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DS-19-856Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address rnntartc Permit O.: DS-04-19-856 Permit Type=l3rivewaysjSiCtel all /Slabs (Nark Classification: Addition/Alteration Permit Status: Approved tssue Date:09/02/201,9 F Expiration: 01/29/2020 Parcel Number 1132060132760 Leocava LLC Owner J&R STRIPING CORP Contractor PO BOX 381703, Miami, FL 33238 RAQUEL GROVE LLANOS Business: 7865566406 Description: RE -STRIPE PARKING LOT Valuation: $ 1,000.00 Inspection Requests: BEHIND FIRE STATION 305 762-4§49 95 STAND NE 2 AVE Total Sq Feet: 5,000.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 Concrete/asphalt/pavers, slabs, dways, $275.00 swalks DBPR Fee $4.88 DCA Fee $3.25 Education Surcharge $0.20 Planning and Zoning Review Fee $50.00 Scanning Fee $6.00 Technology Fee $8.13 Tota I : $398.06 Building Department Copy Payments Date Paid Amt Paid Total Fees $398.06 Credit Card 08/02/2019 $348.06 Credit Card 04/18/2019 $50.00 Amount Due: $0.00 r 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 t/h'a . a e foregoing information is accurate and that all work will be done in co pliance with all applicable laws regulating construction and zoning! F t ore, au orize the above named contractor to do the work stated. i Authorized Signature: Owner Applicant / Contractor / Agent Date August 02, 2019 Page 2 of 2 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20n ('�+� Master Permit No. `D.S 0t.4-1`C� —SS�- Sub Permit No ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBING ❑ MECHANICAL [:]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP JOB ADDRESS: {/� I� / 1 o� E qJ CONTRACTOR sj+ DRAWINGS City: Miami Shores County: Miami Dade zip: Folio/Parcel#: 3206 - o 1' Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Na a (Fee Simple Titleholder): Address: City: %�%lNbl� / `—I✓ owe' Phone#: State: Zip: 33y Tenant/Lessee Name: Phone#: Email: Q p CONTRACTOR: Company NName/(1, : j m `1 Phone#: Address:�/ `3 & ,Q`6�� _ City: �V i /'ll%cM,l l &C/- j I State: c` Zip: �p/3 3,,1 db2— Qualifier Name: LI �NoS Phone#: T 610 State Certification or Registration #: Certificate of Competency #: C-Z30a DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ . / O'er 0 Square/Linear Footage of Work: 0 o o Type of Work: ❑ Addition ❑ Alteration El New ❑ Repair/Replace ❑ Demolition ti Description of Work: t\ i2S�t 'Pam. �"',`-<\-'3 to t ©n�7 Specify color of color thru tile: Submittal Fee -03 Permit Fee $ r� Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ "L Structural Reviews $ (Revised02/24/2014) 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 Zi 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 whiph occurs seven (7) days after the building permit is issued. In the absence of such pasted notice, the inspection will not be appr¢ved and p rj?inspection fee will be charged. Signature (/ r ' — Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of 20 _, by l'� who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLI W,, Sign: Print: Seal: APPROVED BY 0�*ANDREW VOGEL MY COMMISSION#1'F919683 , EXPIRESi November 25,2019 CONTRACTOR The foregoing instrument was acknowledged before me this 2Z-> day of McyC 120 1 C7 by Or who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: 1 1 Print: rR n Seal: ERICAC.HAYNE MY COMMISSION # GG 106978 EXPIRES: July 27, 2021 lFodi��c BMW Thry Notc�t^ y Pub6c UI W*ri18r5 **************** ` Plans Examiner *************** Zoning (Revised02/24/2014) Structural Review Clerk J + R Striping Corp 103 NE 154" St N. Miami Beach, Florida 33162 786-282-0256 3/14/19 State of Florida County of Miami -Dade Before me this day personally appeared ��� ��t who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 105 NE 951" St. Miami Florida 33138. Folio: 11-3206-013-2770 1 Contractor Signature Sworn to (or affirmed and subscribed before me this ZD day of&ch , 2019, by Personally Known / OR Produced Identification Type of Identification Produced ERICAC. HAYNE MY COMMISSION # GG 106978 EXPIRES: July 27, 2021 Bonded Thru Notary Public UrWerwrfters Print, Type or Stamp Name of Notary 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 Exem 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 -rime 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 -rime 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' compensatio insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING'BELC W YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami -Dade n The foregoing was acknowledge before me this day of /'rG''�w , 20 By 7 Q // GL��/lf ( who is personally known to me or has produced as identification. """'� ANDREW VOGEL Notary: MY COMMISSION N FF91%93 ,sa EXPIRES: Novemba 25, 2019 SEAL: J&R STRIPING CORPORATION 103 N.E.15e" STREET NORTH MIAMI BEACH, FL 33162 TEL/CEL: 786-282-0256 July 23, 2019 Miami Shores Village, Bldg, Dept. 10050 U.E. 2n' Avenue Miami Shores, FL 33138 Re: Permit No: 4W, 19-856,AIW Jobsites: 105 U.E. 951h Street 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 Raquel Grove Llanos, President 2 accessible spaces located at northeast corner of folio 11-3206-013-2770. Each accessible space will be 12ft wide, with a 5ft stripped entry ramp way LD-� j S 5 0 ,, ) a te �CN DS Cq - 19 - ?E