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EL-07-19-1607, 910 NE 99th StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 910 NE 99TH ST, Miami Shores, FL 33138 1132060143410 Contacts HANS & URSULA KRAUSE Owner 910 N 99 ST, MIAMI SHORES, FL 33138 Mobile: 3057516529 ELECTRICAL CONTRACTORS CORP MARIANO SANTIESTEBAN 1300 SW 85 CT, MIAMI , FL 33144 Business: 3052654958 Home: 7864439590 Other:7862736194 Contractor I Inspection Requests: Description: ELECTRICAL FOR NEW SWIMMING POOL LIGHTS Valuation: $ 1,500.00� , E 0.00 Total Sq Feet: i� Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.10 Payments Date Paid Amt Paid Total Fees $111.10 Credit Card 07/11/2019 $50.00 Check # 1142 10/24/2019 $61.10 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. AFFIDAVIT: I cerN that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws ;onstruction and ionibb. Futhermore..l authoriaye the above named contractor to do the work stated. re: Owner Applicant / / Agent Date 24, 2019 Page 2 of 2 Miami Shares Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY; INSPECTION LINE PHONE NUMBER: (30S) 762-4949 BUILDING PERMIT APPLICATION F-IBUILDING ELECTRIC ROOFING �I VIED F B(�C 20 ^ Master Permit No.�'l O�` I 160 6 Sub Permit No. ,� �� A 60 l REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF CANCELLATION SHOP Q ,� CONTRACTOR DRAWINGS JOB ADDRESS: l (0 k) t 9 -9�t s i1� CC+ City: Miami Shores County: Miami Dade zip: 3) 3� Folio/Parcel#:5O (4 —u (O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name 1(Fee Simple Titleholder): CIPI.S �L121 �s2 Phone##: Address: CA== 2-0 W. (3yl."j 0= n - City: t Q�P PYZi , CLci) T �Stater rZip: 331 (4() Tenant/Lessee Name: Email: CONTRACTOR: Company Name: �YJI��i��tr1lL EteC CeAQ Cnja C,COC Phone#: �1�36-C(e{3 C) S9© Address: CO 'b-5 P City: t h- M, State: EL Zip:33 Qualifier Name: Aa i1Q no Phone#: State Certification or Registration #: _C l 3C©S �O -4- Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: <�6 etc) N "J 10 0l L'+" City:D0 ✓0LJL State 00 Value of Work for this Permit: $ l GO Square/Linear Footage of Work: _ 4 k1 Type of Work: ❑ Addition ® Alteration New ED0Rep5tr/Replace d Description of Work: ��±± �n -i I-ec-h� C c-W Ri � i m (Yl.t YLQ {% o' i _� l n S ..: 3 30s- 5631 F(� Zip: 3 3 l ❑ Demolition Specify color of color t ru tile: # Submittal Fee $ o �C,�1 Permit Fee $ CCF $ " ' CO/CC $ Scanning Fee $ Radon Fee $ DSPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ ' • I O (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 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 Signature-_--,�VLr•zw� OWN RorAGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of �'11 P 2Q\� by - t day of 20 l ... ,c _ _ g is personally known to n �innl7 nk&Z i2 awho is personally known tm � _ me or who has produced as me or who has produced—~ aE p U) identification and who did take an oath, identification and who did take an oath. i rr— m u�i NOTARY PUBLIC: IINNpR NOTARY PUBLIC: o `' o, z AS ••. �, Sig •' w� F/�. Sign: m r n� ,�', D *9� _ ` 1 Prin *n • Print: . OFFUM Seal: Ste'; , , obi Seal: APPROVED BY �7- L/,( Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 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 BOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. , J Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 2 Z day of , 20J By I aA&T 5 1�4 who is personally known to me or has produced as identification. �— Notary: ICk-) } KELLY J VILLA t h _ b1Y COMMISSION # GG071924 SEAL: EXPIRES February 2E 2021 a;" Sunshine Electrical Contractor Corp 1300 SW 85th Court Miami, FL 33144 786-443-9590 / EC13005807 July 18th, 2019 State of t O f ca a County of h l it'a r Lrwc Nd e Before me this day Personally appeared M arl'ont Janji..R hao, ho, being duly sworn deposes and says: That he or she will be the only person working on the project located at: 01(6 �J 9a,^ S-� V- (aM� g.ofes, 7 ( 33lbo Contractor Signature CL Sworn to ( or firmed) and subsbribed before me this 2Zct�ay of 20_q By al to no G `-e stt� ut Personally Known Porduced Identification Type of identification produced P D W-j • V Wa-, ype, Print ortStamp Name of Notary KELLY J VILLA _ NAY COMMISSION # GG071524 '� EXPIRES February 26, 2021