PLC-19-1399Miami Shores Village
Building Department J/z/ "'t"41&
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 f
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 ("l
BUILDING Master Permit No. CC-10-18-3286
PERMIT APPLICATION Sub Permit No. -0j--9"0 91
F-IBUILDING F-1 ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING F-1 MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9835 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
Address: 4141 NE 2nd Ave. Suite #204A
City: Miami
Tenant/Lessee Name. SINS GASTROBAR
Email: sins@sinsgastrobar.com
State: FL
CONTRACTOR: Company Name: A Sunny Plumbing Co.
Address: 6800 SW 17 St
305 455 1800
Zip: 33137
Phone#: 786 863 7798
hone#: (305) 281-7317
City: Miami State: FL Zip: 33155
Qualifier Name: Osiris Chaviano
State Certification or Registration #: CFC1427249
DESIGNER: Architect/Engineer: YCM Engineering
14245 SW 21 Terr
Phone#: (305) 281-7317
Certificate of Competency #:
Phone#: 305 484 5596
City: Miami state: FL Zip: 33175
Value of Work for this Permit: $ 3800 Square/Linear Footage of Work:
Type of Work: Addition Alteration New Repair/Replace
Description of Work: Provide Gas system to Kitchen equipment and Hot Water Heater
at new Sins Gastrobar Restaurant in existing Shopping Center.
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $,
Structural Reviews $
Revised02/24/2014)
Training/Education Fee $
CCF $
DBPR $
Demolition
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ { G— • O 5
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
Zip
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.
9 Lz/&w
Signature Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
day of d n 20_ Iqr , by
Y -UJ) , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:V W
Seal:
Y.,
oPrint:
of
Commission : GG 246553
o Seal sYpo . ANAYS GO
Notary Public - State or Floriad
Bonded through National Notary can
Commission # GG 246553
My Comm. Expires Oct 26 2022
Bonded through National Notary Assr
The foregoing instrument was acknowledged before me this
day of L
120 , by
le91 r4 S 1%4W14-0 , who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: u U
Seal:
Y., aNAYs LAGo
Notary Public -State Florida
of?"
of
Commission : GG 246553
My Comm. Expires Oct 26, 2022
Bonded through National Notary can
APPROVED BY _ •./y-/S Plans Examiner
Structural Review
Revised02/24/2014)
as
Zoning
Clerk
A SUNNY PLUMBING, INC.
6800 SW 17ST Miami FL. 33135
305 219 0427
June 26, 2019, 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 -10.18.3286 — Sins Gastrobar at 9835 NE Zed Ave.
Before me this day personally appeared Osiris Chaviano who, been duly swum, 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
Osiris Chaviano
A Sunny Plumbing, License # CFC 1427249
Sworn to (or affirmed) and subscribed before me this 26th day of June, 2019
Personally known V
Notary Pubfi, , 5.
ANAVS 144 ° JAStn, tttlj,` Commissicv" vi :'-6PublicNotarynMYComm. Ex:;: -`M a;t'x
Bonded through h„; we.: hata
CC. Maria Fuentes for 9801 Park LLC
X61 J10-4 -
Notice to Owner -- Workers' Com
Miami shores Village
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. 440.05allowscorporateofficersintheconstructionindustrytoexemptthemselvesfromthisrequirementforanyconstructionprojectpriortoobtainingabuildingpermit. 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-timeemployees, including the owner, must obtain workers' compensation coverage. Corporate officersormembersofalimitedliabilitycompany (LI -C) in the construction industry may elect to beexemptif:
I . The officer owns at least 10 percent of the stock of the corporation, or in the case ofanLI.C, 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 FloridaDepartmentofState, Division of Corporations; and3. The corporation is registered and listed as active with the Florida Department ofState, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members areallowedtobeexempt. Construction exemptions are valid for a period of two years or until avoluntaryrevocationisfiledortheexemptionisrevokedbytheDivision.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not usedaylabor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she willbetheonlypersonallowedtoworkonyourproject. In these circumstances, Miami Shores Village does not require verification ofworkers' 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 ITSCONTENTS-
Signature--
Owner
ONTENTS_
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this ^G day of Gl^Z. 20 1
By,G#i
who is personally known to me or has produced
as identification. ,a"'u'.. ANAYS LAGC
Notary Public • State o` FloridaNotaryrQ. Commission. GG 216553
My Comm, Expires Oct 26. 2022
Bonded through. National Notary Assr. SEAL: