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(�ceupancy Type: Laad: Constructi��Type�� �Flood Zone: �FE� FFE:
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Quali�er Nam�: GL c'"� ��� �j� i ~f�'f c� Ahc�n�#: • �" �� c�
State C�rtifcation c�r Registratic�rr#: �� /� ,�11"� ,�� Ceetific�te of C�mp�t�ncy#: ,� ��7�'��C� `�
DESI�RIER;,4rchit En�ine�r: Rhone#: O
Address: Cit)°� State: Z p:
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Vatu�of Wc�rk fur thi�Pe it:$ ��- `��qaar�/L`rn�ar Faoia�e o�1Nark:
Type of W�+rk: ❑ �dditic�n [� Alteratiora IVew
❑ Repaie/Rep{ac� � [7e nolition
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Scannit��Eee� Radan F�e$ E?�PR$ M�t�ry$
T hnologY 5 Tr�iningjEduc�tacsn Fee$ Qaubl�Fee$
StructuraE Revie $ ��nd$
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Laeation Address Parcel fUumber
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123 P�tE 99 ST 12320602321�1
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� THE OLfViNE 6R�UF HOMES LEC C#wn�r SUNSHINE EIECTRICAL GONTRACTC�RS Cc�ntractcrr
� zs���sz sr,n��,�n�i,������� eo��
� �usin�ss:3Q53005174 MARIANO SANTI�STE�AN
� 13QQ SW 85 CT,MEAMI,FL 33144
,
� Business:3Q52654958
Ncame:7864439590
� Other:7fi62736194
i
z �Ll A�OUT CC}NSTRUCTIQN IM1lC A�ent
i
o�iel toleda
� 455 s biscayn�river dr,miami,F�33169
; �usiness 305-3QQ-5174 aacelectricaEe@gmail.eom
Mobile:305-3Q0-5174
s . „ a�a�a
w.w_._wa.m__.�_.��.M._�..mw_.__.._�w.......��......_.._...�...__.........._._..._....._,_._..,__.___.�....._._..._�..�_.............._................_.........._.......�..� F...,,_..._.�.__..�....�.....n......__....r_.....__.._.�_..�....�_....�._.w...._.._._......_.�.....,..,
' !ns �ct�ern Re��s
� E��seription: NEW SENCa�E STORY,4 B�DROOMS,3 i V�lu�tian: �29,000.00 � ���',������ � �
; BATHROQMS,SfNGLE FAMELY NQME 36QQ SC2FT QF TOTA� � ` ` " \��<��°��
E CONSTRUCTION � 'Fotat Sq Fe�t: 3,604=�0 � ,,_ , � ,, � � <� � �� ?;�
: � �. �.. .. , ,., �
; 123NE94ST �
; ��-��as-az�-�2�z
�
` ��Y Rur�
F�es Amount �a�ments �ate Paid Amt Faid
Appiicatian Fee-Qther $50.00 Tota1 F�es $1,1��.7�
eeF $57.40 Check#1020 Q1/13J2021 $2,�3$.?Q
Char�ge af Can[ractor $110.00 Credit Card 06/21/2021 �110.Q0
DBPR Fee 513.45
QCA Fee 58.70 A€�tc�urtt Du�: $4.�0
Educat�on Sureharge S5.$0 � �
Permit Fee $82Q.0�
Scanning Fee SSQ2.dQ
Techno[agy Fee $21.75
Tc�tal: $1,248.7Q
uil In e nt
En consideration of the issuance to m� of this permit, ! agree to perform the work couered her�under in compiiance with all ordinances and regulations
pertaining th�reto and irt striet confctrmity with the plans, drawings, statsments or specifiicatio�s submitted to th� prpper authori#ies af Miami Shor�s
Village. In acc�pting this p�rmit I assume responsibility for a!l work done by eitt��r my�elf, my agent, servants, or�mp�oyes. { under�t�nd that sepaeafe
permits aee required fcar�L�CTRIGA�, PIUM�IPJG, MECHANICAL,WINDflWS, DQQRS, RC3QFING and SWItv�MING POOLwork.
