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RC-19-1252Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 IssueDate: Location Address Parcel Number 338 NW 111TH TER, Miami Shores, FL 33168 1121360010560 Contacts Permit Ato.: RC-05-19-1262 Permit Type: Building, f Residential) Work Clossifrcation: Alteration Permit Status: Approved Expiration: 12/23/2019 STARCRIM LLC Owner ZARABYSON CONSTRUCTION INC Contractor 4770 Biscayne BLVD 1280, Miami, FL 63304 CARLOS FUNDORA 18735 SW 124 AVE, MIAMI, FL 33177 Business: 7865250559 Description: KITCH EN REMODELING, (2)BATHROOMS Valuation: $ 29,580.00 Inspection Requests: uests: IMPROVEMENTS TotalSq Feet: 305.00 Fees Amount Application Fee - Other $50.00 CCF $18.00 Certificte of Completion for Single Fam $50.00 and Duplex DBPR Fee $13.31 DCA Fee $8.87 Education Surcharge $6.00 Permit Fee $837.40 Scanning Fee $27.00 Structural Review ($90) $90.00 Technology Fee $22.19 Total: $1,122.77 Building Department Copy Payments Date Paid Amt Paid Total Fees $1,122.77 Credit Card 05/31/2019 $50.00 Credit Card 06/26/2019 $1,072.77 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, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFID VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constr coon and zoning. Futhermore, I authorize the above named contractor to do the work stated. / Applicant / Contractor / Agent Date June 26, 2019 Page 2 of 2 S�ORJ;S 1 `. Miami Shores Village e �sr � � sn� Building Department n 10050 NE 2 Ave Miami Shores FL 33138 •rT+res ,N S �ORID INSPECTION REQUESTS: (305)762.4949 or log on at https:llbidg.msvfl.goviensrgc;v—Prodiselfservice Requests must be received by 3:30pm WORK IS ALLOWED: MONDAY THROUGH FRIDAY, 8:OCAM - 7 COPM SATURDAY 8:OOAM - 6:00PM. NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH Fr, IDAY . NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED . PLANS ARE READILY AVAILABLE . IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY PAArERIAL REQUIRED TO ALLOW INSPECTION . Owner's Name: STARCRIM LLC Job Addres W 111THTER Miam ores, FL 33168 i ontractor(s) Phone ZARABYSON CONSTRUCTION IN (786)525-0559 POST ON SITE 1121360010560 Owner's Phone: Total Square Feet: 305 total Job Valuation: $ 29,580.00 Address 18735 SW 124 AVE, MIAMI, FL 33177 Description: KITCHEN REMOIJELING (2)BATHROOMS IMPROVEMENTS WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Page 1 of 1 ' Certificate ��u�� Completion �_�� Miami Shores Village 1OO5ONE2ndAve, Miami Shores, Florida 33138 Tel: 3U5795-22O4Fax: 3O5750-8872 Building Inspection Department Description: KITCHEN REMODELING, (2)BATHRO0MGIMPROVEMENTS Permit Type Building (Residential) Bldg. Permit No. RC-05-19'1252 � Owner STARCR|MLLC Contractor ZARABYSONCONSTRUCTION INC Subdivision/Project Date Issued 1204/2018 Construction Type t-B Occupancy Single Family Type Square Footage 305.00 Flood Zone X Location |fthe building iolocated inaspecial flood hazard area documentation ofthe as -built lowest floor 338Nyy111THTER elevation or lowest horizontal structural member has been provided and is retained in the records of K8iomiShores, FL33108 K�iamiGhoeoVi||ag* This certificate issued pursuant tothe requirements ofthe Florida Building Code certifying that at the ORESe time of issuance this structure was in compliance with the various ordinances of the jurisdiction C. 1932 regulating building construction or use. Building Officials Approval Not Transferable POST |NACONSPICUOUS PLACE Ismael Naranjo, CBO � � INSPECTION RECORD