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RC-10-23-2613 BathroomMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit No.: RC-10-23-2613 Permit Type: Building (Residential) Work Classification: Alteration Permit Status: Approved Issue Date:12/07/2023 Expiration:08/18/2025 Location Address Parcel Number 395 NE 96TH ST, Miami Shores, FL 33138 1132060135930 1 Contacts Gonzalo Perez JR Owner 39596 Home: 7024982501 joyandg.perez@gmail.com ARCHITECTURE DEVELOPMENT & Contractor CONSTRUCTION ASSEMBLY MANUELALMANZAR 5211 SW 90 AVE, COOPER CITY, FL 33328 Business: 7542100839 Ilcadca@gmail.com Description: REPLACING OLD TOILET, SHOWER, FAUCET AND Valuation: $ 3,500.00 Inspection Requests: TILE WITH NEW. REPLACING SHOWER DOOR W/ GLASS. Visit our websitewww.msvn.gov and REPLACING OLD CABINET SPACE FOR USEABLE SPACE FOR Total Sq Feet: 65.00 Click on Permits BATHROOM. HOUSE WAS RE -WIRED UNDER PERMIT EL-04-19-841 Fees Amount Application Fee - Other $50.00 CCF $2.40 Change of Contractor $145.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $1.20 Notary Fee $5.00 Permit Extension (Manual) BD 322-000 $75.00 Permit Fee $55.00 Scanning Fee $9.00 Technology Fee $10.50 Total: $357.10 Payments Date Paid Amt Paid Total Fees $357.10 Check# 595 10/24/2023 $50.00 Cash 02/18/2025 $75.00 Credit Card 05/16/2024 $150.00 Credit Card 12/07/2023 $82.10 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 Signature: Owner / Applicant 7-�CdDlEacter— / Agent Date February 18, 2025 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: RC-10-23-2613 Permit Type: Building (Residential) Work Classification: Alteration Permit status: Approved issue Date: 12/07/2023 Expiration: O6/07/2024 Location Address Parcel Number 395 NE 96TH ST, Miami Shores, FL 33138 1132060135930 Contacts Gonzalo Perez JR Owner ARCHITECTURE DEVELOPMENT& Contractor 39596 CONSTRUCTION ASSEMBLY Home: 7024982501 joyandg.perez@gmail.com MANUELALMANZAR 5211 SW 90 AVE, COOPER CITY, FL 33328 Business: 7542100839 Ilcadca@gmail.com Description: REPLACING OLD TOILET, SHOWER, FAUCETAND Valuation: $ 3,500.00 Ins ection Requests: TILE WITH NEW. REPLACING SHOWER DOOR W/ GLASS. U!sit our website www.msvR.gov and REPLACING OLD CABINET SPACE FOR USEABLE SPACE FOR 11 Total 5q Feet: 65.00 Click on Permits BATHROOM. HOUSE WAS RE -WIRED UNDER PERMIT EL-04-19-841 Fees Amount Application Fee - Other $50.00 CCF $2.40 Change of Contractor $145.00 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $1.20 Notary Fee $5.00 Permit Fee $55.00 Scanning Fee $9.00 Technology Fee $10.50 Total: $282.10 Payments Date Paid Amt Paid Total Fees $282.10 Checkt1595 10/24/2023 $50.00 Credit Card OS/16/2024 $150.00 Credit Card 12/07/2023 $82.10 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, 1 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 apd zoning. Futhermore, I authori7�e„ tl a above named contractor to do the work stated. / Agent May 16, 2024 Page 2 of 2 Miami Shores Village ENTEREk-Al 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 APR 3 0 2024 BY: — FBC 2023" 94`' BUILDING Master Permit Now lD'23-13 PERMIT APPLICATION Sub Permit No. ®BUILDING E3 ELECTRIC I3 ROOFING 13 REVISION 13 EXTENSION ®RENEWAL PLUMBING ® MECHANICAL [M/CHANGE OF I3 CANCELLATION ® SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Q C� 3�S N� �lbf+�'• City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1131D6 0 I3S 0).3y Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): &6&k ef��[j/14 l� �Qitrf1- Phone#: 6% -w - 0-'1 City: yvliauL,,�h� State: Zip: Tenant/Lessee Name: //�� Phone#: Email: 1 Oct (3JA, C1 F��VQ� /0 �INIGtn I - C61A-- - CONTRACTOR: Company Name: Addre< Email: Qualifier Name: �Mao%'4k 1 A I mot r) LoA V Phone#: 159 —7 /0 —0133 cI State Certification or Registration #: C6C ( '�.;3 3 6 y ti Certificate of Competency #: DESIGNER, Architect/Engineer: Phone#;i Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: I3 Addition I3 Alteration M New ® Repair/Replace Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ DCA Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews 5 CCF DBPR $ P&Z Review $ Zip: I3 Demolition c0/cc $ Notary Double Fee $ Bond $, TOTAL FEE NOW DUE $ (Revised04/05/2022) 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. Signature 1) a — O or The foregoing instrument was acknowledged before me this _day of 'vp`- 1 .20.Li by G�(DVN a P�r{?nvho is personally known to me or who has produced r ✓`�3 LLG as identification and who did take an oath. Signature CONTRACTOR The foregoing instrument was acknowledged before me this .3 o day of &�!r k . 20 Z-q by fvkj'�e.l 4(rn 6bi%Ar, , who is personally known to me or who has produced i1:7:L t---y-1 J e. s C, � as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: U Sign: Print:y t V 1 -e-yw%, \4GL, Print: u0uuupi Vivienne ao VivienneYao Seal: 'P..... o Comm.MH222410 Seal: �Prv�Bo, =t Comm.:HH 222410 Expires:Jan.31,2026 -:. _ >n. _ - Exires:Jan.31,2026 of \„o� Notary Public -State of Florida %�++t;&F;¢F, N2taryPublic •StateofFlorida APPROVED BY t() Plans Examiner Zoning Structural Review Clerk Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.qov 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: ! I Vl "-1s reg6esting a permit under this workers' compensation exemption and has ack owledge 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. 114 Signature: Address: jj q y��• �r�. wner U"ut,V�' , SHaui t - 3�c3� State of Florida County of Miami -Dade The foregoing was acknowledge before me this 0 day of r' ( 202H . Bpace?__ J r who is personally known to me or has produced �Lw3 �u a as identification. Notary: SEAL: m0""""�•. �pv n B`= VivienneYao Comm.:HH 222410 Expires: Jan.31,2026 ..�,iA< %a'„�Fa•` Notary Public - State of Florida Rev12122022 Notice to Owner Page 1 of I BusinessName: Address: Phone: ( ) Qualifier Name:- Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov E-mail: Contractor Registration Form Qualifier Lic Number: Contractor may register license and insurance information with the Village on an annual basis. The initial fee will be $50 with an annual update fee of $30. Contractors that elect not to maintain their information on file will need to provide their information with each permit applied for. Please confirm if you would like to register your Contractor for a fee of $50. A FLORIDA STATE CERTIFIED CONTRACTOR: A. Copy of Local Business Tax Receipt B. Copy of Qualifier State Licenses C. Copy of Liability Insurance* D. