PL-07-19-1608, 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 La Casa de la s Piscinas Inc Contractor
910 N 99 ST, MIAMI SHORES, FL 33138 Maria C Rodriguez
Mobile: 3057516529 2601 NW 18 TER, Miami, FL 33125
Business: 3056339699
Other:3052163107
Inspection Requests:
Description: POOL PIPING FOR NEW SWIMMING POOL Valuation: L1,500.00J TotalSq Feet: �
..j
Fees
Amount
Application Fee - Other
$50.00
CCF
$1.20
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$0.40
Plumbing - Pool - Residential
$100.00
Scanning Fee
$3.00
Technology Fee
$3.75
Total:
$162.35
Payments
Date Paid Amt Paid
Total Fees
$162.35
Credit Card
07/11/2019 $50.00
Check # 1142
10/24/2019 $112.35
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.
OWNE S AFFIDAVIT: I cert' th t all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regu ati g co stru on and zo uthermore, I a thorize t e above named contractor to do the work stated.
C 7j„
Autliorize Signatu t
Owner / Applicant / v Contractor / Agent Date
Dctob 24, 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: (30S) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC ❑ ROOFING
7J
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UL i 20IT"
BY:_ .
FF BCQ20 l C�j
Master Permit No. i_ )� 1 0-1' I I r' LID
Sub Permit No.
❑ REVISION ❑ EXTENSIONRENEWAL
LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 910 WE R q A S I,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#. (k- 3 ZO (o , O N 3u (O Is the Building Historically Designated: Yes NO _
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): 44ans YCV au S2 Phone#:
Address: 0 • (�0.t.1 R-Mine
City: S aNYN i n)P_aC" State: _'FL Zip:
Tenant/Lessee Name:
Email:
eD
CONTRACTOR; Company Name: /.a CuSa �P - (is. �vSCX(Nrls Phone#:
Address: 4-->0 ( &)W ig t Pig( rA Cam_
City: t i iam ; state: V�::� Zip: 3 3125
QualifierName: t QC. " Phone#: A 121 167-
State Certification or Registration #: Certificate of Competency#: DESIGNER: Architect/Engineer: U (' CQ n-f'e-�a V- C-0 Phone#: 3 _�D S
Address: i5 -1 o UW (09 C-4- City: DO / C@._ State: TC Zip: 3 �
'er
Value of Work for this Permit: $ A _ '5 OO O` Square/Linear Footage of Work:
Type of Work: ElAddition ❑ Alteration New _Repbir/Replace ❑Demolition
Description of Work:
Specify color of color thru the:.
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee$
Technology Fee $
Structural Reviews $
Radon Fee $ DBPR $ Notary $
Training/Education Fee $
Double Fee $
Bond $
TOTAL FEE NOW DUE $' ( 2 , 3S
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company s Address
City State
Mortgage Lender's Name (if applicable) _
Mortgage Lender'sAddress_
Zip
City ,,/ State 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,
rURNACES, 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�wr�i posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature 7V6 Signature
OWNS or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument "w'as acknowledged before me this
day f Nl '1 20 �� . by �^ day of ��My 20 Lq by
Attl ��V) who is per66n--a -y now-n10 -- Rat a C. r 4--ho is personally known to
me or who has produced as me or who has produced as,,,
identification and who did take an oath.
NOTARY PUBLIC:
rnnr. — : w.,0
• OFF "qV
Seal: _
identification and who did take an oath.
NOTARY PUBLIC:
Print: c IteN : '
Seal:
APPROVED BY ig Plans Examiner
Structural Review
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Zoning
Clerk
(Revised02/24/2014)
La Casa De /as Piscigas
2601)VW 1844P Tefrace
Afiajvi, fL 33125
305-216-3107 / M145001
July 18th, 2019
State of f [ oI i Q (L_
County of Hl a N1? - l
Before me this day Personally appeared M cti j 1` o, being duly sworn
deposes and says:
That he or she will be the only person working on the project located at:
4(D OC9a� A(70mt,sboy-es .TL 33)38
Sworn to ( or affirmed) and subsbribed before me this 2b(day of 20 19 By
Personally Known
Porduced Identification
Type of identification produced
Typ Print ok Stamp Name of Notary
YES: �•F:A�� KELOY J VILLA
MY COMMISSION # GG071524
k�r� EXPIRES February 26, 2021
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
nsation Insurance Exemoti
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.
l . 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' compensatiyel insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BEYOW 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 2 day of _ _ , 20 19.
BL (� Q V s e-, who is personally known to me or has produced
as identification.
Not (,� _ra; ��: KELLY J VILLA
: MY COMMISSION # �G071S2.4
°r EXPIRES February 26, 2021
SEAL: °'° Y