOTARY PUBLIC:""'
Sign:
Print:
Seal:
APPROVED BY
•
& EXPIRES: Jan.11, 2022
Bonded fire Aaron Notary
, 201Z , by
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Plans Examiner
RAUL NAVARRO
MY COMMISSION #FF972714
EXPIRES: MAR 20, 2020
Structural Review
Zoning
Clerk
(Revised02/24/2014)
Notice to Owner — Workers' Com
p
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
ensation 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 Iwo 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 cob- . It from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOUi 1 ' LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
sir
MEW
Signatur
State of Florida
County of Miami -Dade
The fore •' as ac , • • dge before me this AP day of , 20 Ig .
By _11 ■111111ht�— who is personally nown to me or has produced
�.%�... —
I vomm ,,,,,.,Aii ` , i—i-7" �1 as identification.
•
Nota , . •.:!
••tea `::°
IMFINITY CONSTRUCTION SERVICES INC
LICENSE # CAC 1816795 - CFC 1428288
PHONE NUMBER 786 443 9590
Date; 7/26/ 2017
COUNTY OF MIAMI SHORES VILLAGE
Building Department
Before me this day personally appeared Antonio Luvara who, been duty sworn deposes and says:
That he will the only person working on the property located at o y ME o TM Av-32.
Cordial
Anto Luvara
Sworn to and subscribed before me this t3 day of c ) 20 11 by k'nk-or..k o 1) r-
Personally Know I
Or produced Identification
Type of identification
Print, Type or stamp seal of Notary
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M� 000\ SMFR Sole cOacc