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EL-11-20-2529Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 730 NE 94TH ST, Miami Shores, FL 33138 1132060141690 Contacts MARTA GIERCZYK Owner Marta Gierczyk Applicant 730 NE 94 ST 730 94th ST NE 730, Miami Shores, FL 33138 Mobile: 305-639-0194 MARTAGIERCZYK@GMAIL.COM martagierczyk@gmail.com SUNSHINE ELECTRICAL CONTRACTORS Contractor CORP MARIANO SANTIESTEBAN 1300 SW 85 CT, MIAMI , FL 33144 Business: 3052654958 Home: 7864439590 Other:7862736194 Inspection Requests Description: KITCHEN REMODEL REPLACE CABINETS COUNTER Valuation: $ 1,000.00 30S 49�I9 TOPS, ADD TILE Total Sq Feet: 116.00 Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 11/20/2020 $110.30 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. Authorized A nature: Owner / Applicant / Contractor / Agent Date November 20, 2020 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING -S] ELECTRIC Miami Shores Village PIE: EIVEID 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 Gj FBC 201 Master Permit No. _t. — 7 2 C7 Sub Permit No. ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS:' Folio/Parcel#: Miami Shores iami Dade Is the Building Historically Designated: Yes NO_ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ��+(�� v1�C-� )� Phone#: Address: �� Ci City: )('V\\ ��kl� �� , State: Zip: 'T�j1-!) V Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address:! <_y ,D .r-3 j L e#: City: rV C: State: Zip: 915 1 ` "—A Qualifier Name Phone#: az;� so +A 35 f 5 0 State Certification or Registration #: Q--- (�� �� Cy"�} Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ -.VO10 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition j �- Description of Work:'• K '4 r� a S cci�1 �� Specify color of color thru tile:, Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $_ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ''O •3 (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 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. Signatur t a WNER or AGENT The foregoing instrument was acknowledged before me this day of n�J , 2 ? , by �{ L2' ho is personall_ v known to Signatur C GrYiic CONTRACTOR The foregoing instrument was acknowledged before me this day ofYVIJ 20 C" by �,y G 1 1P2( Cfl� J��1 b� ^� who is personally known to me or who has produced as me or who has produced _ak identification and who did take an oath. identification and who did take an oath ry Public Sate of Roma tl, NOTARY PUBLIC: NOTARY PUBLIC: r tUn GG 962953 u,,1 u12.0= •, ^�*.�►e, a. c';, a'^ a x`�fi`�./°t�`w�"'�'^+e,°%a�'+�s"w„�' .fit ,fit Sign: r _�_ _ - Sign: Print: Print: Seal: Nt,*riry Public State, of FioWa Seal: '� IdsUi Pl.a nu r,r rirt'' G 9o2353 d 'b APPROVED B z� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 4860764 BUSINESS NAME/LOCATION SUNSHINE ELECTRICAL CONTRACTORS CORP 1300 SW 85TH CT MIAMI, FL 33144 OWNER SUNSHINE ELECTRICAL CONTRS CORP rin MARIANn RANTIPATPRAN Worker(s) 1 RECEIPT NO. RENEWAL 5073093 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13005807 LBT EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 €i 19 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 09/2212020 ECHECK-20-247919 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit or a certification of the holder's qualifications, to do business. Voider must comply with any governmental or nongovemmentaf regulatory laws and requirements which apply to the business. Muft The RECEfPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sac ga-276. MI�AM� For more information, visit www raiamidade.ggvttexcolleetor SUNSHINE ELECTRICAL CONTRACTORS License #13005807 Phone # 7864439590 Date: State Of Florida County: Before me this day personally appeared ��1 `mac, n� Who being duly sworn, deposes and says: That he or she will be the only rson working in the project located at ()�� 11� IDN 5T Contractor Signature Sworn to (or affirm) and subscribed before me this�� -- By r V\A C/l-C> v u a'' Notary Public State of Florida f�rsuiNa , to G 562853 x con,,;, Ran `3vg. FkR r�� Gs/ UIY014 p� day of ri.'lj 20 Personally Know J / . Or produced identification Type identification Produced Print, type or stamp name of Notary 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. s Signatu �.1..:W ,, w i O 4er 114 State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of nQ0 , 20-2-7 . / By 00 t G � t-� �r (�2'1 (� who is personally known to me or has produced as identificatio,,� �. Nit / Pubii . S ate of Flora Notary: .yn GG 962853 c G.i/20/s:024 SEAL: