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PL-13-2840I Miami Shores Village a Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: I / T-e12Z DEC 19 2013 FBC 20 Permit No. el 13 —.2 Master Permit NoAC 03 City: Miami Shores County: Miami Dade Zip: 3 j " Folio/Parcel#: Is the Building Historically Designated: Yes NO v'11 Flood Zone: OWNER: Name (Fee Simple City: .s State: Tenant/Lessee Name: • -� Email: CONTRACTOR: Company Name: Address: 0. : Zn�= *3 2-4 ?- ?-", City: C' V te: s Qualifier Name: ® /q d _ Phone #: State Certification or Registration #: 4' FC. Qom/ L'%i % cate of Competency #: _ r � Contact Phone# 3b )- 9 L ,,A 17 k � Email Address: �� v �2 � �' DESIGNER Architect/Engineer: Phone #: Value of Work for this Permit: $ �Y� ®) Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace Description of Work: a 1 �✓ ,o� "T- � 1 ,n,n s1-7 ,IV, � 9�W. 6 77 Zip: ; 3 1 ('l 3,L-,T) Submittal Fee $ Permit Fee $ ,9 CCF $ CO /CC $ Scanning Fee It RArinn Tian P. DBPR $ Bond Q Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ a. (-'0V)- ❑Demolition 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 h sen e of such posted notice, the r inspection will not be approved and a inspection fee will be charged. 1 SignatureSignature re lull Owner or Ag t ontractor The foregoing instrument was acknowledged before me this The fore going instrument was acknowledged before me this day of 2- , 20 by �' (Mo day of ��n Z0 by `�— , who is per�aali � e or who has produced who ' to m e or who has produced `` As identification and who did take an oath. NOTARY PUBLIC: \ \tutu i i titre /�/ Q1 Sign: 0. Print: % � • : `��p \ °" :' •a My Commission Expires: APPROVED BY / t -/ r-77 Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009XRevised 3/15/09) as identification and who did take an oath. NOTARY PUBLIC: Sigr�� Prim: MACO , ��ssA� Aes;_ s a•� \. of ®niis Zoning Clerk Report Viewer t a f. JEFF ATWATER 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: 7/12/2013 EXPIRATION DATE: 7/12/2015 PERSON: ROJAS EDWARDO FEIN' 453073611 BUSINESS NAME AND ADDRESS: EDWARD ROJAS PLUMBING CORP 800 NE 111 STREET BISCAYNE PARK FL 33161 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by Ming a certificate of election under this section may Trot recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12). F. S , Certificates of election to be exempt... apply only within the scope of the business or trade fisted on the notice of election to be exempt Pursuant to Chapter 440 05(131, F.S. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation it. at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no Unger 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 of of this section. DFS- F2 -DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)413.1609 Page 1 of 1 https: / /apps8. fldfs. com/ crreportviewerlreportViewer.aspx ?data= kdvpginc9D7Q3gH6TER6... 7/12/2013 M 7 :, .rou� : ,.� . F, FK THIS DOCUMENT MAS- A COLORED B/>'CKGROUND iMICROPRINTING LINEIARK ";0AT6 TED4PA�PER huh 6149344 OF • . DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD $EQ# L12060101426 .. - LICENSE NBR 06/01/20121110409884 ICFC049431 The PLUMBING CONTRACTOR Named below IS CERTIFIED. Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 ROJAS, EDWARDO EDWARD ROJAS PLUMBING 880 NE 111TH ST BISCAYNE PARK RICK SCOTT GOVERNOR CORP FL 33161 DISPLAY AS REQUIRED BY LAW Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5175658 BUSINESS NAMEMOCATION EDWARD ROJAS PLUMBING CORP 880 NE 111 ST **** BISCAYNE PARK, FL 33161 11� RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2014 2371250 Must be displayed at place of business Pursuant to County Code Chapter 8A —Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED EDWARD ROJAS PLUMBING CORP 196 PLUMBING CONTRACTOR BY TAX COLLECTOR 45.00 07/29/2013 Worker(s) 1 CFC049431 0228 -13- 000930 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 holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory taws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles — Miami —Dade Code Sec 88-276. MIAMFOWDE For more information, visit yw w miamidade gov/taxcollector KEN LAWSON SECRETARY e � Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 204817 Permit Number: PL -12 -13 -2840 Scheduled Inspection Date: December 23, 2013 Permit Type: Plumbing - Residential Inspector. Diaz, Osvaldo Owner: TER HORST, BARBARA Job Address: 1130 NE 91 Terrace Miami Shores, FL Project: <NONE> Inspection Type. Final Work Classification: Addition /Alteration Phone Number (305)432 -1775 Parcel Number 1132050010410 Contractor: EDWARD ROJAS PLUMBING CORP Phone: (305)944 -6788 comments [-0171 ad: role] e7 INSPECTOR COMMENTS False December 23, 2013 For Inspections please call: (305)762 -4949 Page 21 of 39 Inspector Comments Passed Failed El <3) Correction Needed ❑ Re- inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 23, 2013 For Inspections please call: (305)762 -4949 Page 21 of 39