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EL-19-719Permit NO.: EL-04-1`9-719 Miami Shores Village Permit Type: Electrical - Resider�ai 10050 NE 2 Ave 11 1! 1 y� Miami Shores FL 33138 } Work Classification., Alteration 305-795-2204 1 Permit Status: Approved 20191 Expiration: 12/02/2019 Location Address Parcel Number 351 NE 105TH ST, Miami Shores, FL 33138 1122310130290 Contacts JERRY AND SARAH ENGEL Owner SAME & Q ELECTRIC INC Contractor 351 NE 105 ST, MIAMI SHORES, FL 33138 MANUEL E QUESADA 5310 SW 7 ST, CORAL GABLES, FL 33134 Business: 3052190427 Description: REPLACEMENT LIGHT FIXTURES AT KITCHEN Valuation: $ 2,000.00 Inspection Requests: FAMILY ROOM AND BATHROOM AND HALLWAY TO REPLACE 3054 949 PERMIT#EL17-2366 Total Sq Feet: 600.00 Fees Amount 100% Permit Renewal Fee $100.00 Application Fee - Other $50.00 Total: $150.00 Payments Date Paid Amt Paid Total Fees $150.00 Credit Card 04/03/2019 $50.00 Check # 553 06/05/2019 $100.00 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 age�t, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFIN 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 regulating construction and zoning. Futhermore, I authorize the above named contractor to do thew rk stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date June 05, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING A ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 P�(jy Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 9.c 0449-�1 Master Permit No. Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEW"' ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: z�G wv- IoSL CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 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 (FeeSim l Address: -a6\ Vv� City: WA U VVO Tenant/Lessee Name: Email: Titleholder): - `1 Oi;Vc�— Phone#: chi Stater Zip Phone#: -7->3[ 316 CONTRACTOR: Company Name: Ca-U j� a 1�Phone#: , 4) Address: City: /'( (Oa V&S State: Zip: Qualifier Name: �A A,,t`f U 6-1—. �-7 Phone#: ('!!5) © -� s State Certification or Registration #: 130Q 4 / Z)R Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $zcQCgpki1Q'6 Square/Linear Footage of Work: Type of Work: ❑ Addi�.tionn��,,,, ❑ Altleration� I' ID New ❑ Repair/Replace A❑ Demolition f Description of Work: _fAo J ; L.i�� Specify color of color thru tile: ' ' r ✓� ' .. .4 to � � . •.,y,4.�„mq,'ti,h.. �..... ,;ta,•e•xf ,.a.,�,..•d'°V.,� "om''`,. �. n. ., w 1 a: .*` %e 'R. .6 •,�. t. Submittal Fee Permit Fee $ CCF $ . CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ I Oy ' CQ (Revised02/24/2014) I 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 y Application.is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commeht:ed 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 , OWNER or AGENT The foregoing instrument was acknowledged beforemethis 2 S day of _ a V 4)- 20 � / by J who is personally known to me or who has produced as identification and who did take an oath. , .4 NOTARY PUBLIC: ✓ Signature CONTRACTOR The foregoing instrument was acknowledged before me this L day of 20 % , by �A who is perso ally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print:St,-lcL4— Print: Seal: �.NP "4 Notary Public State of Florida Seal: e" Notary Public State ot Fbridg Sandi Pena ? +� Jorge Ortigosa My Commisson O(3 244973 My Commission FF 952774 « Expires oMB12022 T "�'or a� Expires 02/07/2020 ********************* APPROVED BY as ******************************************************************** ' I Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) SAME & Q ELECTRIC, INC Miami, FL-33183 State of Florida, Miami Dade Miami Shores Village 10050 NE 2"d Avenue Miami Shores RE.: Contractor Affidavit Before me this day personally appeared MANUEL QUESADA who, being duly sworn, deposes and say: That he or she will be the only person working on this project located at: Property: 351 NE 105st — Miami Shores, FL 33138 Contractor Sworn to (affirmed) and subscribed before me thisaday of G1 L.: .2 Personally Know Q OR Produced Identification malakl-,Shore§' Village. Building Department, .10050 N,E 2nd Avenue Miami'Sh rei t,, of lnda'33138 Tel: (305) 795,2204 Faz: (305) 756.8972 Notice to Owner— Workers' Compensation'I motion` Florida Law requires Workers' Compensation insurance coverage under Chapter, 440 of ,tlie 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' C&npensation Employer Facts Brochure» An employer in the construction industry who employs one or more pair -time- or full -tune employee's, including the owner, must obtain workers'.conipensation coverage.; Corporateofficers or'members of a limited liability company (LLG) in the construction -industry may elect to be exempt if: `The officer owifs at least 10 percent. of the�stock_oflhe corporation, or.in-the case of. -an LLC; a statement attesting to theminimum 10 percent ownership:, 'The, officer is listed as an officer of the. corporationAwthe` records of..the Florida Department of State Division of Corporations; and The corporation is -registered and `listed, as' active with` the.fFlorida Department ,of State; Division of Corporations. No more than three corporate officers per corporation or ,li,nited_liabilitY coin- an mernbers ate compAny 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 underthis workers' compensation �exemption`and has acknowledge that he,orshe Wtnot u'se, day labor; part-time employees or subcontractors for your project. The contractor has provided ah-affidavit stating that he or she. will be the only person allowed to work on your project. In these circurnstances;aMiami Shores Village'doesnot require verification of BY kSIGNING BELOW s YOU ACeKNOWLEDGEoTHATr}YOU A Er READ_ labor, THk S-fa employees or subcontractors. P g P day NOTICE AND UNDERSTAND 1'I'S- CONTENTS. Signature: v Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this L_ day,of 1 '! , 20. By GG lir %jh Q who is personally known to me or hasof644ceil as identification: � "Notary Public StaM of Florida Notary: �— •e /cam_ 6�+vNSendipena a isjyn GG 244913 SEAL: V1 