EL-18-3132Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
issue Date:11/29/2018
Location Address Parcel Number
580 NE 106TH ST, Miami Shores, FL 33138 1122310140170
Contacts
Permit No.: EL-10-18-3132
Permit Type: Electrical - Residential
Work Classification: Pool
Permit Status Approved
Expiration: 04/08/2019
JUAN ZULUAGA Owner ALL PHASE ELECTRIC CORP Contractor
580 NE 106 ST PEDRO LUIS LOPEZ
11899 NW 91 AVE, HIALEAH GARDENS, FL 33018
Business: 3053456480
Description: NEW POOL. Valuation: $ 500.00 Inspection Requests:
305 762-4949'
Total Sq Feet: 520.00
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
10/10/2018 $50.00
Credit Card
11/29/2018 $60.30
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
refluLiting const uction and zoning. Futhermore I authorize the above named
/ contractor to do the work stated.
v"}'— �� " �M Si p--i u\
A rized Signature: Owner / Applicant / Contractor / Agent Date
November 29, 2018 Page 2 of 2
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
BUILDING
PERMIT APPLICATION
❑BUILDING ® ELECTRIC ❑ ROOFING
0
FBC 20 C�
Master Permit No--p> P PIS - (3
Sub Permit No.
��
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION [:]SHOP
CONTRACTOR DRAWINGS
(JOB ADDRESS` I S S O ti E t O 6 5+
J _ --_-
City: Miami Shores County: Miami Dade zip: 3.3 i 3 S
Folio/Parcel#: is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Tj(x'(� T �v1 Phone#:
Address: SSC3 NI`, 10 1�' 1'11 5�^1RQy
City: M\04,k 5�10'Al State: Zip
Tenant/Lessee Name: Phone#:
Email:
3313
CONTRACTOR: Company Name: A- l 12 c44-.p ECe- e✓ l C i -,&j one#: '4, (p �' WJ 6 2 3 d
Address: /JLt)
e
City: L4 ut' L State: Zia:
Qualifier Name:
State Certification ccf Registration #: e C- — ' 13j U -b Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
�--� 6'p/ C. 23 s'
Address: City: State: Zip:
Value of Work for this Permit: $ � O O Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
o
Description of Work: ` a dI C I �'J 4, C 1 V 1 S+ q 1 10\+% C V1
Specify color of color thru tile:
Submittal Fee $ `-'" Q Permit Fee CCF $ CO/CC $
Scanning Fee S
Technology Fee $
Structural Reviews $
Radon Fee $
Training/Education Fee $
DBPR $
Notary
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ &0 . 4-50
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lenders 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. 1 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 reinspects ee will be charged.
Signature ;
OWNER or AGENT
The foregoing instrument
�,-,was acknowledged before me this
' `/ da of a C I KA `AA 20 ( r by
who is personally known to
me or who has produced �—
identification and who did take an oath.
NOTARY P
Sign: �(
Print: CAn
Signature
CONTRACTOR
Theforegoinginstrument was acknowledged before me this
I r/ day of d CYIP fJ' 11 20 % k , by
Qe a4c) L `O _1 , who is personally known to
as me or who has produced as
identification and who did take an oath.
NOTAR,YYF,,.
D
Sign.
Print:f-
Seal: Seal:
�r
,p Notary Public State of Florida � � Notary Public State of Flodds
Juan S Gomez Juan S Gomez
+� My Commission GG 211304 My Commission GG
211304
4 Expires OtU22P2022 s ��
APPROVED BY s%� f 4�//B Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
ALL PHASE ELECTRIC
Date: Tuesday, November 27, 2018
County of Miami Dade
Before me this day personally appeared ;V9D;d ZO;P96 who, being duly sworn deposes
and says:
That he will be the only person working on the project located at:
580 NE 106th St, Miami Shores, FI, 33138
C tractor Signature:
Sworn to and subscribed before me this 27 of November, 2018, by: ;V5V; (> 40;V5F
Personally know
Or produced identification
Type of identification produced:
Prime or Stamp Name on Notary
fAv 04/& LUIS FERNANDEZ
* My COMMISSION # GG 041161
r EXpIRES: November 7, 2020
't- Bonded Thru Budget Notary Services
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:
Ow er
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of ►"aV_� `�'(� , 20
By v U �� `y t U C__ who is personally known to me or has produced
q D , !E� U 10 U 0 as identification.
1 M#
Notary: 7+TNAR.:
SEAL: 's
co �'y'•.