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ELC-19-909Location Address Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 issue Parcel Number 9801 NE 2ND AVE, Miami Shores, FL 33138 1132060134380 Contacts Permit iva: ELC-04-19-909 Permit Type, Electrical - Commercial Work Classification. Low, Voltage Permit Status: Approved Expiration: 10/22/2019 9801 PARK LLC Owner SAME & Q ELECTRIC INC Contractor 4141 NE 2 AVE 204A, MIAMI, FL 33137 MANUEL E QUESADA 5310 SW 7 ST, CORAL GABLES, FL 33134 Business: 3052190427 Description: LOW VOLTAGE, CCTV, DATA, TV, PHONE AND Valuation: $ 5,900.00 Ins vection Requests: SOUND FOR PROPOSED NEW RESTAURANT IN EXISTING 305-762-4949 SHOPPING CENTER, ALL INTERIOR IMPROVEMENTS Total Sq Feet: 2,600.00 Fees Amount Application Fee - Other $50.00 CCF $3.60 DBPR Fee $2.66 DCA Fee $2.00 Education Surcharge $1.20 Permit Fee $127.00 Scanning Fee $3.00 Technology Fee $4.43 Total: $193.89 Payments Date Paid Amt Paid Total Fees $193.89 Check # 1020 04/25/2019 $193.89 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. AFFIDAI4T-�- I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws construction and zoningFuthermore, I authorize the above named contractor to do the work stated. V - Oi -,.Q- '�\ C�i r—C f- i j Signature: Owner / Applicant / Contractor Agent Date April 25, 2019 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 F-IBUILDING ❑■ ELECTRIC ❑ ROOFING g�C APR12 5 019 �� FBC 20 Master Permit No. CC -11-18-35177 Sub Permit No. 'L _ 4-11-%l ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9801 NE 2nd Ave City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-013-4380 Is the Building Historically Designated: Yes NO X Occupancy Type: A-2 Load: 150 Construction Type: III Flood Zone: X BFE: FFE: 10.35' OWNER: Name (Fee Simple Titleholder): 9801 Park LLC Phone#: 305 455 1800 Address: 4141 NE 2nd Ave. Suite #204A City: Miami State: FL Zip: 33137 Tenant/Lessee Name: Amaranthine Restaurant Phone#: 954 394 4140 Email: Yiannikg@gmail.com CONTRACTOR: Company Name: Same & Q Electric Inc Address: 950 SW 104 Court C301 City: Miami State: FL Qualifier Name: Manuel E. Quesada State Certification or Registration #: EC13007128 DESIGNER: Architect/Engineer: YCM Engineering 305 219 0427 P: 33174 Certificate of Competency #: hone#: 305 484 5596 Address: 14245 SW 21 Terr City. Miami State: FL Value of Work for this Permit: $ SO/00 Square/Linear Footage of Work: 2520 SF Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: LOW VOLTAGE; CCTV, Data, TV, Phone and Sound for Zip: 33175 Proposed new Restaurant in existing Shopping Center, all interior improvements. Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ _ DBPR $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address N/A City N/A State Mortgage Lender's Name (if applicable) Mortgage Lender's Address N/A City N/A 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. Sig13 Sig nature Fly/ nature OWNER or AGENT The foregoing instrum nt was acknowledged before me this _ day, of 20by Lt SCJ min ; who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Aye , l s, r��C as CONTRACTOR The foregoing instrum nt was acknowledged before me this day of i0 , 20 / �/ by Gt�vIU , who is personally/known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: AM,41'S' LqA('] Seal: Seal: •.., ANAYS u _-: \, Nc:a^r PaChc - State of Florida '�� y :- Notary Public - State of Florida ,_ ��"fAV rs<h., ° GG M Cor,-isvcn = GG 246553 �� v 246553 4' 01' 26. 2012 C r. # E• res Ckt 26. 2022 * v r. � ��#"�#ro*wary#�s�. Boncec i:ir0��!1 d o APPROVED BY Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk Notice to Owner — Workers' Com Miami Shores Viliage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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: Owne State of Florida County of Miami -Dade The foregoing was acknowledgebeforeme this �� day of—AIi.1 20 j By P6/Z_1'4 w�'`� ' CS who is personally known to me or has produced as identification. E-11 `ANAYS LAGO Notary: •C; Notary Public - State of FloridCommission ; GG 246553 My Comm. Expires Oct 26, 2022 SEAL: onded through National Notary Assn. SAME . & QELECTRICJO INC. Miami FL. LIC & INS (LIC) EC#13007128 PHONE (305)-219-0427 14110 SW 165 STREET MIAMI, FL, 33177 RESIDENTIAL, COMMERCIAL AND INDUSTRIAL APRIL 10th, 2019 State of Florida, Miami Dade Miami Shores Village 10050 NE 2"d Avenue Miami Shores, FL 33138 RE: Contractor's Affidavit Property: 9801 NE 2nd Ave, Miami Shores FL. 33138 Folio# 11-3206-013-4380 Owner: 9801 Park LLC 4141 NE 2nd Ave, #204A, Miami, FL 33137 Permit # CC -11-18-3517 Before me this day personally appeared Manuel Quesada who, been duly sworn, deposes and says: That he will be the only person working on the project located at: 9801 NE 2"d Avenue Miami Shores FL. 33138 Contra or Signature Same & Q. Electric License # /?_g Sworn to (or affirmed) and subscribed before me this 101h day of April, 2019 Personally k Y °Q, Notary Public State of Florida WD Danay Bazain My Commission GG 131884 FFExpires 08/06/2021 10820 SW 200' Drive Suite: Office Miami, FL 33157 305-253-8225 •305-252-18 fax 9 305-742-3199 cel / RR State of Florida inn GG 131884 /2021 Public Notary CC. Maria Fuentes for 9801 Park LLC 10820 SW 200' Drive Suite: Office Miami, FL 33157 305-253-8225 • 305-252-18 fax • 305-742-3199 cel