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 6th edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice to Owner form and Contractor Affidavit) A MIAMI DADE COUNTY CONTRACTOR: A. Copy of Certificate of Competency of Qualifier B. Copy of Local Business Tax Receipt C. Copy of State Registered Contractor Licenses or Miami Dade County Municipal Contractor's Tax Receipt. D. Copy of Liability Insurance* E. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 61h edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice of Owner form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 26016WR STONE ROAD TALIAHASSEE FL 323"-()7M Congratulations! With Nis license you becme one of the nearly one million Floridians licensed by the Department of Business and Professloral Regulation. Our professionals and businesses range from anldtM to yacht brokm from boxers to barbe4ue restaurants. and they keep Florldbas economy strong. Every day we work to Improve the way we do business In order to serve you better. For information about our services. plea. lag onto wwwmyfloridalkense.mm There you can find more Information about our dlvlsbns and the regulations that impact you, wbudbe to department newsletters and team more about the Department's initiatives. Our mission at the Department Is: License EfficienW, Regulate Fairly. We constantly strive to serve you better w that you can serve your customers. Thank you for dolng business in Florida, and congratulations on your new license! STATE OF FLORIDA DEPARTMENT dbpr �BUSSlN SSANDPROFESSIONAL cuass✓F as .=21t»:3 CFarrFlm GEW MCpifMCfW MNa1IIAR MWVELA MCF1nFCNa[ pfKIONAMi a NNFIRU LI sm uNDW e10VRa Y. nOMW S11MFS faR.T MTE'Nltaafi X.M Ron DeSanti, Govmwr Melanie S.G Ifin. ScaeWy STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER: CGC1533644 EXPIRATION DATE: AUGUST 31,2024 THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489. FLORIDA STATUTES ARCHITE IREDELA 0 ARCHITECT MANUEVELOPMENig CONSTRUCTION ASSEMBLY LLC r— SN 1 SW BOTH AVE COOPER Ow FL 33329 ❑� rc nsumav37ram AlwayFredfy hu.n.mneal Mooridatkenu-eon Ooml Llx Ntla Crcumenr Inxry Fo1m. TNa Is yxa Ikmu. R is uMa.rrul for anyolroxlxr tlw the E<msm to 1ne Nh dorurcnt. BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-357-4829 VALID OCTOBER 1, 2023 THROUGH SEPTEMBER 30, 2024 Business Name: ARCHITECTURE DEVELOPMENT & CONSTRUCTION ASSEMBLY LLC Owner Name: MANUEL A ALMANZAR Business Location: 5211 SW 90TH AVE COOPER CITY Business Phone: 7542100839 Receipt #:180-334493 GE GENERAL CONTRACTOR (GENERAL Business Type: CONTRACTOR) Business Opened: 0 7/ 13 / 2 0 2 2 State/County/Cert/Reg:CGC15 3 3 64 4 Exemption Code: Rooms Seats Employees Machines Professionals 2 For Vending Business Only Number of Machines: Vending Tvee: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 6.75 0.00 25.00 58.75 Receipt Fee 27.00 Packing/Processing/Canning Employees 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: ARCHITECTURE DEVELOPMENT & CONSTRU 5211 SW 90TH AVE COOPER CITY, FL 33328-5110 2023 -2024 Receipt #WWW-23-00246212 Paid 05/06/2024 S8.75 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-357-4829 VALID OCTOBER 19 2023 THROUGH SEPTEMBER 30, 2024 Receipt #: 180-334493 Business Name: ARCHITECTURE DEVELOPMENT & Business Type: GENERAL CONTRACTOR (GENERAL CONSTRUCTION ASSEMBLY LLC CONTRACTOR) Owner Name: MANUEL A ALMANZAR Business Opened: 07 / 13 / 2 02 2 Business Location: 5211 SW 90TH AVE State/County/Cert/Reg: CGC1533644 COOPER CITY Exemption Code: Business Phone: 7542100839 Rooms Seats Employees Machines Professionals 2 Signature For Vending Business Only Numhar of Mar_hinpc• {/nnAinn Tvee. Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.001 6.75 0.00 25.00 58.75 Receipt #WWW-23-00246212 Paid 05/06/2024 58.75 AC04l29/2024YYYORN CERTIFICATE OF LIABILITY INSURANCE DATE ( In /2024 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. B the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. N SUBROGATION IS WAIVED, subject to the teens 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 Ueu of such endorsement(s). PRODUCER Simply Business 1 Beacon Street Floor Boston, MA 02108 CONTACT Simply Business N (8441654-7272 ° IAIC15th ADDRESS: contactus@simplybusiness.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Ac:aedited Suraty And Casualty Company 6379 CURED Architecture development & construction assembly 5211 SW 90th Ave Fort Lauderdale, Florida 33328 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : 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. MR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL, LIABILITY CLAIMS MADE OCCUR TSGL4463930XB /29/2024 /29/2025 EACH OCCURRENCE 1,000,000 NTED 100,000 MED EXP one n 5,000 PERSONAL 14 ADV INJURY 1,000,000 GEM AGGREGATE LIMIT APPLIES PER: XPRO- POLICY ❑ JECT LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS -COMPIOPAGG 2,000,000 AUTOMOBILE LIABILITY ANY AUTO SCHEDULED OWNED AUTOS AUTOS ONLY HIRED NON4YWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per scddent) PROPERTYDAMAGE n UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED I I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory In NH) B s. describe under DESCRIPTION OF OPERATIONS below N I A PER OTH- E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT PROFESSIONAL LIABILITY EACH CLAIM AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addltiortal Remarks Schedule maybe ansahed If more space Is required) Lloense number 0 CGC1533644 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE BLDG DEPT, ACCORDANCE WITH THE POLICY PROVISIONS. 