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EL-18-1797y� Miami Shores Village �eNO"s 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 y� tea` Phone: (305)795-2204 F�ORtDP' Permit NO. EL-7-18-1797 Permit Type: Electrical - Residential ' Worts Classification: Addition Permit Status: APPROVED Issue Date: 7/11/2018 1 Expiration: 0110712019 Project Address Parcel Number Applicant 1139 NE 105 Street 1122320280400 WELSER TORRES Miami Shores, FL 33138-2107 Block: Lot: Owner Information Address Phone Cell WELSER TORRES 1139 NE 105 Street (305)972-1481 MIAMI SHORES FL 33138- 1139 NE 105 Street MIAMI SHORES FL 33138- Contractors) Phone Cell Phone A PLUS ELECTRICAL TECHNOLOGIE: (305)216-1164 /pe of Work: ADDITION TO BACK OF THE HOUSE dditional Info: lassification: Commercial canning: 1 Fees Due Amount CC F $2.40 DBPR Fee $3.38 DCA Fee $2.25 Education Surcharge $0.80 Permit Fee - Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $240.03 Valuation: $ 4,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # EL-7-18-68105 07/02/2018 Credit Card $ 50.00 $ 190.03 07/11/2018 Credit Card $ 190.03 $ 0.00 Available Inspections: Inspection Type: Review Electrical 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 c that• he foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. err» j guthorize the above named contractor to do the work stated. July 11, 2018 Authorized Sit n ture• er / Applicant / Contractor / Agent Building Dep rtment Copy July 11, 2018 1 0e BUILDING PERMIT APPLICATION IVlldl I II JI IUI CJ V IIIdgC �EDE� QED Building Department auto 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 2 ?018 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 (04A FBC 2011 Master Permit No. PIf Sub Permit No. eL-1 ❑BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [-]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS 1139 NE 105th ST JOB ADDRESS: Folio/Parcel#: 1122320280400 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Welser Torres Phone#: 3059721481 1139 NE 105th St Address: City: Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: City: 4' AWR; Qualifier Name: State Certification or one#. 4 DESIGNER: Architect/Engineer: Phone#: _ Address: City: State: Value of Work for this Permit: $ 1 C7. 01, Square/Linear Footage of Work: Type of Work: 0 Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Addition to back of the house )WO, 150, Zip: ❑ Demolition Specify color of color thru tile: 3riN47 Submittal Fee $ Permit Fee $ �� �° CCF $ CO/CC $ Scanning Fee $ Radon Fee $ o�2 ' �" DBPR $ 3 • 38 Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE S U3 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 absb ewe of such posted notice, the ved Qnd a reinspection fee will be charged. inspection will not be appro Signature or AGENT The foregoing instrument was acknowledged before me this 20 day of June 120 18 by Welser Torres who is personally known to me or who has produced pAT(P -W -6C - Ci 0 as identification and who did take an oath. NOTARY PUBLIC: FM Print: +. � 4 Seal: = Notary Pu is - State of Florida =`r• .�: • . •; Commission # GG 033043 My Comm. Expires Oct 17, 2020 " Bonded through National Notary Assn. Signature / RACT The foregoing instrument was acknowle g re me this 20 day of June 20 18 by is personally kaqw-n—tp— me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: ****ssss*ssss*s***ssss**sss*s�s�rss�s�*s*ssss**sss*s**s�sssti APPROVED BY �X2 JO e A y /BPlans Examiner EMMA RIVERO Notary Public - State of Florida Commission # GG 033043 f, My Comm. Expires Oct 17, 2020 **m9d4hreto li-ftlaliletarfinei ssss****s**sss*ss** Zoning Structural Review Clerk Notice to Owner - Workers' Corn Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 sation 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 BIQI,OW nYOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. \ `1 Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this :a vday of L) L!IV. , 20_fk_. By 0 w TQ r t e5 who is personally known to me or has produced )L 162? - b 00M - 1 P - 0 as identification. Notary: EMMA RIVERO Notary Public - State of Florida My Comm. Expires Oct 17, 2020 Bonded through National Notary Assn RICK SCOTT GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA 9E ARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC0002993 I J The ELECTRICAL CONTRACTOR Named below ISICERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 VAZQUEZ, RIGOBERTO A PLUS ELECTRICAL TECHNOLOGIES, INC. 1633 N.W-143 WAY PEMBRO i E PINES FL 33028-3003 ISSUED: 09/20/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1609200000739 1 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6895289 BUSINESS NAME/LOCATION �A PLUS ELECTRICAL TECHNOLOGIES INC DOING BUS IN DADE CO MIAMI FL 33000 I RECEIPT NO_ EXPIRES RENEwAL,� •SEPTEMBER 30, 2018 7170913 s Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED A PLUS ELECTRICAL TECHNLGIES INC 196 ELECTRICAL CONTRACTOR I C/O RIGOBERTO VAZQUEZ 1R PRES EC0002993 BY TAX COLLECTOR Worker(s) 1 $75.00 09/22/2017 CREDITCARD-17-061263 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 6a-276. For more information, visit www.nliamldade.aovftaxcollector JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW I CONSTRUCTION INDUSTRY EXEMPTION This certifiesithat the individual listed below has elected to be exempt from Florida Workers' Compensation law. I EFFECTIVE DATE: 10/6/2017 EXPIRATION DATE: 10/6/2019 I PERSON: VAZQUEZ RIGOBERTO FEIN: 452137777 BUSINESS NAME AND ADDRESS: A PLUS ELECTRICAL TECHNOLOGIES, INC I 1 1633 N.W 143 WAY , PEMBROKE!PINES FL 33028 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. I DFS-F2-DWG-252 ! CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609