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PLC-18-3635Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date': 02/05/2019 Parcel Number 9710 NE 2 AVE, Miami Shores, FL 33138 11320601323SO Contacts Permit No.: PLC-12-18-3635 Permit Type: Plumbing - Commercial WorkCiassftation: Alteration Permit Status: Approved Expiration: 06/05/2019 SHORES LANDING LLC Owner SHORES LANDING LLC Applicant GLADYS MATZ GLADYS MATZ Other:3055258816 GLADYSMATZ@AOL.COM Other:3055258816 GLADYSMATZ@AOL.COM DOCTORS PLUMBING INC Contractor FERNANDO ARIAS Business: 3056020400 Description: MAINTENANCE ON EXISTING PLUMBING AREAS Valuation: $ 700.00 Inspection Requests: 305-62-4949 "AFTER THE FACT" UNIT 9730 Total Sq Feet: 2,193.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $2.50 Work Without Permit 1st Offense $100.00 Work Without Permit 1st Offense $100.00 Total: $360.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $360.30 Credit Card 12/07/2018 $50.00 Cash 02/05/2019 $310.30 Amount Due: $0.00 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. n1i21() Cq S7i �u7 re: Owner / Applicant / Contractor / Agent Date February 05, 2019 Page 2 of 2 Miami Shores Village Building Department 10050 NtE nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING. - PERMIT APPLICATION BUILDING ❑ ELECTRIC ROOFING EC 0 FBC 20 I 28 Master Permit No. CC.1 r-,I — Sub Permit No. ❑ REVISION ❑ EXTENSION RENEWAL 'PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: --�n-a 7 t'� Y'I A\fp City: Miami Shores County: Miami Dade zip:�3 Folio/Parcel#: - DO(O — 013- L-I&-O Is the Building Historically Designated: Yes NO.. Occupancy Type: Load: Construction Type: Flood Zone: BFE ., FFE: OWNER: Name (Fee Simple Titleholder): C-1k nctiZ PhoneM3ris— S.;I5" 459 11 Address: 'Im EVE City: yliGIM% State: 1 C.- Zip:,33 3—+ Tenant/Lessee Name: �A`\J(ka) Cat>bNlt7 Phone#a (-,-P�)1S--1Uy Email: CkWafo (�aDO a n �AO-VN W . CQXn CONTRACTOR: Company Name: t©G o Phone#:3C - Gw- UiM Address: 5 5-4 '?o sr City: -�—� Zip: r Qualifier Name: C--fn� BrQ5 a�t� Phone#: State Certification or Registration #: OrC I LI Z'7 3yV Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit ;$ 'f�W Type of Work: ❑ Addition ❑, A1til Description of Work: iY)Our i Square/Linear Footage of Work h ^ ❑ New .� t1 3, i �;,.1 �� Repair/Replace, Specify color of color hru tile: Submittal Fee $ I Permit Fee $ 1 00 . CAD CCF $ CO/CC $ Scanning Fee $ Technology Fee Radon Fee $ Training/Education Fee $ DBPR $ Zip: Demolition Notary $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ � 0 - 3b (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 Zip • z 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 charge Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 11 by C-�1ac#U5 MCA} Z who is personally known to me or who has produced 1(%\(ei U[ en.5c,- as identification and who did take an oath. d. Signature C RACTOR The foregoing instrument was acknowledged before me this (.D day of bt,CttYI)c�r—C 20 i�" by F-CCoCY7)C6 9k ;CIS who is personally known to me or who has produced ���V'ei I.as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ,t.y„ KATIA J CASTILLO W; KATIA J CASTILLO MY COMMISSION # GG009999 '= MY COMMISSION # GG009999 Sign: EXPIRES July 10, 2020 Sign: Moe.' EXPIRES July 10, 2026 P r i S Print: Seal: Seal: ************:**s*****s**s*****��*******:********s****************:*******•****s*s*s*�***s**r*.*******:**:*** APPROVED BY JjC10 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice zo uwner — 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: wne State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of _ Cen t 20 I3 By �who is personally known to me or has produced ,Jed as identification. Notary: ROXANA NERMIDA My COMMISSION # FF967850 SEAL: EXPIRES March 06, 2020 I401) 3106.0):a F am DOCTORS PLUMBING 2357 W 80 ST 6" 4 HIALEAH, FL 33016 LIC# CFC1429344 (305) 602-0400 MIAMI, FLORIDA JANUARY 29, 2019 State of Florida County of Miami Dade Before me this day personally appeared Fernando Arias who, being duly sworn, deposes and say: That He will be the only person working on the project located at: 9726-9730 NE 2 Ave. Miami Shore, FL 33138 FERNANDO ARIAS JR. 'S PLUMBING Sworn to affirmed and subscribed before me this 29 day o January, 2019 "7f" V Not ry Public% State—RFlorida By Fernando Arias Jr. aF�,,a ion p FF 958026 Personal, know sY C mm. Expires Feb 7, 2020