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CHANGE OF CONTRACTOR \ \ ` � 1 \ \ {l: y,'�BJIR��� 2 \\ -'9 r \ :..\ � ` t�. . \� \\ � ��� � ` \ �� 1 � �,�� �� '� ���� Mi�r��St�t�re�ViLI��� � ` �� � `��. , � �� � �� � ,� � ; � " < , � �� 10050 NE 2 Ave �� � .� Z�,��i �� � ���E � �� Miami Shores FL 33138 = � ��`�����������" � �` �. _�-�,� 305-795-22Q4 � � � � ���� � ��� r, ��t � � r �� _� � � � ������ �s s�� c�, ���3� „ti ,���� ,� ��'������������ Exp�rafi�or�e v3/o�/2�22 ��� �.� Laeatian Addr�ss F�rcel Numb�r ��.�m_.�_= ���� . ��, _....�. wm �� ._me �..m.. .. �_n �.� �.�.� �, � �.� � ��� �,�� �, � � 1�C3 fVE 9$5T 113��6Q132Z�1 ����� � �� �ontacts TFIE OLfVINE GRC}UP HOMES LLC Qw��r 1D Planning and Building Applicant 293 NE 61 ST,MIAMi,FL 33137 Jairo Delgado � �usiness;30530Q5174 2�65 S.QCEAN DR,Nallandale�eack�,Ft 33049 i Pausiness:7862�53585 jairo@jdpianningandbuildin�,ec�m , _ � RC CC}NSTRUCTIC�N&fNVEST,lNC C�antractar Daniel tatour A�ent � RfCARDO CA�RERA S93S NE 2.4VE, Miami,FL 33137 ` daniel@latourdesign.eam � Business.3059754156 rafael@gmigraupllc.com �� ����� ���. .:��a �� ��,�_.��,.,..wu ..�.... �._�,..��u�. �w�_� �.�.__. m�._.�.._�.ti�.�..�_�.... � �.�._�..._..�.._v....v�. . __... �._.� ... , !ns ee#�on Re u�sts: � ���eri�tior�:�vEw s��r�c�s�raft�, a�����on�s,� � v��u��ior,: �a�a.���.z7 ��� ���������� � . � 6ATHRC}OIV1S,SING�E FANtILY H4ME 36Q0 SQFT OF TOTAL ; � CQNSTRUCTION � To�al Sq Fe�t: 3,640.�0 ��; , . � ]23 NE 99 ST �" '��?��"�"������a [ 12-3206-023-2181 I DRY RUN F��s Amount �symer�ts ��#�F�id Amt Paid CCF $273.QQ T�talF�es $2S>703.45 Certificate of Oceupaney(Residential} $150.00 Credit Card 49/16J2Q21 $��7,p0 Change af Contractor $11Q.Q0 Credit Card 03/12�2Q22 $�g.�Q Copies Fee(Manuai) $T9.89 Ct�eck#132 Q$�29j2Q19 DBPR Fee $2Q4.34 �2�Q.�Q Credit Card Cl5/22J2�20 $1�.�9 DCA Fee $136.23 cn��k�soo� �o/z�/�oza �a.�,$lo.a� Education Surcharge $91.00 Permit Card Replaeement $z��Q Check#1�1 04J12f 2019 $q$�.0� Permit Fee $13,422.92 Am�tant�ue: �0.00 Rre[iminary P[an Review(Residential) $36Q00 Residential Application Fee $20Q.00 Scanning Fee 5102.d0 Scanning Fee(Manual) $12.OQ Struetural Review($12Q} $12Q.00 Structura{Reuiew{$4Sj $45.00 Structural Review($90) $9Q.00 Technolagy Fee $340.57 i Q4��. y?Z�y!N�.�,F �E�}�t�'Rt�'}�P Zso�Q�1 Rd�@��'�� � � \ ,yy \ ���p"4t 56a:q��� \• \ \ � � i'.�'6 �. ��fi�R �\ �� Z �,� `� �� t�iami Sh�r�s 1liH�ge � � ��� ` �� �" ' ' � � `n �,�� 1Q050 N�2 Ave Y1�#� ������ � �� ����s � ���� � ���" Miami Shoees FL 33T38 � ���'�''������� � �. �� 3t35-795-2204 �� � �����`�;������ � �`Lt�4iN� \. �- \ � �\: � ����� � � , . . . . . . . . .�.,, .. , >...... ...� „,�,...,,. 