10050 no 2nd ave , Miami shores, FL 33138 AUTHORIZED REPRESENrAnVE 01888 2015 ACORD CORPORATION. All rights reserved. ACORD 2S (2016103) The ACORD name and logo are reglstered marks of ACORD 0 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: 4/11/2023 PERSON: MANUEL A ALMANZAR FEIN: 883211106 BUSINESS NAME AND ADDRESS: EXPIRATION DATE: 4/10/2025 EMAIL: LLCADCA@GMAIL.COM ARCHITECTURE DEVELOPMENT & CONSTRUCTION ASSEMBLY LLC 5211 SW 90TH AVE FORT LAUDERDALE, FL 33328 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05(13), 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(11). F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), F.S., notices of election to be exempt and certificates of election to be exempt shall be subject to revmalion 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 E01702968 QUESTIONS? (850) 413-1609 RULE 69L-6.012, F.A.C. REVISED 01f2023 DATE: 05 1 0-1 1 zy STATE OF J� L COUNTY OF "�ko m \ 6-a6c, wl M%&• e AYrA ARCHITECTURE DEVELOPMENT & CONSTRUCTION ASSEMBLY. - 5211 sw 901h are Cooper City fl, 33328 - LLCADCA@GMAIL.COM 754 210-0839 Before me this day personally appeared -La who, being duly sworn, deposes and says That he or she will be the only person working on the project located at : 39 S N :v-- 9e' �i- Contractor signature Sworn to (or affirmed) and subscribed before me this _� day of , 20.LL, by Ma-vtiuA rn.ml ear Personally know, Or produced identification Type of identification produced r�-- U Vivienne Yao g s Comm.:HH 222410 �.. af Expires: Jan. 31, 2026 Notary Public - State of Florida Print, type or stamp of notary U 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: (305) 762-4949 BUILDING PE MIT APPLICATION BUILDING ® ELECTRIC © ROOFING FBC 20 Master Permit No. eC I C)—?,3 — Zit 3 ® REVISION Sub Permit No._ Wr6TENSION ®PLUMBING [3MECHANICAL ® CHANGE OF ® CANCELLATION ® SHOP CONTRACTOR DRAWINGS © RENEWAL JOB ADDRESS: 395 NE q(0_V"�k Citv: Miami Shores Countv: Miami Dade Zio: �� 3 Folio/Parcel#: 11 3 z-Wo 0 1 35!13 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type:A[[+ Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Gwi-oib Lr Phone#: 7b2zli 1$ - ZJrb, Address: 3�5 �N) F_ 1 �o c City: T ��\ o m 5�� State: r Zip: 33 3 Tenant/Lessee Name: Email: _)o-'Jando►. hone#: CONTRACTOR: Company Name: HKU%_Nt1kAekf VJCXPJU�� Phone#: I !A — Address: k- u-n- RV-6 r" P)C C-:y -VL 3 33 7-5 Email: C, A Qualifier Name:m0oweA nVn007._1Y Phone#: _1514—Z«i —0$3q State Certification or Registration #: C6CI 533�A7 q Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ rJ D b Square/Linear Footage of Work: (o Type of Work: 0 Addition & Alteration ® New ® Repair/Replace ® Demolition Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised04/05/2022) Permit Fee $ DCA Fee $ Training/Education Fee $ CCF $ DBPR $ P&Z Review $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ r�I-L^1-141--a-7 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lenders Address City State 0 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 4roved and a reinspection fee will be charged. The foregoing instrument was me this I (�' day of F7 bit O -� , 20 Z5 by CA,V kt"I h;f- Pe-v e Z , who is personally known to meorvj:&haLwDA cec FL- Drt,/ZVS L-I«'eas identification and who did take an oath. NOTARY PUBLIC: Signature TRACTOR The foregoing instrument was acknowledged before me this day of Ff IorUd e 4 , 20 2--5 by MGvlu•e( A-Im4n7-4 .who ispersonally knoWnto me or whq.has_aroduced Ft_ Dr(✓Q,vS LI Zvn"�as identification and who did take an oath. NOTARY PUBLIC: Sign: L.t. 2,ni .eb (' Sign: LL) gi Print: I,f)2 -)Jay.TcOe Z Print: W P^ I y (20� uPZ Seal: .. ,, Seal WENDY RODRIGUEZ r ` "v"e'•.. WENDY RODRIGUEZ Notary Public • State of Florida t�' �'`� Notary Public • State of Florida Commission # HH 528689® Commission # HH 528689 .,,or r�.• My Comm. Expires May 19, 2028MY Comm, Expires May 19, 2028 *************BlNdeitltFBV;RNMtRl81'N8I9'AS�fit' *********•r*****************doealedaArseghrtyMene4Maear}MrinF. *************** APPROVED BY _„ Plans Examiner Mi ooD WU LAT Structural Review Zoning (Revised04/05/2022) Miami Shores Village RECEIVED OCT 2 4 2023 Building Department 100SO N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30S) 79S-2204 Fax: (30S) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 202-0 - BUILDING Master Permit No. kT�' In-Z3- ZCo 13 PERMIT APPLICATION Sub Permit No. E�BBUILDING ® ELECTRIC I3 ROOFING ® REVISION ® EXTENSION ®RENEWAL PLUMBING I3 MECHANICAL ❑ CHANGE OF I3 CANCELLATION I3 SHOP r CONTRACTOR 'C7r DRAWINGS JOB ADDRESS: "J NLr r✓ (-Di+ V (,I Ci ( 2r-� City' Miami Shores 7 County' V'P5 Miami Dade Zip: 33 I ✓Y'r Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: /' Construction Type: n, Flood Zone: BFE: ��uuII FFE: OWNER: Name (Fee Simple Titleholder): ��W eAVv '- QIAT1--�17 C-- � one#: 7Ol -49 - city: tj (Am I S4- ogels State: FV Zip: 3313� Tenant/Lessee Name: r"""rri• Email: PTO Y^W0raRCMA1Leo CONTRACTOR: Company Name:_j Address: Email: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: _ of Competency #: Address: City: State: _Zip:/ n Value of Work for this Permit: $ mot/� 6 U Square/Linear Footage of Work: 5 • l9 d 5q,' PT , Type of Work: I3 Addition E AlterationnJ M New �1� � [3 eReepair/Replaceen� �/� 13 13e�m�oJlition Description of Work: VC C C:i l.�' I o 1 1 �Y4 z2 vV � t TM0iG) u�"�[.r TI wS e) SALE FD(, �A F+IZOCM . Specify color of color thru tile: `I"u'4 (>44, Ut.y& wmt �p(,,�` Submittal Fee $ �' Lo Permit Fee $ CCF $ �' uC CO/CC $ C` o4 Ate" ' ( Scanning Fee $ '�7k -W DCA Fee $ Z ' DBPR $ Zi Cd Notary $ Technology Fee $ 117 • `C�D Training/Education Fee $ I • �-D Double Fee $ Structural Reviews $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ Z LO (Revised04/05/2022) RECEIVED n/� OCT 2 4 2023 Miami Shores Village .,A Building Department BY: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 gyp, / OWNER BUILDER DISCLOSURE STATEMENT NAME: g0oary C IWV DATE: 0 vZ �V — � ADDRESS: � I � q6 t' �l r IN (,LLr 11- 531 JT Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, RS 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial S. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial_ 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. 9. 