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PL-02-20-324, 100 NE 101st StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: PL-02-20-324 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date:02/13/2020 1 Expiration: 01/13/2023 Location Address Parcel Number 100 NE 101ST ST, Miami Shores, FL 33138 1132060132020 Contacts BRYON THOMAS Owner MOTZ PLUMBING LLC Contractor 136 NE 101 ST, MIAMI SHORES, FL 331382321 LEE MICHAEL MOTZ bryon.thomas@gmail.com 820 NE 23 ST, NORTH MIAMI, FL 33161 Business: 3059924223 Inspection Requests: Description: CHANGE OUT ONE VANITY, ONE TOILET BOWL, Valuation: $ 3,500.00 Inspec ion Re ONE TUB, RUN NEW WATER AND DRAIN LINE FOR WASHER IN 305-7 CLOSET. 49 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $2.40 Change of Contractor $110.00 Change of Contractor $110.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $72.50 Scanning Fee $3.00 Technology Fee $3.06 Total: $355.76 Payments Date Paid Amt Paid Total Fees $355.76 Credit Card 05/08/2020 $110.00 Credit Card 07/13/2022 $110.00 Check # 3085 02/13/2020 $135.76 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 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 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws reg ating construction and zoning. ut rmore, I authorize the above named contractor to do the work stated. �,202-2- 'Uhorize Sighature: Owner / Contractor / Agent 45ate July 13, 2022 Page 2 of 2 Miami Shores Village ENTT, Building Department MaR 020 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 W 1r l FBC 20I71 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit N .' ❑ BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑ RENEWAL fj9PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP r� ! CONTRACTOR DRAWINGS JOB ADDRESS: I. JL1� /b/f� �[�' 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 (Fee Simple Titleholder) - Address: City: Tenant/Lessee Name: Email State: ne#: n CONTRACTOR: Company Name: AA 't W �L'1' Phone#: �C) S z e>G� sg3 2 Address: A)W '( i City: r ✓I/State: Zip: v� Qualifier Name: /��U^ ✓) Phone#: "56-3 Z� c, State Certification or Registration #: �r� �'�I ��Z �' Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ /� l Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alt ration N w Repai /Replace Demolition Description of Work: J (4 �t—G 2\— % l• (� Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (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 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 Frmencement brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issd the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. P Signature �Vq(ZA �� , � Signature 6�� OWNER or AGENT The foregoing instrum nt was acknowledged before me this 1 d f�2� ,20 70 by O\� �— who is personally known to me or who has produced identificatio and who did take an oath. NOTARY LIC: Sian: rt Print: Seal: -0.0ie4 UE�VEYtt.,VFdT ;^r v k `` 1o1`r GOMAaigstorr � GG 92,1124 +r Ei;PIRtS; January •fop tiwOcnieGTkr,,. ###### .1o%..; APPROVED BY as CONTRACTOR The foregoing instrument was acknowledged before me this _12- day of M2t'cL 20 21 by D�- -cy ��U��l�Q� who is personally known to s me or who has produced �L ,� _ W41,!E0, �c� (a., identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ( Seal: SINDIA ALVAREZ *: MY COMMISSION 0 GG 238273 EXPIRES: September 3, 2022 "+..... ••per:• n / Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) March 14th, 2020 Infinity Construction Services, Inc. Antonio Luvara 4156 SW 96th Ave, Miami FL 33165 Dear Mr. Luvara, We are writing you regarding the plumbing job, permit PL-02-20-342, commenced the week of Monday, January 13th under contract with Dilbert Enterprise, Inc., at the following address- 100 NE 1015t Street, Miami Shores, FL 33138. This letter hereby certifies, that as of Monday, March 2"d, 2020 per your office's request, Antonio Luvara/Infinity Construction Services, Inc. is NO longer the qualifier nor contractor on this project. Sincerely, Bryon Thomas Property Owner March 141, 2020 Sunshine Electrical Contractors, Corp. Mariano Santiesteban 1300 SW 85th CT, Miami, FL 33144 Dear Mr. Santiesteban, We are writing you regarding the electrical job, permit EL-02-20-325, commenced the week of Monday, January 13th under contract with Dilbert Enterprise, Inc., at the following address- 100 NE 1015t Street, Miami Shores, FL 33138. This letter hereby certifies, that as of Monday, March 2"d, 2020 per your office's request, Mariano Santiesteban/Sunshine Electrical Contractors, Corp. is NO longer the qualifier nor contractor on this project. Sincerely, Bryon Thomas Property Owner Registered No. RE6730*'15602US Extra Services & Fees ❑ swAhn corffiMw* + oResiswea Maa ea 1� s Rawn �v s , ftrot-cam+ ° D*MY ar1 2 s 0RatunR90W $1I, (ele &-4 S— — Total age 8 Fees OReatricted Qeavary 3_ $ v i, rIA Customer Must Declare Received by Full Value$i,,in_i (13/14/2020 is R a� Date Stamp FMCIAL USE orm N , Regis ed Mall ROrdrpt - SPY 1- Customer 2018, P8N �soo-o2.00p-9ost {See 1r+tomtetlan on Reverse) For domestic delivery information, visit our webslte at www.usps.com ° _ Registered No. A� A � (meS7C�1 Services & Fees OStgnaum Conftmu+Uon fstered Mau ..�_ an Recelpt ❑signature coMtrmauon Der *WPy) s ReWWW wy �d ee Sit . . ---r- Total Postage & Fees W.W Delivery $—'• " 6 . Date Stamp Br Must Declare Reeeived by Dweft ftmm aDtoSgO,D00 e tnUutled based upmi the 1B . v '. • i- -'�-' dcetar� value. NtemsUonal indem* is rm W. (See Rm=). o! —VHF AL LAF-"�'Na Ps Form 3806, Reglsferdd Vall Receipt Copy t - Customer April 2015, PSN 759ao2-oao-soar (See Information on Reverse) L — For domestic delivery information, visit our website at www.usps.com i Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpleee, or on the front ff space permits. 1` nArticle Addressed to:N►'il fit+io �',1�Pt� L-�- A. Signature B. R6¢elved by (Printed D. 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March 21, 2020, 6:09 pm Available for Redelivery or Pickup MIAMI, FL 33175 https://tools.usps.com/golTrackConfirmAction_input?origTrackNum=re673615602us 4/8/2020 USPS.com® - USPS Tracking® Results Page 2 of 2 March 21, 2020, 11:20 am Notice Left (No Authorized Recipient Available) MIAMI, FL 33165 March 15, 2020, 12:16 am Departed USPS Facility M IAM I, FL 33152 March 14, 2020, 5:45 pm Departed Post Office MIAMI, FL 33138 March 14, 2020, 4:58 pm Arrived at USPS Regional Facility MIAMI FL DISTRIBUTION CENTER -n CD March 14, 2020, 9:25 am m a USPS in possession of item M IAM I, FL 33138 Product Information u See Less /\ Can't find what you're looking for? Go to our FAQs section to find answers to your tracking questions. FAQs https://tools.usps.com/go/TrackConfirmAction_input?origTrackNum=re673615602us 4/8/2020 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 i Issue Date: 02/13/2020 Location Address Parcel Number 100 NE 101ST ST, Miami Shores, FL 33138 1132060132020 Contacts Permit NO.: PL-02-20-324 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Expiration: 08/11/2020 BRYON THOMAS Owner INFINITY CONSTRUCTION SERVICES INC Contractor 136 NE 101 ST, MIAMI SHORES, FL 331382321 ANTONIO LUVARA 4156 96 AVE, MIAMI, FL 33165 Business: 7864439590 Description: CHANGE OUT ONE VANITY, ONE TOILET BOWL, Valuation: $ 3,500.00 Inspection Requests: ONE TUB, RUN NEW WATER AND DRAIN LINE FOR WASHER IN CLOSET. Total 59 Feet: 150.00 Fees Amount Application Fee - Other $50.00 CCF $2.40 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Permit Fee $72.50 Scanning Fee $3.00 Technology Fee $3.06 Total: $135.76 Payments Date Paid Amt Paid Total Fees $135.76 Check # 3085 02/13/2020 $135.76 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 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 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 the work stated. Signature: Owner / Applicant / Contractor / Agent Date February 13, 2020 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC [PLUMBING MECHANICAL 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 RECEIVE B 1 2021 BYe F C 20 (-1 j Master Permit Noy( 62-- l b Sub Permit No.4(cl - 2--c' ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PUBLIC WORKS [::]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 6 (7 -) tj 6 1 O ) tj� S+ 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 (Fee Simple Titleholder): 3r](ps.r� n �f'dA Phone#: 305 Q —2 7% 3 7— Address: I kl-�; I Q� / City: tA� nn, 96me-4-5 Stater Zip: Tenant/Lessee Name: \ Phone#: Email: T,��4S(l ��r�n: 1. POwa CONTRACTOR: Company Name: T}'1�i r'11tiL/ ow ' ruc:t. Phone#:?664,4694 q!o Address: 1=%4o .D&.5 13 w 11,4 City: 1-ia o State: �� Zip: 3Qj >) 1 �4 Qualifier Name: hone#: State Certification or Registration #:C �/��7�-� Certificate of Competency #: DESIGNER: Architect/Engineer: Ad City: hone#: _State: Zip: Value of Work for this Permit: $ _� '!�"U C� Square/Linear Footage of Work: Type of Work: El Addition. ElAlteration ElNew Z Repair/ReplacE ❑pia Demolition `A Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Ndtary$-> = 7 Technology Fee $ Training/Education Fee $ Structural Reviews $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature m(ors-71hz-l'Su OWNER or AGENT The foregoing instrru_ment was acknowledged before me this _ 7 day f"�P�C:�Ur12 20 0-0 by ��Cnw�ho is personally known to me or who has produced Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of� 120 ZO by �o �uefo� who is personally known to me or who has produced identification and who did take an oath. identification and who did take an oath. as NOTARY PUB NOTARY PUBLIC: Sign: Sign: g---- Print: _ I (�l�I � t�lA)(�c�E_ ^� Prin 3, RAUL NAVARRO ee .o` M IND►a /,LVAREZ y Commission Expires Seal: Seal: 5QN March ?0 2020 S •`�+• Y COMMISSION k GG 238273 M eptember 3, 2022 =•: PIRES. S '•'Foc 5 ;!•' 90irruzw APPROVED BY o�)) /,._ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) IMFINITY CONSTRUCTION SERVICES INC LICENSE # CAC 1816795 - CFC 1428288 PHONE NUMBER 786 443 9590 Date; 7/26/ 2017 COUNTY OF MIAMI SHORES VILLAGE Building Department Before me this day personally appeared Antonio Luvara who, been duty sworn deposes and says: That he will the only person working on the property located at Cordia y: Antonio Luvara Sworn to and subscribed before me this �I- I day of --'5cn 20-'� I by !00L Q\WQAL&— Personally Know V Or produced Identification Type of identification Print, Type or stamp seal of Notary F, RAIL NA#FR?%0 14 P� �`� Go Commission ExG ° h 2 2020 Q f� 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. 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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: <=�/ri� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this _ day of f E�l3(-,)JpQ_9 , 20 ?—O By `5 (P) I who is personally known to me or has produced 7�- as identification. Notary: SEAL: :air' '' •• SINDIA ALVAREZ MY COMMISSION # GG 238273 Bonded ituu Notan Public undenwdlers ❑ Alteration Miami Shores Village BNTERED Building Department JUL 07 2022 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2020 ' 14JA BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. 2or 32-1 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS eCHANGE OF ❑ CANCELLATION ❑ SHOP ' F _ ' CONTRACTOR DRAWINGS JOB ADDRESS: 10CU A.) L 101 C� SIL City: Miami Shores County: Miami Dade Zip: 3,31-36 Folio/Parcel#: I I —32-o& 3-- ZoZO Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholdeer):_ w� �( (i 2 �LJ�- --Av Phone#:.306.20� 11 Address: /'� 4� Al�' r101/ -% f` City: �� gtLjd G'. 1 Stater Zip: 'S _iit t1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: " 1 Phone#:�� — (� TZ �-3 Address": City: OV oZ. ", State: Zip: Qualifier Name: % /1/� �C— Phone#: '3nt�- State Certification or Registration M Certificate of Competency #: DESIGNER: Architect/Engineer: hone#: Address: City: State: Value of Work for this Permit: $ j�-O oo Square/Linear Footage of Work: Type of Work: ❑ Addition Description of Work: / • A Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $, Radon Fee $ ❑ New Training/Education Fee $ ❑ Repair/Replace Zip: ❑ Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ I 1 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 WE 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signah The for day of ' JU 120 zZ by Al e-xanayc, I ko who is personally known to me or who has produced ' �� ✓'� ✓3 as identification and who did take an oath. Signaturec�z 1ZC �(� CONTRACTOR The foregoing instrument was acknowledged before me this day of -J() L L' 2022- by who is personally known to me or who has produced �2 �r�.✓�� L t L as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: / �� --`' Sign: Print: Print: V -e— � -o Seal: e`' — . c `aQ Vivienne Yao Comm.:HH222410 Seal: Jan.31,2026 `��.�`r`prv��,,� O:.... ... =_: 4 VvienneYao Comm.:HH222410 _�•.� Expires: : Notary Publi - State of Florida Expires: Jan. 31,2026 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Permit Number: -0 Z- 20 — 3 aq Owner's Name (Fee Simple Title Holder):^y, Phone: Owner's Address: /36 /j �5 /0( . -- City: —V U aft,(; State :- Zip Code: -��--9 (32D Job Address (where work is being done): /DO)IJ' City: 1-� Miami Shores State: ✓horida Zip Code: 33/30 ` Contractor's Company Name: Phone Address: City: Qualifier's Name : Architect/ Engineer of Record Name: Address: City: Describe Work: State: State: Zip Code: Lic. Number: Phone: Zip Code: I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature a 4ZT�aat�j, wner / Ag "'�J The foregoing instrument was aknowledged before me this -7 day of,202-o, by (e- I0-',Aye J - -r ``I ` Who is personally known to me or who has produced as indentification. Notary Public: Sign and Seal: Lfo" VI V Signature Contractor / Architect / E The foregoing instrument wa before me this 0 nowledged days ,20 , by Who is personally known to mew who has produced Notary Public: Sign and Seal: as indentification. Vivienne Yao 110620?�Page 2 of��i�..x�aExpires: Jan. 31, 2026 Notary Public -State of Florida Miami Shores Village Building Department 10050 NE 2"d Avenue Miami Shores, Florida 33138 Tel: (305) 795-2204 www.msvfl.gov Change of Contractor/Architect or Engineer A change of contractor, architect or engineer must be done under a permit revision .There is a $110.00 charge for a change of contractor. The owner will submit a Change of Contractor Form completed with notarized signatures of both, owner and current contractor. If the signature of the current contractor cannot be obtained the owner must send a certified letter return receipt notifying the current contractor, architect or engineer the reason for the change .The owner must allow 10 business days for the contractor, architect or engineer notification before action is taken as required under section 8-13(4) of the Miami Dade County Code. A permit application must accompany the change of contractor form, with the information and signature of the new contractor and owner or owner agent as required under FS 713.135 (6)(a) .The new contractor must be registered with the Village or must submit the required documents to register with the Village. 1. Change of Contractor form completed, signed and notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter sent via certified mail along with the returned receipt. In addition to the requirements above the current architect or engineer of record must authorized the new architect or engineer to reproduce his documents. The authorization must be in writing and must be signed and sealed, and shall comply with Florida administrative code 61G1-18.002 11O'S2020 f�-^;a!-ia= _ -- I'="JCi'_ -1' Pa5e 1 0*- rU Dornestic Mail 017/y M Er For delivery information, visit our website at www.usps.corne. Ln Ir Certified Mail Fee $3. 75 $ Oils Extra Services & Fees ptec box, add fee ru El Return Receipt OardcopO $. 0 ❑ R— Receipt let--) $ $171,130 ,Rstrnark 0 ❑ Cerfified Mall Restricted Delivery $ $Q 00 are C3 0 Adult Signature Required $ $A. 9A 0 Adult Vgnatm Restricted DeWwy $ C> C3 PostafU ge rU $ (16 /"),1 Total Postage and For. 38 r-q ru -sent To �ja'4't - - - tea C3 , No.:iiipd Z r? 101 Certified Mall service provides the following benefits: ■ A recelpt (tide portion of the Certified Mali labeq. for an electronic return receipt, see a retail ■ A unique Identifier for your maliplece. fort assistance. To to forrecal ■ Electronic verification of delivery or attempted return for i ta pry this delivery. USPS®-postmarked wed Mali receipt to the ■ A record) delivery (Inclretained the recipient s raw associate. signature) that Is. riod lrted by the Postal Service' - Restricted delivery service, which provides for for a speckled period. delivery, to the addressee specified by name, or to the addressee's autlrorized ammt. Important Reminders: ■ You may purchase Certified Mall service with Rrst-Class Mail®, Rral-Class Package Service•, or Priority Mali* service. ■ Certified Mali service Is notavagable for International mall. ■ insurance coverage Is notavailable for purchase with Certified Mail service. However, the purchase of Certified Mall service don not change the Insurance coverage automatically Included with certain Priority Mail items. ■ For an additional fee, and with a proper endorsement on the mallplece, you may request the following services: - Return receipt service, which pmvldes a record of delivery (Including the recipients signature). You can request a hoAmpy retum recelpt or an electronic version. For a hardcopy return receipt, complete PS Form 3811. Domestic Retum Receipt attach PS Form 3811 to your mailpiece; Adult signature service, which requires the signse to be at least 21 years of age (not available at retall). Adult signature restricted delivery service, which requires the signee to be at least 21 years of age and provides delivery to the addressee specified by name, or to the addressee's authorized agent (not available at retail). • To ensure that your Certified Mall recelpt Is accepted as legal proof of malting, it should bear a USPS postmark. If you would like a postmark on this Certified Mail receipt, please present your Certified Mall Item at a Post Office- for postmarking. If you don't need a postmark on this Certified Mall recelpt, detach the Wooded portion of this label, affix it to the mailpiece, apply appropriate postage, and deposit the mailpiece. WORTMIR. Sane this recelpt for Iom records. vs F m, 3800, Apra 2ois mRan=) PsN 7sso-a2-a*9o47 STATES gAOFODSTAL SERVICE. MIAMI SHORES 9825 NE 2ND AVE MIAMI, FL 33153-9998 (800)275-8777 06/21/2022 10:46 AM Product Oty Unit Price Price First -Class Mail® 1 $0.58 Letter Hialeah, FL 33018 Weight: 0 lb 0.50 oz Estimated Delivery Date Thu 06/23/2022 Certified Mail® $3.75 Tracking #: 70212720000279569324 Return Receipt $3.05 Tracking #: 9590 9402 6882 1104 8783 86 Total $7.38 Grand Total: $7.38 Credit Card Remitted $7.38 Card Name: AMEX Account #: XXXXXXXXXXX5004 Approval #: 820903 Transaction #: 869 AID: A000000025010801 Chip AL: AMERICAN EXPRESS PIN: Not Required Every household in the U.S. is now eligible to receive a third set of 8 free test kits. Go to www.covidtests.gov Text your tracking number to 28777 (2USPS) to get the latest status. Standard Message and Data rates may apply. You may also visit www.usps.com USPS Tracking or call 1-800-222-1811. Preview your Mail Track your Packages Sign up for FREE https://informeddelivery.usps.com All Sales final on stamps and postage. Refunds for guaranteed services only. Thank you for your business. Tell us about your experience. Go to: https://postalexperience.com/Pos or scan this code with your mobile device, or call 1-800-410-7420. UFN: 115885-0118 Receipt #: 840-53300063-1-5479139-2 Clerk: 03 ENTERED June 21st, 2022 Navarro Plumbing & Mechanical Co. DENEY NAVARRO 15236 NW 87 PL Miami Lakes, FL 33018 Dear Mr. Navarro, JUL 0 7 2022 BY: _( We are writing to you regarding plumbing job, permit PL-02-20-324, still pending final approval at address-- 10ONE 10111 Street, Miami Shores, FL 33138. Regretfully, our attempts to reach you over the last several months have been unsuccessful. This letter hereby certifies, that per our repeated unanswered phone calls and text messages to schedule completion of the final plumbing finishes, Navarro Plumbing will NO longer the qualifier on this project. Thank you in advance, Bryon Thomas Property Owner 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 BELOW 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 day of u 20 22 . By A 2«,rt �„ lcYy�-S who is personally known to me or has produced as identification. Notary: .1� QCkv V c V i -6+1 ✓ a- V G( v SEAL: ,��p'r""��,� Vivienne Yao Comm.: HH 222410 Expires: Jan. 31,2026 WN° �;;��`Ak Notary Public - State of Florida 305-992-4223 license# CFC1429581 june 21 st 2022 State of Florida Village of Miami Shores Before me this day personally appeared Lee Motz who, being duly sworn, deposes and says: That he will be the only person working o the project located at: 100 ne 101 st street contractor signature Sworn to (or affirmed) and subscribed before me this _� day of 20 Z2, by 1 no IVOtZ Personally know Produced id t%�- --�► ��'�� Type of id VivienneYao � pr ►Ui�i %14 Comm.:HH 222410 Expires: Jan. 31 2026 Notary Public • State of Florida Print type or stamp name of notary