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PL-18-352o,� Miami Shores Village �sKO1S 10050 N.E. 2nd Avenue NE " Miami Shores, FL 33138-0000 y4f�.f Phone: (305)795-2204 FtoxYVA Permit NO. PL-2-18-352 Permit Type: Plumbing - Residential Per I' t Work Classification: Addition/Alteration Permit Status: APPROVED issue Date: 2/21/2018 1 Expiration: 08/20/2018 Project Address Parcel Number Applicant 10 NE 102 Street 1132060131490 SAT LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell SAT LLC 10 NE 102 Street (561)254-4057 MIAMI SHORES FL 33138- 10 NE 102 Street MIAMI SHORES FL Contractor(s) Phone Cell Phone EXCEL GENERAL CONSTRUCTION IN (305)984-3488 of Work: REPLACE FAUCET IN THE SAME LOCATION of Piping: itional Info: Bond Return : Classification: Residential Fees Due Amount CCF $0.60 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $158.85 Scanning: 1 Valuation: $ 800.00 Total Sq Feet: 0 Pay Date Pay Type Amit Paid Amt Due Invoice # PL-2-18-66416 02/12/2018 Cash $ 50.00 $ 108.85 02/21/2018 Credit Card $ 108.85 $ 0.00 Avananle Inspection Type: Top Out Final Review Plumbing 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 I certify that e r ing information is accurate and that all work will be done in compliance with all applicable laws regulating construe ' n a in . Futherm I a o ' the above -named contractor to do the work stated. February 21, 2018 th&ized S' nature: Owner / Applicant / Contractor / Agent Date Building Department Copy February 21, 2018 1 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 FBC201q BUILDING Master Permit No.__RC- PERMIT APPLICATION Sub Permit No3s2- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL OPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / O Aj C /O a S i City: Miami Shores County: Miami Dade Zip: .3-31 3 & Folio/Parcel#: 11 - 3.1 D 6 - o l 3 - t 4 ci o Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): S A T L. L C. Phone#: Address: 10 N t I b z S T City: tl(14 H/ 5j1 o aid - State: `t Zip: 3 3 38 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: (fx cel Address: 17621 54tj 12 6ed/&AA/ sr Co�v / N C Phone#: City: /"l/RAHAfZ State: Ft '330Z9 __zip: 3 0 5 - 'f -3 Qualifier Name: -Do)( TAD Phone#: State Certification or Registration #: C FC A01 8 ,i91 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Piermit: $ $ 0C). O 6 Squarg/linear; Footage of Work: Type of Wdrk: ' 0' A clition ❑ Alteration ❑ New ®` Repa%ir/Replace ❑ Demolition Description of Work: `2e214 Ce --A ct cc) .0 A kf e %, i, Au ee rL � A Specify color of color thru tile: Submittal Fee $ Permit Fee $ %^�©f CCF $ -��-- CO/CC $ Scanning Fee $ Radon Fee $ CAD DBPR $ a• - act 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 Mortgage Lender's Name (if applicable) Mortgage Lender's Address City 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. "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. Signatur Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -�9 day of fchau a�20 /B by dayof 2Ccelilu,42d 20 /g by ,rJ who is personally known to 7y y %a o who is personally known to me or who has produced d/ :' as me or who has produced L/ as identification and who did take an oath. NOTARY PUBLIC: ��'4 AMBER CORDOBA * * MY COMMISSION 0 GG 000 ` EXPIRES: January 21, 2021 Sign: Print: 0 14 Z& fZ 4�0,¢c%V//a identification and who did take an oath. NOTARY PUBLIC: AMBERCORDOBA * * MY COM MSSION / GG 06M �-� a�P` E*IRES: Jeiriary 23.2021 Sign: Z�gz - Print: laH,beg /Stz J.4 Seal: Seal: APPROVED BY — 2 - Plans Examiner Structural Review Zoning Clerk i� (Revised02/24/2014) February 20, 2018 State of Florida County of Miami -Dade Before me this day personally appeared Duy Tao who, being sworn, deposes and says: That he will be the only person working on the project located at: 10 NE 102 Street, Miami Shores, Fl. 33138 Signature of Qualifying Yzg) Prin am Sworn to (or affirmed) and subscribed before me this,20 day of diva 2018 By buy -7-Ao Type of identification produced Print, Type or Stamp o Notary A�3tY PLe40 AMBER CORDOBA * * MY COMMISSION # GG 06M OF59_9 EXPIRES: January 23, 1 Excel General Construction Inc. 17621 SW 18t" Street, Miramar, Fl. 33029 Phone: (305) 984-3488 Fax: (305) 420-8173 PLUMBING CONSTRACTOR STATE CERTIFIED #CFC1428591 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to UWner — WorKers" compensation insurance txernwion 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: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of , 20_1_%_. B0 N aI J TR 11 1—t A N who is personally known to me or has produced as identification. Yp Notary:Z�24 AMBERCORDW * * W COMMISSIONS GG 06M SEAL: QP� EMRES: Ja M 23, 2021