WS-14-1177Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
Permit Type:
JOB ADDRESS:
BUILDING
Permit No.
iE,,T�
JUN 00214
RR EE C
BY:
FBC 20 �O
Master Permit No. W S 1'_1 t
ROOFING
City: Miami Shores County: Miami Dade Zip: .33 /SO
Folio/Parcel#: 1/- 310/ —O1 -1 - O Z I O
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): W qan myem+uru t✓LC Phone#:
Address: `` IIlli tg Bel � eadl Llan d pn y
i
City: 14 rr I State: FL Zip: 3313,p
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: S A R;"4111�4mct hzo dayi w, /h G Phone#: h s G) 413 " 4 1
Address: q 2 3g s W 227 if # 2i
City: CuA r bow State: PC Zip: 33 :9 0
Qualifier Name: d UG 11 C • 8 uaoLe Phone#: h 14 , q 13- -0/61
State Certification or Registration #: ('6C E6 4 q 3 ! Certificate of Competency #:
Contact Phone#: l p (o 1 y 13 Email Address: 1?V_#P Giy 1 rl /fid DrI j C o "A
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 8000 % Square/Linear Footage of Work:
Type of Work: DAddition WAIteration ONew ORepair/Replace ODemolition
Description of Work: % 3 O n tri ( �1 Aj i a jAx"d ! 14,r„�G L f " �')/ l t�QiO �✓ ✓.
Color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $ -
I 1 : "
Technology
a tr 131:5 171
TOTAL FEE Now �..r.0��ArA
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 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 and a reinspection fee will be charged.
Signature
Owner or Agent
The foregoing instrument
,was acknowledged before me this
day of le' Arc.. , 20 ` , by 1q,1 v 0 d SK V C
who is personally known to me or who has produced
—0 L- As identification and who did take an oath.
Signature
Contractor
The foregoing instrument was acknowledged before me this-
day of Jo �� , 20 �, by , )J&11 C t ,
who is personally known to me or who has produced L
a L as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
^y �npn ca mal 4'1, Lu l!
n SqW§plon # FF 000194
Bonded Through National Notary Assn.
APPROVED BY
Structural Review
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk
Devil. by -Entity Name
4 It
Florida Limited Liabiliity Company
KALYANI VENTURES, LLC
Filing Information
Document Number L12000146241
FEI/EIN Number 46-1443305
Date Filed 11/20/2012
State FL
Status ACTIVE
Effective Date 11/26J2012
Principal Address
1015 BELLE MEADE ISLAND DRIVE
MIAMI, FL 33138
ailing Address
1015 BELLE MEADE ISLAND DRIVE
MIAMI, FL 33138
Registered Agent Name & Address
SUSSMAN, HAROLD S
5300 N. FEDERAL HIGHWAY
FORT LAUDERDALE, FL 33308
Authorized Person(sl Detail
Name & Address
Title MGR
SUSSMAN, HAROLD S
5300 N. FEDERAL HIGHWAY
FORT LAUDERDALE, FL 33308
Report Year Filed Date
2013 03/25/2013
2014 04/28/2014
r
Page 1 of 2
http://search.sunbiz.org/Inquiry/CorporationSearchISearchResultDetaillEntityNatne/flat-112... 6/6/2014
CFN: 20140390420 BOOK 29172 PAGE 4795
DATE:06/02/2014 09:44:15 AM
NOTICE OF COMMENCEMENT HARVEY RUVIN, CLERK OF COURT, MIA -DARE CTY
A RECORDED COPY MUST BE POSTED ON THE .JOB SITE AT TIME OF FIRST INSPECTION
PERMIT NO. TAX FOLIO No. 11-3101'ni9-yW6
STATE OF FLORIDA:
COUNTY OF MIAMI -DADS
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance with Chapter 713, Florida Statutes, the following information
is provided in this Notice of Commencement.
I. LrI description of properly and stmt /address:
Name and address of fee simple titleholder.
4. Contractoes name and address:
5. Surety: (Payment bond required by owner from contractor, if any) ' -
Name and Address:
Amount of bond $
S. Lender's name and address:
7. Persons within the state of Florida desigrinted by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes.
Name and Address:
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenoes Notice as provided
in Section 713.13(1)(b), Florida Statutes.
Name and Address:
9. Expiration date of this Notice of Commencement: (the woradon date Is 1 year from the date of recording unless a
different date is specified)
Print Owner's Name—&A aA S ,UWIQ,n Prepared by
.. 20 _1
Address:
CANCELLEI