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PLC-18-3779Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 01/3/2019 Location Address Parcel Number 716 NE 92ND ST 1M, Miami Shores, FL 33138 1132060440510 Contacts Permit NO.: PLC-12-18-3779 Permit Type: Plumbing - Commercial Work Classification: -Repair Permit Status: Approved Expiration: 06/26/2019 ROBERT GONZALEZ Owner SHORES PLAZA EAST CONDO Applicant 9120 NE 8 AVE UNIT 4G, MIAMI SHORES, FL 331383247 745 NE 91 ST QUINTERO GENERAL CONSTRUCTION Contractor BERNARDO QUINTERO 8801 NW 112 TER, HIALEAH, FL 33018 Business: 7864875738 Description: REPLACE 3" STACK IN KITCHEN AREA REPLACE Valuation: $ 1,850.00 Inspection Requests: STACK IN BATHROOM INCL. UNDERNEATH FLOOR (SANITARY 1305-762-4949 DRAIN) 4" Total Scl Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.10 Payments Date Paid Amt Paid Total Fees $111.10 Credit Card 01/03/2019 $111.10 Amount Due: $0.00 Building Department Copy 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 constuwetien-and-zeaing, Futhermore, I authorize the above named contractor to do the work stated. er / Applicant / Contractor / Aent 'i Date January 03, 2019 Page 2 of 2 Edtl"b -kilo 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 C 20 n Master Permit No. `�- o ^ ✓ 07 lq" Sub Permit No. 37^1 / ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF jro CONTRACTO JOB ADDRESS: 1 1�0 t-i �_ l 0, S ❑ CANCELLATION ❑ SHOP DRAWINGS 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 Titlleeholder):.9;�(V-� Q lX A tom' 6t•.)Do Phone#: Address: `7 -t� � � L \ S C City: zs" ' C> F \ " � State: Zip: �%�✓ ��, Tenant/Lessee Name: N Phone#: \ Email: Sek' c kK- • tom CONTRACTOR: Company Name: �ry-''�2J GP..72a C&7-) JJ.4ZtV,6..J�hone#: qs� i 7r�'�' Address: ��OI �� , a 1 -editi City: M Qualifier Name: Zip: Phone#: State Certification or Registration #: �i/-t_- l7� �-3 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 1 U Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ A!I�Cption ❑ New Repair/Replace ❑ Demolition Description of Work: (" 1�_'AMAU-J 44A I \���'Pl�'C�� ��c�- \� �'J�i�fl�� It`i'LL U��►�12-N��'J'CL��L Specify color of color thru tile:: .A Submittal Fee $ Permit Fee $' CCF $ �.�CO/CG $ _ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ (I i Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address `Ctyi State Zip 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. r "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-subjeci to -attachment. —Also; a -certified -copy of the-recarded rratice-ofcommencem-,ant-rnust be po3te-d at -the joLFsite--- - - 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 �� OWNER or AGENT The foregoing instrument was acknowledged before me this ZZ day of iijCEw,h�# 20 17 by C,421-aZ Tip L4 fiEel�- ho is personally known to me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The foregoing instrument was acknowledged before me this ZZ- day of �t KC —A% tj&--& 20 43 by HOWAM&IJ, QU o is personally known to me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Sign: _. Print: SSG - Print: CAf2 ltil b Seal: .40 ft&4�6 Nary Public State or Florida Oscar M Zaragoza""' My Commission FF 939267 Seal: teary Public State or #iorida Oscar M Zaragoza My Commission FF 939267 a a Expires 12108l2019 pNd Expires 1ZVW019 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ii �Quintera�,' Goacra, contmetur QUINTERO GENERAL CONTRACTOR CORP Bernardo Quintero 8801 nw 112 terrace Hialeah Gardens fl 33018 Date: State of florida County of dade Before me this day personally appeared Bernardo Quintero who, being duly sworn, deposes and says: � I✓ That he or she will be the only person working on the project locate at -7 1 � t l-- ' q2 S I VA -- Sworn to (or affirmed) and subscribed before me this Z-�r of -7-QLEP by �-� �� - Q U r tiX7kO Bernardo Quintero Personally knowjtJ Or produced identification Type of identification produced Print, type or stamp na a of notary Nota=:F Oscar My C o Eupim 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 — vvorKers- 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: l . 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. Signatures Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this ? Z�©y of WVA8k/L , 20_. By Gi�2 fib"S �'�� 61 i/�R �I who is personally known to me r has produced as identification. Notary: SEAL: . ry Public state of Florida 4)scar M Zaragoza My Commission FF 939267 . texalres 12/0812019 AFFIDAVIT OF UNIT OWNER Before the undersigned authority personally appeared 200 er fi ��� t who being first duly, sworn, deposes and says: 1. My name is j�o D E�-C Go,4 ZAt - C Z ,1 am over the age of 18 and have personal knowledge of the matters set forth therein. 2. My residential address is VPT A 3. I am the registered owner of the property located at T E 2 "'U JT ACT I M M� , S -o k L 3�j 135. By virtue of this ownership, I am a member of Shores Plaza East Condominium Association, Inc. 4. It has come to my attention that the unit within Shores Plaza East Condominium Association requires repairs and/or modifications. 5. I fully authorize Shores Plaza East Condominium Association, Inc., to handle all aspects of these repairs and/or modifications. Affiant' Signature Sworn to and subscribed before me on this 20 day of , 2018 by pw -eYR,��o produced Fla Drivers License as form of � t � I Ia�202�-1 identification and also known personally to me. Public MAHARAI K. GONZALEZ MY COMMISSION # GG 044602 E EXPIRES: November 2, 2020Bonded Thru Notary Public Underwriters - °°°°°° ° ° ° ° ° °° ° °°°°°° °°°° ° ° 0000 PLUMBING PLANS Date . ��!mus J 03 AT TiME Of I INSPECTION '� `~