PL-19-2559Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Dater 10/30/2019
Parcel Number
1158 NE 99TH ST, Miami Shores, FL 33138 1132050180130
Contacts
Permit NO.: PL-10-19-2559
Permit Type: Plumbing - Residential
Work Classification: Pool - Private
Permit Status: Approved
Expiration: 04/27/2020
SUSAN PINNAS Owner La Casa de las Piscinas Inc Contractor
1158 NE 99 ST, MIAMI SHORES, FL 331382641 Maria C Rodriguez
2601 NW 18 TER, Miami, FL 33125
Business: 3056339699
Other:3052163107
Description: NEW SWIMMING POOL PLUMBING Valuation: $ 1,500.00 Inspection Requests:__
305-762-4949
Total Sq 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
Plumbing - Pool - Residential
$100.00
Scanning Fee
$3.00
Technology Fee
$3.75
Total:
$162.35
Building Department Copy
Payments
Date Paid Amt Paid
Total Fees
$162.35
Check # 1504
10/28/2019 $50.00
Check # 1509
10/30/2019 $112.35
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
r guI ting construction a d zoning. Futhermore, I authorize the above named contractor to do the work stated.
raA A/1D
Authorized Signature: Owner
/ Applicant / Contractor /
Date
October 30, 2019 Page 2 of 2
A
R
Inl �gl��
BUILDING
PERMIT APPLICATION
❑BUILD
LUMBING
JOB ADDRESS:
Citv:
Folio/Parcel#:__j
Occupancy Type
E
Miami Shores Village
C.VC-2 19
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
F BC 20
Master Permit No. ,P-r�"/(�' -in&
Sub Permit No. L iy— i i—L SS e)
❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
A CONTRACTOR DRAWINGS
�� k o�4
OWNER: Name (Fee
Address: i 11 (11 , IW)
City: INt�=j
Tenant/Lessee Name:
Email:
res / County: Miami Dade Zip: '3
�yj��1�W Is the Building Historically Designated: Yes NO
Load: Construction Type: _ Flood Zone: BFE: FFE:
Titleholder): JSnn'N-nog Phone#:
2
�i State: C�-� Zip: 33
Phone#:
CONTRACTOR: Company Name: 4
Address: o / Z(4 )"9 ` f
City: L --7f lr to
rinnlifiar Alnma•
tl17, 7-1-
s<710 Phone#: 36G3�—��5 1
_Zip:
e#: -2
v
State Certification or Registration #: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $lit W_r Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration New ❑Repair/Replace
Description of Work: 61
Specify color of color t4ru tile:
Zip:
❑ Demolition
so r3P► C 1 150 CCF $ 1.90 CO/Cc $ P1
Submittal Fee $ � Permit Fee $
Scanning Fee $ 3. 60 Radon Fee $ V. 00 DBPR $ 4�2 On Notary $_jel"5
Technology Fee $ 3 • 5 Training/Education Fee $ 0-go Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(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
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 pQted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signat re Signature 1-11
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this
of UIVI U 20 i by
Q � who is personally known to
me or who has produced
identification and
NOTARY PUBLI
Sign: p
Print: Q
Seal:
an o#AW*QWb=
0O■IM00EI3M
E*kW M6rd 20, 2023
em" TM AN011 k"
as
The foregoing instrument was acknowledged before a this
.._1
2 day of 20 , by
hQ_, ersona k into
me or who has produced _
identification and who did take an oath.
NOTARY PUBLIC:
Sign: �•�"�
Print:
Seal: y�?••.�+pFF99p]5g
APPROVED BY <� //NI_ Plans Examiner
Zoning
Structural Review
(Revised02/24/2014)
Clerk
L -
-----------------------
003685
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL - DO NOT PAY ILBT
5637708 EXPIRES
RECEIPT N0.
BUMNESSNAME?LOCATION RENEWAL SEPTEMBER 30, 2020
LA CASA DE LAS PISCINAS INC 5880746 Must be displayed at place of business
2601 NW 18TH TER Pursuant to County Code
MIAMI FL 33125 x� Chapter 8A - Art. 9 & 10
SEC. TYPE OF BUSINESS PAYMENT RECEIVED
OWNER 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR
LA CASA DE LAS PISCINAS INC CPC1456901 $45.00 09/ 12/2019
MARIA C RODRIGUEZQUALIFIER CHECK21-19-082432
Workers) 2
ceipt only confirms payment of the Local Business Tax. The Rece
This Local Business Tax Re"it is not a license,
I to the business.
permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governments
or nongovernmental regulatory laws and requirements which apply
The RECEIPT NO. above must be displayer) on all commercial vehicles - Miami -Dade Code Sec 8a-276.
For more information, visit wvyw
midade 00VAtaxcollector
CVIE g r
�T
�OIn WE
JIMMY PATRONIS STATE OF FLORIDA
CHIEF FINANICAL OFFICER
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: 2/22/2019 EXPIRATION DATE: 2/21/2021
PERSON: MARIA C RODRIGUEZ EMAIL: h1RODR1447@GMAIL.COM
FEIN: 650219797
BUSINESS NAME AND ADDRESS:
LA CASA DE LAS PISCINAS INC
2601 NW 18 TERR
MIAMI, FL 33125
SCOPE OF BUSINESS OR TRADE:
Licensed Pool Contractor
a
LA CASA DE LAS PISCINAS INC
2601 NW 18T" TERR
MIAMI, FL
Date:
State of ROVAal
County of
Before me this day personally appeared tA" riAUft who, being duly sworn,
deposes and says:
That he or she will be the only person working on the project located at:
Contractor Signature
Sworn to (or affirmed) and subscribed before me this 2 day of �� 204
by l,/ .
Personally know
OR Produced Identification
Type of Identification P o uced
Print, Type or Stamp Name of Notary
cmNdsdMiessm
Expka: Mad 20, 2023
BoWW rov Aaron Notary
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 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
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.
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this _L1) day of 20 .
By �r who (ispersonally know Rio me or has produced
as identification.
SEAL: dawn
ftm6ftQ,d 0- GGiW
E*y_Mwo 20, 2023