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DS-19-557Pere nr"t No.: DS-©3-19-557 Miami Shores Village Permit r YFe: Driveways/Sidewalks/Slabs 10050 NE 2 Ave Miami Shores FL 33138 I Work Classification: Addition/Alteration 305-795-2204 Permit Status Approved Issue D-08/82/2019 Expiration: 01/29/2020 Location Address Parcel Number 9636 NE 2ND AVE, Miami Shores, FL 33138 1132060132500 Contacts Palazzo Leoni Inc. Owner J&R STRIPING CORP Contractor PO BOX 381703 RAQUEL GROVE LLANOS Business: 7865566406 Description: RE -STRIPE PARKING LOT Valuation: $ 1,500.00 Inspection Requests: TotalSq Feet: 10'000.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 Concrete/asphalt/pavers, slabs, dways, $525.00 swalks DBPR Fee $8.63 DCA Fee $5.75 Education Surcharge $0.40 Planning and Zoning Review Fee $50.00 Scanning Fee $9.00 Technology Fee $14.38 Total: $664.36 Building Department Copy Payments Date Paid Amt Paid Total Fees $664.36 Credit Card 08/02/2019 $614.36 Credit Card 03/13/2019 $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, Zerm, CHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify hat information is accurate and that all work will be done in compli nee with all applicable laws regulating construction and zoni g. F trize the above named contractor to do the work stated. J Q L Authorized Signature: Ow4r / Applicant / Contractor / Agent August 02, 2019 Page 2 of 2 RECEIVED Miami Shores Village MAR13 201s g p � ti�� � � Buildin De artment S V \ 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 hCA , U Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 201:4 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. YUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENE:WAL [—]PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS I ��3 h N JOB ADDRESS: Z' A-v\R-- _ City: Miami -Shores County: Miami Dade Zip: 3 , 3 q Folio/Parcel#: [ 32 O 6 -c)13 — 250--o Is the Building Historically Designated: Yes NO .� Occupancy Type: Load: Construction Type: Flood Zone: BFE: ' FFE: OWNER: Nam (Fee Simple Titleholder): Phone#: Address: �� ��� 3. I City: �rQM �' State: �� Zip: 33 L3 9 !' Tenant/Lessee Name: _ Phone#:_ Email: �ervi �6/✓I PC�'ll GS , Go rvn CONTRACTOR: Company me S�Y1 ^► t� �o� ���— p Y Na` _ P �p ' Phone; Address: % ()3 �rG \sy ST City: ��►Mn�l State: L_ Zip:��✓' Qualifier Name: Cl4„C�.V e-i i.�Q� 0 5 Phone#.GG _�•� ����1' State Certification or Registration #: _Certificate of Competency #: DESIGNER: Architect/Engineer: hone#: Address: ii City: State: Zip: Value of Work for this Permit: $ l 150 Square/Linear Footage of Work: /v7 v-z'-D Type of Work: ❑ Addition ❑ Alteration 5 New ❑ Repair/Replace Description of Work: Pe_ 5-�r:Pe- Pc`rV—`1"3 Io Specify color of color thru the: Submittal Fee Scanning Fee $ _ Technology Fee $ Permit Fee $ Radon Fee $ Training/Education Fee $ ❑ Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ _ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ � . 3 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 ►9 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 whit occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approv4d and a reinspection fee will be charged. Signa L". ER or AGENT The f regoing instrument was acknowledged before me this ay of(T,�rj6,,r 20 _, by Lwho is personally known to me or who has produced identification and who did take an oath. NOTARY PU IC: Sign: ,o Print: as Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of � V ` W CV\ 20 1 by l %M who is ersonally known to me or who has produced L cvwS as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: Seal: :•: �. MY COMMISSION # GG 10697 "^ ArTDREW VOGEL EXPIRES: July 27, 2021 MY COMMISSION # FF919683 %'r • t: EXPIRES: November 25, 