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EL-19-11754 t4� i 9 Location Address Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 06/12/2019 Parcel Number 10090 N MIAMI AVE, Miami Shores, FL 33150 1131010210090 Contacts Permit : EL -05-19-1175 Permit Type: Electrical - Residential Work Classification: Solar Permit Status: Approved Expiration: 11/18/2019 LUISA FERNANDA LUNA Owner NODAL CONSTRUCTION & ELECTRIC Contractor 10090 N MIAMI AVE, MIAMI SHORES, FL 331501216 ASSOCIATES INC Other: 3057573133 JOSE A NODAL 9053 NW 189 TER, HIALEAH, FL 33018 Business: 7865863020 Description: GRID CONNECTION Valuation: $ 1,000.00 1�0iS-762-4949 Inspection Requests: Total Sq Feet: 0.00 Fees Amount CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Total: $4.60 Payments Date Paid Amt Paid Total Fees $4.60 Check # 1055 06/12/2019 $4.60 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 Nrhhe at nocurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I auth ize a ov: named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date June 12, 2019 f Page 2 of 2 Miami Shores Village RECEIVEn Building Department MAY 221019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 `O�I_ FBc2o1�_1 BUILDING Master Permit No. `co 19-1 m PERMIT APPLICATION Sub Permit No. �"v�—� -1 — [1 - ?'s ❑BUILDING W ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: /C090 &- /wd/w 6Ve City: Miami Shores County: Miami Dade -Zip: 33/50 Folio/Parcel#: // 3101.0.2/• P. X Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): L U/S4 1-()A%,4 Phone#: Address: /0090 A/. A f/,d Mt 4 j/6 City: _ M<QMI ;5 D� State: 7-z;_; Zip: Tenant/Lessee Name: _ 516w/1F Phone#: Email: CONTRACTOR: Company Name: �ZODAL Q14WL ,MW -%y-1A;GC7eC Phone#:l 7WJ %6 - Address: z0 -Address: 9453 AIW /89 72!!5e City: -10�Lcaio# State: �L Zip:.33018 Qualifier Name: 00-I�V_2 f Phone#( -z • 6•c O�O State Certification or Registration #: 4-C 13co-ope6_ Certificate of Competency #: ' DESIGNER: Architect/Engineer: .74goA9S, 'PeOG-O'fi 2 ► ELub 7¢277) Phone#A D/ 990 • / 77� Address: 664rm/4 /©/ City: i?/Jf'� State: 6/7- Zip: DC7 Value of Work for this Permit: C00. = Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ��QQ--ID Demolition Description of Work: C -N /y C V,1d5 C72QV Specify color of color thru tile: 4�t� Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ A Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) __ Mortgage Lender's Address City State 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. /I (Revised02/24/2014) - 4 Signature - Signature_l .col ad roof OW or AGENT ONTRACTOR The foregoing instrument was acknowledged beforeme this The for goi was acknowledged before me this E X day of 6?&4, 20 `/ by �� dQ y 19 20 by LUis4 Ll/U�I who is personally known to E- who is personally known to me or who has produced -1%%— as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print : Print:CO-7�- , CAR.OS E. PADILIA*UINTERO Seal: • MY COMMISSION IIS GO 2406M Seal s CAR -OS E. PADILLA-QUINTERO EXPIRES: August 27, 2022 5i• ti MY COMMISSION / GG 240506 fY • Bonded Thru Notary Public U =+,Z�z� EXPIRES: August 27,2W '•. 15PS=W Thru Notary Pubk Underwriters ******************* ************************************** * ******************************************** APPROVED BY Z� l Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) � N 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. t Signature: % O er State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 20_Lj_. �\1� (\] � 1 (J r a C who is personally known to me or has produced By "19A -�(_Tz1 15t-yz wanxt�, as identification. Notary SEAL: SINDIA ALVAREZ MY COMMISSION # GG 238273 EXPIRES: September 3,2022 ..F„_ _, mac• _ NODAL CONSTRUCTION & ELECTRIC ASSOCIATES INC 9053 NW 189 TERRACE HIALEAH FL 33018 DATE: 6/11/2019 STATE OF FLORIDA COUNTY OF MIAMI DADE BEFORE ME THIS DAY PERSONALLY APPEARED JOSE A NODAL WHO IS DULY SWORN, DEPOSES AND SAYS: THAT HE WILL BE THE ONLY PERSON WORKING AT PROJECT LOCATED AT: /cnsc�o 144146"t ,oyE , A411AA it <#bee�� 72Z 3,515O SWORN TO(OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS DAY 6/11/2019 BY D%>- 'O/N. PERSONALLY KNOWNAOR PRODUCED ID y CARLOS E. PADILIA-QUINTERO MY COMMISSION 8 GG 240506 a o' EXPIRES: August 27, 2022 \ � �'•! of n°e`: Bended Ttuu NGtery Pubft Unilerw m PRINT TYPE OR STAMP OY NOTARY