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PL-17-2448 (2)Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit No. PL-10-17-2448 Permit Type: Plumbing - Residential: Per ' Work Classification. Addition/Alteration Permit Status: APPROVED Parcel Number Issue Date: 11/30/2017 1 Expiration: 05/29/2018 Applicant 7 NE 91 Street 1132060130080 ANCAR GLOBAL COMPANY Miami Shores, FL 33138- Block: Lot: Owner Information ANCAR GLOBAL COMPANY 7 NE 91 Street MIAMI SHORES FL 33138- 7 NE 91 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone DOCTORS PLUMBING INC (305)602-0400 Type of Work: KITCHEN & BATHROOM REMODELING Type of Piping: Additional Info: KITCHEN & BATHROOM REMODELING Bond Return : Classification: Residential Scanning: 1 Fees Due Amount CCF $L20 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $160.45 Phone Cell (786)484-9143 Valuation: $ 2,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # PL-10-17-65337 10/12/2017 Check #: 1442 $ 50.00 $ 110.45 11/30/2017 Check #: 1472 $ 110.45 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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 ELECTRICA ,PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFI VIT: I certify tha all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction aliionrmore'I authorize the above -named contractor to do the work stated. November 30, 2017 orized-Signature:Owner / Applicant / Contractor / Agent Building Department Copy November 30, 2017 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 1 1-4a-1- S+h FBC 2014 Master Permit No. C 1 ` b Zb Sub Permit No. 7,418 ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: s-a i Folio/Parcel#: the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: i Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): (\am_ A.cr 61 j GL � "—, I Phone#: Address: U %-i City: ► rvt", State: Tenant/Lessee Name: Email: ne#: ip: 1.Z i13 CONTRACTOR: Company Name: ri A1. er-) Phone++.� Address: 1LS�"7' t._3 ST 484 ` G i 4_2_>'-> MI lair City: Qualifier Name: �'o J'rn ED Art State: 14 Q /4e ne#: State Certification or Registration #: _C C L 147.-' A4 Certificate of Competency #: DESIGNER: Architect/Engineer: Add Phone#: City: State: Zip: Value of Work for this Permit: $p Square/Linear Footage of Work: Type of Work: ❑ Addition ,1 1❑ Alteration ❑ New j A Repair/Replace ❑ Demolition Description of Work: ; tG h �, r• "'� ace,;-1 k tZ-y10 �t� Specify color of color thru tile: Submittal Fee $ 1 _ Permit Fee $ �� CCF $ r� Radon Fee $ � . G� G DBPR $ G • -� Notary $ Scanning Fee $ Technology Fee $ Structural Reviews $ Training/Education Fee $ CO/CC $ Double Fee $ 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 aoaroved and a reinsoection fee will be charred. � �3 -- S i g n a t e r OWNER Or AGENT The foregoinginstrument was acknowledged before me this 1,A day of _ _ 0 20 1 by Ay%,�5 V/t' Ve" who is personally known to me or who has produced ��i-J�� as identification and who did take an oath. Signature CONTRACTOR The foregoing instrument was acknowledged before me this Z'I dayofd C1 , 20 1'i by :F,—&,'uVC0 Ar`tiS who is personally known to me or who has produced k is t�, as identification and who did take an oath. NOTARY PUBLIC: �' "tis RICCARDO BAILEY NOTARY PUB Commission * PF 8.7042 •""""'° RICCARDO BAILEY My Commission Expires ommission # FF 87042 Sign: M f ��' January 2a, 201B Sign: Lay commission Expires Print: Print: Sea]: 9� Seal:`l APPROVED BY ?� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Notice to Owner — Workers' Corn Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation Insurance Exemation 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 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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. Signat e:ZOwner ' p State of Florida County of Miami -Dade The foregoing was acknowledge before me this. day of d C( , 20 1 '7 . B di ( VI VOLS who is personally known to me or has produced as identification. Notary: SEAL: RICCARDO BAILEY Commission # PF 87042 My Commission Expires January 28, 2018 DOCTOR'S PLUMBING INC Date: 0 State of County of Before me this day personally appeared &apaelell irl G'4. who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Contractor Signature Swo to (or affirmed) an subscribed before me this W day of byLpZCsLlin il— Q4. 20 1 ', Personally know Or produced Identification Type of Identification Produced A .'. ,�. JAER - Pis ;r°. . VI Notary Publ' - S fie" of Florida '_ • : . • _ Commis on FF 958026 �N M My�Commxp' es Feb 7, 2020 Bonded thro tional N ry Assn Print, Ty0e or Stamp Name of Notary Local Business Tax Receipt Miami --Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6106371 --•y BUSINESS NAMEILOCATIObf RECEIPT NO. EXPIRES DOCTORS PLUMBING INC RENEWAL S E PTE M BE R 30, 20'18 OPERATING IN DADE COUNTY 8369276 Must be displayed at place of business MIANII FL 33999 Pursuant to County Code Chapter SA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED DOCTORS PLUMBING INC 213 SERVICE BUSINESS BY TAX COLLECTOR Employee(s) 1 $75.00 08/23/2017 FPPU09-17- 012095 Not a Contractor Receipt This local Business Tax Receipt only cordirrns payment of the Local Business Taff. The Retteipt is not a license. permit, or a certification of the holder's qualificatlosm to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all coumsmiai vehicles - Mlsm -Dade Code Sac Sn-ZX For more information, visit � THE STi� JIMMY PATRONIS CHIEF FINANICAL 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 certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/18/2017 PERSON: ARIAS FEIN: 204464688 BUSINESS NAME AND ADDRESS: DOCTOR'S PLUMBING INC 2357 W 80TH ST BAY 4 HIALEAH FL SCOPE OF BUSINESS OR TRADE: Licensed Plumbing Contractor 33016 EXPIRATION DATE: 8/18/2019 FERNANDO JR IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609