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DS-10-23-2670Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 520 GRAND CONIC, Miami Shores, FL 33138 Contacts Permit No.: DS-10-23-2670 Permit Type: Driveways/Walkways/Slabs Work Classification: Addition/Alteration Permit Status: Approved Issue Date:0110212024 Expiration:07/02/2024 Parcel Number 1132060271440 MARIANO VARELA Owner 520 GRAND CONCOURSE, MIAMI SHORES, FL 33138 Home: 3058733388 mjvarela@yahoo.com JA GLOBAL SERVICE GROUP Contractor JOSE ANAYA 2461 W 76 ST, HIALEAH, FL 33016 Business: 7862366545 j8000252@hotmail.com Description: NEW FACTORY 3000 PSI CONCRETE DRIVEWAYAND Valuation: $ 10,900.00 WALKWAY Total Sq Feet: 1,160.00 Fees Amount Application Fee- Other $50.00 CCF $6.60 Concrete/asphalt/pavers, slabs, dways, $100.00 swalks DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $3.30 Planning and Zoning Review Fee $70.00 Scanning Fee $9.00 Technology Fee $15.00 Total: $258.15 Payments Date Paid Amt Paid Total Fees $258.15 Credit Card 10/27/2023 $50.00 Credit Card 01/02/2024 $208.15 Amount Due: $0.00 u 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 n truction and zoning. Futhermore, I authorize the above named contractor to do the work stated. 7 c-);twle 60lcoo )141) q Aut n ad Signature: Owner ! Applicant / Contractor / Agent Date January 02, 2024 Page 2 of 2 ENTERED Miami Shores Village OCI 262023 Building Department BY=--y -- 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 �`}h INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 200 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. BUILDING Ij ELECTRIC E3 ROOFING [3 REVISION ® EXTENSION ®RENEWAL PLUMBING Q MECHANICAL ❑ CHANGE OF ® CANCELLATION ® SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 520 GRAND CONCOURSE City Miami Shores County: Miami Dade Zip:33138 Folio/Parcel#11-3206-017-1430 Is the Building Historically Designated: Yes NO X Occupancy Type: residential Load: Construction Type: Flood Zone: BFE: FFE: Ip�Oa�•� OWNER: Name (Fee Simple Titleholder):MARIANO JULIAN VARELA Phone#:3058733388 Address:520 GRAND CONCOURSE City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Email: mjvarela@yahoo.com CONTRACTOR: Company Name) A Global Service Group Inc. Phone#: 7862366545 Address: 2461 W 76 ST. #104 Hialeah FL 33016 Email: info@ concretesolutions.today Qualifier Name Jose Rafael Anaya State Certification or Registration #:CGC1512575 DESIGNER: Architect/Engineer: Value of Work for this Permit: $10,900 7862366545 ofCompetency#: 0GC1512575 _City: State: _Zip: square/linear Footage of Work:1160 Type of Work: M Addition ® Alteration 13 New ® Repair/Replace ® Demolition Description of work: New factory 3000 psi concrete driveway and walkway Specify color of color thru tile: concrete Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews $ (Rmsed04/05/2022) Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary Double Fee $ P&Z Review $ Bond $ TOTALFEE NOW DUE $ 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 abswwC4 such posted notice, the inspection will not be approved and a reinspection fee will be charged. ) �� Signature z fi _ OWNER or AGENT The foregoing instrument was (acknowledged before me this J day of ©C- � . 20 ?- �li� by R6LV-iQr17 V 4V aK.C) who is personally known to me or who has produced t' (— as identification and who did take an oath. NOTARY Print: (Revised04/05/2022) Florida Comm. Expires Mar 15. 2027 .hrouBh National Notary Assn. The foregoing instrurent was acknowledged before me this `"11 day of 20 `, . by who is personally known to me or who has produced F L -J-)L-- as identification and who did take an oath. NOTARY PUBLIC: --- �n Sign: .