PLC-19-1558Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date: 07/11/2019
Location Address Parcel Number
1700 NE 105TH ST 514, Miami Shores, FL 33138 1122300500900
Contacts
Permit O.: PLC-07-19-1558
Permit Type: Plumbing - Commercial
Work Classification: Alteration
Permit Status: Approved
Expiration: 01/07/2020
CHRISTOPHER SWARTZ Owner
1700 N. E. 105 ST. #513
DECONEX INC Contractor
JOHN A DAVID
247 BIRD RD, CORAL GABLES, FL 33146
Business: 3058178777
Description: PLUMBING FOR KITCHEN AND TWO BATHROOM Valuation: $ 1,600.00 Inspection Requests:
UPDATE 05-762-4949
TotaISq Feet: 400.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$111.10
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$111.10
Credit Card
07/11/2019 $61.10
Credit Card
07/09/2019 $50.00
Amount Due:
$0.00
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certi the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating constructiq zonin Futhermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor / Agent Date
July 11, 2019 Page 2 of 2
Miami Shores Village C I E
Building Department JUL 9 19
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 fax: (305) 756-8972 BY:
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20
BUILDING Master Permit No. C 1 oz. 10, 4"�1
PERMIT APPLICATION Sub Permit No. — -7-19- SS 8
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
, CONTRACTOR DRAWINGS
JOB ADDRESS: 11``oc M IG 1 CS 14
City: Miami Shores County: Miami Dade Zip: OW 3$
Folio/Parcel#: 00 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone:
OWNER: Name (Fee Simple Titleholder): CAWK064elt— .51LIA 07—
Address: i70o dl,a Mg yr• ",S14
City: Ml
�4% 544 Ma% State:
Tenant/Lessee Name:
Email
one#: '30O'1Opb
Zip: 3313
lone#:
CONTRACTOR: Company Name: Dee-o ex Phone#:30j 9s0 — If-
Address: 2q1 i��" l � Nf. \
City: 40GP4L0_S State: �� Zip:
^331 �Q
Qualifier Name: VMIC> �� Phone#:
State Certification or Registration #:y�l' G� �'�Z"31 Certificate of Competency #:
DESIGNER: Architect/Engineer:
e#:
Address: �,��,�� City: State: Zip:
Value of Work for this Permit: $ - 3jmap . c eb Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work: 1^11MM Wr-1 -4 $PM�40fta$K
Specify color of color thru tile:
Submittal Fee $__DU I Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
DBPR $ Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
u
(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."
F
Notice to Applicant: As a condition to the issuance of a building permit with an estimated volueexcleedi4$1500,'th"e applicant must
promise in,good faith that a copy of the notice of commencement and construction lie law brochure will be delivered to the person
whose property is subjeci to attachment. Also, a certified copy of the recorded no ' e of co encement must tie posted at the job site
for the first inspection which occurs seven (7) days after the building perm' is issued. I he 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
—1 day of Cl'20 by
AIKQIF � 4~1- who
`s personally kn_ o^ w��
me or who has produced as
The fore ing instrument
was
acknowledged before me this
day of �! �f �: y 20 by
D�1D who rsonallyknowwtb
me or who has produced
as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: r
A. t
Print: i-R>M1O Print:
o�fRY PUe�k LAZARO ALVAR �"o Pue, LAZARO ALVAREZ
Seal: ? * MY COMMISSION # FF 946879 Seal: 20 /,
* * MY COMMISSION # FF2020
w e 46679
EXPIRES: January 17, 2020 * ' EXPIRES- January 17,2020
Bonded
9TF f� OQ Thru &dPt Notary Semces SWIM
w r
OF j9ff OF po BW#d TMU I&AW NOWY
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revisedo2/24/2014)
Deconex
247 Madeira Ave.
Coral Gables, FI 33146
786-768-4330
6/17/2019
State of Florida
County of Dade
Before me this day personally appeared
bMl l% �" who, being duly sworn,
Th sh will be the only person working on the project located at
1 00J,,ne 1 V #514 Miami shores, FI 33138
ContoWr Iizna ure
Sworn to (or affirmed) a I ed before me this I day of �! .2019
By
Personally known x
Or produced ID
Type of ID produced
�o4�"?uB4c+ LAZAROALVAREZ
AMY COMMISSION # FF 946879
\oe EXPIRES: January 17, 2M
FOP w Bonded Thru &x*t NoWy Swim
PRINT, type or stamp name of notary
Notice to Owner — Workers' Corn
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
tion Insurance Exemotion
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 n your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insuran coverfrom the contractor's company for day labor, part-time employees or subcontractors.
CONTENTBY SIGNING BELOW YF� A WLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this & day of J94 7 , 20 /4
By 60WA01#6 -411419M who is personally known to me or has produced
A- 04- as identification.
Notary:
SEAL: ��YPu LAZAROALVAREZ
' ��� W COMMIt810N M Rf "6879
*_ 1� ri /'_` ;XPIRESI JiNS 7, 2020
Bonded 1blu