1 �' ������� � �� �X�tC��1�YE; ��������'�� �uilding D�partrner�t CopY In eon�iderafion of th� issuane� ta me of this permit; I agree to perf�rm the work eov�r�d hereund�r in compiiance with ail crrdinanees �nd reguEations p�rtaining thereto �nd in strict conformity with the plans, drawings, stafiements or specificati�ns submitted ta th� praper autharities of (vliami Shores Vifl�ge. In accepting this permiF I assume r��pansibility for ail wark done by either my�elf, my agent, servants, or�mpiaya�. I under�tand that�epaeat� permits are r�quired f�r EL�CTRICAL, P�UMBENG, M�CNANICRL,WIN�QWS, DOCtFtS, RC}OFING and SWfMMING POQL work. QWNE�S A,FFiC?RViI": 1 eertify that �II the faregoing information is accurate and that �11 work wili be do�r� in compiiance with aIl applieable laws regulating constructian and zoning. Futhermare, � hori named eantractor ta do the work stated. Authorized aignatur�:Own�r / Applicanf t � etor i Agent C}ate §eptemb�r 16,2Q�1 Pag�4�f 4 i i r �II i I i r �������-������ ����� � �.QQSQ N.E.2r�d P,�renues Miami Shores,Florida 3313� � � " � � . ,�� r�i: ��as}��s-zza�F�x:��os)�s�-$��2 ��`� � � �n�s��crr�ary�.�N���c��v�n��m�E�:��o���sz-�s�� ���,. � *�° mv ��..w � �.,.�._ � _ ����.� t ' ast�r P�rrnit N�. ��-Q4�19��02 � � ' St�b��rm�t I��. ❑�u���€rv� ❑ ���c�R�� � Rao���� ❑ ��v�s1�� ❑ Ex-rE�s��� �RE��w�� [�P�un�a��� ❑ ��c����c�� ❑�u���cwo��s ❑ cH���E oF ❑ �a��EL�a-rcc�� ❑ s�oP CC}NTRACTQR �RAWINGS )��a���E��: �23 NE 99 ST Citv: Miami Shores Countv: Miami Dade Zi� F�ti�/Parcel#: �1����������� Is tF►e Buildin�Hi�fiarica6ly�esi�nat�d:Yes NQ Qccupancy�fype: Load: Construction Type: Fload Zone: BFE: FFE: �v�ttdER: Name(Fee Simpie Titleholder}.(�LIVEN� CRC}tJP I-I�M�� L�G Phone�s: �345}753�111� �ddress:293 N� 61 �T City: 1111�IAM1 State: ��{��IC�A �i�: 33137 TenantJ�essee Name: Phone#: �ma��: nbra�f��rie�gm�il,��m ��t��' C�'��:Cc�mpar�y�ame: R� �(�N�TRI��T'!�N INV��`���(�ETS, I��� �ho�e#: 3Q5-975-4156 �ddress: �40� �Rl����.L ��Y ����T �15 �,ty: �I��11 state: FL�RI�� ���: 33131 C2ualifier�Iame: RI�AF2D� �A�F���A �hanet�: State Certification ar Regis�ration#: CC`aC054329 Certificate of Cc�mpetency#: ��S�Gtv��;Archit�ct/�ngir�eer: C)EP�I�� �R��CM�I� Phone#: 3Q5.�03.5397 Address: City: State: Zip: Vaiue af Work for this�ermit:$ �.� �� �' SquarejE�n��r Foota�e of Work; 3,600 Type of W�rk: I._._I Addition ❑ A,Iteration ❑ New ❑ RepairJReplace ❑ �er�olition e��s�r�ption of Wark� CN�NC�E �F �CJNT�A�CTC�R S �c�i c�l�r of c�l�r thru fi�l�: Submittal F�e$ Permit F�e$ CGF$ ��!jCC$ Scannin�F��$ R�don F�e$ DBPR$ Notary$ T�chnolagy Fee$ Tr�inin�f Educati�n F�e$ @auble Fge$ Stru�tural Reuie �$ Band$ TOTAL FEE N�W�UE�� ' � {fte��sedoz/2�1zo2a) « ��ndin�Cor�pany's l�ame(if applieable} 6ondin�Company's Addr�ss City State Zip Mc�rt����L�nd�r`s Name(if app(icable} I�ort������nd�r's�lddr�ss �ity 5���� 2ip Applie�ticrr� is h�r��y made t��btain a permit to dca th� work ar�d inst�llati�ns�s indic�t�d. 1 c�rtify that no wcrrk or installation has c�mmenced pricar to th� issu�ne� �f a p�rmit and that �II w�rk will be perform�d t� m�et th� st�nd�rds �f al( laws re�ulating ccsns�ructian in th�s juri�d�ction. I und�rstand th�t a separate permit