�N gi Print: ( L--A ` - r r1t�t Structural Review Clerk ReportOFFICE OF THE PROPERTY APPRAISEJ Summary Folio 11-3206-017-1430 Property 520 GRAND CONC Address MIAMI SHORES, FL 33138-2465 Owner MARIANO JULIAN VARELATRS , MARIANO JULIAN VARELA REV TR Mailing 520 GRAND CONCOURSE Address MIAMI SHORES, FL33138 Primary Zone 1300 SGL FAMILY- 2801-3000 SQ Primary Land 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Use Beds/Baths 3/2/0 /Half Floors 1 Living Units 1 _ Actual Area 3,192 Sq.Ft Living Area 2,308 Sq.Ft Adjusted Area 2,633 Sq.Ft Lot Size 13,465.4 Sq.Ft Year Built: Multiple (See Building Info.) Year 2023 2022 2021 Land Value $888,899 $672,963 $473,905 Building Value $589.424 $596,980 $174.206 Extra Feature Value $18,818 $18,966 $19,114: Market Value $1,497141 $1,288,909 $667,225 Assessed Value $1,28T850 $1,250,340 $667,225 Benefit Type 2023 Save Our Homes Assessment $209,291 Cap Reduction Year .:'COUNTY Exemption Value Taxable Value SCHOOLBOARD Generated On: 10/27/2023 2023 2022 2021 $50,000 $50,000 $0 $1,237,850 $1,200,340 $667.225 Exemption Value $25,000 $25,000 $0 Taxable Value $1,262,850 $1,225,340 $667,225 „CITY Exemption Value $50,000 $50,000 $0 Taxable Value $1,237,850 $1,200,340 $667,225 2022 2021 REGIONAL Exemption Value $50,000 $50,000 $0 Portability Assessment $38,569 Reduction Homestead Exemption $25,000 $25,000 Second Exemption $25,000 $25,000 Homestead Note: Notall benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). :.NY M idM i� MIAMI SHORES SEC 4AMD PB 15-14 LOT 9&10 BLK 97 LOT SIZE 13465 SQ FT M/L 75R40296 COC 25528-2522125/26/27/28 0307 6 Taxable Value $1,237,850 $1.200.340 $667.225 Previous Price OR Book- Qualification Description Sale Page 04/01/2021 $1,41 D,00032453-2829 Qual by exam of deed 04/13/2011 $0 27707-1050 Corrective, tax or QCD; min consideration 04/13/2011 $415.000 27659-1128 Oual by exam of deed 03/01/2007 $720,00025528-2522 Other disqualified The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hftp://www.miamidade-gov/infoldisclaimer.asp I-";1:1p1cFJvFAD DEC 0 8 2023 0. 0. At. U METAL = 0 METAL u-i POl 1 U71i 1.sT. 29 24' USE BASE ', ji� .. * j �- 4% . .�-ci A ci TILE21 b PUBOC WALKWAY TO BE i Y, 4 9 DRIVE LOT 9 WTH6-THMMOONOREIT LOT 9 r f RIBBONS BLOCK 97 6V60ki bj % bb F I - - - - AODRIONI " bit vL %. ..-.I . % BLOCK 51 b sz r I ir r 3000 PSI CONCRETT REINFORCED Wff H METAL MESH WITH 4- THICKNESS F If r r r r 42 bj% EIg�'���I�h 10 2 bi b t 16.6 Ill —1 6.�- 21.9' 5.g 1 6.2- .9 U) ri .6 b1% PZ C." 212 F F EL , F J� 1 4 � tj 0 - - K) - --1 -Fr in 132 c2 GAR. i CD n IT GAR. RESIDENCE 0 cn RESIDENCE -r- FF ELE'V.=8.71' C? r-3 FIF ELEV.=8.71, 0 W6� # 520 ilt 520 no %.N1 212 F.F. El IN coL � F.F. El 1 HIGH) F.l 'HIGH) 0.3 b A/C r-l-F-r- �4 A/C b.51 r dot b.51 m F-r- r rq 0 m 243 2 . c 56 I W cg) 16ff %.0 Ca C=2 bit 24.8' 1161Y b -0A 172 — J-J-Ujj VZ jjj -U-jj iiiji-i-i-ji-i b! SAIJ 0 , CD E2 bit 24.V _U_J_J_jj_ b -IiAJ -i (Atk S.0 %.* -i -j-j- to -j- 10 -1-1 -j-j- LOT10 J- J-1 LOT J-j -j-j- ST ON j- POOL -ij 41 POOL `0 J- m § I BLOCK 97 BLOCK 97 J-j s2b J- c c L -j LOT 10 2 _j 4*1 C c J_j POOL BLOCK 97 _jj _J_j �b. eb % 9_b 'A -i-i -j-j- t.eb -J-J-J, i-ii-i-i -j-j-j- b. bq)JJJ to %51 :)D Om bit Dz .0 85' 2.6"ON b. b-g$ 2 li :z b. .0K N xb* L3 91 bN 3.0-pN 3.0'XON 11 — - •-0 x wbi ilk xw�A— x xw Ill ----- - - I MEWAYMOA W% EXISTING SITE PLAN PROPOSED SITE PLAN i PLANNING DEPARTMENT4 RrfttP2, +F CL�) I'�ECEIVEI3 Mission: Ron Deaan6s To probed, promote&aproetle health DEC 0$ Z�23 Governor of all people in Florida through integrated O v state, tautly&arrrnntydhft 1 i TH �n«tae Surgeon Mn H!• A 1 TLJ � �------_ State Surgeon General Mallon: To be the Healthiest State in the Nation December 08, 2023 Ja Global Services CITY 520 Grand Concourse Miami, FL 33138 COPY RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP2025711 Centrax Permit Number: 13SM-2830041 620 Grand Concourse Miami, FL 33138 Lot: 9 10 Block: Subdivision: Miami Shores Sec 4 Amd Plat Dear Applicant, This will acknowledge receipt of a floor plan and site plan on 12/06/2023 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. NO OBJECTION FOR NEW DRIVEWAY AS PER SITE PLAN. NO FLOW INCREASE, NO BEDROOMS ADDED. This office has reviewed and verified the floor plan and site plan you submitted, for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement, or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted, the Department cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at (305) 623-3500. Miami Shores Village Buil ing Department Zoning Dept. Date-�-�� Building Dept. ate Subject to compliance with all Fed al, State and County rules anri regulations. Permit#-2_lo7a PW- t0_-Z3-2-67( rleeW Myrlw, of limb in Dade County • • ,Florida PHONE: (305) 623-3500 Sincerely, Gabriel Toledo Engineering Specialist II Department of Health in Dade County T ITTER:HealthyFLA FACEBOOK FLDepartmentoMeakh YOUTIBE: fidoh RUNBINGSIfEPLW WALLQ.BANODTDLTML -XO1-10 [GVA NO OBJECTION Florida Health Miami -Dade County O.S.T.D.S. B Well Program Application No.: APPnPN711-Date: 19/08 Signature Ea DECEIVE DEC 0 8 2023 Ron DeSantis, Governor Melanie S. Griffin, Secretary dbK)r a STATE OF FLORIDA JEPAFi I MEN I OF BUSINESS AND PROFESSIONAL REGULATION 3016 LICENSE NUMBER: CGC1512575 EXPIRATION DATE: AUGUST 31, 2024 Always verify licenses online at MyFIoridaLice nse.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5971610 BUSINESS NAME/LOCATION JA GLOBAL SERVICES GROUP INC 2461 W 76TH ST APT 104 HIALEAH, FL 33016-5672 OWNER JA GLOBAL SERVICES GROUP INC Worker(s) RECEIPT NO. RENEWAL 6229595 EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 GENERAL BUILDING CONTRACTOR CGC1512575 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 08/01/2023 INT-23-418035 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. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba-276. For more information, visit www.miamidade.gov/taxcollector ACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/31/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ANA PHONE (305) 380-8350 FAX (305) 380-8352 A/C No Insurance for Less Inc AD`DDRIESS: anniepital2200gmail.com 14750 SW 26 St Suite 115 INSURERS AFFORDING COVERAGE NAIC # INSURER A: ASCENDANT UNDERWRITERS,LLC Miami FL 33185 INSURED INSURER B : INSURER C : Ja Global Services Group INSURER D : 2461 W 76 St # 104 INSURER E : INSURER F : hialeah FL 33016- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICYEFF MMIDCD� LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y Y GL314777MGA 09/07/2023 09/07/2024 EACH OCCURRENCE $ 1.000.000 PREMISES Ea occurrence $ 100.000 MED EXP (Any one person) S 5.000 PERSONAL & ADV INJURY $ 1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT OTHER: GENERAL AGGREGATE S 2.000.000 PRODUCTS -COMP/OP AGG $ 2.000.000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ S UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe ender DESCRIPTION OF OPERATIONS below N / A PER STATUTE I I ER OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE HALL THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. GUIDING &ZONING 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33138 a 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD [HE Sl ��yyyy f� JIMMY PATRONIS CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 12/20/2022 PERSON: JOSE R ANAYA FEIN: 650963850 BUSINESS NAME AND ADDRESS: JA GLOBAL SERVICES GROUP INC 14108 SW 51 LANE HOLLYWOOD, FL 33027 SCOPE OF BUSINESS OR TRADE: EXPIRATION DATE: 12/19/2024 EMAIL: JOAN102460@MSN.COM Plumbing NOC and Drivers Concrete Wirk Incidental To Wallboard,Sheetrock,Drywall, Rooting - All Kinds and The construction Of Private Plasterboard, or Cement Drivers Residence Board Installation Within Buildings & Drivers IMPORTANT: Pursuant to subsection 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 440.05(13), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01640048 QUESTIONS? (850) 413-1609 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 Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stan. § 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 Theforegoingwas acknowledgebeforemethisZ Z day of v By V �Q� QLn n QLX � I CJ— who is personally known to me or has produced as identification. r n�.. IGOR E. KIDD aARALT SEAL: x°�• Notary 1U11iC , State of Florida Commission # HH 344658 My Comm. Expires Mar 15, 2027 COMPANY LETTER HEAD Date: State of Flo(-(d o, County of ode Before me this day personally appeared deposes and says: who, being duly sworm, That he or she will be the only person working on the project located at: SaO GrcanJ Concourse /f1r`omi .Shores fL 33138 by to ( or affirmed) and subscribed before me this .