1 agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. W 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htti)://www.mvfloridalicense.com/dbpr/pro/cilb/index.htmi Initial pr 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: qA ft-% �l( 1110 _, 'n 1 r �� n S� Initial 12. l agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial IVY Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's worker's compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 9-4 day of 20 P� :5 �, G n Z.9-L4.;) who was personally known to me or who has Produced there License or ✓-�-� Lr G as identification. r 9� 1 /1 V 1.e h rL e l� N E R NOTARY ��i Vivienne Yao Comm.0 222410 Expire s: Jan. 31, 2026 ��; ;•�`' Notary Public • State of Florida iioil Summary Report Generated On: 1V/24/2023 Folio 11'3200-013'5930 Property Address 385NE96OT k1|AW|SHORES, FL3313O'ZT1T. 6UNZALOPEREZJR.CATHE8|NEAk�BER | Owner � P[REZ . Mailing Address 895NE 96ST � M|AM|3M0RE5. fLOD1O0 � Primary Zone 14O0SGLFAMILY -30O1'32505O Primary Land Use 0101RESIDENTIAL ' SINGLE FAMILY: IUN|T! Beds / Baths 8Ua|Y3/3/0 Floors 1 Living Units 1 ' Actual Area 2.050Sq.F\ � Living Area 2,814Sq.Pl � � Adjusted Area 2.8205q.Fl Lot Size 11.973.8Oq.R Year Built 1940 Year 2023 2022 2021 COUNTY Year 2023 2022 2021 Exemption Value 550.000 $50.000 $50.000 Land Value %790`391 $562'501 S383.803 Taxable Value $485.324 $455 9�� $470' Building Value $242`052 $242,852 $185,515 `109 SCHoOLB8ARD Extra Feature Value �1Q158 �19320 �19402 --'---��-'----c-----�� Exemption Value $25.000 $25,000 $25.000 Market Value $1.052,401 %824.773 $508.980 Taxable Value $510,833 $495,324 $480.169 Assessed Value $535.933 $520.324 8505.160 �CITY�, Exemption Value . $50,000 $50.00 $50.000 Benefit Type 2023 2022 2021 Taxable Value $485,933 $470.324 $455'109 Save Our Homes Assessment @516.408$304,449Q83.731 REGIONAL Cap Reduction Homestead Exemption $25.000 $25'000$25.000 Exemption Value $50,000 $50.000 $50,000 Second Exemption �250U0 �25VO0�25V00 ` ' � Taxable Value $405�933 $4T0�324 S455169 ` Homestead Note: Not all benefits are applicable tvall Taxable Values (iv. ;ovo\y��oo|000rU�uyxo0.00a|)� � � ' Previous Ph�o OR Book. Qualification Description 3o\e PmRw M|AM|SHORES SEC 1AMDP810'70 01/24/2016 $195,50830374'2145 Cv/xn�votaxmin ' � consideration LOT13 &24BILK 43 10/09C2013 $51O,00O28885'20OVOua|hy exam o[deed LOT SIZE IRREGULAR � 04N1/1390 $230.8O018084'253V Sales which are qualified 0R10004'253804901 04/01/1995 $135.0OV10747-0897 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 Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at ht\p:Vvm^w.miamidade8vv/inhxdindaiwer.upp Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Issue Date; 08/02/2024 Parcel Number .Ff705TIMM N ITQ11.71 PZ SI F*44 Permit Type: Revision Work Classificatmn: Building Permit Status: Approved Expiration: 11/12/2024 1395 NE 96TH ST, Miami Shores, FL 33138 1132060135930 ' Contacts Gonzalo Perez JR Owner ARCHITECTURE DEVELOPMENT& Contractor 39596 CONSTRUCTION ASSEMBLY Home: 7024982501 joyandg.perez@gmail.com MANUELALMANZAR 5211 SW 90 AVE, COOPER CITY, FL 33328 Business: 7542100839 Ilcadca@gmail.com Description: REMOVE OLD TILE AND REPLACE, REPLACE STUDS, Valuation: $7,500.00 Ition Requests: REPLACE ROTTEN WOOD IN SHOWER INSTALL NEW FIXTURES licit our website www.msvfl.gov and AND ELECTRICAL -NEW OUTLET FOR TOILET, NEW GFCI OUTLET Total Sq Feet: 65.00 -lick on Permits Fees Amount CCF (Manual) $4.80 DBPR Fee (Manual) $3.38 DCA Fee (Manual) $2.25 Education Surcharge (Manual) $2.40 Permit Fee (Manual) $225.00 Scanning Fee (Manual) $12.00 Technology Fee (Manual) $22.50 Total: $272.33 Payments Date Paid Amt Paid Total Fees $272.33 Credit Card 08/02/2024 $272.33 Amount Due: $0.00 Applicant Copy For Inspections, Call (305) 762-4949 or Log on at https:/Ibldg.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 maybe found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. August 02, 2024 Page 1 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:08/02/2024 Location Address Parcel Number 395 NE 96TH ST, Miami Shores, FL 33138 1132060135930 Contacts Permit NO.: REV-05-24-1225 'Permit Type: Revision Work Classification: Building Permit Status: Approved. Expiration: 11/12/2024 Gonzalo Perez JR Owner 39596 Home: 7024982501 joyandg.perez@gmail.com ARCHITECTURE DEVELOPMENT & Contractor CONSTRUCTION ASSEMBLY MANUELALMANZAR 5211 SW 90 AVE, COOPER CITY, FL 33328 Business: 7542100839 Ilcadca@gmail.com Description: REMOVE OLD TILE AND REPLACE, REPLACE STUDS, Valuation: $ 7,500.00 Ins ection Requests: REPLACE ROTTEN WOOD IN SHOWER INSTALL NEW FIXTURES Vislt our website www.msvfl.gov and AND ELECTRICAL -NEW OUTLET FOR TOILET, NEW GFCI OUTLET Total Sq Feet: 65.00 Fees Amount CCF (Manual) $4.80 DBPR Fee (Manual) $3.38 DCA Fee (Manual) $2.25 Education Surcharge (Manual) $2.40 Permit Fee (Manual) $225.00 Scanning Fee (Manual) $12.00 Technology Fee (Manual) $22.50 Total: $272.33 Payments Date Paid Amt Paid Total Fees $272.33 Credit Card 08/02/2024 $272.33 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 re ating constructi and zoning. Futhermore, I authorize the above named contractor to do the work stated. A zed Signat re: Owner / Applicant / Contractor / Agent Da e August 02, 2024 Page 2 of 2 Miami Shores Village R11.1-rnn7,n Building Department MAY 16 2024 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 j BUILDING Master Permit No.?.(, lU -2,3 -4 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING �EVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �r ,� r j,Q'j,tCONTRACTOR DRAWINGS JOB ADDRESS: J /VE q I" yf—' City: 'Miamii Shores County: Miami Dade Zip: Folio/Parcel#: j(— 3R6 - 613 . 0 36 Is the Building Historically Designated: Yes NO Occupancy Type: Load: QConstruction Type: Flood Zone: BFE::1� (� /['F9FE: c OWNER: Name (Fee SiVe Titleholder): 11 f lAi`1Y`�U' l �W�.�,�/ Phone#: 6 6—t7(� P" all ?nf� dI /2mi CZ\� Tenant/Lessee Name: a Email: _I_ULA CLQ CONTRACTOR: Company Name: Ayr14-eCii,f re �QV 21 UDrn Phone#: Address:'SZIj 5(,J IV" RV,9 , Go00Pr Q�V -7i 333ZA Email: w-p. \C'Et&moat .Cpm Qualifier Name: ma&'e\ P'kiY i�ck"-1.AY Phone#: 7� —yto -02 3q State Certification or Registration #: 1..GCk 53304LJ Certificate of Competency #: DESIGNER: Architect/Engineer: Email Value of Work for this Permit: $ 1,500 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ CCF DBPR $ P&Z Review $ CO/CC $ Notary: Double Fee $, Bond $ _ TOTAL FEE NOW DUE $ _ (Revised04/26/2024) Bonding Company's Name (if applicable) Bonding Company's Address City 51 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. Signature 00 04 ER or AGENT The foregoing instrument was acknowledged beforemethis — —dayof 201q`Y by who is personally known to v me or ho has produced F(i; 2 O- i o ,Nt S C- as identification and who did take an oath NOTARY PUBLIC: Signature Aogz CONTRACTOR The foregoing instrument was acknowledged before, OIL/ this � �day of I"La�r .20 aY by MO Y UI 0 kAtM Ot n 7-a V , who is personally known to me or as produc Y/o 4JA iet1/a-gS i✓L as identification and who did take an oath. NOTARY PUBLIC: Sign: �/ ) Sign:�IL.