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PL-19-2099Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 IYq?'��'U!1iILL� Issue Date: 09/17/2019 Location Address Parcel Number 9701 N MIAMI AVE, Miami Shores, FL 33150 1132060130970 Contacts Permit No.: PL-09-19-2099 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Expiration: 03/16/2020 STARFISH HOMES LLC Owner V & D PLUMBING SERVICE INC Contractor 3001 W HALLANDALE BEACH BLVD, PEMBROKE PARK, FL 33009 VICTOR DIAZ Business: 9549811154 Business: 3053934126 Description: BATHROOM / KITCHEN REMODELING, INTERIOR Valuation: $ 10,000.00 Inspection Requests: RENOVATION, FLOORING 3fi5-762-4949 TotalSq Feet: 447.00 Fees Amount Application Fee - Other $50.00 CCF $6.00 DBPR Fee $5.25 DCA Fee $3.50 Education Surcharge $2.00 Permit Fee $300.00 Scanning Fee $9.00 Technology Fee $8.75 Total: $384.50 Payments Date Paid Amt Paid Total Fees $384.50 Credit Card 09/10/2019 $50.00 Credit Card 09/17/2019 $334.50 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 regulating construction and zoning. Futhermore rate and that all work will be done in compliance with all applicable laws I c tractor to do the work stated. Authorized Signature: Owner / Alrplicant / Agent Date September 17, 2019 Page 2 of 2 Miami Shores Village Building Department 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. Z.L - U-,- lct- \174> PERMIT APPLICATION Sub Permit No. PL- D-!' 1 q - o20L1 g ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL LUMBING R MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: g701 Rqt City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ' U 13 - U�1'Iy Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): S�c�r�5� �oMiS Phone#: gS7-q- 160- 1 IS N Address: jc7y l.J t\ai�cc�{ l3cc cl,,v) City: ?e 16 noKt 17� l! State: Zip: 001A Tenant/Lessee Name: Email: ZL1,11"fi1c.) CONTRACTOR: Company Name: Address: City: Quali Phone#: S"�f V(g 7 4hone#:6 IT `(I L4t Zip: 35111 Phone#: State Certification or Registration #: 10 Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: �,(�,( City: State: Zip: Value of Work for this Permit: $ ,�I{di e2i: ( � Square/Linear Footage of Work: Type of Work: ❑ Addition 5 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: /4-- / n 3 - , e -'. 2.. • • • - Specify color'(# colgr "tlir.'u the Submittal Fee $ M Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Structural Reviews $ Training/Education Fee $ 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 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 ommencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue \ l the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. ,(Signature Signature 0 ER rAGENT CONTRACTOR The foregoing instrument was acknowledged before me this )CX' day of �U41 W , 20 V1 by buw" �A2Q.�C who is personal) known nown to ,me or who has produced identification and who did take an oath. NOTARY PUBLIC: OCONNOR i s`0N p'%riisso(L The foregoing instrument was acknowledged before me this day of �Y�"'" 20 16 by V Z>iaL who is personally known to as me or who has produced /L identification and who did take an oath. NOTARY PUBLIC: as �i?,p.Sal�n f��Z•annorrA Print: _til W� Print: Seal: �� , �: Seal: NY; �ROSALIN ALZAMORA •••' • F sondz5��vo FF F%� L0`f ,State of florid. tJOUry Public �i 0 •.; gel iJo`'`; O ,� :�• Commission k GG 242544 �T9Ry •(••••t��fp .F ' My Comm;sion Expires APPROVED BY �---� g /�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 UWner — WorKers' uomaensation insurance txernDtion 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. r Signature: ner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 120 tq By +tkn i\A/�,N JLA 2n who is personally known to me or has produced /�. as identification. �t � ; ��;p1�,, ROSALIN ALZAMORA Notary: �1V1 AAOM ;state of Florida -Notary Public y;c Commission N GG 242544 SEAL: ��„u� My commiAugusts26, 2022 Expires ,� ae� �0 mt V and D Plumbing Services Inc. 14266 SW 162 ST MIAMI FL, 33177 305 393 4726 305 232 8950 9 September 10, 2019 State Of Y 1%` County of tAlwk d' Before me this day personally appeared Who, being duly sworn, deposes and says: That he or she will be the only person working in the project located at: Contras sig ature Sworn to ( or affirmed) and subscribed before me this 1 day of c G 2019 by -C, to Ds Z- Personally known Or produced identification Type of identification produced V✓ ar» at Me tr 4, , type or stamp name of Notary MA� all 207-3 -t- V and D Plumbing Services Inc. 14266 SW 162 ST MIAMI FL, 33177 305 393 4726 305 232 8950 r• September 10, 2019 State Of "�L'1DP" County of WW1 Q Q� Before me this day personally appeared lL Who, being duly sworn, deposes and says: That he or she will be the only person working in the project located at: `j10\ 0 V 1IWi MF- NilWt Stb"s Tt) 3�IW Contrac r sig ature Sworn to (or affirmed) and subscribed before me this 11 day of �e 2019 by JjC, (0 � �i4 Z Personally known Or produced identification Type of identification produced type or stamp name of Notary MA� al, 2023