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MC-18-1839F�oRtDA Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit No. MC-7-18-1839 tPermit Type: Mechanical - Residential er' Work Classification: Addition/Alteration Permit Status: APPROVED Parcel Number issue oate: 7/19/2018 1 Expiration:01/15/2019 Annlicant 975 NE 94 Street 1132060350020 Miami Shores, FL 33138- Block: Lot: SEVEN BALCONIES LLC Owner Information Address Phone Cell SEVEN BALCONIES LLC 6815 BISCAYNE Boulevard (786)387-1483 MIAMI SHORES FL 33138- 6815 BISCAYNE Boulevard MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone ELEPHANT AIR CONDITIONING CORF (305)397-7339 al Info: BATHROOM EXHAUST ation: Residential d: In Review Denied: ning: 1 Fees Due Amount CCF $0.60 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.20 Penalty Fee $100.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Work without Permit Fee $150.00 Total: $408.85 Date Approved:: In Review Type of Work: BATHROOM EXHAUST Valuation: $ 500.00 Total Scl Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC-7-18-68163 07/19/2018 Credit Card $ 358.85 $ 50.00 07/09/2018 Credit Card $ 50.00 $ 0.00 Avauame Inspection Type: I Final Rough Duct Review Mechanical Underaround 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, AUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID at all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction zo". ff the re, jaAorize the above -named contractor to do the work stated. July 19, 2018 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy July 19, 2018 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ PLUMBING ❑ ELECTRIC IECHANICAL Miami Shores Village Building Department JUN 0 9 Q18 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 r/ Master Permit No. R -S- - b Sub Permit No._�kc Ig - \S3� ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [—]PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9-*N C C) Lt 4(_ City: Miami Shores County: Miami Dade Zip: J :3 13 Zs Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): -)n U .tn I J 4t I C o V1 1 (' N Phone#: T N % 3 �S� 1 4 %3 Address: City: M 1 A► vim• I Tenant; Lessee Name: Email: 6101 O I C'1 S c k.e State: Zip: OnC#: � CONTRACTOR: Company Name: Cl( � A-� NtJ*0-rr OArI-AS&- Wae- Phone#: 36�f `302- 0 0 P Address: 502 3 $ VS 1 H? AA19 City: r(ASAA 4L State: PL Zip: 331 q'2> Qualifier Name: -SoP_(TE A&UZOWL. Phone#: 9'13(a '-'>a2. ' 0`2►-7 State Certification or Registration #: CACle 149 oo? Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ lr-; a 0 t Square/Linear Footage of Work: 300 Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Rfplace ❑ Demolition Description of Work: % 1) 1 V1 tr M O m Specify color of color thru the: Submittal Fee $ Scanning Fee $ Technology Fee Permit Fee $ 0 t 0 V CCF $ \ CO/CC $ Radon Fee $ a DBPR $ • a-5 Notary $ Training/Education Fee $ Double Fee $ 19D' W Structural Reviews $ Bond $ Q1 �0 - TOTAL FEE NOW DUE$ (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 City State Zip Zi 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 insoertinn which ocrrrrs ceklen (7) rinvc nRpr the .yrrilrli�?2 nermis ir k u,a,a, in tho rihcPnCP .,f siich nncted not;- the inspection will not be approv Aand a reinspection fee will be charged. Sig to Signature OWNER or AGENT UCC14TRICTOR The foregoing instrument was acknowledged before me this day of 20 ► 9..) by r R Lwho is personally known to me or who has produced -�' �, b L— as The foregoing instrument was acknowledged before me this 2 �nday of 20 P6 by Arvil C� who is personalLyknown to me or who has produced identification and who did n oath. identificati n and who did tak �F 2�P hi BERTHA PALMA M`! COVMISSION # GG 037337 NOTARY P BLIC: NOTARY BLIC: = b' EXPIRZS. 