-�1� ./ Print: tZl b� �� K �I79"D Print: lI.// P ".9 1 f i h't7 Seal: Seal: KRISTINE KEPPLE VAO KRISTINE KEPPLE YAO Notary Public - State of Florida Notary Public - State of Flonda C mmission # HH 452227 Commission F HH 452227}F: My Comm. Expires Oct 8, 2027 1 `dieo-% r 0 ««««««««*«** ***»* dn'6 difi1Au'�tf0�fl5R�l i�Ai«±�PiiLQi4>Q*WW* ************** rced through National Notary Assn. >var.:u APPROVED BY Plans Examiner Zoning (Revised04/26/2024) Structural Review Clerk Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 395 NE 96TH ST, Miami Shores, FL 33138 Contacts Issue Datee05/08/2024 Parcel Number 1132060135930 Permit NO.: REV-05-24-1091 Permit Type: Revision Work Classification: Plumbing Permit Status: Approved Expiration: 11/08/ 2024 Gonzalo Perez JR Owner 39596 Home: 7024982501 joyandg.perez@gmail.com MOTZ PLUMBING LLC Contractor LEE MICHAEL MOTZ 820 NE 23 ST, NORTH MIAMI, FL 33161 Business: 3059924223 OWNER Contractor ARCHITECTURE DEVELOPMENT& Building Contractor CONSTRUCTION ASSEMBLY MANUELALMANZAR 5211 SW 90 AVE, COOPER CITY, FL 33328 Business: 7542100839 Ilcadca@gmail.com Description: REPLACE EXISTING BATHROOM WITH NEW Valuation: $ 7,000.00 Inspection Requests: DRAINS AND WATER LINES AND INSTALL FIXTURES Nisit our website www.msvfl.gov and Total Sq Feet: 65.00 L.lick on Permits Amt Paid Fees Amount Payments Date Paid Revision: Major Change of Plans $90.00 Total Fees $90.00 Total: $90.00 Credit Card 05/08/2024 $90.00 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 construct"n nd zoning. Futhermore, I authorize the abev@ named contractor to do the work stated. , / Contractor / Agent May 08, 2024 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: (305) 762-4949 BUILDING PERMIT APPLICATION ©BUILDING Ij ELECTRIC ® ROOFING MAY 01 024 FBC 20 � Master Permit No. _r' - to- �cu -I Sub Permit No. L" Z- 23 314 L 6-D5-24-iD`1I REVISION EXTENSION RENEWAL PLUMBING []MECHANICAL ❑ CHANGE OF 0 CANCELLATION I3 SHOP {�yn k��+J G�/ (\�.yCLONTRACTOR DRAWINGS JOBADDRESS: J `i lyv 0 , Citv: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO V Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Tenant/Lessee Name: Email: CONTRACTOR: Company Name: Phone Address: g2o /0 K',� /o%A.v„ Email: %ir'irs�ic'� C9- Qualifier Name: �/J?- b iriL Ae Phone State Certification or Registration #: l C-%i 9i% Certificate of Competency #: DESIGNER: Architect/Engineer: Phone Address: City: Value of Work for this Permit: $ 142, 0-0 6 Square/Linear Footage of Work: Type of Work: M Addition [(3 Alteration 13 NNew ® Repair/Repllaarce Description of Work: /,L02, / f - i ,L�yft<'J E✓� �—+ Specify color of color thru tile: Submittal Fee Scanning Fee $ Technology Fee $ Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ 7 n T_ nn '1 i 6\ e: _Zip: ® Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ P&Z Review $ Bond $ (Revised04/05/2022) TOTAL FEE 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signatu e jt-;W ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The forgoing instru en was acknowledged before me this �,1 _ day � 20 , by Gle day of 20 Z�! . by Oro L4 CIA] a_ Z_ who is personally known to Ltv- , who is personally known to me or ho has produ d �0 6z:��F � 2./�s L jC. as me or who has produced r1� D ci\k c L,l c �, as �__— identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign, j Print: r Nvt V� KRISTINE KEPPLE YAO . Rom'•• Seal: Seal: =r°: ` �c Notary Public -State of Florida Notary Public State of Florida _ c Commission # HH 452227 Luis Javier Lavalle ova` My Comm. Expires Oct 8, 2027 My Commission `I 3rnded through National Notary Assn. IIN HH t 8878t I Exp. 1/1/2426 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised04/05/2022) `( lr�i4n�i r L - D- - 2T _ 31'� Plumbing Plans BATH 3 Replace existing toilet with new toilet - Replace existing sink and shower with new sink and shower and new copper waters lines to code J' - Replace cast iron stack pipe/vent with PVC to code - Replace cast iron shower drain under crawl space with PVC to code C n1Y �j KITCHEN n.t«.;rsatk�N DINING R001.1 I ..d i 1 CITY MAY 02 � 024 w� COPY BATH 3 I ¢ BEDROOM 3 I i [,lstu rorrvr3+ CIL --CLO. 1k.L BATH 2 C10. i / BEDROOM RECEIVED Section 1 10. t Construction or work shall remain exposed and provided with access for inspection purposes until approved. ELECTRICAL LEGEND ® CABLEWALLOUTLET 06 GFI DUPUEXWALL OUTLET y TELEPHONE AND DATA WALL OUTLET 06 WATERPROOF DUPLEX WALL OUTLET ® EXHAUSTFAN OR RELOCATED DUPLEX WALL OUTLET SINGLE POLE SWITCH 0E EXISTING DUPLEX WALL OUTLET $} 1WAY SWRCH % 7100UTLET $0 DIMMER SWITCH TO WALL TV OUTLET (VERIFY HEIGHT) Lp DISCONNECT OUADWALLOUTLET 50 SMOKE DETECTOR 1+ �1J- NEW WALL MOUNTED LIGHT FIXTURE ELECTRICAL PANEL i }N TQ CEILING MOUNTED LIGHT FIXTURE ® CEILING MOUNTED JAOX RECESSED UGHTFLXTURE OSP AUDIO SPEAKER (01V.P. VAPOR PROOF RECESSED UGM FIXTURE SP SPEAKER ® WALL MOUNTED J8OX GARBAGE DISPOSAL # SWITCHEOOUTLET BATHROOM RECEPTACLE ON 20 AMP CKT AND G.EI PROTECTED N �'G 2 1e , V 6 A )C=� ) CITY COPY ELECTRIC:ALRLVIEW i J APPROVED DATE. NOV 1 6 2023 OTY COPY 1 NwbM�Y4A*; N+wvia awsm � ZWOOW38 � VIOOtl�J�O yvRaro�a;sm WHOO 70 `-- cc 1bm�+" i tic�a3e c Hive � v n1 l3 LIS— Miami Shores Village Building Department Zoning Dept. Date Building Dept tIn 1 Subject to complia ith all a eral, State and County rules and regulations. Permit# ^cc— R.Ec'- Ifav, ED OCT % 4 _3 BY: L2 1 i 1 1 1 o 1 AdOO Ally ItjL� NrCt"''ah�s y11 1y.i �d1 �1<y c� v�Nti NbXZ -kr� iM a�� - Cl'c�✓gel S..�w�N�. "�� „aZl X, HS I },�... _. r yJ. iwo _ 1: y T N y .o sepueyY apad gL 0B886oN 4ZOZ i [ Nnr u I-vw,n,e,H --a O 7,:�JIN 1 4 P"dpp 204— IOMWIS -�k 01/ DSIZN 'TuvDin g kh o,pProva\ by �,,��h apecovea bv��a�r.9 pans C'�.1eC�'c1ca� 11�5PeC.