-2] day of /\1d\J-6-6e,,r20_23, Personally known OR Produced Identification Type of Identification Produced 171-J) L Ile Slate of t4oka P Flores MYHH ommsl 274836 c.n. 617212626 Print, Thpe or Stamp Name of Notary Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 520 GRAND CONIC, Miami Shores, FL 33138 Contacts MARIANO VARELA Owner 520 GRAND CONCOURSE, MIAMI SHORES, FL 33138 Home: 3058733388 mjvarela@yahoo.com Issue Date: 01/02/2024 Parcel Number 1132060171440 JOSE ANAYA 2461 W 76 ST, HIALEAH, FL 33016 Business: 7862366545 Description: NEW FACTORY 3000 PSI CONCRETE DRIVEWAYAND Valuation: $ 10,900.00 WALKWAY Total Sq Feet: 1,160.00 Fees Amount Education Surcharge $3.30 Public Works Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $10.00 Total: $122.30 Building Department Copy Permit NO.: PW-10-23-2671 Permit Type: Public Works Work Classification: Public Works Permit Status: Approved Expiration: 07/02/ 2024 Payments Date Paid Amt Paid Total Fees $122.30 Credit Card 01/02/2024 $122.30 Amount Due: $0.00 j8OOO252@hotmail.com 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 AFFIDAV T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating consj�c Jr aad-zoning. Futhermore, I authorize the above named contractor to do the work stated. r Owner / Applicant / Contractor / Agent January 02, 2024 Page 2 of 2 EATIMRED nrT 2s n Miami Shores Village 2 23 Public Works Department (305)795-2210 BYc--I-- Public works forms are available from the building department,10050 NE 2n4 Ave., Miami Shores, FL 33138 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miaml-Dade Property Permit#: Pi-� - 10 -�3 - 9y7 l Name of Applicant (if utility see below): MARIANO JULIAN VARELA Owner off the following described property: Legal Description: Lot 9 & 10 Block Subdivision MIAMI SHORES SEC 4 AMD Folio #; 11-3206-017-1430 Address: 520 GRAND CONCOURSE, MIAMI SHORES, FL 33138 UTILITY NAME: Qualifier/Authorized Agent: Address: City: Telephone: State Certification or Registration #: Email: CONTRACTOR NAME: JA Global Service Group Inc Qualifier/Authorized Agent: Jose Rafael Anaya Address: 2461 W 76 ST. #104 Hialeah FIL State: Certificate of Competency # City: Hialeah State: FL ZIP: 33016 Telephone: 7862366545 Email: info@concretesolutions.today State Certification or Registration #:CGC1512575 Certificate of Competency #:CGC1512575 Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: Replacing the excisting driveway with new concrete Factory 3000 PSI Type of Work: ❑ Paving ❑ Utility ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Landscape ❑ Antenna 0 Other: Concrete Driveway DESIGNER: Architect/Engineer: Address: Citv: Telephone: Registration #: _ State: Email: ZIP: Value of Work for this Permit: $10,900 Square/Lineal Footage of Work: 1160 ►rsss Fees'"xarr Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ Bond $ (if required) Total Fee Now Due $ 1 10 Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. 1 understand that separate permits must be secured for CONCRETE DRIVEWAY APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the 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 public works permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection will be charged. Signature Applicant or Authorized Agent The foregoing instrumentsacknowledged before methis(�dayof �"r"oex .20by hns:awY.o Vl:xc-ZvQ who is personally known to rpg owho has produced 12L <, as identification Signature Company/Utility Agent The foregoing instrument was acknowledged before methis _ day of 20�by is personally known to me or who has produced as identification. NOTARY PUBLIC: Sign: _ate IGOR E. KIDD BARA'-T Print:`: Print: SEAL: ' a' commissior e Hi 34e658 SEAL: My Comm. Expires Mar 15, 2027 Bonded through National Notary Assn. APPROVED BY: �� 23 Public Works Director, or Designee 2017-04-15