INSPECTION DATE INSP Foundation Stemwall Slab Columns (1st Lift) Columns (2nd Lift) Tie Beam Truss/Rafters Roof Sheathing Bucks Interior Framing Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Cap In -Progress _ Roof Installation Roofing Final Shutters Attachment Final Shutters Rails and Guardrails IADA compliance i DOCU EfTSI d' Soil Bearing Cert Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification 1 STRUCTURAL COMMENTS 1 WINDOWSDOORS INSPECTION DATE INSP Attachment PUBLIC INSPECTION WORKS DATE INSP Excavation ELECTRICAL INSPECTION DATE INSP Temporary Pole 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Underground Footer Ground Slab Wall Rough Ceiling Rough Rough cJ b 1 Telephone Rough Telephone Final TV Rough TV Final Cable Rough Cable Final Intercom Rough Intercom Final Alarm Rough Alarm Final Fire Alarm Rough Fire Alarm Final Service Work With o3a �q ELECTRICAL COMMENTS INSPECTION JDATE INSP Final Sprinkler Final Alarm PLUMBING INSPECTION DATE IN Rough Water Service 2nd Rough Top Out Fire Sprinklers Septic Tank Sewer Hook-up Roof Drains Gas LP Tank Well Lawn Sprinklers Main Drain Pool Piping Backflow Preventor Interceptor Catch Basins Condensate Drains HRS Final PLUMBING COMMENTS ryq INSPECTION DATE INSP Underground Pipe Rough Ventilation Rough Hood Rough Pressure Test Final Hood Final Ventilation Final Pool Heater Final Vacuum MECHANICAL CO MENTS -50C--.- IC�5-ZZ�� Miami Shores Village ;r'j� Building Department ali+ �i,,,,. =,e 1005C NE 2 Ave � Miami Shores FL 33138 �O RIOQ' PW Permit NO. RC-05-19-1252 I Type: Building (Residential) I Work class: Alteration x 7 01F, Permit Status: Approved i Issue Date: 6/26/2019 Expires: 12123/20191 INSPECTION REQUESTS: (305)762-4949 or log on at https://bldg.msvfl.govlenerguv_prod/selfservice Requests must be received by 3:30pm WORK IS ALLOWED: MONDAY THROUGH FRIDAY, B:OCAM - 7 GOPM SATURDAY 8:OOAM - 6:00PM. NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAYTHRCUGH FRIDAY . NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD iS DISPLAYED ,, AND HAS BEEN APPROVED . PLANS ARE READILY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPON SIBILTY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY 0.1AFERIAL REQUIRED TO ALLOW INSPECTION . Owner's Name: STARCRIM LLC Job Address ,$8 NW 111TH TER Miarn�XShpres, FL 33168 ZARABYSON CONSTRUCTION I Description: KITCHEN REMO Phone (786)525-0559 POST ON SITE 1121360010560 Owner's Phone: Total Square Feet: 305 total Job Valuation: $ 29,580.00 Address 14735 SW 124 AVE, MIAMI, FL 33177 LING, (12)BATHROOMS IMPROVEMEiuTS WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Page 1 of 1 INSPECTION RECORD (INSPECTION DATE I INSP Foundation Stemwall Slab Columns (1st Lift) Columns (2nd Lift) Tie Beam Truss/Rafters Roof Sheathing Bucks Interior Framing Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Cap In -Progress Roof Installation Roofing Final Shutters Attachment Final Shutters Rails and Guardrails IADA compliance DOCUMENTS Soil Bearing Cert _ Soil Treatment Cert _ Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification I STRUCTURAL COMMENTS I WINDOWS�DOORS INSPECTION DATE INSP Attachment INSPECTION WORKSPUBLIC DATE INSP Excavation ELECTRICAL INSPECTION DATE INSP Temporary Pole 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Underground Footer Ground Slab Wall Rough Ceiling Rough Rough Telephone Rough Telephone Final TV Rough TV Final Cable Rough Cable Final Intercom Rough Intercom Final Alarm Rough Alarm Final Fire Alarm Rough