2019 ••;;odF °' E;onded TT�N N018fy PUS Uilers M1 APPROVED BY 1 Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk 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 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: 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 ' BE OW 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 j� 1—% & V day of� , 20L-L. By . Z. V/J �/ L N / who is personally known to me or has produced as identification. Notary:. t� s ANDREW VOGEL MY COMMISSION # FF919683 a EXPIRES: November25, 2019 SEAL: J + R Striping C;om 103 NE 154ul St N, Miami Beach, Florida 33162 736r282-0256 Yl 1/19 State of Florida County of Miami -Dade Before me this day personally appeared 1�1 1)� ��� oa being duly sworn, deposes ana sav s: That he or she will be the only person, working on the project located at: 9636 N9 2nn,Aye Miaxni Florida 331.3R C;orntractor sistnatme S-worn to for affirmed and subscribed before me this ,� day of �% ..2019, A4 La Personally Known OR, Produced Identification 1,ype of Identification ERICA C, HAYNE MY COMMISSION # GG 106978 EXPIRES: July 27, 2021 Bonded mru Notary Public Wdwv Mm Print, type or Stamp Name of" Notary 3/13/2019 Detail by Entity Name Detail by Entity Name Florida Limited Liability Company PALAZZO LEONI LLC Filina Information Document Number L13000150548 FEI/EIN Number 46-4350354 Date Filed 10/25/2013 Effective Date 10/25/2013 State FL Status ACTIVE Principal Address 9600 NE 2 AVE MIAMI, FL 33138 Mailing Address PO BOX 381703 MIAMI 33238 AF Changed: 03/06/2014 Registered Agent Name & Address LEONI, TODD 9600 NE 2 AVE MIAMI, FL 33138 Authorized Person(s) Detail Name & Address Title MGRM LEONI, TODD 9600 NE 2 AVE MIAMI, FL 33238 Annual Reports Report Year Filed Date 2016 03/31 /2016 2017 03/20/2017 2018 03/28/2018 Document Images 03/2812018 — ANNUAL REPORT View image in PDF format 03/20,12017 — ANNUAL REPORT View image in PDF format 03131/2016 — ANNUAL REPORT View image in PDF format 03/19/2015 — ANNUAL REPORT View image in PDF format 03/06/2014 — ANNUAL REPORT View image in PDF format 10/25/2013 — Florida Limited Liability View image in PDF fonnat http://search.sunbiz.org/Inquiry/CorporabonSearctVSearchResultDetaiI?i nquirytype=EnttyN ame&direcbonType= Initial&searchNameOrder=PALAZZOLEON 1°/a .. 213 IV J&R STRIPING CORPORATION 103 N.E.154TH STREET NORTH MIAMI BEACH, FL 33162 TEL/CEL: 786-282-0256 July 23, 2019 Miami Shores Village, Bldg. Dept. 10050 N.E. 2nd Avenue Miami Shores, FL 33138 Re: Permit No: 19-557, Jobsites: 9636 N.E. 2nd Avenue Miami Shores, FL 33138 Dear Sir or Madam: In reference to the above -mentioned permits, please be assured that all striping will be done in accordance with all -codes and zoning requirements. Specifically, all drive lanes will be at least 24' wide, and all parking spaces will be 81/2' x 18'. All ADA spaces will be 12' x 18, as well as the 5' space adjacent to ADA parking. Respectfully Submitted �J Raquel Grove Llanos, President eof e r lI Lutz F rt �ctT & Dtir ,xie>e=s .......... ,5'P4 c 4L gd—riPZ� HE 871h SrOPET IAP OF BOUNDARY SURVEY GRAPHIC SCALE N r E i ut 3AN. I AUk ® FlMh, w AM ­TWMS .w•.,.�w.r:..,r..u,.n.wm.:nw.w mmrw. w�:.::,m� �`• 4i L. V L30A1ION3NETCN T..r. LEGAL OESCRS'nON: P ERTYADORESS: cERmunox: lFOAI NOTES TOACCOWANY31(ETCX OFSURNEY' %Fi�RIIr iFEgiYA'f�Fai4GF6w 1T�x-€ems xo mxapr r .ro ratvruo.rvsiauo r to tFdfirwa uur.riore ATamK'noxi Ass[Av.nrAN ae YAuu[ns rP4i.ieoa u.esso3[xrEo r.A.xucrroscue.rax.uam mvTai .w3wu Tonunxau.rav rara FLOOOZONEOIR WnMQONrte M:Aawusuueo:.w rcr vruuuw SUR�YOVE RSNOIEJ. l��Loio u:uAM[oNO:O:.x er SrLMrn cW:rv�amxs�3�G rnartmr.lr wreersmY rm rnM�rtwNoio LEGEND �S- b7 I \ 5 s /, �-- t-- RECEIVED MAR 13 2019 kj;h • i i • • � cl 4w S5,4