�WN�RS AFFIC?AVIT: I certify that al! the foregoing informatita� iS acc te and tha all wark will be done in compliance with alI applicable Iaws
regu(�ting constructian and zoning. Futhermare, I authorize the�bove nam cont a�t �t do th�work stated.
,�
Ruthorized Signature:t?wn�:r ( Applieant f Cantraetor ! ge Date
lune 21,2021 �_ Page 2 of 2
�andin�Company`s Name(if a{aplicabl�}
Bonding Campany's Address __� _
City _State Zip
Morigage�ender's Narrre(if applieabie}
Mort�ag�Lend�r's Address
City State Zip
Applieation is h�ereby made to obtain a permit ea da the wc�rk and installations as indic�ted. I certify ehat nQ�rork or installac'sc�n has
eommeneed prior ta the iss€aance of a permit and that aN wr�rk will be perfarmed to meet the standards af ail iaws regulating
canstruction in this jurisdiction. I understand that a separate permit must be secured for EIECTRIC, PttJMBING, SIGNS, PQC}LS,
FURNACES,BC71t�ERS, HEATERS,TAM1IKS,AIR CQRIC?ITIdNERS, ETC.....
�WNER'S AFFID�VIT`: E cerLify that all the fnre�oing informatian is aceurate and that aEl work will he don� in camplianee with alE
applicabl�laws regulating construction and zoning.
tf M�N� .13 i 4f ��1'4. T i.�Li(1 1"�I��R� F LO �im48.P(14J tY i.lT�i+E 6Jf S.� � 44 � ( M�
RESULT IN YC}UR PAY�NG T ICE FpFt I RR�VEMEN`TS T Y UR PROPER , IF Yt?U t TEN
T� C> TA1 FIN�NCING, C�RISULT WITH Y4l�R CEN�ER �R AN A �RNEY EF�RE RECQ �1lV�
Yql1R N TICE �F C ENCE E T."
�
IVoziee to Apptieant; �s a ctzrtdition to the rssuance af a building permit wrch an estimatet�valr��exc�eding�25Q0, the appfieant must
prornise in good�nith that a eopy t�f the nQtice a�eamm�neerr�ent t�nd construction tien law brocht�re wlll b� delivered ta the person
vuhc�se pro�aerty is subject tc�aftachr�a�nt. ,4tso, c�eertified eopy e�f fhe recorded notiee of commerac�ment must be posted at the jvb site
for the first inspection which oecurs seuen (7� days after the 6uildrng permit is issued. Ir� the cabsence of such pasted notice, the
inspeetion wi((nat be ap�rroved and c�reinspeccron fee will be chcrrged.
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Signature_ � Si�nature �_`�`,��`�,��"��'�'���� �„M �.�������`� , �•��� ��.�;
OWNER or�E�ENT CQRJTftACTC}R
The foregaing insteument was acknawledged befare me this The fore�ain�instrumen�was ael<na�ledged b�fore me this
day of ,20 t� , by ��� day o ____�.�,2� �� f , �Y
� � �
i � _,wha is personall known�to ,�vhc�is personally knawr�ta
me or wha has produced as me or who has produc�d �..'�� ,��° '.�� �as
id�n�iffc�tic�n and who did take an oath. ide�tifica�ion and whc�did take ar�Qath.