I Fire Alarm Final Service Work With fl3bl� ELECTRICAL COMMENTS INSPECTION DATE INSP Final Sprinkler Final Alarm PLUMBING INSPECTION DATE INSP Rough 3/rr Water Service 2"u Rough Top Out Fire Sprinklers Septic Tank Sewer Hook-up Roof Drains Gas LP Tank Well Lawn Sprinklers Main Drain Pool Piping Backflow Preventor Interceptor Catch Basins --r Condensate Drains HRS Final PLUMBING COMMENTS 1 .1 i •ie - SI MECHANICAL INSPECTION DATE INSP Underground Pipe Rough Ventilation Rough Hood Rough Pressure Test Final Hood Final Ventilation Final Pool Heater Final Vacuum MECHANICAL CO MENTS .n EAV / BTD LLC 8425 Biscayne Blvd., suite 103 Miami, FL 33138 T.305.758.4566 F:305.7584567 www.bigtimedesignstudios.com October 4, 2019 Re: Starcrim LLC. 338 NW i» Terrace Miami Shores, Florida Dear Building Official: EXTnn=D NOV 09 W9 AIV This letter shall serve as notice that I have no objection with the installation of the non -bearing partition walls and envelope components that has been noted on our approval permit set documents for the above reference address. The installation of the 2" X 4" typical non -bearing wood stud interior partitions installed with 2 x 4 P.T. Wood Bottom Plate nailed with Power Actuated Fasteners (PAF) to concrete slab at 24" o/c. as in lieu of cut nails as shown on approval plan in compliance with the F.B.C. The 1 x 2 P.T. Wood Furring were nailed at the perimeter wall with Power Acutated fasteners (PAF) spacing at 16" o/c. as per approved plans and in compliance with the F.B.C. I verified that the 1/2-inch-thick fiber -cement at were installed at the perimeter of the shower and tub compartment and % inch thick nonabsorbent surface finish material Gypsum Board attached to studs with #10 x 15/8 inches flat -head screws at 6 inches on center at the end joints and 8 inches on center at intermediate studs. I hereby attest that to the best of my knowledge, belief and professional judgment, the structural and envelope components of the interior partition walls and wood furring installation at the referenced address, are in compliance with the requirement of the Florida Building Code 2017 (6T" Edition). Should you have any questions or need any additional information, please do not hesitate to contact me. Sincerely, ��0 F4 �o o 000 A, o P BERTp o � o a of rpG O t 0 W N O J O O O O O O G� 436900\,`CuG� 0 0 0 0 0 o� FRED Ate' Eduardo A. Vasquez, R.A. R.A.# 14369 EAV / BTD LLC 8425 Biscayne Blvd., Suite 103 Miami, FL 33138 T.305.758.4566 IF 305.7584567 www-bigti medesignstudios.com October 4, 2019 Re: Starcrim LLC. 338 NW »i Terrace Miami Shores, Florida Dear Building Official: BY:, 4 This letter shall serve as notice that I have no objection with the installation of the non -bearing partition walls and envelope components that has been noted on our approval permit set documents for the above reference address. 1. The installation of the 2" X 4" typical non -bearing wood stud interior partitions installed with 2 x 4 P.T. Wood Bottom Plate nailed with Power Actuated Fasteners (PAF) to concrete slab at 24" o/c. as in lieu of cut nails as shown on approval plan in compliance with the F.B.C. 2. The 1 x 2 P.T. Wood Furring were nailed at the perimeter wall with Power Acutated fasteners (PAF) spacing at 16" o/c. as per approved plans and in compliance with the F.B.C. 3. 1 verified that the 1/2-inch-thick fiber -cement at were installed at the perimeter of the shower and tub compartment and % inch thick nonabsorbent surface finish material Gypsum Board attached to studs with #10 x 15/8 inches flat -head screws at 6 inches on center at the end joints and 8 inches on center at intermediate studs. I hereby attest that to the best of my knowledge, belief and professional judgment, the structural and envelope components of the interior partition walls and wood furring installation at the referenced address, are in compliance with the requirement of the Florida Building Code 2017 (6T" Edition). Should you have any questions or need any additional information, please do not hesitate to contact me. Sincerely, ° F'4 Av o O O O P BERTO �O 0 oQ O� o o W N o o o 0 0 0 0 0 4369 0 o iST000000 o� FRED A� Eduardo A. Vasquez, R.A. R.A.# 14369 EAV / BTD LLC. - 8425 Biscayne Blvd., Suite 103 Miami, FL 33138 T.305.758.4566 F:305.7584567 www. bigti medesig nst udi os. co m October 4, 2019 Re: Starcrim LLC. 338 NW m Terrace Miami Shores, Florida Dear Building Official: I perform site observation visits on a regular basis and due to field condition, which have been encountered during construction, I have no objection with the installation/means and methods by the general contractor of the structural and envelope components; and therefore, shall supersede what has been noted on our approved permitted set of documents. 1. The installation of the 2" X 4" typical non -bearing wood stud interior partitions installed with 2 x 4 P.T. Wood Bottom Plate nailed with Power Actuated Fasteners (PAF) to concrete slab at 24" o/c. as in lieu of cut nails as shown on approved plans in compliance with the F.B.C. 2. The 1 x 2 P.T. Wood Furring were installed at the perimeter with Power Actuated Fasteners (PAF) spacing 24" o/c. as per typical wall section and approved plans and in compliance with the F.B.C. 3. 1 verified that the 1/2 inch thick Gypsum Board nailed to studs 'nches on center at the end joints and 8 inches on center at intermediate studs as s` , vn r plans and in compliance with the F.B.C. I hereby attest that to the best of my knowledge, belief and professional judgment, the structural and envelope components of the interior partition walls and wood furring installation at the referenced address, are in compliance with the requirement of the Florida Building Code 2017 (6T" Edition). Should you have any questions or need any additional information, please do not hesitate to contact me. Sincerely, Eduardo A. Vasquez, R.A. R.A.# 14369 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 EWED MA' 3 1 '2019 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201� 1'_j 1� BUILDING Master Permit No.-P,� OS -I I IZSL PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 33 AIJ /// /�%/iL C,- City: Miami Shores County: Miami Dade Zip: IC, Folio/Parcel#: //•y.36 - a!)/• 0560 Is the Building Historically Designated: Yes NO X— Occupancy Type: Load: Construction Type OWNER: Name (Fee Simple Titleholder): 0 /t Address: 4 PO &-S(AV)V e SjVd, City: '�Afl"lq /_1 Tenant/Lessee Name: _ Email: ,%CCi Z Sr. N!• CO R t JC 1290 Flood Zone: BFE: FFE: State: FL r Phone#: l e(S nisi 1125y Phone#: Zip ssj 31 CONTRACTOR: Company Name: i'/Zz�VSC�JD?/ 7/�G/ !iy� Phone#: 7O Address: /`^ ,,,a' City: State: zip: Qualifier Name: Phone#: 7d'6 S 05�1 State Certification or Registration #: C� %f 4 71 f e Certificate of Competency #: DESIGNER: Architect/Engineer: t` duAgp0 A. �/,gzQ UFzY �,� Phone#: -786 ' 2 31�-,1-51'2 Address:Sq'2Jr /S'C,�JVy-z- 8&d OW City: �//°4State: %=L zip: 33/32 Value of Work for this Permit: $ �y, $ V �� Square/Linear Footage of Work: ? 