RC-19-1956Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:
Location Address Parcel Number
113 NE 101ST ST, Miami Shores, FL 33138 1132060131910
Contacts
Permit NO.: RC -08=
Permit Type: Building (Residential)
Work Ctossificatton: Solar
Permit,status: Approved
Expiration: 03/09/2020
DANIEL YEH Owner ENERGY SMART SOLAR LLC Contractor
RENIELSANTOYO
Business: 9542284902
Inspection Description: SOLAR PV ROOF MOUNTED Valuation: $ 15,000.00 Re nests:
62-4949
Total Sq Feet: 0.00
Fees
Amount
CCF
$9.00
DBPR Fee
$6.75
DCA Fee
$4.50
Total:
$20.25
Payments
Date Paid Amt Paid
Total Fees
$20.25
Credit Card
09/09/2019 $20.25
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
regulating coWtruction anq zoning. FutqMnore, I authorial the above named contractor to do the work stated.
G
Authorized Sig6ature: Owner i Applicant / Contractor / Agent Date
September 09, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
BUILDING ❑ ELECTRIC
:��xsys D
Miami Shores Village
Building Department 4Y
' ba'9
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B
Tel: (305) 795-2204 Fax: (305) 756-8972 -� I
INSPECTION LINE PHONE NUMBER: (305) 762-4949 (0
FBC 20 (*�
Master Permit NoE�-Oe—
Sub
`'—Sub Permit No.r�` d� 3�—
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: /1-1 AIF' 1,0/ S
City: Miami Shores County: Miami Dade Zip: '' 3la5e-
Folio/Parcel#: / / -- -2,2o A� - O 1-13- / `I 1 Is the Building Historically Designated: Yes NO V
Occupancy Type: Load: Construction Type: Al" I Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Phone#::?0--
Address: 11-9 4[i / & / 5T7
City: 514y Aks State: rL Zip:
Tenant/Lessee Name:
Email:
Phon
CONTRACTOR: Company Name: E14�g�,r�� .s0 t--nQ Phone#: 9S', a2�t-
Address: &2 9 is d
City: _ id it ji sM> ES State: E74- Zip: ?�
Qualifier Name: f F(� f�Tb yb Phone#: Z!L4- a;;6(-Aj90�
State Certification or Registration #: CVC 55!700J Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ /�' !J b Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration OeNew ❑ Repair/Replace ❑ Demolition
Description of Work: 'Sg L/ 'a g P V
Specify color of color thru tile:
Submittal Fee
Scanning Fee $
Technology Fee $,
Structural Reviews $
(Revised02/24/2014)
Permit Fee $ CCF $_
Radon Fee $ DBPR $
Training/Education Fee $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $'
"J,
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 approved and a reinspection fee will be charged.
Signature i1c"L
OWNER or AENT
The foregoing instrument was acknowledged before me this
Signature
CONTRACTOR
The foregoing instrument was acknowledged before me this
/ =0– day of _ Q LJGLL ST 20 1 9J by _ day of 19L( 49 415-1' 20 1 !Z by
—AhiIK `f w , who is personally known to I&AE-1– ;s4 k�-npiio , who i ersonallyTn to
me or who has produced Z:1L as me or who has produced
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
as
Sign:
Sign:,��<i�
Print: I v46d _ _ Print: L LAi
it
I �il1
Seal: ;ooAr Poet
Notary Public State of Florida Seal:
Alexander Pavlinek
=o�Pnr P!/*4
Notary Public State of Florida
Alexander Pavlinek
-J�2
My Commission GG 035271
4
My Commission GG 035271
ore+
Expires 12/19/2020
qc.
'FOF o�
F
Expires 12/19/2020
APPROVED BY
(Revised02/24/2014)
Plans Examiner
Structural Review
Zoning
Clerk
Profit from your roof space • Reduce your energy bills • Let us show you how!
September 9, 2019
Stare of Florida
County of Broward
Before me this day personally appearedwho, being duly sworn,
deposes and says:
That he will be the only person working on the project located at: J t 3 N, 1 Q 1 5T- -
Contr ctor Signature
Sworn to (or affirmed) and subscribed before me this day of ��p� , 20�
by Kaiy/,,� 5,*1;rD.y0
4971 S.W. 941h Way
Cooper City, FL 33328
Personally know
Or produced Identification
Type of Identification Produced
Notary Public
H
Notary Public State of FloridaAlexander Pavilnek My Commission GG 035271Expires 12/19/2020
954.228.4902
energysmartfl@gmail.com
www.energysmartsolar.com
Miami shores Village
Building Department
10050 N.E_2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
1vvL1k;W w owner - Workers compensation insurance txemption
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:
I . The officer owns at least 10 percent of the stock of the corporation, or in the case of
an I..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. The contractor has provided an affidavit stating that he or she will
he 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.
13Y SIGNING 13ELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature: -
OF cr
State. ofFlorida
lorida
County of Miami -Dade
The foregoing was ackno,.vIedge before me this day ofSeJs.._f20L%-.
By.. .... ...._._ r .........__.............__._. _ - who is personally known to me or has produced
as identification.
r
RaEl
lic State of Florida
Notary: Pavlinek
ssion GG 035271
SEAL: 19/2020