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PL-18-3295Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue : bate: Parcel Number 299 NE 99 ST, Miami Shores, FL 33138-2434 1132060134580 Contacts Permit NO.: PL-10-18-3295 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: Approved Expiration: 04/24/2019 TREVOR & KRYSTLE HAGUE Owner TREVOR & KRYSTLE HAGUE Applicant 299 NE 99 ST, MIAMI SHORES, FL 33138 299 NE 99 ST, MIAMI SHORES, FL 33138 Other:3053934461 Other:3053934461 ERNIES PLUMBING AND SERVICES LLC Contractor ANIBAL MUNGUTA 1950 SW 122 AVE 101, MIAMI, 33175 Business: 7862395614 anibal.munguia@yahoo.com Description: NEW PLUMBING FOR TWO BATHROOM AND Valuation: $ 7,000.00 Inspection Requests: LAUNDRY CONNECT DRAIN PIPE TO SEWER SEPTIC 305-762-4949 Total 5q Feet: 1,393.00 Fees Amount Application Fee - Other $50.00 CCF $4.20 DBPR Fee $3.68 DCA Fee $2.45 Education Surcharge $1.40 Permit Fee $195.00 Scanning Fee $3.00 Technology Fee $6.13 Total: $265.86 Building Department Copy Payments Date Paid Amt Paid Total Fees $265.86 Credit Card 10/26/2018 $50.00 Credit Card 11/02/2018 $215.86 Amount Due: $0.00 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. cz!��-z^D Authorized Signature: Owner / Applicant / Contractor / Agent Date November 02, 2018 Page 2 of 2 Miami Shores Village c�T"rfrr1 Building Department OCT 2 6 2018 —CL::�" 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 By. Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING FBC 201 4 C Master Permit No. 4 - f >; - 334 Sub Permit No. Qr — ✓2cIS ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [-]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: IV / q City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Address: 3"7(F7 City: I'k aryl Tenant/Lessee Name: rewor Lt-zLAe-- Phone#: S[i5=•��13,�yGl State: EL Zip: 33 �..ma Email: �) ���w� ('I ' �✓� CONTRACTOR: Company Name: L ;,% Tl�(JY �S 4 " nQ g ,� /1'Gp f LAC Phone#: �2- 3 q— 66/ q Address: 1 / j0(3 SGl% /3 � PIP Ce City: 'Q State: Zip: 33 / !2 Qualifier Name: / /i / Phone#: 2L�c9—.5/�,6 State Certification or Registration #: L PL 143 0002 _Certificate of Competency #: DESIGNER: Architect/Engineer: • .Phone#: Address: /� �lj m City: State: Zip: Value of Work for this Permit: $ 7i 019 (/ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑j Alteration New ❑ Repai /Replace ❑ Demolition �J Description of Work: / /tVj P/UrY! �n �% 409 /yaw g;�;/ z0 (e Specify color of color.,thr�u tile:.•,�:T - Submittal Fee $ Permit Feb $ ° ' CCF $ CO/CC $ Scanning Fee $rRadon'Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 1 ' 4 96 (Revised02/24/2014) 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 OWNER or AGENT The foregoing instrument was acknowledged before me this ^_710 day of 20 �J by `-�'( �a V o is personally known to me or who has produced WQ as identification and who did take an oath. NOTARY PUBLIC: Print: Seal: MAHARAI K. GONZALEZ EXPIRES: November 2, 2020 Bonded Thru Notary Public Underwriters Signature CONTRA TOR The foregoing instrument was acknowledged before me this -2� day of 20 18, by A #I/N64)1q 1E i�personally known to me or who has produced R5oZ �0/.3:-Yicf76'fas identification and who did take an oath. NOTARY P LIC: Sign. G Print: li Seal: '�ra�l�,, Maria I Santos Commission IFF931611 Bonded thru Aaron Notary APPROVED BY Plans Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) o e 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 - 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 l . 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. Signature: O ner State of Florida County of Miami -Dade The foregoing was acknowledge before me this CJ0 day of 201%9;k% By I I who is personally known to me or has produced QADS-e as identification. Notary: SEAL: MAHARAI K. GONZALEZ #: MY COMMISSION # GG 044602 U :o�= EXPIRES: November 2, 2020 :Fot� IV Bonded Thru Notary Public Underwriters Ernie's Plumbing & Services LLC Wednesday October 24th, 2018 State of Florida Miami Dade County Before me this day personally appeared Anibal Munguia holder of State License CFC1430073 registered for Ernie's Plumbing and Services LLC, who being duly sworn deposes and says: That he authorises Ernesto Munguia to be the only person working on the project located at: 299 NE 99th Street, Miami Shores, FL 33138. Contractor Signature Sworn to (or affirmed) and subscribed before me this o Y day of 20 /J0, by gnih//, Ruy(,v14 9jov, e Produced Identification 05,,,25 -013 Type of Identification 1) C Print and Stamp of Notary commissionMaria I Santos OFF931611 Expires: October 28, 2019 %o�� Bonded thru Aaron Notary JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 11/1/2018 PERSON: ERNESTO MUNGUTA FEIN: 462904429 BUSINESS NAME AND ADDRESS: ERNIES PLUMBING AND SERVICES LLC 1950 SW 122 AVENUE APT 101 MIAMI, FL 33175 SCOPE OF BUSINESS OR TRADE: Plumbing NOG and Drivers EXPIRATION DATE: 10/31/2020 EMAIL: PLUZQUINOSF@HOTMAIL.COM IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609