musfi b� secured f�r ElE�'TRIC, PLUkVI�lRIf�, SIGNS, P�C?l�S, FURNA�ES, �t�[LERS,NE�T'ERS,TANKS,AER��f�E�ITIC}NERS,ET�...,. � NER'S AFFIDA�IT'� I e�rtify that all th� f�are�oin� infsrr�atien is accurat� and that all �ark will be dan� in campli�nee wifih �II �pplicable laws regc�la�ira�c�nstru�tion�r�d zaaning, „ 1 T E : Y � I�U T C TI�E F � E CE E 1° 1� ES LT I V P YI ICE F I F' VE E TS 1` Y PE e IF Y 1 TE D T T 1 FI �1 , � Sl�IT I°T Y' CE � R EY EF E E� 1 � T � 1��e� � 4 � �� `�'otl Nc�t�c� to,4��aldcant: �4s�conditic�n ta th��ssua�rrc��f�buil�ing p�rmit�vrth czn esfirrrert�d value ex�eedr`ng$25(7Q, the nppli�ant rraust �romise tn g�ad faith the�t a ceapy c�f th� no�Ic� e�f��rrrrrren�errr�rat�nd ec�nstru�fion lierr l�w brca�h�rre wrr'fl be��llvere�to th�pers�n avh��e pr�perty os subjeet fca c�ctachment, ,Qts�, �r c�rtr`fi�c�ccapy caf the re�cord�d rrcatic�caf cr�mmc�ne�rrrent rnust be�ost��at th�jc�b sdt� for the first irrs,�eeti�n whrch �c�urs sev�n �T) �ays aft�r th� buitding �aermit rs issuecf. (rr the abserrc� of suct� p�st�d ns�tr`ce, the inspectr�n wilt n�t be� ��and a r�insp�etian fee wf!!be charged. _.. �""�� % M , ,. .. , �: � ._ . _� � �� ��--� _. -�~� ___�� _._; __ _ Si�natu�= `�� Si�rtatt�re CtWP1ER c�e A�Et�'f Ct�t�TRACTt�R Th�for�gc�eng instrur��nt r�as ackn�w(�dged befer�m�this Th�fore�ain�instrument was�cknowled��d bef�re me tMfs 1�t a�y c�f Ju�� �� 21 �Y 1�t aay o�Jun� �� 2021 �v N��ol�� �r�a�h�ri� w��is��rsc�n��iy�n��n�� Ri��rd� �abr�r� wt,c���p�rs�n���y�n��r�c� m�ar who has prc�de�eed as me c�r�vho has prod�ae�d _ , as id�nti�e�tic�n and who did take an F�. idencifie�tion and wha did t�k��n�ath. Rit?TAR�I Pl1BlIC�;,�''_ f'�`� N�TARY Pl1EtCl�; �'� "'� . , �` ' � ���``�� �� .�F�f� s���,: .� ���`� s�gn; � Print:��r��� �,�St��IQC1 Print: D� �1 ��St�IlCtil SE�I� �T nt�t�ry Pu�ttc st�tes ov Fs��c9� Seal: a�' hto4�ey F�uahc st�t��t F�arEct� g� , [�A��{3�t�� TEL�t�i� .� ��A����.C,4�TE��"}N � hAy G�t71€�t���t F9ti 0�1�35 � . e �ty C��`tmESS� Mhf @07�35 ��' � �ce(zfe��f�tt� C}2A � �� ��,� �xp�r��Ot3l06�2924 �r���*�*��* t� »: a�x������������:�� ���x�v��»:���e�r��**���*��a���a:a��*�a�u�a�*������+�*a��:a�*��a�a��:a���x���*�**��+�*��#��u��* RPPRCIVE��Y �� �� Plans Examin�r Z�nin� Sfiructura!R��iew �lerk (Rev�s�aazla4lao�a} ♦��4R�� �'I � �� iarni h�r-es ill��� i�M• �� �11YlM� �� � �����'��tM�p�Y� �� 1��" �QQ��} N.�.�t�t� �X�IIU� Miami Sh�res, Fl�rida 33!3$ �`�1: (3�5} 795.220� F : {305} 756.�972 / t P�r° �t N.RC-04-19-8Q2 t�wner's Nam� (Fee Simple Tiele Halder):TNE�LEVINE GRC?UP HOM�S �LG PhQne #:305-30Q��174 Owner's �ddress: 293 NO�TN�AST 61ST �TRE�T City; MIAMI Stat� : �� �ip Cade:33137 �ab Atidress (C�f where work is being dc�ne}:123 Rl� 9�th Street City: i� i Shores State:�Fl�r�da �ip �ode;33138 �ontra�tor's ��mpany Nam�: RLL A�C}UT �0�1STRUCTIC?N Phone#:786�487-6133 �lddress: 13375 NE 4 CT �ity: tVQRTH MIAMI State:F�- Zip Cade,33169 Qualifser's Nam� : � .