BPP-17-982Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit NO. BPP-4-17-982
tPermit Type: Pools1W'birlpools/Hot Tubs
er' Work Classification: New
Permit Status: APPROVED
Parcel Number
issue Date: 412812017 I Expiration: 10/25/2017
Applicant
573 NE 102 Street 1132060171000
Miami Shores, FL Block: Lot: JULIETA TEPPA
JULIETA TEPPA 573 NE 102 Street
MIAMI SHORES FL 33138-
573 NE 102 Street
FL
Contractor(s) Phone Cell Phone
MASTER DIAMOND POOL SERVICE C (786)419-1260
roved: In Review
Approved:: In Review
Denied:
of Work: Swimming Pool
ional Info:
,ification: Residential
Fees Due
Amount
CCF
$1200
DBPR Fee
$8.55
DCA Fee
$8.55
Education Surcharge
$4.00
Permit Fee
$594.00
Scanning Fee
$12.00
Technology Fee
$16.00
Total:
$655.10
Occupancy: Private
Bond Return
Scanning: 4
Cell
Valuation: $ 19,800.00
Total Scl Feet: 448
Pay Date Pay Type Amt Paid Amt Due
Invoice # BPP-4-17-63638
04/07/2017 Check #: 3444 $ 50.00 $ 605.10
04/28/2017 Credit Card $ 605.10 $ 0.00
mvanaoie inspections:
Inspection Type:
Final
Pool Deck
Wall Steel
Fence
Review Electrical
Review Planning
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 ELECTRICALjlulthWore,
PLUMBING, MECH
ANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: rthat all thregoAng information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. I au t above -named contractor to do the work stated.
April 28, 2017
AuthorizedS' :Owner / Applicant / Contractor / Agent
Building D ment Copy
1
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
DD j CHANG
E OF CONTRACTOR / ARCHITECT
Permit N. { i" i'
Owner's Name (Fee Simple Tide Holder):_ e a ��(A Phone # _ l e - �+ -+ (,8
Owner's Address: _ '�- 3 N G I Q 2 S 4 (�
Crcr. 1 Gtru S'�re S State : 1.
Zip Code: 2j Q
Job Address (Of where work is being done):_ S �t '--IN E 109 5 -V
d
City Miami Shores State: _Florida Zip Code: I � ► �
Contractor's Company Name: a_=w
}�{Idress:
City: M ; rim 1 I n►
bC Qualifier's Name
Architect/ Engineer of Record Name:
Address:
City:
Describe Work
State:
3
1. Zip t
Uc. Number.
Phone #
Zip Code:
—1L(0()
1 hereby certify that the work has been abandoned and/or the contractor/architect
is unable or unwilling to complete the contract. 1 hold the Building Official and the
Miami Shores harmless of all le volvement.
Signatu Signature
Ror �t Convector or Architect
The foregoing instrument was aknowledged before me he foregoing instrument was aknowledged before me
this AadaY of ,2017:by,_�)� t t this 1 -r day of f)f .bbAc 201-4br Pt A-iod-L-
Who is personally known to me or who has produced who is personally known to me or who has produce
as indentification. D - - I M �� as indentftation.
Notaryublia Notary lir.
Sign:
Sign:
Seal
Seal:
NATHAUE BASS
Y�
�`; .. ,t
NATWE PM
* * MY COMMISSION t FF 166797
EXPIRES: October 7, 2018
# *
MY COMMISSION f FF 16997
Notary
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Bow Thrru Budget 5emca
',T.,de Bonded Thru budget Notey Swim
F►
r
October 25, 2017
State of Florida
County of Miami Dade
Morros and Munoz Contruction LLC
Before me this day personally appeared Percy Munoz who, being duly sworn deposes and says:
That he will be the only person working on the project located at: 573 NE 102 St Miami shores, FL 33138
Sworn to (or affirmed) and subscribed before me this 25- day of .20 by
Personally know
OR Produced Identification
Type of Identification Produced A<5Jb (oa-4 4 M
,►�Y P!k, NATWWE BASS
ro •••' * My COMMISSION 4 FF iWM
* EXPIRES: October 7, 2018
�''+�.,_., .": Bonded Thru BudgetNotary Services
Print, Type or Stamp Name of Notary
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:
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:
caner
State of Florida
County of Miami -Dade
The foregoing was acknowledgebeforeme this day of 20_B—.
Bye'\ �" V C who is personally known to me or has produced
L#T w U x (Pal U as identification.
Notary:
SEAL:
DA'�aY POP,, NATHAUE BASS
a ' o MY COMMISSION t FF 166797
Bonded Thru Budget Notary Senkes