0-3 Type of Work: ❑ Addition FV1 Alteration / ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1i,-Ie`�eN %ge "'now" "? Specify color of color thru tile: Submittal Fee $ t l S I C Permit Fee $ e �� - "7 CCF $ i J ^^11 Scanning Fee $-�—t • O0 Radon Fee $ <9 DBPR $ Technology Fee $ 22 (� Training/Education Fee $ ` Structural Reviews U , 0j CO/CC $ Q(3 - C/l7 Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 0_� 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 iss d. In the absence of such posted notice, the inspection will not be oppr ved and a reinspection fee will be charged. r 7 Signature —�� Signature 0 or AGE CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing i strument was acknowledged before me this day of 20 h by nn day of �w� 20 �� by �J -r-j S who is personally known to Cam✓ �S �n who is (Personally known to me or w4has produced h `P1C-6 S- L(10 as mee_pr who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign: ' MARYULYs T LEDC Print: "�� r a Cornmissior # GG 5966'. Seal: t1y Comm. Expires Dec 5, 202' ;.,,, Ecrdeo:nro�gnNa�ionallo:aryAsan NOTARY PUBLIC: Sign: 0 Print: Seal: Notary Public — State of Florida My Comm Expires Dec 5202' ©o^ded:hro,ghNaaora Nc:aryAssn **************************** **************************************************************************** APPROVED BY Plans Examiner Zoning , �f Structural Review Clerk (Revised02/24/2014) Detail by Entity Name.pdf Guardado erg Dropbox • 31 may. 2019 11:25 a. m. INDWHIMMM I KOGTIMTFIM• • C • ► • • 11raRGi1�;• • • • No Events No Name History Detail by Entity Name Florida Limited Liability Company STARCRIM LLC Filing Information Document Number L17000010196 FEI/EIN Number 32-0518391 Date Filed 01/12/2017 State FL Status ACTIVE Principal Address 4770 Biscayne Blvd Suite 1280 MIAMI, FL 33137 Changed: 03/16/2018 Mailing Address 4770 Biscayne Blvd Suite 1280 MIAMI, FL 33137 Changed: 03/16/2018 fegistered Agent Name & Address IMRE BORSANYI CPA PA 1001 Brickell Bay Dr tarcri c Search Address Changed: 03/16/2018 ►_TFRi . Name & Address Title MGR CARDENAS,JOSTER 4770 Biscayne Blvd Suite 1280 MIAMI, FL 33137 _ot W M I:-..� Report Year Filed Date 2018 03/16/2018 2019 01 /10/2019 Document Images 0110/2019 -- ANNUAL REPORT View image in PDF format 03%16 2018 _ANNUAL REPORT View imaga in PDF format 01112i2017 -- Florida Limiter! I iabbly View image in PDF format Previous On List Next Or LjFt Return to ii t No Events No Name History tarcn c Search 0 ZARABYSON CONSTRUCTION INC 18725SW 124 th Av, Miami FZ 33177 p. 786.525.0559, fax 305.238.7851 LIC # CGC 1507148 05/30/2019 State of Florida County of Miami Dade Before me this day personally appeared Carlos Fundora who being duly sworn, deposes and says: That h� or she will be the only person working on the project located at: 33r 111 Ter Miami Shores Fl 33168 V�. �-� s mow• Sworn to and subscribed before me this day of�'y' 2019, By C°aI ljtcv,��� who is personally known to me or has or produced as identificationfj���� f� Zia Notary: aq<R ;.: ANA MARGARITA FEBLES Seal: =• Commission # GG 04M Expires December 27, 2020 Bonded Thru Troy Fain Insurance 8W385-70i9 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er State of Florida County of Miami -Dade The foregoing was acknowledge before me thil day of 1 , 20_LJ. By _--�) s4 e e C� Q� `e to 145 who is personally known to me or has produced P ( L/ U-41t dot as identification. Notary: SEAL: SELKIS TERRY Notary Public, State of Ronda My comm. expires Nov. a 2022