FW-04-20-806, 935 NE 99th StMiami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
935 NE 99TH ST, Miami Shores, FL 33138
Contacts
Issue Date: 04/24/2020
Parcel Number
1132060340251
Permit NO.: FW-04-20-806
Permit Type: Fence/Wall
Work Classification: Wood Fence
Permit Status: Approved
Expiration: 10/21/2020
USA SPECIALTY REALTY LLC Owner VULCANO IRON WORK CORP Contractor
3233 Commerce PKWY, Miramar, FL 33025 HAREM QUINTERO
21361 SW 125 PATH, MIAMI, FL 33177
Description: NEW WOOD FENCE TO REPLACE Valuation: $ 5,132.00 Inspection Requests:
uests:
PERMIT#FW-07-19-1560
49
Total Sq Feet: 0.00
Fees
Amount
Payments
Date Paid Amt Paid
50% Renewal Fee
$55.00
Total Fees
$60.00
Notary Fee
$5.00
Credit Card
04/24/2020 $60.00
Total:
$60.00
Amount Due:
$0.00
COVI D 19
Applicant Copy
For Inspections, Call (305) 762-4949 or Log on at https://bldg.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 24, 2020 Page 1 of 2
Miami Shores Village Ry10EIVEI>
Building Department A PIR, z .;
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 BY: I
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 20 i T
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No. ;"yy —bY— 2,0 " 8(4
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLICWORKS 0 CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 935 N E 99th Street
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:1132060340251 Is the Building Historically Designated: Yes NO X
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): USA Special Realty LLC Phone#:9544477635
Address:3233 Commerce Parkway
city; Miramar State: FL Zip: 33025
Tenant/Lessee Name: Victor NOffra Phone#:7868630077
Email: victorno@noffra2000.com
CONTRACTOR: Company Name: _l4'tj&G,vti0 T rinn W c) yl Phone#: U4- y j y-- j0V 11
Address: f %'Z L� S tA)J 'tP ► v t �}
City: _U.'AD ;n kAf State: G L Zip: raj (�'
Qualifier Name:
State Certification or Registration #: _1 (66 S 0 0 0 4 S Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $_ n 0 Square/Linear Footage of Work: /o 57
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Specify color of color thru tile:
Submittal Fee S
Scanning Fee $
Permit Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $
DBPR $
CO/CC $
Notary $.
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $
t#
(Re,Ased02/24/2014)
bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
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,
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.
Lo
Signature
Signature
71WER JIJI
The foregoing instrument was acknowledged before me this The foregoing instru
a L day of H(\Y'C-J, , 20 ZC:) by // 2a day of _
t�l mac., ca F;✓ ° n�who is personally known to (z r`1
me or who has produced vo-,, l ; C¢ ,tie — as me or who has prod
identification and who did take an oath.
NOTARY PUBLIC:
identification and
NOTARY PUBLIC:
Sign: Sign:
Print: Print:
Seal: Notary Public stet of Florida Seal:
Latasha Arlin
< My Commission GG 288664
Expires 01114023
w
is
APPROVED BY Plans Examiner
it was acknowledged before me this
IA-c,— C344 20 '30 by
o is personally known to
T '-_ b/` L"�M t-'L-X- h a
did take an oath.
sP ' SINDIA ALVAREZ
MY COMMISSION # GG 238273
moo; EXPIRES: September 3, 2022
Zoning
Structural Review
(Revised02/24/2014)
Clerk
Property Search Application - Miami -Dade County Page 1 of 1
OFFICE OF THI"E PROPERTY APPRAISER
Summary Report
Property Information
Folio:
11-3206-034-0251
Property Address:
935 NE 99 ST
Miami Shores, FL 33138-2568
Owner
USA SPECIALTY REALTY LLC
Mailing Address
3233 COMMERCE PKWY
MIRAMAR, FL 33025 USA
PA Primary Zone
1100 SGL FAMILY - 2301-2500 SQ
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
3/2/0
Floors
1
Living Units
1
Actual Area
2,833 Sq.Ft
Living Area
2,124 Sq.Ft
Adjusted Area
2,447 Sq.Ft
Lot Size
9,996 Sq.Ft
Year Built
1961
Assessment Information
Year
2019
2018
2017
Land Value
$279,193
$299,483
$299,483
Building Value
$253,876
$256,935
$259,994
XF Value
$2,010
$2,010
$2,010
Market Value
$535,079
$558,428
$561,487
Assessed Value
$535,079
$558,428
$561,487
Benefits Information
Benefit Type 2019 2018 2017
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
5-6 53 40
MIAMI SHORES SEC 8 PB 14-33
E34FT LOT 18 ALL LOT 19 BILK 170
LOT SIZE 84.000 X 119
OR 9319 438
Generated On : 4/21/
Taxable Value Information
2019
2018
2
County
Exemption Value
$0 $0
Taxable Value
$535,079 $558,428
$561.
School Board
Exemption Value
$0
$0
Taxable Value
$535,079
$558,428
$561
City
Exemption Value
$0 $0
Taxable Value
$535,079 $558,428
$561.
Regional
Exemption Value
$0 $0
Taxable Value
$535,079 _ $558,428
$561
Sales Information
Previous Sale
Price
OR Book -Page
Qualification Descriptic
04/04/2016
$675,000
30033-2581
Qual by exam of deed
06/25/2012
$550,000
28204-0816
Qual by exam of deed
02/01/2004
$385,000
22083-4943
Sales which are qualified
05/01/1976
$87,500
00000-00000
Sales which are qualified
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appra
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
https://www.miamidade.gov/Apps/PA/propertysearch/ 4/21 /2020
Detail by Entity Name
Page 2 of 3
Detail by Entity Name
Florida Limited Liability Company
U.S.A. SPECIAL REALTY LLC
Filing Information
Document Number
FEI/EIN Number
Date Filed
State
Status
Last Event
Event Date Filed
Event Effective Date
Principal Address
3233 COMMERCE PKWY
MIRAMAR, FL 33025
Mailing Address
3233 COMMERCE PKWY
MIRAMAR, FL 33025
L15000112340
47-4447051
07/02/2015
FL
ACTIVE
LC STMNT OF AUTHORITY 21
04/05/2016
NONE
Registered Agent Name & Address
ZAMBRANO,ALEXANDER
3233 COMMERCE PKWY
MIRAMAR, FL 33025
Authorized Person(s) Detail
Name & Address
Title MGR
ZAMBRANO,ALEXANDER
3233 COMMERCE PKWY
MIRAMAR, FL 33025
Annual Reports
Report Year Filed Date
2017 04/22/2017
2018 03/31 /2018
2019 04/29/2019
Document Images
0412yJ1(1 J_-.-. ANNUAL_EiEi'UFi:i'
View image in PDF format
03/31 /2018 --
ANNUAL REPORT
View image in PDF format
04i2Z`2017..:::_NNUf
L_REPt)RT
View image in PDF format
04/05/2016 --
CORLCAUTH
Vises image in PDF format
0312412016 --
ANNUAL REPORT
View irnage in PDF format
07t( 212G1_.?._-:_Elorid_LimiYed._Liahility
View image in PDF format
http://search.sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entity... 4/21 /2020
Detail by Entity Name
Page 1 of 3
Florida Department of State
Department of State / Division of Corporations / Search Records / Detail By Document Number /
DIVISION OF CORPORATIONS
http://search.sunbiz.org/Inquiry/CorporationSearehISearchResultDetail?inquirytype=Entity... 4/21 /2020
Date: L-o
State of: %-00 rr ,
County of i
O
VULCANO IRON WORK
1331S SW 13S TH AVE
Miami Fl=, 33186
y personally pp �a.��t ,T— who, being Before me this day ersonall appeared �s �P wi l'/ � g duly sworn,
Deposes and says:
That he or she will be the only person working on the project located at:
-� 1� iv e �n -�� -C'ire t
r;
Cont ctor Signature
Sworn to (or affirmed) and subscribed before me this i 5^ day of 20 20 ,
by 4dotem 00,n4A-V
Personally know "
Or Produced identification
Type of identification produced
P e�
PNP Notary Public Stat4 of Florida
:P Maria Rodrigues
My commission GG 952502
Expires 02106120Z4
Mami 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
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 providedan 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:" y
ner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this t � day of
By A� eX a,rtd tL� Z G' ` �✓ a+-� who is personally known to me or has
` 17,r : v tJLs L cs �-n� r as identification.
Notary:��
Fejl%� No�ry Pubic Stste t
SEAL: Latasha Artie
My Convoisew GG
Expires 01/1412023
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
1
Issue Date: 07,
Parcel Number
935 NE 99TH ST, Miami Shores, FL 33138 1132060340251
Contacts
Permit ND.: FW-07-1 9-iSSO
Permit Type: Feem/ Afall
Work Class+f' rcation: Wood,Fence
Pemft°Stttus:
Expiration: 01/13/2020
USA SPECIALTY REALTY LLC Owner
3233 Commerce PKWY, Miramar, FL 33025
APC ENGINEERING ENTERPRISES INC Contractor
DAVID DIPUGLIA
2150 w. 10th ave, hialeah , FL 33010
Business: 3052198267
Description: NEW WOOD FENCE Valuation: $ 5,132.00 Inspection Requests:
7t3-4949
Total Sq Feet: 0.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$3.60
DBPR Fee
$2.00
DCA Fee
$2.00
Education Surcharge
$1.20
Planning and Zoning Review Fee
$35.00
Scanning Fee
$9.00
Technology Fee
$2.75
Wire and Wood Fence Fee
$60.00
Total:
$165.55
Payments Date Paid Amt Paid
Total Fees $165.55
Cash 07/15/2019 $165.55
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, FOOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accui
regulating construction and zoning. Futhermore, I authorize the above named
Authorized Signature: Owner / Applicant /
in compliance with all applicable laws
Date
July 15, 2019
Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
T I 305 795 2204 F 12ncl 756 8972
� CEIVEID
J 0 9 2019
BY•4�
INSPECTION LINE PHONE NUMBER: (305) 762-4949 al
FBC 20
BUILDING Master Permit No. t W o �q j5(06
PERMIT APPLICATION Sub Permit No.
BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL
❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
3�
A
JOB ADDRESS:
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:
11�
OWNER: Name (Fee Simple Titleholder):
t t
S
S`T
Address:
JJ 1I9
City: in; &qi
State:
Zip:
Tenant/Lessee Name:
Phone#:
Email:
/
CONTRACTOR: Company Name:
`
g'r
cal Phone#:C 47 �3
Address:
-
City: i e, lCC<<"
State:
P, Zip:
Qualifier Name: ✓;
Phone#: 3cS� S3 71
,State Certification or Registration
Certificate of Competency #:
DESIGNER: Architect/Engineer:
Phone#:
Address:
City: State: Zip:
Value of Work for this Permit: $
Square/Linear Footage of Work: MST i /l
Type of Work: ❑ Addition
❑ Alteration rVI
New ❑ Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ 0 Permit Fee $
Scanning Fee $ Radon Fee $
Technology Fee $
Structural Reviews $
Training/Education Fee $
CCF $
DBPR $
CO/CC $
Notary $
Double Fee $
Bond $
TOTAL FEE NOW DUE $ (0�;
(Revised02/24/2014)
Banding 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 $1500, 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
T�NER or AGENT
The foregoing instru//m(e �uJas acknowledged before me this
day of M.. n 20 9 by
z�, jo�,� i�i%44,,r ✓ , who is personally known to
me or who has produced L S l 4, _d l cI it zga as
identification and who did take a oathbL
NOTARY PUBLIC:
Signature ,
CONTRACTOR
The foregoing instrument was acknowledged before me this
ICI day of !- A 020 lei by
who i ersonally known o
me or who has pr duce3 d as
identification and who did take an oath.