NC?'��RY RtJ�LIG: lVOTARY PU�LIC:
, f" �
Sign: Si�n:
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Print: � , ��� Prin �� ` �� � �f��'�;�'�—� ,�-���`� � �;
S�al: ,�a*�•"4e. NaY�ry 6'uCs1�c�t�ta�f Ftor�d� SeaE '*� k^ C�mm6ssion k�i6 9fi2f353
�yR z� ����v���.�f1�.���,.��� „.�,� ,�'< �}+�Ctt11CXt. �M(?IE@�a�}3���?'�Q2A
'R �'at�?fl11TY1 �����4�� �F��t�t{4��,' �QPI(��('��h[QU�t1
��� ��p�r�� 2� huckleb�try E4ae�ry Banding tnc
*���a���� � � � � * � � �����a���*�*�a��**�s��e�*��:�w*����:���:���+��:+������������**�a��z�������a������
� � � ,
APPR�VED BY � � � ' ���^����PEans Ex�miner ZQning
Structura) Review Clerk
{Revisedaztz4lzo��}
��,�o��� �
��a�' iarni h�r�s �I1� �
�.t! � ,iiiE�
�' �
�j���$t��4� 10050 N.E.2nd ,�v�nu�
Miami Shcar�s, Flc�rida 33138
1"�t. {345) 795.2.2Q4
F : (3Q5) 756.�972
CHANGE Q� C�►NTI�.A�Tt�R / ARCFII�t�'E��'
Per it .�L-01-21487
C}wner's Name (Fee Simple Title Halder):TNE Q�IVIN� GRQIlP HOMES LLG Ph�ne #:305430Q-5174
Owner's Address: 293 NQRTNEAST 615T STREET
City. MIAMf State : F�- _ �ip Code:33137
,�ob Addr�ss (C�f where w�rk is b�ing done);�23 NE 99th Street
�it}�: M�a i Sh�r�� Scat�:�Flarida Zip Cc�d�:33138
C�ntract�r's Company Name: AL�.A�OUT Ct�NSTRUCT(QN Phone#:7�6-487�6133
Address: 13375 N� 4 CT
City: NC?RTH MIAMI State:F� Zip Code:33161
Quali�er's Name � �RNA�DC� A. TEXI�dR �ic. Number:
Ar�hit�eel Engineer of Record Name: Ph�ne #:
Addr�ss:
City. State: ��� Zip Cod�: �
� � � � '
D���P'1�@ QCIC: ��� � ' �
1 n�r� y �� °r t at t � ��k M�.s een a �r� ora� �r� 1�r t +� ��ntracto�/ar�nit�e�
is un�. I� o�r un illi� �c� I�t� �h� �cc�ntr�.�t. 1 0� the uil in E�i�l �.r� t �
��'�` � ia � ���-es harr�less of all �e� al invol�r� �r�t.
... ,��,.._ �
��� ..�,�' �
S�gnature �� a��n��ure
�.
� wner Apent Coneraetar or Architect
�h�f�regaing instrum�nt was aknowledged befare me � The fore�oing instrument was aknowledged before me
�,:
this��day of ���'�=c.-�� ,20`���,by �������� ��.�� this day of � , 20,�by . ��� �E ��'�
Who is�parsonally kn��c� me ar whc� has produced wha is perse�nall�known to me or who has �ra�dueed
� o ;� �.a �
`��` �< €.-��� �=� �-` ntification� as indenrification.
� y�"��E� ������. �.����� �C?�� �tt �i °
NUt� �,�ffi��c�ry P�bii�aSt�t�o# Fl�rid� �"}`
�� *� ��s�rr�i��ian # �IM 22743 "
SI�CI: � ' I( Sl�tt: __ �-
°Ek�i°riit«°� ���t��Y1�3�C��, �f}2� t; . � a .,tP, ��i�� ; 3�EL����i
Seal: Seal: � �� �t�����;t�1���Sit» ��t��t�a�fts
"'aaa�`` EiX]'El�t 5 \Rareh 24,2C12�
1 � � � � � �
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(�ate:
State Qf Florida
C�unty:
E�efore m� this day p�rsc�r�al�y appeared ���°����� ��'.���.� ��� ��� ���--� Whc� la�in�duly
sworn, depc�ses and says:
Th�t he �r she will be the only person wc�rking in the prajeet located at
� �� ���.� � �� ���
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�ontra te�r Signature
Swcarn t� (or affirm} and s�bscribed before me this � day c�f � 20 �- �
�����'1�;?-� �, � �_:���'����,�`.�-{` "�
Persc�nally Know
�..�
Or prc�duc�� identificatie�n �
Typ� identific�tion Prr�d�aced
s�. "1
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,,,�,,,' RAUL NAVA�R�
;�,�Y"�+`�>,y Natary Public-5c�t�s af F4orid� Rrint, tY�J� OC S��t11p Ci�i11� Of�10����
='�' �'= Cammi��ion� �G 962953
p�y "= My Gamm. Expires 03-20-202�
'�,��,��`op��` Bond�d The�ugh
Nuckleberey Nercary Esonding Ine
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,� c�c.as��� �
� i�r�i har�� ill�g�
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�. -������'� ��a�o �.�.�nd a��nu�
�� � � Mearr�i �r,car��, Floriaa �31 s�
� T�t: {3Q5} 795.2204
F�x. (3Q5}756.�972
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Ftorid� I,��u requires 1�Vc�rkers' Cc�n�pensezti��� if7slu:�zzce �«v°e�-<�ge t��lder Chapter �=�0 of tl�e k�loi-ida Statutes. FI<e. Stat. � 44t).Q5
ai(aws co�-�or�te c�fficers is�the cozlstruetion indu�try tc�exena�t theniselces fronl this rec�uireme��t fot�an�°ec��stnzctic�n p���j�ct��rior tc�
� c�bt�i�tizig�buticting p4.rtnit. Pursuatrt to the Fforida Divisic�tl of Vvc�rkers"�at»peilsation El���lc�yer I��cts Brochure:
.�t3 emplo}���� ir� tlle constructioi� indust�-� ���ho emglo}�� c�ne or rnore ��a��t-time c�r full-tirne
etZ�p�ovees, i�7clt2din�the o�uner,mt�st obtaiz7 workers' campensatian co�era�e. Corpot�ate officers
or z�ea�E�er4 of a lisnited liability com�any (LLC� in the cc���structic�i� ii�dustry may �lect tt� I��
exert�p[i1:
1. The c�fEicer c�wns at l�ast 1 Q�>ercent e�E�tix�stack af the c�rpo�•ation. �r iz���i�case of
an LLC,a st��terl�ent att�sting to tl�e nlir�i���un� 1�perceE�t ou=i�eE-sllip;
2. `I'fae ofhcer is list�d <�s aii ot�icec �f tl�e corpc>r�tion irz t�ie records a��the Flarida
L�epartm�nt ot�State,I�ileision of C'or��r�tions;�nd
3. T1�e corpotatian is registei•ed at�d (isteci as �cti4e �°ith the I�lorida I�e�artrrlent of
Statc,,I�ivisiail af Corpotations.
No mc�ie Cl�an tiuee cc�rporatc offlcers �er corp�t-ati�i� ar li�slited lixbility com���ny ��aembers are
alla���ed to t�e �xeinpt. C;c�zl,truction exez�l�tic�ns are ti�alici for a periad af two years �r uaitil a
v�luiltary revaeation is fit�d or the exeinption is revoked by the I)ivision.
Yc>u��c;antractc�r is eec{uesti�i�a�ez-nzit undez�t1�is wc���k�rs'conz�ensatian exen�ptiotl a��c�ha�acki�o��teci�e that t��or sh�wi11�lot use
day�labc�k-,��rt-time��nplc���ees or s���contr�ct�f•�far i�c�tar�a��c�j�e.t. Tlle ec�ntractor has prc���id�d an affickavit statin�tl�at l�e e�r�he v�fill
be kl�c;onty person ailow�ed to woek on your prajece. ln t]lese ciX-cuiTistar�ces,ivlian�i Sho�-es Vi(I��e ctoes nvt req�ure tir�ri�catio�7 uf�
u��orkers'�c>m�aer�s�tic�n insurance cc�l�era�e fz-e�in tl�e cc�ntraetor'�coi��ai�y tar ciay laboi�,part-tzzne�;m�lc�}`ees or sl�bcantr�ctai-s.
I3�' �IG1�IN(� I3L�:L,C�I�u` YE�tt ,1(;KNC?G�'LL:I�€;L TII.��T YC�t; It.<1L`L; I�LrII� TIIIS NtITICL: �1Nt) L.TNI>EI2ST.�NI� ITS
C;()NTF,NTS. �,,..
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Si�nati�re:
�net•
State c>f P!«rida
C'o��nty af i'��i�emi-L}ade
� Thc�t«re�c>i ��vas ackne�lil�dge bef<>re m4 this c�t�y af ,20 ��.
B�� � � �t` _w(zo is persc�nally krlow�7 to ti�e or has praduced
,f �
� as iciez�t'tficatit�n.
�c�tarv:
i+d ry�`'�tt4ic St�i��9 FS
SL;�L: � �,�E�Cs�L C T�IL�N
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