RC-14-2054Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-226225 Permit Number: RC -9-14-2054
Scheduled Inspection Date: January 12, 2015 Permit Type: Residential Construction
Inspector: Rodriguez, Jorge
Owner:
Job Address: 490 NE 91 Street
Miami Shores, FL 33138 -
Project: <NONE>
Inspection Type: Final Building
Work Classification: Alteration
Phone Number (305)596-0111
Parcel Number 1132060190010
Contractor: FAM CONSTRUCTION Phone: (305)298-3216
tsunama uet)artment comments
NEW KITCHEN
INSPECTOR COMMENTS False
January 09, 2015 For Inspections please call: (305)762-4949 Page 19 of 26
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
January 09, 2015 For Inspections please call: (305)762-4949 Page 19 of 26
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
FBC 20 0
Master Permit No. ALT ` '20 5
Sub Permit No.
Eil'BUILDING
❑ ELECTRIC
❑ ROOFING
❑ REVISION
[:] EXTENSION
❑RENEWAL
❑PLUMBING
F-] MECHANICAL
❑PUBLICWORKS
❑ CHANGE
CONTRACTOR
r-] CANCELLATION
❑ SHOP
DRAWINGS
JOB ADDRESS: 1' D t4t_:: j, I q STI` wT
City: Miami ShoresCAunty: Miami Dade Zip:
t 1
Folio/Parcel#: - �ia</t�i' -0( q 'W(Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): nc)U,5tr4C (,&AoiLZ 909- t 7k -?V
Address: y90yf0'%'�
City: vl'/� /InVCI State: ��� Zip:
Tenant/Lessee Name: Phone#:
Email
CONTRACTORS: Company Name.
11�lW C-0
Address: �`'`7y �/ �5 AV V, 4-3;
city:
Qualifier Name: f vW 11,11-k
_State: �t,��(o� Zip:
A6v Phone#:
State Certification or Registration #: C l�l�O V Certificate of Competency M
DESIGNER: Architect/Engineer:
133tzk3
Address: City: State: Zip:
Value of Work for this Permit: $ DOD Square/Linear Footage of Work: /_z;>0 —<v F� "
Type of Work: ❑ Addition ` 11 AIteration�j ❑ New ❑ Repair/Replace ❑Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee $ L� , r�� J Permit Fee $`mak rW ' 00 CCF $ CO/CC $ �"
Scanning Fee $ Radon Fee $ DBPR $ oL W Bond $
Notary $ Training/Education Fee $ 6 • v Technology Fee $ • 2C�
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ t bq - Lin
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
Zip
State Zip
i
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 the absence of such posted notice, the inspection will not
be approved pat" reinspectionft will be charged.
Signatur / /
Owner or Agent
The foregoing instrument was acknowl dged before me this
qday o=rsonally
� Who i to me or who has pro uced
As identification and who did take an oath.
V.
NOTARY PUBLIC:
Sign
Print:
My Com ission Expires: +io`""v` �g GUILLERMO M. DIAZ
n Notary Public -State of Florida
My Comm. Expires Apr 26, 2015
Commission # EE 87672
********************
APPROVED BY
r
L`� b
Plans Examiner
Signatur
Co ractor
The foregoing instrument was acknowlericed before me this'
Y 00
of 6W- , W-
who isp onally know to me or who has produced
�`" as identification and who did take an oath.
NOTARY PUBLIC: /�1 r
Sign: n
Print: y �� v
My Commission ra u E ices: •
s e`fi,_ GUILLERM0 M. DIAZ
,+ n Notary Public - State of Florida
»4 My Comm. Expires Apr 26, 2015
o ;PCommission # EE 87672
-1 Structural Review
Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007)
Zoning
Clerk
Detail by Entity Name
it by Entity Name
E HOUSING LEAGUE, INC.
iment Number
N98000003439
:IN Number
650841175
Filed
06/11/1998
FL
is
ACTIVE
Event
AMENDMENT
t Date Filed
05/24/2013
t Effective Date
NONE
046 Treasure Coast Plz
�te A370
'ero Beach, FL 32960
:hanged: 02/22/2014
failing Address
046 Treasure Coast Plz
to A370
ero Beach, FL 32960
:hanged: 02/22/2014
registered Agent Name & Ac
LICK, JERRY
119 COTORRO AVE
;ORAL GABLES, FL 33146
lame Changed: 08/03/2000
ddress Changed: 04/20/2002
Ifficer/Director Detail
lame & Address
itle P -D
LICK, JERRY
119 COTORRO AVE
Page 1 of 4
http://search. sunbiz.orglInquiry/CorporationSearchISearchResultDetaillEntityName/dome... 8/14/2014
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
MARTINEZ, FERMIN A
FAM CONSTRUCTION CORP
8340 SW 65 AVE #3
MIAMI FL 33145
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque restaurants,
and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to
serve you better. For information about our services, please log onto
www.myfloridalicense.com. There you can find more information
about our divisions and the regulations that impact you, subscribe
to department newsletters and learn more about the Department's
initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly.
We constantly strive to serve you better so that you can serve your
customers. Thank you for doing business in Florida,
and congratulations on your new license!
DETACH HERE
RICK SCOTT, GOVERNOR
r, STATE OF FLORIDA
-° DEPARTMENT OF BUSINESS AND
PROFESS A FEGULATION
k� k
CGC019440 ;SU.� ,07/02/2014
CERTIFIED GE
MARTINEZ, FE
FAM CONSTRi
IS CERTIFIED under the provisions of Ch.489 FS.
Expiration date : AUG 31, 2016 L1407020001234
KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD '
�CQC0919440 "
The GENERAL CONTRACTOR
Named below IS CERTIFIED
y
Under the- provisions of -Chapter 489 FS.._""'*"
Expiration date: "AUG 31, 2016
MARTINEZ, FERMIN A
'
'FAM CONSTRUCTION COIP
8340 SWI AVE 43_`
MIAMI FL331�45*
_
=
•-gym
JEFF ATWATER
CHIEF FINANCIAL OFFICER STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CERTIFICATE OF ELECTION To SE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the iTdik,4V t9,
EFFECTIVE DATE: 9117/2014
PERSON: MARTINEZ
92210059tl
8340 SW 65TH AVE #3
MIAMI FL
- 1 � - fle I DOE 7
LICENSED GENERAL
CONTRACTOR
EXPIRATION it 9/16120' 1
FERMIN
41CM
Pursuant to Chapter 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 Chapter 440.05(12), FS., Ceffificates of election to be exempt... apply only
within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 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
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609
♦ 5Nii0' "�
onto Miami shores V
Building Department
lOR1Dp 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability ` company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you maybe
personally liable for the worker compensation injuries of My person allowed to work under this permit. Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner
Print Name:
Signature:
State of Florida )
County of Miami -Dade }
Sworn t and bsc 'bed before mQ this 2�
day of , 20.
(SEAL) '
Type of Identification
Contractor
Print Name; ! �,-
/'
r-
Signature:
State of Florida ) .
County of Miami -Dade )
Sworn o and s bscri ed b fore
day of
920
By l f� M ft N
UVILL.cnmU m. UJAL
Notary Public - State of Florida
My Comm. Expires Apr 26, 2015
Commission # EE 87672
Iof Identification
is
i
N0ta1YPublic • State of Florida
My Comm. Expires Apr 26, 2015
Commission # EE 87672