EL-19-1909Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Parcel Number
9330 NE 12TH AVE, Miami Shores, FL 33138 11320SO070160
Contacts
Permit MO.: EL-08-19-1909
Permit Type: Etectrical - Resideottal
Work CfassUkatton: Alteration
Permit Status: Applied
Expiration: 02/15/2020
WEI CHEN Owner ONLY ELECTRIC CO INC Contractor
9330 NE 12 AVE, MIAMI SHORES, FL 33138 YOAV ADIKA
348 NW 102 TERR
Business:3057856059 onlyelectriccompany@gmail.corn
Description: AS PER ARCHITECTURAL DRAWINGS SUBMITTED Valuation: $ 3,800.00 Inspection Requests:
76�-4949
WITH THE MASTER, ELECTRICAL WORK
Total Sq Feet: 380.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$2.40
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.80
Permit Fee
$83.00
Scanning Fee
$3.00
Technology Fee
$3.33
Total:
$146.53
Payments
Date Paid Amt Paid
Total Fees
$146.53
Credit Card
08/27/2019 $146.53
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 construction and zoning. Futhermore, I authorize the above na ^ contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
August 27, 2019 Page 2 of 2
BUILDING
PERMIT APPLICATION
Miami Shores Village
JC
Building Department I'll 9 2 19
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
gY:
Tel: (305) 795-2204 Fax: (305) 756-8972 i
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC W-
Master Permit No.
C��C I ��
Sub Permit No. U
❑BUILDING EIELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: GIJ75 0
City: Miami Shores County: Miami Dade Zip: • 3t3l3,6
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): V� e (&V\' Gam. Phone#:
Addr
City:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name:
Address: . ? l7 2 1� '
n
ne#:
ne#:
City: L N St -ate: �/ Zip: 3 33�2,-py
Qualifier Name: `/ �fi�//j/� Phone#:
State Certification or Registration #: EC- 13 e9e 2-3/3 Certificate of Competency #:
DESIGNER: Architect/Engineer:
ne#:
Address: City: State: Zip:
r rt of tm
Value of Work for this Permit: $ 3 V00.00
qf th t lv�Squ re/Linear F,%ntage of Work:
q
Type of Work: ❑ Addition Alteration ❑ New E I Repair/Replace ❑ Demolition
Description of Work: i7�i- t, &WQjI d V u b mi # e d w }i the m o r t"
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $ CO/CC $
DBPR $
Notary $
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $
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
Zi
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.
r
i
Signature_L�- Signature
OWNER or AGENT
CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
� day of v-�6 20 by da of 20 by
.r I
e C WA
�w/h�o is persona4 known to who is ersonally kno to
me or who has produced F�it>�%�%�as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC:
Sign
NOTARY PUBLIC:
Prin% r• M, PENA Print 7,�
.A 1 MY COMMISSION * GG054738 MY COMMISSION * GG054738
Seal: PENA
N?iEXPIRES December 13, 2020 Seal: EXPIRES December 13, 2020
l�
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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 Exempti
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.
i
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was CAM
before me this _ day of f , 20 C
By W� t f� lam'! IM who is personally known to me or has produced
NPC as identification.
_ CAYTEN CLARK
:�.• �"°6it:
Notary. ;; t: MY COMMISSION # GG089356
' SEAL: ,n ^,. EXPIRES February 03, 2021
`" ��-"
rr.
ONLY ELECTRIC CO.
348 NW 102 TERRACE
PLANTATION, FL 33324
P: 305-785-6059
State of �tiC Gl
County of �� v'
August 22, 2019
Before me this day personally appeared who, being duly sworn
deposes and says:
That he or she will be the only person working on the project located at:
u g6124-h A" u& M ir0 mi G i nrP c •F. 5313V
ontractor Signature
SVvorn to (oraffirmed) and subscribed before me this 2.19 day of S2019, by
V
::�'�•; AILEEN PENA
MY COMMISSION # GG054738
'? EXPIRES December 13. 2020
Personal Know
Or Produced Identification
Type of Identification
Print, Typ Stamp Name of`Notary