� �� Lic. Number: j.� � ,0.rehit�et/ Engine�r of Ree�rd Name: Phorr� #: Address: City: St�te: �ip �c�de: eserib� cx�k; � � � �I� �� 1 �re y c� �fy t at th� �rlc has ��n �n �r�e an lor t e �c� tract �l rc ite�ct is ur�abl� or� un ill'n �a ��► plete �h� +cor�tra�t. 1 k�o! tF�e �ildin, fEiei�l an t e f � s r� i ,`Shcar�s harmless of all I��cLI It1V!DIV�� 'nt� +�� ��_� ��., `�` �I �� ,`�"�'' .....�,'���/��i Signature Sign�t�r� , ��,�� � -: ,� �- �` �� Ow� Agenc ��� � Concract r or Architect The faregaing instrument was aknowledged before me The for�going instrument was aknowled�ed befare me this ��5 day of �,� �,2Q2��,by ��c���t ��'� ��z�ti,��.�, this �� day of � , 2 by�(� �s Wh� is per�c�nally known me or who has produced who is p�rsoe�ally known to m� or wh� has praduced � � �` � '�� �as indentification. �� as i�dentifieatian. Notary PubE n � FVcatar�r �"u ic: �,,���d�,P,.,, ���44EL �..�1`�t1� Sign: � "���t�ry P�bti�a�t�e��f Flczri�� Sign: P�F:,,, ,, � ,,� '�,'� ��� �ai ��m�i��i�n E�pir�� � t ,�: Seal: S��I: o � ti�{ w�t�G30��8� "`'�rrrr�i;°°� ��pf�tTtb�t 2�, 2Q24 `� ` F`�s i}�l�4� '�Iarct�?`�,���23 �eo x a R.C,G�N C�"I�N�I E�'t'�IE S,LLC 14���RI�KELL Y DR�1�.S� �15 �IA�1,FI� �31 TEI,3Q5 975-415� E 1�:r������� ����.��r� [�ate: �� � � ���� St�t�af _�t��C"�t��� C�untyca� ��t`p`�e �"'�L � ��� `��,-. �� ; �� �efore me�his day persor��Ely appear�d ����;�'�°��� �����'�����C�_ Who, bein�dufy swcarn, d�p�s�s�nd s�yse That he or she u�rill b�th��n6y p�rsar�w�r�ing c�r�th� pro��ct I�acated at: �� � �'��: ��`���'�', `<����.�� �--��Fa � ��.�..�'`�.� `� �._, F � :�.� R� � � Cc�r�tr�ct�r Si�nataar� � Swr�r�t�(ar af�irm�d} �nd subscribed bef�ar� m�this i� day�f m��.� =' , 20 �� g �--`��,��.�� �, �� � .� Y �` �'.� P�rsonalCy Know C}r Prc�duced Ed�ntifieati�n �__ Type e�f Id�ntification Produced r' �� �.�� t ''" '" } `.��µ � �' .�`�/l���,t ���.�'� �,� �' ��.�� � Print,l�yp��r Stamp Rl�m�of��tary �- � H�z ��ai�c sa�c���E�,� � t�,��it��t�,��T��t�3t� � �y c�m�,��s ��s oor�as ���� �ra�sre�ffi Qsro� 2�t � �����;.���� � � � �� �� 1� 1 tl�° � I�� �«�� � �� �� ���.� �E,Il�dlr�� Dep�r�l"�"1�11� �,�������� �o��o �v.�.z�►� ����,�� �t��t"��'' Miarni �hore�, Florida 3313� Tel: (305} 795.2204 �axw (3Q5} 756.�972 1 1" � C �' ' 1 � C 1 , h� , �, ,. 1 R "'�\ i �S.\ t `-,. .1�>.� i .2. '.I '�. \ t l .5�. 'l..` 1 �C.. ..\ '� \ .. \ Si,', l . \ \ . `,.\ �. S �.tip ti..: ..1 . � .\l��� .�.t`.. l \.., > l � l t i. S... t , l. , � \ \ . ,.?:\ \...... �� S S '\ .e, h \ �.. ';,.:): . C,�... . "`.. . t ., S. 2 . � \ 1���: . S'�� ��� . ��\�s. .\.. � .4. .C... ..1 . ti i `� \ `� � t ,\ . �` �.,� �....,,..� �.s ��� . ��. � . ti�.. l .�� z ..:..�\ �.,.,.s. . �,�.,� . ���;^. ���C. . \ .\.. - t. , t ..l . \..\. S. . ..1 ��.;� \ . ,t t \.,,1}... .<\ . � ..:�'� \�.. ..�.. 4 .� '' . .\ \�..,i . l..rk �,... `.. \ c .\.i\ l. �,`*�. � ..\ �l� .,\. �. .\. \�lT .\.. .b. .<\ . �:: ...1 ... ',< .�\�. ..