�v`� Said S Can arce z ��ubrri\fi.,ed aPPro�e.d ercj►reeY bu�1��n9�tAns1 w.ic , .. ,BRi112 177: NITDC �•I�hir N DINING DOOM EEDNOOM2 1 r4r'h'�!UHu.M1 !6YV:i'.gWh 1 1 ...1 1 i W�si 1 BAM 1 1 w:mn.: 1 DEN t'} IMKo.eW IMNG POOM wrlwvecw G ENM 79 '-,M0K 1CAA6DN W,040XIDE DETECTORS C UDROO�°"00A ANY AND ALL CLOTH AND RUBBER I NJULA:TED CONDUCTORS TO 3E REPLACED. IZ 1 Zf%,VV 2,4 11 rJ?.,$ Compliance Statement for Level 2 Bathroom Alteration This bathroom alteration project complies with the following codes and standards: 1. **Florida Building Code (FBC)** - Structural requirements (Sections 301-310) - Fire safety requirements (Section 803) - Ventilation requirements (Section 1203) 2. **Florida Plumbing Code (FPC)** - Fixture installation and clearances (Chapter 4, Sections 405 and 417) - Water supply and distribution (Chapter 6, Section 604) - Sanitary drainage (Chapter 7, Section 705) 3. **National Electrical Code (NEC)** - GFCI protection (Article 210) - Electrical boxes and fittings (Article 314) - Receptacles and GFCI requirements (Article 406) All work will be performed in compliance with these codes to ensure safety, functionality, and accessibility. SCALE 1/2 - 1 INTERIOR WALL SPECIFICATIONS AND DOCUMENTATION 1. NEW TOLIET INSTALLATION 42" CLEARANCES: MINIMUM 15 INCHES FROM CENTERLINE TO SIDE WALLS OR OBSTRUCTIONS. \ INTERIOR 35INCHES IN FRONT OF TOILET. \ HALLWAY ROUGH -IN: 12INCHES FROM THE FINISHED WALL 03 INSTALLATION NOTES: USE CORROSION -RESISTANT SCREWS AND SECURE TO FLOOR ACCORDING TO MANUFACTURER SPECS SHOWER 'A 2. BATHTUB REMOVAL AND SHOWER INSTALLATION PAN AREA c SHOWER BASE :42 INCHES BY 70 INCHES WATER PROOFING: DUROCK CEMENT BOARD WITH WATERPROOFING MEMBRANE DRAIN: CENTRALLY LOCATED, SLOPED FLOOR WITH 1/4INCH PER - FOOT TOWARD THE DRAIN TOILET SHOWER HEAD: POSITIONED 72 INCHES FROM THE SHOWER FLOOR �� VANITY T 3. DUROCK CEMENT BOARD INSTALLATION �. 12 SINGLE _!v I=i 0.1 SCOPE OF WORK M 125 EXTERIOR WALL 1. INSTALLING A NEW TOILET. 2. REPLACING THE EXISTING BATHTUB WITH A NEW SHOWER. 3. INSTALLING A NEW VANITY. 4. INSTALLING DUROCK CEMENT BOARD FOR THE SHOWER WALLS 5. REPLACE CURRENT 2x4 STUDS WITH PT 2x4 Compliance and Certifications • Florida Building Code: All work will comply with the FBC. • Waterproofing: Meets FBC waterproofing requirements. • Accessibility: Ensure ADA compliance where required. • Energy Efficiency: Fixtures meet or exceed WaterSense and energy efficiency standards MATERIAL: DUROCK CEMENT BOARD FASTENING: #9 X 2-1/4 IN CEMENT BOARD SCREWS, SPACED 8 INCHES APART ON STUDS WATERPROOFING: APPLY A WATERPROOFING MEMBRANE OVER THE CEMENT BOARD SEALING: USE ALKALI RESISTANT MESH TAPE AND THIN -SET MORTAR FOR JOINTS -INTERIOR SHOWER AREA COVERED WITH CEMENT BOARDS 1/2" - CEMENT BOARD TO BE SEALED WITH FIRE RATED CAULKING -PT -WATERPROOF'X BOARDS 4' WOOD STUDS ON A6REST OF SPACE SPREAD oi� :�Q�O�,�O ENSpOF1it BATHROOM ALTERATION - LEVEL 2 * No98830 :cc RESIDENCE Au Q ••. STATE F 4/. 395 NE 96th STREET %wit` t o R MIAMI SHORES FL 33138 ELECTRICAL LEGEND ® CABLEWALLOUTLET #GF GR DUPLEX WALL OUTLET Y TELEPHONE AND DATA WAIL OUTLET 06 WATERPROOF DUPLEX WALL OUTLET ® EXHAUSTFAN NR RELOCATED DUPLEX WALL OUTLET SINGLE POLE SWITCH #E EXISTING DUPLEX WALL OUTLET i} 3-WAYSWRCH # 220 OUTLET $0 DIMMER SWITCH 9 WALLTVOURETIVEWFYHEIGHTI LG DISCONNECT + OUADWALLOUTLET ©D SMOKE DETECTOR a NEW WALL MOUNTED LIGHT FIXTURE tM ELECTRICAL PANEL l r CEILING MOUNTED LIGHT FIXTURE ® CEILNG MOUNTED JAOX Q RECESSED LIGHT FIXTURE OSP AUDIO SPEAKER Q R.P. VAPOR PROOF RECESSED LIGHT FIXTURE ® SPEAKER ® WALL MOUNTED JAOX GARBAGE DISPOSAL QI SWITCHEDOUTLET ELECTRICAL REVIEW I APPROVEDDATE- Section I 1 o.1 Construction or work shall remain exposed and Provided with access for inspection Purposes until approved. NOV 1 $ 2023 BY: -W N, It -* %%iU Puek AtGT— BATHROOM RECEPTACLE ON 20 AMP CKT AND G.F.I PROTECTED A)G I) �G �torB �' ` a 0 7' ,, �f>`7- i NG h Y THIS MUST BE ON FIELDace 2 4 ZOZ3 �cntae�w a(dt: OB AT TIME OF INSPECTION COPY 0,AJ e Spa w� c2odY � .� o BATH 3 BEDROOM 3 n) I W.I.C. BATH 2 E KITCHEN DINING ROOM {--{ BEDROOM2 �,is•n- u�sr+n u i OWN, TUKWpn i ..J t t F17rT7:\,7\:F--- � n Miami Shores Village Building Department Zoning Dept. Date Building Dept. Daji G Subject to com?liance with all a eral, State and County rules and regulations. Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 395 NE 96TH ST, Miami Shores, FL 33138 Contacts Permit NO.: PL-12-23-3147 Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Approved Issue Date:12119/2023 Expiration:06/17/2024 Parcel Number 2132060135930 Gonzalo Perez lR Owner 39596 Home: 7024982501 joyandg.perez@gmail.com I MOTZ PLUMBING LLC Contractor LEE MICHAEL MOTZ 820 NE 23 ST, NORTH MIAMI, FL 33161 Business: 3059924223 Description: REPLACING OLD TOILET, SHOWER, FAUCET AND TILE WITH NEW. REPLACING SHOWER DOOR W/ GLASS. REPLACING OLD CABINET SPACE FOR USEABLE SPACE FOR BATHROOM. HOUSE WAS RE -WIRED UNDER PERMIT Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $6.00 Technology Fee 520.00 Total: $121.80 Building Department Copy Valuation: $ 1,575.00 Total Sq Feet: 65.00 Ins ection Requests. 305-762-4949 Payments Date Paid Amt Paid Total Fees $121.80 Credit Card 12/19/2023 $121.80 Amount Due: $0.00 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 constructionAd zoning. Futhermore, I authorize the above named contractor to do the work stated. / Contractor / Agent December 19, 2023 Page 2 of 2 Miami Shores Village I' PCEIVED Building Department DEC 19 2023 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2020 BUILDING Master Permit No. IZc- l0 - 2,3 PERMIT APPLICATION Sub Permit No. R— IZ'23- 31y-1 ®BUILDING [3ELECTRIC ® ROOFING [3REVISION E3EXTENSION ®RENEWAL Q PLUMBING I3 MECHANICAL CHANGE OF Il CANCELLATION I3 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 395 ne 96th street City: Miami Shores County: Miami Dade Zip:33138 Folio/Parcel#: I1— 1rqM —0 I3 — J 1 So Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: Gonzalo Perez 646-662-5524 OWNER: Name (Fee Simple Titleholder): Phone#: Address:395 ne 96th street CiRiami shores StAprida Zip: 33138 Tenant/Lessee Name: Phone#:C41 -4 o!!i Email: o( �— Will UN— Motz Plu bing Llc 305-992-4223 CONTRACTOR: Company Name: Phone#: Address: 820 Ne 123rd street, North Miami Florida 33161 Email: Motzplumbing@gmail.com Qualifier Name Lee MOtz Phone#: 305-992-4223 State Certification or Registration # CFC1429581 Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $� �, Q8 Square/Linear Footage of Work: Type of Work: 0 Addition I3 Alteration ® New 13 Repair/Replace ® Demolition move drain lines for bathtub and change to shower, move drain for sunk and turn to double sinknew water lines and pressure balance valve Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ DCA Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ 12,1 •re, C, (Revised04/05/2022) 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 absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 4 - OWNER or AGENT The foregoing instrument was acknowledged before me this q day of 6A4- , 20 -2 3 , by who is personally known to me or who has produced �r� ✓�- �- as identification and who did take an oath. NOTARY PUBLIC: Signature CONTRACTOR The fxgoing instrument was acknowledged before me this S} day ofje ( '�'''� � 201.E , by who is personally known to me or who has produced bvLv- A t � c1AYt as identification and who did take an oath. NOTARY PUBLIC: w � t , / sign: Uy Sign: Print: `%L V (-�vt vy� Q,� Print: �S �GIviYc vh Seal: ��Y PV///�� VivienneYao Seal: Notary Public State of Florida �*'' �; Comm.:HH2224�4 A► Luis Javier Lavalle 'x .31 202fi Lill My Commission Expires: Jan Exp. 18 72 .. ��izazs %,'oF.