PL-19-574Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 03/25/2019
Location Address Parcel Number
1431 NE 103 ST, Miami Shores, FL 33138-2625 1132050310160
Contacts
Permit Ata: PL -03-19-574
Permit Type: Plumbing - Residerial
Work Clossifrcatforr: Gas
Permit Status> Approver#'
Expiration: 09/23/2019
CARLOS EDUARDO ARRIETA CHRISTINA Owner CARLOS EDUARDO ARRIETA CHRISTINA Applicant
MARIA CABALLERO MARIA CABALLERO
1431 NE 103 ST, MIAMI SHORES, FL 33138 1431 NE 103 ST, MIAMI SHORES, FL 33138
INFINITY CONSTRUCTION SERVICES INC Contractor
ANTONIO LUVARA
4156 96 AVE, MIAMI, FL 33165
Business: 7864439590
Description: PLUMBING FOR GAS VENT Valuation: $ 300.00
Inspection Requests:
305-762-4949
Total Sq Feet: 520.00 11 1
Fees Amount
Application Fee - Other 50.00
CCF 0.60
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.20
Permit Fee 50.00
Scanning Fee 3.00
Technology Fee 2.50
Total: 110.30
Payments Date Paid Amt Paid
Total Fees 110.30
Credit Card 03/14/2019 $50.00
Credit Card 03/25/2019 $60.30
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 constructio nd-eenin . Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent Date
March 25, 2019 Page 2 of 2
CIE" D
Miami Shores Village MAR
Building Department BY:
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No.
22 G -
i
I bU 3
PERMIT APPLICATION Sub Permit No. FL -S ` 1 1 ::if
BUILDING ELECTRIC ROOFING M REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION [—]SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: (U 31 We 1 0 3 51
City: Miami Shores County: Miami Dade Za: 3313 l
Folio/Parcel#: 1132-0503101(60 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):CAK L 0 S E Du AR Do &f j:k 1 tTrA Phone#:
Address: 1431 Ne 10-3 S ree 7 -
City: City: MICCM i ShOre-V State: 9L Zip: -3313 P
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name
Nv 1 LCI r 6-T-
Address: 'Coq l A V_v—
State: -(l t zip 2a) I b 6
Qualifier Name: Af'gO iA% e) Qoa G ®- Phone#:'(
a4q1_
69
State Certification or Registration #Q _ Cr l9e?Bab 5 Certificate of Competency #:
nt3fo LA LA
DESIGNER: Architect/Engineer:
Address: City: State: Zip:
Value of Work for this Permit: Square/Linear Footage of Work:
Type of Work:
1Addition [_
1 Alteration F-1New Repair/Replace El Demolition
Description of W0 l w 7 "\C' 4e hoz-
Specify color of color !Iru tile:
Submittal Fee $ 6OPU 1 Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $
Structural Reviews $
Revised02/24/2014)
Training/Education Fee $ Double Fee $
Bond $
TOTAL FEE NOW DUE $ " ' v
0. —
t
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
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 o 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 issu . In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
signature Signature
OWNER or -AGENT, CONTRACTOR
The foregoing instrument was acknowledged before me this
r day of (amu rJ-) 20 19 by
ZA'y_ L. A (n`e-- ' who is personally known to
me or who has produced
The foregoing instrument was acknowledged before me this
i ) day of r00r c 7 20 1 by
AllicoN I t) `U OCt fP1who is personally known to
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: AUL N VARRO
RAUL NAVARRO :° ommission #FF972714
Commission #FF972714 My Commission Expires
My Commission Expires March 20 2020
Sign: March 20 2020 Sign:
Print: Print:
Seal: Seal:
s********************s*s**ssssssssssssss******s*s***sss*ssssssssss*ssssssssssssssssssssssssssssss**sssss
APPROVED B<:::-"4 Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)
License: CFC#1428288 License CAC1816795
6955 NW 77T" Avenue Miami, FL 33166 Phone #786 443 9590
Date: March 14, 2019 1431 NE 103 Street
COUNTY OF MIAMI SHORES VILLAGE
Building Department
Before me this day personally appeared Antonio Luvara who, been duty sworn deposes and says:
That he will the only person working on the property located at 1431 NE 103 Street, Miami
Shores, FL 33138
Cordia
Antonio Luvara
Sworn to and subscribed before me this day of ry! 20#—by 6UL'Ag
Personally Know v
Or produced Identification
Type of identification
AMTOW E GONZ
WCOWMMEM3115
S: AUG 2k M9
r-l stamp seal of Notary
08W*dthm*jdSWW",0
679 N. Miami Ave, Loft #3, Miami, FL 33136 1 Office: 305.200.3131 Fax:305.200.3422
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to uwner -- worKef s, t;omnensatlon Insurance Cxemotion
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.
Signatu
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this .1 day f r) -)c)( C" 20_ .
BG f ?-R a who is personally known to me or has produced
as identification.
O,*
RYP&6 RAUL NAVARRO
Commission 714
Notary,: _ My Commissionion Expires
March 2020
SEAL: