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PL-06-19-1273, 9353 NE 9th AVEMiami Shores Village 10050 NE 2 Ave Miami Shares FL 33138 305-795-2204 Permit NO.: PL-06-19-1273 Permit Type: Pkimbing - Residential ' Work Classification: Alteration, Permit Status: Applied Iss"Date.,94/13/2020: Expiration:l0/12/2020 Location Address Parcel Number 9353 NE 9TH AVE, Miami Shores, FL 33138 1132060010040 Contacts 9353 FLORIDA LLC Owner BANANAS GROUP, INC. Contractor 9353 NE 9TH AVE, Miami Shores, FL 33138 RAFAEL LEYVA 27501 S DIXIE HWY 403, NARANJA, FL 33032 Business: 3052571000 eallen.bananas@gmail.com Ins ectionRequests: Description: PLUMBING FOR BATHROOM RENOVATION 1 BATH Valuation: $ 1,200.00 3fl5-762-4949 TOP 1 SINK ON FIRST FLOOR, SECOND FLOOR, 1 SHOWER 1 SINK Total Scl Feet: 0.00 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 Work Without Permit Fee $100.00 Total: $211.10 Payments Date Paid Amt Paid Total Fees $211.10 Credit Card 04/13/2020 $161.10 Credit Card 06/04/2019 $50.00 Amount Due: $0.00 COVID 19 Applicant Copy For Inspections, Call (305) 762-4949 or Log on at https://bidg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that may be found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. April 13, 2020 Page 1 of 2 U r,N RECF;IVED Miami Shores Village J04 2019 Building Department BY --I —. 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 1GJ FBC 20 I+ YJ BUILDING Master Permit No. :vc—C-10- I9- 7 � PERMIT APPLICATION Sub Permit No-?_4__ 66- LCi 17 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS e. "GjE JOB ADDRESS: —63 ` City: Miami Shores County: Miami Dade Zip: 311S Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Flood Zone:: BFE: FFE: Construction Type":: OWNER: Name (Fee Simple Titleholder): %) �� _nOhClA �(� Phone#: Address: 0 ST'/ City: jl//1 I'�Lvl /�1CLlG-� State: I.y Zip: Tenant/Lessee Name: Phone#: Email: (Q l/—�� CONTRACTOR: Company Name: E/I f c "► ' r ' J Grob -'P � Phone#: ' ` Address,tla�Tf't�� City: N r l4u1 A State: 1" L Zip:�— Qualifier Name: 64 6i, CS�t�f �/ll-- Phone#: State Certification or Registration #: L - ^ 1 14_5© 15 /-7 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ % Z 0 © Square/Linear Footage of Work: Type of Work: ❑ Addition El Alteration El New M Repair/Replace El Demolition p Description of Work: AIAYot, ►.mot �,o yta ,sc• ]r; d/ �c S / 0j dfk rk' C 0L..C.!r C)'-_ 1 Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ - Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ �t V (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) ays after the building permit is issued. In the absence of such posted notice, the inspection will noLbeapproved and a reinspectio ee will be charged. Signature ` Signatu OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 1. (.601'A%13 day of,,//��� ���►► Yv r 20 by Tires fnk-, wh �persoown to me or who has produced identification and who did take an oath. as The foregoing instrument was acknowledged before mm,e+ this day of �rrJ C"1 by whoJisersonally know to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: 1,42 Print: SANWA DIAZ Sea Seal: ;#'' l: 222300, NY OOMMMSION le 43G0152iM troesry Punic Stets ofFbride EXPIRES Mwch 06. �1 • Elston Allen tea ` ME�ir�s 81Z02rtCormnlWon � APPROVED BY I IfY /��� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) d License #: CGC1527091 CFC1430157 CCC1331744 27501 S. DIXIE HWY., SUITE 403, NARANJA, FL 33032 Office #: 305-257-1000 Date: 0-` i r ` q State of Florida County of Miami Dade iM--L- Lo ;' �AA Before me this day personally appeared TJ who, being duly sworn, Deposes and says: That he will be the only person working on the project located at: q 35-5 rJC R M� Contractor Signature Sworn to (or affirmed) and subscribed before on this - day of -F& Personally known V_ 1 - 14l Stamp and Sign ,� Notary Public State of Florida Jef Elston Allen pt=My Oommiasion OG 222380 few o512812022 2019. 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: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this J1q dayof By 1- G(,_a :5 who is p rsonally known to me or has produced as identification. XMMJ5zj1Ur4Notary:Y CO SEAL:EXPIRES March 06, 2021