PLC-18-3778Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
715 NE 91ST ST 4A, Miami Shores, FL 33138
Contacts
Issue Date: 01/03/2019
Parcel Number
1132060440060
Permit NO.: PLC-12-18-3778
Permit Type: Plumbing - Commercial
Work Classification: Repair
Permit status: Approved
Expiration: 06/26/2019
RAFAEL FELIZ Owner SHORES PLAZA EAST CONDO Applicant
715 NE 91 ST 4A, MIAMI SHORES, FL 33138 745 NE 91 ST
QUINTERO GENERAL CONSTRUCTION Contractor
BERNARDO QUINTERO
8801 NW 112 TER, HIALEAH, FL 33018
Business: 7864875738
Description: Valuation: $ 750.00 Inspection Requests:
r-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
01/03/2019 $110.30
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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent> Date
January 03, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village RFCE,V
E�
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 'j,Il
FB` C 20 l
Master Permit No. PLC- is r _3,a*i r
Sub Permit No.
❑ BUILDING ([� ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL
PLUMBING [] MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF
. t S � CONTRACTOR
JOB ADDRESS: -7 I Irr q I IvtLl_ tj(14 ,J,h
CANCELLATION ❑ SHOP
DRAWINGS
City: Miami Shorers County: Miami Dade Zip:
Folio/Parcel#: 113 yo 2 0440(v0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Nam-e/(Fee Simple Titleholder
Address: �77 N r, - ` S
City: '> ,
Tenant/Lessee Name:
Email: S�t-N' �E
2
,Iis�
> s3 Y IAZA tA'rN
r
Grath Phone#:toS ', s� 10 L�
State: _f_L— zip:3313rO
hone#:
CONTRACTOR: Company Name: � � �w! (0 Phone#: )f YJ7 S;4 O
Address: $p t) l I I v1 Te ftA. -
City: tom`
Qualifier Name:
I
State: r (
zip:
State Certification or Registration #: CSC �`�J d f 7� Certificate of Competency #:
DESIGNER: Architect/Engineer:
Address:
Value of Work for this Permit: $
Phone#:
City: State: Zip:
Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: EP�1(Z. -1 �j�i� $}FO�J�C� 1�IL (63&1.► eA _kC Q'kSS S
—V- �..Ay I NI Ce 9-0d re %;�
Specify color of color thru tile:
,._ L
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Technology Fee $,
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary $,
Double Fee $
Bond $
TOTAL FEE NOW DUE $ k 1 6 ' 30
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
City. A - 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.
SignatureSignature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
CONTRACTOR
The foregoing instrument was acknowledged before me this
Z Z. ,L day of N:,L 20 by Z day of Ve!! L Ea1h 0x 20 (g by
o is personally kno— wn to ,9A. 2,3 QV iAQ n►�(who is personally known
me who has produced as rr or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: r,,. Notm Pint State or FWW
�%�, Oscar M Zaragoza
cd� My CommlNlon FF 939287
�hd� Expfna 12/08/2019
**********
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:y , Jooy • � ��i�%�WA
Seal: .rr nNote„y pubNe State d F'13 a
Oscar M Zaragoza
My CommWWw FF 939267
orao' E)Ores i2mand19
APPROVED BY �� Plans Examiner
Structural Review
Zoning
Clerk
(Revised02/24/2014)
�Quinte�o�
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:
That he or she will be the only person working on the project locate at
f S f4 L q l
Sworn to (or affirmed ) and subscribed before me this u of ��' Z'VA—, byT,Fe-o
Bernardo Quintero ersonally kno
Or produced identification
Type of identification produced
Print, type or sta name o notary°
°u� Notary PuN is State d Fbrida
S , Oscar M Zaragoza
wu My Commission FF 93M7
'�i Expires 12/08/2019
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:
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.
Signature: � I Cc., "ISO
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this ZZ14,dayof �� {��-/L , 20_V,.
By CA-t_a.>Swho is ersonally known to m or has produced
as identification.
Notary:
SEAL: �^ NWA og Public St!%e ofbA Fda
Oscar M Zaragoza
My Commbtbn FF 939267
��►ww Expfna 12/08/2019
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