'rbruary 10, 2021 �FOF uP Bcnd.,d Thru No'ary Public Underwriters Sign: n: hp — Pr' t: TA g,,�rPGerc'; Notary Public • State of Flon , eal: _ DERTHAPALMA Commission # GG 007076 ° ~ iffy r,0, .9ISSION # GG 037337 EXPIRES: February 10, 2021 ?,,F; My Comm. Expires Jun 29, 2020 -1i Thru Notary Public Underwriters !. Oc fL \� ''��,�� Bonded through National Notary Assn. f��N Bonded APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETAR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC 181600 ThP CI ASS R AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 AGUILAR. JORGE ANDY ELEPHANT AIR CONDITIONING CORP 5823 SW 149TH AVE MIAMI FL 33193 X ISSUED: 08/23/2016 DISPLAY AS REOUIRED BY LAW SEQ # L1608230002464 OC2532 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6321046 BUSINESS NAME/LOCATION ELEPHANT AIR CONDITIONING CORP 5823 SW 149 AVE MIAMI FL 33193 OWNER ELEPHANT AIR CONDITIONING CORP Worker(s) 1 RECEIPT NO. RENEWAL 6587530 EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC1816007 BY TAX COLLECTOR S75.00 08/30/2017 FPPL102-17-021RF-) This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nenowernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit Fpy_yy miemj#8dQ. o a�4Qlj4gt4r JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION " CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certi`es that the individual listed below has elected tc be exempt from Florda Wtcrcers' Compersatior :aw. EFFECTIVE DATE: 10i21'2016 EXPIRATION DATE: I'Y?112G18 PERSON: AGU"—AR JORGE 2 FEIN: 26315/321. BUSINESS NAME AND ADDRESS: ELEPH.ANT AIR CONDITIONING CORP 5823 SW 149 AtlE MIAMI % FL SCOPES OF BUSINESS OR TRADE HEATING, 'VENTILATION AIR-COND r.r.ar.::o C .axx �..:C"'t:. t .. 3t1 ^,._: G� a :C!'f_f3L�, w.,� �2'Y 2Ce.^� .G� ,44,+., .. .^.q7:e' •t4•S c Gl...{e:2 C•. !�!GE3R i..'�2f C''S Y_'1 ]' - ' •s ;r ��.rnbYsa:n^ .nGe«�s �:aC._ . ��^;uan: C urapte-:5.G5,12;. -.S . �a;ia:!s :r elec6C.,._ .,_ ac^ v cry Y.jsmess f?C^ hSt: J o� "e efecae^ 7; Le cren.:. P�.S.:ani to �=:prer 'ac^or •• ee er!'= >_n_ Wr'V.CMes Ct etect ;r tb ze eMnC: sha4 be s b eG W revbcaCCn 4, at any Lme afte, tre `E rg c't`e nc_-e Cr the iS&;3%e sf the cen:5;a:e. ... xaa� r•e :.CC :� :'e'3tiGe a' CeR:fLy:p rG Ai1�Y beete he •e^.:i.'6'i!rt5 G :+s see.Cr. iy ieS�e`L! W a z:-�itz:e. -;.e �a�a:u-,mu sr. a!; :e:�e a 0FS-F2-7r7G252 CERTIFICATE C' ELE:.TION TC BE EXEMPT REVISEC J&' 3 QUESTIONS? iBbO�413 :609 Date State of —&CR i his County of k-(_i 4t A6UI�I)At,V-&e 670 Alta coijo,1 o&)W6 ecep ie/9 vlti 144', 3 319 3 CAB(- 3oz- 0(>5� Before me this day personally appeared A(,U� who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: PI Contractor Signature A -34 t4iARI -3 3313S S wQLn to (or, irme and subscribed before me this �� day of V 20 /8 , by A tk�e� r, I Personally know OR Produced identification c [�k= APALMA ype of Ide ification ProducedION # GG 037337ebruary 10,2021 ry Pubi:c Underwriters Print, Type or Stamp Name of Notary ;,SIvN # GG 037337 I * y P ti,__ ribruary 10, 2021 i �.''••° 6,,: "'r � rJdsy Pubi'.0 Undervriers Notice to Owner - Workers' Com Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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: I . 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: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this q' "• day of JU b , 20 Ig By_ C- 1 Us+1)yek-tY who is personally known tome or has produced �i►V�QY �I G`QXls'e as identification_ Notary: 2018 SEAL: J N 09 MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 Bonded Thru Notary Pu :':c Urd"fiv,'r