NOTARY PUBLIC:
i
Print:
e+PLa�,,, SANDY ROMERO
r""VO``= SANDY ROMERO
?�r,� •,° Notary Public - State of Florida • . _ Notary Public •State of Florida
' Commission # FF 915708 =�, «o� Commission # FF 915708
P' My Comm. Expires Sep 7, 2019
�frsstNssairi?�ll{ii� *i+rpss* s sssssss*sssssssss*s sssss*ssssssss*sss ssss **s�sjs***s*s**
APPROVED BY `/ Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Property Search Application - Miami -Dade County Page 1 of 7
Address Owner Name Folio
SEARCH:
935 ne 99 st Suite Ci
PROPERTY INFORMATION
Folio: 11-3206-034-0251
Sub -Division:
MIAMI SHORES SEC 8
Property Address
935 NE 99 ST
Owner
USA SPECIALTY REALTY LLC
Mailing Address
3233 COMMERCE PKWY
MIRAMAR, FL 33025
PA Primary Zone
1100 SGL FAMILY - 2301-2500 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE FAMILY 1 UNIT
Beds / Baths I Half 3/2/0
Floors 1
Living Units
1
Actual Area
2,833 Sq.Ft
Living Area
2,124 Sq.Ft
Adjusted Area
2,447 Sq.Ft
https://www8.miamidade.gov/Apps/PA/propertysearch/ 6/24/2019
Property Search Application - Miami -Dade County
Page 2 of 7
Lot Size 9,996 Sq.Ft
Year Built 1961
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Detail by FEI/EIN Number
Page 2 of 3
Detail by FEI/EIN Number
Florida Limited Liability Company
U.S.A. SPECIAL REALTY LLC
Filing Information
Document Number
FEI/EIN Number
Date Filed
State
Status
Last Event
Event Date Filed
Event Effective Date
L15000112340
47-4447051
07/02/2015
FL
ACTIVE
LC STMNT OF AUTHORITY 21
04/05/2016
NONE
Principal Address
3233 COMMERCE PKWY
MIRAMAR, FL 33025
Mailing Address
3233 COMMERCE PKWY
MIRAMAR, FL 33025
Registered Agent Name & Address
ZAMBRANO,ALEXANDER
3233 COMMERCE PKWY
MIRAMAR, FL 33025
Authorized Person(s) Detail
Name & Address
Title MGR
ZAMBRANO,ALEXANDER
3233 COMMERCE PKWY
MIRAMAR, FL 33025
Annual Reports
Report Year
Filed Date
2017
04/22/2017
2018
03/31 /2018
2019
04/29/2019
Document Images
04/29/2019 -- ANNUAL REPORT
Q3_3112018__ ANNUAL REPORT
04/22/2017 — ANNUAL REPORT
04/05/2016 — CORLCAUTH
03/24/2016—ANNUAL REPORT
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Date : 07/08/2019
State of Florida
County of Miami -Dade
Before me this day personally appeared t/C (J� - i�`P1�1� who, being duly
sworn, deposes and says: U
That he or she will be the only person working on the project located at:
935 NE 99' St Miami Shores, FL 33138
Contractor Signatur
Sworn to (or affirmed) and subscribed before me this J day of , 20 J
Personally know
OR Produced Identification
Type of Identification Produced
SANDY ROMERO
i • Notary Public - Slate of Florida
•c` commission # FF 915703
1 'ar
%y;�uv-;F'' My Comm. Expires Sep 7, 2019
APC Engineering Enterer'
2150 West 10`" AVENUE - Hialeah, FL 33010 - T (305) 885-5371 - F (305) 885-5073 - apchomeinspections@gmail.com
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.
State of Florida
County of
The foregoing was ack owledgge%before me this p day of , MIT—.
By4&,v41de4_ who is personally known to me or has produced
as identification.D (�
Notary:
SANDY ROMERO
Notary Public • State of Florida
Commission # FF 915708
FENCES, WALLS, HEDGES
INSTALLED ON ALLEY MUST
LI-0 W ,--4,Q _60. FT. FOR
TRASH CANS, TREE TRIMMINGS, ETC.
'Anb
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& CCK )70
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No 19. 11 13
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C06,169 no 01
N.E. 99th STREET
F(=Z2MX PROPERTY OF. U.S.A SPECIAL REALTY, LM, -A
�ffi P SPAM- I FLORIDA ClAefffED LIABILITY COMPANY,
CQMMIM" Mc 120=
935 NE 99th STREET.
AAMIMI SHORES, FLORIDA 33138MPEV
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Fences Good Side lttjitj and horizontal
supporting mem') i = ifeilc(, shall face the
interior of the rm,i 1.,r which the fence is located
and the finished oAl:o shall face the adjoining
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PROFESSIONAL SURVEYING AND MAPPING
WAS Aki" UAW,4 MY 3 A-T IlYl A� MWT�
SrAhOARDS DF �kACITKX SA f FORM BY TW
LANNE &GARCIA INC.
LB # 2098
TliF SIGMA TURE ANO 7HE
A-1—TIVE COVEPURSUAW TO
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FRANCISCOF. FAJARDO PSM#4767 (QUALIFIER)
LuPAPILOIRDALIIIXSW
-"�"C44 PERFONI& MAX AWJ C DAV CT T 0 THE
2700 SW 37th AVENUE,
MLAMI, FLORIDA 33133
PH (305) 666-7909 FAX (305) 442-2530
m4lolo2mcoF. FAJARDO
IR ORoDA PROFES51-NAL 5
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