•�` Notary Public - State of Florida APPROVED BY Plans Examiner Zoning (Revised04/05/2022) Structural Review Clerk fl JIMMY PATRONS `aim re Win+ CHIEF FINANICAL 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: 2/1/2022 PERSON: LEE M MOTZ FEIN: 812252115 BUSINESS NAME AND ADDRESS: MOTZ PLUMBING LLC 820 NE 123RD STREET, MIAMI, FL 33161 SCOPE OF BUSINESS OR TRADE: Plumbing NOC and Drivers EXPIRATION DATE: 2/1/2024 EMAIL: MOTZPLUMBING@GMAIL.COM 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 E01447617 QUESTIONS? (850)413-1609 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores. FL 33138 305-795-2204 www.msvfl.gov 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: lip VW 4 ty, 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: Address: / caner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 19 day of By %n ws2 La f P—Y'Z.Z who is personally known to me or has produced as identification. �� „ Notary: "PY'P?A,/ %vienneYao Comm.:NH222410 .: o? ., `' 2026 Expires:Jen.31,ofFl SEAL: ` Notary Public - Stale of Florida Rev 12122022 Notice to Owner Page 1 of 1 BusinessName:_ Address: Phone: ( ) Qualifier Name: Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov E-mail: Contractor Registration Form Qualifier Lic Number: Contractor may register license and insurance information with the Village on an annual basis. The initial fee will be $50 with an annual update fee of $30. Contractors that elect not to maintain their information on file will need to provide their information with each permit applied for. Please confirm if you would like to register your Contractor for a fee of $50. A FLORIDA STATE CERTIFIED CONTRACTOR: A. Copy of Local Business Tax Receipt B. Copy of Qualifier State Licenses C. Copy of Liability Insurance* D. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 61h edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice to Owner form and Contractor Affidavit) A MIAMI DADE COUNTY CONTRACTOR: A. Copy of Certificate of Competency of Qualifier B. Copy of Local Business Tax Receipt C. Copy of State Registered Contractor Licenses or Miami Dade County Municipal Contractor's Tax Receipt. D. Copy of Liability Insurance* E. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 6`h edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice of Owner form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. 305-992-4223 license# CFC1429581 MOTZ PLUMBING LLC December 11 th 2023 State of Florida Village of Miami Shores Before me this day personally appeared Lee Motz who, being duly sworn, deposes and says: That he will be the only person working o the project located at: 395 Ne 96th Street ractor signa ure a� Sworn to (or affirmed) and subscribed before me thisday oAJ u&20-n by �"'- I t 1 ! H.t,- Personally know Produced id Type of id L nvr P ' t type or stamp name of notary Notary Public State of Florida Ell Luis Javier Lavalle My Commission HH 188781 Exp. 1/1/2026 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 395 NE 96TH ST, Miami Shores, FL 33138 Contacts Permit NO.: EL-05-25-1129 Permit Type: Electrical - Residential Work Classification: Alteration Permit 5tatus: Approved Issue Date:05/14/2025 Expiration:11/14/2025 Parcel Number 1132060135930 Gonzalo Perez JR Owner ARCHITECTURE DEVELOPMENT & Contractor 39596 CONSTRUCTION ASSEMBLY Home: 7024982501 joyandg.perez@gmail.com MANUELALMANZAR 5211 SW 90 AVE, COOPER CITY, FL 33328 Business: 7542100839 Ilcadca@gmail.com Contractor INC OMAR VILLAR Business: 7863028970 JOYANDG.PEREZ@GMAIL.COM Mobile: 7863028970 Description: DEDICATED ARE FAULT CIRCUIT TO GUEST BATHROOM Fees Amount Application Fee - Other BD322-000 $50.00 CCF BD208-400 $0.60 DBPR Fee BD208-300 $2.00 DCA Fee BD208-200 $2.00 Education Surcharge BD 322-130 $0.30 Permit Fee BD 322-000 $50.00 Scanning Fee BD 322-110 $9.00 Technology Fee BD 322-120 $10.00 Total: $123.90 Valuation: $ 900.00 Inspection Requests: Visit our website www.msvfl.gov and Total Sq Feet: 65.00 Click on Permits Payments Date Paid Amt Paid Total Fees $123.90 Credit Card 05/14/2025 $123.90 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. AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws =structionand zoning. _6atherrnore. I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent May 14, 2025 Page 2 of 2 BUILDING PERMIT APPLICATION 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: (305) 762-4949 Master Permit F EIVE 1 4 2025 1 FBC 20 RC-10-23-2613 Sub Permit No. 05— ZS— 1) 2-9 ®BUILDING Er ELECTRIC ® ROOFING ® REVISION ® EXTENSION j3RENEWAL PLUMBING I3 MECHANICAL ❑ CHANGE OF I3 CANCELLATION I3 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 395 NE 96 Street City: Miami Shores County: Miami Dade Zip; 33138 Folio/Parcel#:11-3206-013-5930 Is the Building Historically Designated: Yes NO X Occupancy Type: SFR Load: Construction Type: Flood Zone: BFE: FFE: CCA� OWNER: Name (Fee Simple Titleholder): GONZALO PEREZ JR, CATHERINE AMBER PEREZ � 6�E6'6�"JS Address: 395 NE 96 Street City: Miami Shores State: FI Zip: 33138 Tenant/Lessee Name: Unlimited Electrical Tech., Inc. CONTRACTOR: Company Name: Phone#: Address: 11575 City Hall Promenade Building 4-141 Miramar, FI 33025 Email: erica@gogetterspermits.com Qualifier Name: Omar Villar State Certification or Registration M EC0002054 DESIGNER: Architect/Engineer: of Competency M 786-302-8970 786-302-8970 State: _Zip: Value of Work for this Permit: $ -106 Square/Unear Footage of Work: Type of Work: Cl Addition 0 Alteration ®New I3 Repair/Replace Description of Work: Specify color of color thru Submittal Fee Scanning Fee $ Technology Fee Structural Reviews $ Permit Fee $ DCA Fee $ Training/Education Fee $ CCF $— DBPR $ CO/Cc $ Notary 1 Double Fee S. P&Z Review $ Bond $ Demolition (Revised04/05/2022) TOTAL FEE 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 he 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. CAI� I 1Z 1A7_:::& OWNER 'rAGENT � The foregoing instrument was acknowledged before me this day of �rl , 20 z5 , by �:rlZa>t.o P2x-e—Z-) who is personally known to me or who hated d 1-�7L -t)L as identification and who did take an oath. NOTARY PUBLIC: Sign: l Jam^ t \, Print: Vr(VI --r-Ir e fau �Vivienne Seal: oPPVN"eo�auuu„1o, Cornm.:HH22200 iE Expires: Jan.31,2026 a` .'' F ate' Notary Public -Slaleo1Florida ssssss+rrrrrrrrrrirrr+r+++s+++rrrr++rr+ssrrrrrrrrrrr APPROVED BY Signature 1C V CONTRACTOR The foregoing instrument was acknowledged before me this W dayof HarC.) 20 25 by !