PL-19-1544Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date.47/12/2019
Location Address Parcel Number
395 NE 96TH ST, Miami Shores, FL 33138 1132060135930
Contacts
Permit NO.: PL-07-19-1644
Permit Type: Plumbing - Residential
Work Classification, Alteration
Permit Status: Approved
Expiration: 01/08/2020
GONZALO & CATHERINE AMBER PEREZ Owner
JTRS
395 NE 96 ST, MIAMI SHORES, FL 33138
SPECTRUM RENOVATIONS, LLC Contractor
EZZARD MATUTE
12985 TANGERINE BLVD, WEST PALM BEACH, FL 334122085
Business: 7864457072
Description: ADDING NEW LAUNDRY BOX FOR WASHER IN Valuation: $ 1,000.00 Inspection Requests:
KITCHEN AREA 305-762-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$0.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.20
Permit Fee
$50.00
Scanning Fee
$3.00
Technology Fee
$2.50
Total:
$110.30
Payments
Date Paid Amt Paid
Total Fees
$110.30
Credit Card
07/05/2019 $50.00
Credit Card
07/12/2019 $60.30
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 th I the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating co and uthermore, I authorize the above named contractor to do the work stated.
Owner / Applicant / Contractor 1 Agent
Date
12, 2019 Page 2 of 2
"7 I �,� I ion
Miami Shores Village
CE
BUILDING
PERMIT APPLICATION
Building Department JUL 0 2019
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
Master Permit No.^ ! — (S - CJ1
S G
Sub Permit No, L 0l—] c_ 1 S !` 1
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION 0 RENEWAL
PLUMBING ❑ MECHANICAL Ej PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
/ CONTRACTOR DRAWINGS
JOB ADDRESS: 375 �I b 4
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): t7%/o% ZGa (y f-e rt Z_ Phone#:
ol
Address: 3 ? 57 Al ✓ '�/ 6 S+-
City:(^I% -Q `7 State:
Tenant/Lessee Name:
Email
63`,,l-C42 - 5
f _ Zip`��c`�G��-
Phone#:
CONTRACTOR: Company Name: SPECTRUM RENOVATIONS, LLC Phone#: 561-291-8350
Address: 12985 TANGERINE BLVD
City: WEST PALM BEACH State: FL Zip: 33412
Qualifier Name: EZZARD C MATUTE Phone#: 561-685-1024
State Certification or Registration #: CFC 1427616 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City:
Value of Work for this Permit: U 00 Square/Linear Footage of Work:
Type of Work: ❑ Addition " Alteration / �❑ New ❑rRepair/Replace
Description of Work: Qddz ham, a ezA) �4 G�km d ✓` y &)( T cy 1, Aq
Specify color of color thru tile:
Submittal Fee $ l Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
CCF $_
DBPR $
State: Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $
Bond $
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 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 posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
N or
The foregoing instrument was acknowledged before me this
day of 20 by
ho is personally k wn to
p Y
me or who has produced
identification and who
NOTARY
MAI RAPHAEL
°.•�: <. Notary.Public — State of Florida
Commission # GG 171005
My omm. Expires Dec 26. 2021
Qbndbd Tnoto Namna, Notary Assn.
Signature 5� �s
CONTRACTOR
The foregoing instrument was acknowledged before me this
day of 20 101 by
who is personally known to
as me or who has produced
as
identification a o did take an oath.
NO TAR ,PUBLIC: ��°� MAIRAPHAEL
Notary.Public — State of Florida
' = Commission # GG 171005
I ;,�y bfy Comm. Expires Dec 26.2021
c i.. Boded 3wougn Nawns, NotaryAssn.
Print: \ ( J \\/'\ \V \ _ I Print:
Seal: Seal:
************************************************************************************************************
APPROVED BY ��/ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Spectrum
ons, uc
CGC1513036 CCC1327978 CFC1427616 CMC1249932
Date: July 11th, 2019
State of Florida County
of Miami -Dade
Before me this day personally appeared Ezzard C Matute who, being duly sworn, deposes
and says:
That he or she will be the only person working on the project located at:
395 NE 96th St.
Contractor Signature
Sworn to (or affirmed) and subscribed before me this i \ day of 1 .20d
by 9'7_Z A b A+e;--
Personally know,
OR Produced Identification
Type of Identification Prod
X
Print, Type or Stamp Name of Notary
12985 Tangerine Blvd West Palm Beach, FL 33412
T:561-291-8350 F:561-370-7019 chris@spectrum-renovations.com www.spectrum-renovations.com
Notice to Owner — Workers' Com
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation Insurance Exemption
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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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
MAI RAPHAEL
i . Note y.Public - State of Florida
Corrmissior if GG ' 71 QC$
My Comm. Expires Dec 26. 2N'
Sonded:hro,gnNa',rona Nc:a�yAssr.
The foregoing was acknowledge before me this �� day of 20-11—.
By & 0 A ZGt who is personally known to me or has produced
as identification.
Notara
SEAL: