EL-15-397 (2) Miami Shores Village
Building Department Zo,S
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 (6
BUILDING Master Permit No�C'
PERMIT APPLICATION Sub Permit No. L:
BUILDING %ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
`, �,/ CONTRACTOR DRAWINGS
JOB ADDRESS: _ I lel J (VD � 1 1 ,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE`:: c / FFE::
OWNER: ame(Fee Simple Titleholder): 14ana on 2a l`'�z- Phone#: 1 b b )9 V 'i 3
Address: q2—n W (X -X�-
City: H j Qfl-y�t S ho K S State: Zip: J ��
Tenant/Lessee Name: Phone#:
Email: /
CONTRACTOR:Company Name: Phone#: 1 ,6 6, ��y'_
Address: r"'" l.c, S
City: Z�(,214 .4 State: lEz Zip:
Qualifier Name: -r2�2 a.-H - c"6 6�L q Phone#:
State Certification or Registration#: t-C 6?eq 3 3,�T_Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ 4?O(9 Square/Linear Footage of Work:
Type of Work: ❑ Addition [� Alteration New ❑ Repair/Replace
/ ❑ Demolition
Description of Work: ELF e7( 4('6
Specify coldr of color thru tile:
Submittal Fee$ �� �( Permit Fee,$,, CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ I 0
(Revised02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
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 aE' p7ectionfe ill be charged.
y.
Signatur Signature
OWNER or ANT CONTRACTOR
The foT going instrumen was acknowledged before me this The foregoing instrument was acknowledged before me this
i day of 20 I`l by da�Y doff , Jcx"L.Pet✓ti 20 i r by
1 ��z ho is personally known to ;�r,M cc r� c�(� ��1 9 v�isfrn,mLh is personally known to
me or who has pro uc as me or who has produced as
identification and who did take an oath. identification and who did take oath.
NOTA UBLIC: NOTARY PUBLIC:
Sign-A//L/Otp�
' Sign:Prin >/r�G C �� Print:
Seal: Seal:
•i'ay o;;• ELIODORO VALLEJO
Seal: ;
MARTHA L CAREAtaA ;r. Notary Public-State of Florida
MY COMMISSION#EE0O6077 ;•; My Comm.Expires Jul 9,2017
EXPIRES:July 4,2015 9, P Commission#FF 004890
PuDMn Undenvrlhxe ' OF f��'ii Bonded Tho h
.�1�/S
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
01/01/2006 10:41 3054601852 ZUBIADVERTISING PAGE 01
+ STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395
1840 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
SAAVEDRA,ARMANDO
MANNY`S ELECTRICAL CONTRACTOR INC
6547 SW 37tH STREET
MIAMI FL 33155
Congratulations! With this license you become ane of the nearly
one million Fk+rrdians licensed by the Department of Business and k�
Professional Regulation. Our professionals and businesses range STATE OF FLORIDA :4;3
from architects to yacht brokers,from boxers to barbeque,restaurants, DEPART'M F BUSINESS AND �s
and they keep Florida's economy strong, PROF K ULATION
Every day we wont to improve the way we do business in order to EC1'300338M �0$1't4�0"I 4
serve you better. For irrfvrmation about our services,please log onto '
zr .I
.myfloddaticense,com. There you can find more irifortnation a CERTIFtED' C' 41
about our divisions and the regulations that impact you,subscribe "5 S, tDRA;
to department newsletters and loam more about the Department's
MAK1tdY'SEL �R'INC �:,
initiatives.
Our mission at the Department is:License Efficiently,Regulate Fairly.
We constantly stove to serve you betterso that you can serve your
custorners. Thank you for doing business in Florida, rsG-RkFtES ut� r the p'rov�ai�rrl8 ?r Gh_48044
,
and congratulations on your new lioense!
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DETACH HERE
RICK SCOTT, GOVERNOR
LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF 9USNESS AND PROFESSIONAL RIFOUL.ATION.
. ELtCTRICAL' OIVtRAC`tOIIS MCI=LASING BQARLi
' EC'C�088359 .
ELECTRICAL CONTRACTOR
Nfamed'tietrvw 1SCER"nFiEC '
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Local Bus ness Tax Receipt only confirms pay
me' t of the local Business Tax.ThegJReceipt is nit ar license, N
permits a'cafication of the'holder`s qualifications,to do business,Fllder must comply with anyxgavernnsental
" f', o n ngovernm ntal regulatory lads and requirements which apply to the business.
The REMPT NO. above must be displayed on all commercial vehiclei" Miami-Made Code Sec 8a-276. o
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M1AM visit ww miamidade govltaxcollec�
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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'Compensaticn law.
EFFECTIVE DATE: 3!9!2014 EXPIRATION DATE: 3/8!2016
PERSON: SAAVEDRA ARMANDO
FEIN: 650277842
BUSINESS NAME AND ADDRESS:
MANNY'S ELECTRICAL CONTI
6847 SW 37 ST .
MIAMI FL 33155
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
Pursuant to Chapter 440.05(14),F.S..an officer of a corporation who elects exemption from thk chapter by tiling a certificate of election under this section may
not recover beneft or compensation under fids chapter.Pursuant to Chapter 440.05(12),F.S.,Certillcsrlas 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 elet;tion to be exempt and rRdficates of
election to be exempt shall be subject to revocation d,at any time after the filing of the notice or the issuance of the certftRte,the person mrmed on the notice or
certilicete no longer meets the requirements of this section for issuance of a oettiflcate.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 07-12 QUESTIONS?(850)413-1609
• r ,
5 t1ORES
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.... .....� Miami shores Village
d Building Department
ORiDp' 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 and acknowledges 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..
Therefore,you may be Personally liable for the worker compensation iniuries of any 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 0602
Contractor
Print Name: ancc Print Name:
✓YJ c2 � a_.�r- 9,
Signature: Signature:
State of Florida) State of Florida)
County of Miami-Dade) County of Miami-Dade)
Sworn to and subscribed before me this Sworn to and subscribed before me this
day of vU E ,20 I S: day of �� n,x�.�_ ,20 /,S- .
By r,; By
(SEAL) (SE
Type of Itle ' ep produEt;tlbo0R0 Type 0
EE220Public-St
e-d1 Florida = c My Comm. Expire Jul 92017
pir Jul 9,2017 : v.n #FF 004890 ° Commission#FF 004890
10,
° �"' Bonded Through National Notary Assn.
ational Notary Assn.
MANNYS ELECTRIC
January 29, 2015
State of Florida
County of Miami Dade
Before me this 29 Day of January, 2015, deposes and says:
I Armando Saavedra owner of Mannys Electric will be the only person working at the job
located 166 NW 100 Terr. Miami Shores Village, FL 33150.
Sworn to I rme and subscribed before me this 29 Day of January, 2015, by
Armando Saavedra
��PwY''o'•• ANA PARRILLA
Notary Public State of Florida Personally known
My Comm.Expires Apr 21,2017 Produced identification
•••,FOF Commission#EE 867787 Type of Identification
Print Type or Stamp Name of Notary
6847 SW 37 ST,MIAMI FL 33155