� � mar V 11, tor- who is personally known to me or who has produced l I��_ as identification and who did take an oath. NOTARY PUBLIC: Seal: """ ;,.. Erica Brunswick =_ "'-.4 Comm.: HH 370566 `Asp= Expires: March 7, 2027 Plans Examiner Structural Review Zoning Clerk (Revised04/05/2022) Iir STATE OF FLORIDA DEPARTMENT OF RUSIN ESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS' LICENSING BOARD xai dikc:Fzcat coxtrtnciok 1#RED h C&atnslu i,vcte ua[ PROYI"SOPE11APIC.R8R4, FLM0ASblIAJ'0 Vf"R. OMAR �:MI!.nRL IClGJ4K.it tla.NR�LGGNSYt[ ❑eri GttY tf(VFPPlI�ACiAWA ' MIItRIdAN --',Q.'�4�T5 —5 S 9(MwVIIafLWiAt AUausfai:�3Cta AMu'!!+'wYrktae a>tiMN AwaFCOa nwmmmv:ms+ bums x.. a..aao.n+rcb+mrtarn - lAt.e.�o-v 4tree.PF:✓�+MWlwar�mKCOf!i4an(M1[mwebu�elM9aWV:+t Miami --Dade Count., State Of Floride OWNUR UNUMTE0 ELELTRICAL, TcCH NC OMAR VILLAR PRE$ :WordcmfsS ;:.:.. {v��n ogrF ti� ns t�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: 3/17/2025 PERSON: OMAR VILLAR FEIN: 650873004 BUSINESS NAME AND ADDRESS: EXPIRATION DATE: 3/17/2027 EMAIL: UET1@LIVE.COM UNLIMITED ELECTRICAL TECHNOLOGIES, INC. 11575 CITY HALL PROMENADE APT, 141 HOLLYWOOD, FL 33025 This certificate of election to be exempt is NOT a license issued by the Department of Business and Professional Regulation. To determine if the certificate holder is required to have a license to perform work or to verify the license of the certificate holder, go to www.myfloridalicense.com. IMPORTANT: Pursuant to subsection 440.05l13), 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(11), F.S., Certificates of election to be exempt issued under subsection (3) apply only to the corporate officer named on the notice of election to be exempt. Pursuant to subsection 440.05(12), 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 rertlficate to meet the requirements. of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT RULE 69L-6.022, F.A.C. REVISED 01/2023 E02070631 QUESTIONS? (850) 413-1609 AcoRV CERTIFICATE OF LIABILITY INSURANCE 4km. �''' DATE (MMIDDIYYYY) 01 /10/2025 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 IS 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 endorsements . PRODUCER NAME ACT Addana L Clavijo PHONE , (305) 226-3900 AIC No): (305) 226-3997 Excellence Insurance, a Div of Afore Insurance Services, LLC E-MAIL clavijoa afore.insure ADDRESS: Gay 5201 Blue La Dan Drive # 982 g INSURERS AFFORDING COVERAGE NAIC # INSURER A : HISCOX INSURANCE COMPANY INC. 10200 Miami FL 33126 INSURED INSURER B : INSURER C : UNLIMITED ELECTRICAL TECHNOLOGIES INC. INSURER D : 11575 City Hall Promenade Building 4 INSURER E : Apt # 264 1 INSURER F : Miramar FL 33025 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. INSR L TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MAD EFF IPOLICDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX__1 OCCUR P100.695.712.7 10/30/2024 10/30/2025 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY1:1 JECT LOC OTHER: GENERAL AGGREGATE $ 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) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAR EXCESS LIM OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) License # ECOOD2054 113iis1M111=I:1 Miami Shores Village Building Department 10050 NE 2nd Ave. Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Aer 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.aov 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: (lnl.ltnu id �QSGtI IihLl rQ1�1.� I VLi 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. Address: 3506 Q q(y % q State of County of Miami -Dade The foregoing was acknowledge before me this 1 � day of r r l , 20 ZS . By C� Os 1ZR4 0 ��L— who is personally known to me or has produced C:-1 bLL as identification. Notary: " l `� � e�„ vivieni)Oao �`1pPY'PueC i Comm.:HH222410 SEAL: z: �_ `. - <= Expires: Jan.31, 2026 le. ' Notary Public -State of Florida Gq,an, U� Rev12122022_ Notice to Owner Page 1 of 1 Unlimited Electrical Technologies, Inc. 11575 City Hall Promenade APT 141 Hollywood, FL 33025 EC0002054 Date: 3/20/2025 State of Florida Miami Dade County Before me this day personally appeared Omar Villar, who, being duly swom, deposes and says: That he or she will be the only person working on the project located at 395 NE 96th Street. Erica Brunswick °`.•• Comm.: HH 370566 Expires: March 7, 2027 °••�.„�"��'' Notary Public - State of Florida Sworn to (or affirmed) and subscribed before me this 1 0 Contractor Signature Print Name day of Hlr c 1 2025, by 11h� �I t �r (x) personally known or produced identification type + eJA-V-- Notary Signature Bonding Company's Name (if applicable) Bonding Company's Address City SI Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State 0 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) day after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a r"pection M will be charged. or The foregoing instrument was ackoo(Nledged before me this ZL� dayof dC—tobQ 20 2-3 by Cnn -zkLo Pea--e--z- who is personally known to me or who has produced 15C -I>- r-:s Li c— as identification and who did take an oath. NOTARY PUBLIC: CONTRACTOR The foregoing instrument was day of me or who has NOTARY noOmged before me this �� . 20. by who is personally known to as who did take an oath. Print: I� T �' < Print: ��\\pYiPV'4G Vivienne Yao Seal: ,..�.••• . e . Seal: ' `i% Comm.:HH222410 Z Expires: Jan. 31, 2026 ......: Notary Public -State of Florida ](11W1 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Re ised04/05/2022)