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PLC-19-1398Miami Shores Village Building Department j 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 8�0 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 -� FBC 201 - BUILDING Master Permit No. CC -11-18-3517 PERMIT APPLICATION Sub Permit No. PLC -06 -19 —)39 ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL OPLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9801 NE 2nd Ave Cir: 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#: 9543944140 Email: yiannikg@gmail.com CONTRACTOR: Company Name: A Sunny Plumbing Company Phone#: (305) 281-7317 Address: 6800 SW 17 St City: Miami State: FL Zip: 33155 Qualifier Name: Osiris Chaviano Phone#: (305) 281-7317 State Certification or Registration #: CFC1427249 Certificate of Competency #: DESIGNER: Architect/Engineer: The Architects Group Phone#: 305 740 0150 Address: 8000 NW 7 Street City: Miami State: FL Zip: 33126 Value of Work for this Permit: $ $5000 Square/Linear Footage of Work: 2410 SF Type of Work: ❑ Addition ❑■ Alteration ❑ New Re air ❑ /Re lace p p E:1 Demolition Description of work: Provide Gas system to Kitchen equipment and Hot Water Heater at new corner Restaurant in existing Shopping Center. Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ / t TOTAL FEE NOW DUE $ (OS ' (Revised02/24/2014) Bonding Company's Name (if applicable) N/A Bonding Company's Address N/A City State Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address N/A 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. Signature Signature g OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this q� day of _ 20 by 2 day of 120 by 1 �"n-i'✓l/Q t .� who is personally nown to who is personallyknown to me or who has produced as ,. me or who has produced as identification and who did take an'oath. NOTARY PUBLIC: A(,Aoo Sign: Print: i Seal: ;o1,i1�YO�o�G. ANAYSLAGO Notary Public - State of Florida Commission # GG 246553 Comm.Expires Oct 26, 2022 AMY #####*##### *###D* -k �AtlkfK*Sk9Fl���iPtta(1k� ■ identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED BY�6'/ S�/yS�/y Plans Examiner Structural Review (Revised02/24/2014) X, - ANAYS LAGO �^ Notary Public - State of Florida > Commission a GG 2.46553 ' My Comm. Expires Oct 26, 2022 Londe isr#o t !R9 �I4tq Zoning Clerk A SUNNY PLUMBING, INC. 6800 SW 17ST Miami FL. 33135 305 219 0427 June 25th, 2019 State of Florida, Miami Dade Miami Shores Village 10050 NE 2nd 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 Osiris Chaviano who, been duly swom, deposes and says: That he will be the only person working on the project located at: 9801 NE 2nd Avenue Miami Shores FL. 33138 ' ;Ch;a�vi; A Sunny Plumbing, License # CFC 1427249 Sworn to (or affirmed) and subscribed before me this 250, day of June 2019 Per onally known X 'i►F"'L''• ANAYS LAGQ Public Notary'" �`: Notary Public • State of Florida Commission * GG Z%553 CC. Maria Fuentes for 9801 Park LLC a Bond led COMM. National 00'26. 0Ury 2022, 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. C 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 (LI.C) 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 L.LC, 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. 'Che contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. Irl 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.xCiZ'td Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this< day of 20 jj BY, Af L a, t . _. ._.... .. who is personally known to me or has produced as identification, Notary:___-_...__. l SEAL: (�= Notary Public- Sutc r`=_,)riCa a Commission = GG :' r My Comm. Expires Oct 26. 7,c < Bonded through National Notary a:, .