\t�,. . .l r1,,... ..ti,. \� � i -T. �.. �.\. \i.. }. �, l T. \ \ �l. 3.� `� .�.. \� ', .\.a. ,�. �.,\ ? \.„...,1 . .{ �,... '.. ..�- ,t .�, �. ,..�, �: �.. t�� t .� � .� t �. 4 1 \. . �...L. \. ,� .y t �,. �, l *.� ..l . l, ,,. � :.1..\ .\ ..� .;..a t�- .\. .O t } ��l ,� . .. ,� .. i �, .\ l ? �., . �.. . �.`\. �. S.. .�' �.. Z. .. , ,1. � .�4� ,.< <o- j,S��tis1�,a} ..t�.,k�>....�,.,.r� �T�,�;.�*�>��1,�.-.�,,..1 ,.<��« , .� .;�,ez,t;�,,,�A,.�\�s.A\.t,.�,.��SSo..i�.,.. ...,$�..i �„�.tit�saz'a,�\�?.,ti.Az� �. , �. � ,\�,1,5\, .`,<�„�.�„�'„A l<wli� „�4,�., fi;1.eL\,.»\:y,•'��.���,��,.: Fiorida L�w reqt�ires Wc�rkers' Comp�rtsat�c�n insc�raz�ce ctauer�ge under �h�pter 440 of the F'lorid� Statt�tes. Fia. Stat. § 440.OS �ltows corpcaz��te�fficers in the cons ctic�n industry tc>�x�rnpt themselves frorn this requirement for y construction project prior to obt�ining a bu�lding permit. �'ursuant to th�Flarida I�ivision of Worl��rs' Compens�tian EznpiQy�r Facts�rochure: An eznployer zn the canstrt�cCic�n industry who employs one ar more part-time ar fult-time employ��s, inciuding th�o er,must erbtain wQrkers'cca�np�nsatic�n cc�verage. Gorporate afficers or members of a limr`ted Ii�bility cotnp�ny {I.,I.C) i� the canstructic�n indust�y na�y ele�t to be exempt if: 1. The offic�r own�at least I(�percent of the stock of the�orporatian, c�r in the case of LLC,a statement attestiza�to the mznim l0 perc�nt Qwnersh�p, 2. The offic�r �s listect as an affzcer c�f th� corporation in tl�� records of th� F2orida L?�pa �nt c�f�tate,L�ivision of Cor{ac�rations;and 3. Th� carporatior� is r��i�t�red �nd listed as activ� with the Florida D�pariment of St�te,Div�s��n of Carparations. No more than three corpo te officers per cc�rpora�ion or limited liabitity company members are aliowed to be exempt. �ons ctic�n exemptic�ns are valid far a peric�d of two y�ars er until a votuntar�revocatsar�is�Z1ed c�r the exemptian is revc�ked t�y the Division. Ya�aa-cantra�tar is requestin�a pe �t und�r this workers' �cs�tapensatzon exemp�ian and has acknowied�e tls�t he or she w�ti nat use day labc�r,part-time�mplray�es oz-subcontractors for your proje�t.The can��ctcar has pravzd�d aff d�vit stating�hat h�or she will b�the only person a11av✓ed to work on yo project. In these circumstances,Mzami Shares Village doe�na�t require v�ri�cation of workers' comp�.n�ation insur ce covera��frc�rn the cantraetor's campa�y far day labor,partetim���aployees or subcontractors. Ii1' SIGNING BELQW Y�U AC QWL,EDCiE THAT YOU HAVE RE THIS NQTICE d4NZ> UNIJF'RSTAND FTS Ct)NTENTS. �_�...�_-- _ �-� ��� �� , �.___� Signature• -_ .�. .�-�-��a�, � Q�wner State c�f Florida County c�f Miarn�-Dade Th�foreg in�was aeknowledge before rrae this day af ��� l�� ,20 � � By � ��'�° �-� wt�o is person�t(y knc�wn tc�me t�r h�s produced ; as identificat�on. NatarYa ��� � ��° ��t���u�ti�st�6��F lear�c�v SE . _ � �����L�.��tE�.�.�)t� ..---� . ����re,� ��o����� ��