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PL-15-432 g (. LID 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-2437501 Permit Number: PL-2-15-432 Scheduled Inspection Date: September 22,2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: CRIFASI,VINCENT Work Classification: Addition/Alteration Job Address:860 NE 99 Street Miami Shores, FL 33138- Phone Number (516)633-0380 Project: <NONE> Parcel Number 1132060142421 Contractor: EDWARD ROJAS PLUMBING CORP Phone: (305)944-6788 Building Department Comments BATHROOMS REMODELING Infractio Passed comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-238191. not per approved plan new water heater required or revision of plan 75.00 refee Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 21,2015 For Inspections please call: (305)762-4949 Page 33 of 44 Miami Shores Village REc Building Department SEB s �01� 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 Y. INSPECTION LINE PHONE NUMBER:(305)762-4949 nFBC 20 6NL4 BUILDING Master Permit No. rh��-' 1-:k PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ROOFING REVISION EXTENSION RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: (16� ­.*C-eg.{ . V\�'7Mi .�V) D \ _ 3��) i City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: %% - 3' 40(a -0\4 - 2.4Z\ Is the Building Historically Designated:Yes NO Occupancy Type: Load: IConstruction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): �' !�C I (f nl&f j Phone#: Address: City: Gy State: _ Zip: Tenant/Lessee Name: Phone#: C-_t k> C.: S Email: CON'T'RACTOR:Company Name: Phone#: Address: 'bc6o Nc-7 ) S� City: n C FckC State: Zip: Qualifier Name: eclk.�rc QAD' S Phone#: State Certification or Registration#:__CP- C;)l 4 a Certificate of Competency#: DESIGNER:Architect/Engineer. h.w3�oCt1 \z'tay:r-Sc;2 Phone#: 1 6(©-_ZGQ 1�j ZZ Address: 22\2\ 5W 5-t A�up City: Cfjj-Qk S Qjbk�State: Value of Work for this Permit:$ 35oo Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: ,. ��� �Pcnocllnp Specify color of color thru tile: LLnn SSP Submittal Fee$ Permit Fee$ _ J�'` CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$_ Technology Fee$ T ' ing/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised 02/24/2014) 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 he 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs .seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved a rein cdo a will be charged. """- Signature 4 Sign Owner or Agent Contra for The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day ofIowa/` 20 IS ,by V i0r-n-t- C r,i L Ue� day of e -ate ,20 E by who Wme or who has produced who is Pers n 1 k wn to me or who has produced identification and who did take an oath. as identification and who did take an oath. NOTARY P NOTARY PUBLIC: .As Sign: Signe .tiPRY YVB i� Print: =° %: Notary Public-State o]27 Print: n� ii'I M Co �=ssion fres: s My Comm. Expires May P�''• 3C0 O gIl]811yp 9, Commission#EE 87My Commission Expires :; cCommission#FF061271 Bonded Through National No ' �F.xPires: Oct 09,2017 ''�n Fi•`` WWW"ONNOTARY.eom APPROVED BY "L6f3 Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) wixuccrT+ rt:r FAX) P.0021002 Report Viewer Page 1 of 1 �.��a rl .s �[,• a ae �,00� CMW a OMM sraTe OF FLORIDA . DEPARTMRNT OF FINANCIAL.SERVICES DIVISION OF WORKERS'COMPENSATION "CERTIFICATE OF FJ.ECIION TO BE EXEMPT FROM FLORIDA WORKL5651L.-Cowogj�TfON LillFd" �XMSTRUCTION INDUSTRY EXEMPT'" This 08Itlflas ttlil NA individual fisted bedew has elected to be exempt from Fwiu ftft S'Compufs bm few. EFFECTIVE MATE. 7[1212013 EXPiRaTtON DATE. 72215 PERSON; ROJAS EDYJARDO FEIN. 458078611 f f3USRt?SS NAME AND ADDRa$- EDWAFiD ROJAS PWMSIN(a CORP 806 NE 111 STREET BISCAYNE PARK f1 $3161 t{ SCOPES OF BUSINESS OR TRADE: DR IV RSC NOC AND nusee•rwpl b•Wtw1•rw�r.,�4 ar�r. e. . fake ares apo •►�N�wofwa�.esartlMirre.d.r w ��. arlttntbw )I••mMMOf 1KM111� phi/�.Tll•WWKTtlW7ilrit•Mkf�iM4�6f*elY bfMY1h1YIfMY1�(b1.• !f7 ism ww��Br eeBerobnfHtM KgttlYY�tlOq aFsfiteywb•2t12caR�tc,�rsot<etgarioroioeeexe�rraEve�oQr.�y evae'rpft87l+uUWta�eos 1 • t `.i .1 b a • https://apns8.fldfs.cowlcrreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH5'TER6... 7/12/2013 Keport Viewer Page 1 of 1 N � 1�/1 ► pl 1100% JEFF ATWATER •A �``�� 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: 4/7/2014 EXPIRATION DATE: 4/6/2016 PERSON: ACUNA LEONARDO A FEIN: 453073611 BUSINESS NAME AND ADDRESS: EDWARD ROJAS PLUMBING CORP 600 NE 111TH ST BISCAYNE PARK FL 33161 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440.05(14),F.S.,an offoer of a corporation who elects azemption from this cnaplar by flingg a teNSeata of election uMer lh'e section may not recover benefits orcompaftsa0on under this chapter.Pursuant to Chapier440.05112).F.B.,Certificates ole action to be exempt-apply only wilhin the scope of business or trade tilled on the no0ce of election to be exempt Pumusat to Chepler 440.05(13),F.S..Notices of alechon to be exempt and certificates of election to be exempt shall be subJecl to revocation If,at any time Oat the fdkng of the notice or me issuance of the certificstethe poison named on the notice or eerttficale no longer meets the requirements of Nis section for issuance of a certificate,The department shelf revoke a ceNfGte at any lim 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?(650)413-1609 file:///C:/Users/RUTHL/AppData/Local/Temp/Low/4MFJ4QW5.htm 4/7/2014 5NhOc.;,ins n Miami shores Village Building Department �OR1DA 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 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.. 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. O er ontractor ~� Signature: Signature { G State of Florida State f Florida County of Miami-Dade County of Miami-Dade The foregoing was acknowledge before me this The foregoing was acknowledge before me this .2--,F day of T-Q\,:) Q=ZSA�,20 l�� day off ,,�r ,20 13- . By By who is rsona 1y-Wol 1y-Woe or has produc d who is personally known toVme or has produced r.1 a. _1 .a0uf aside icajop;,;,,, as identificatig . a y ublic State of Florida ll�sjlagman Expires May 4,2017 tCommission#FF061211� Notary: •: •'- #EE 873648 Notary: , : Oct 09,201 SEAL: 8o a ugh National Notary ss . SE WWW.AAR0NNoTARY.ccd I February 25, 2015 State of Florida County of Miami Dade Before me this 25 Day of February, 2015, deposes and says: I, Lonardo Acuna and Eduard Rojas, of Eduard Rojas plumbing will be the only person working at the job located 860 NE 99 Street, Miami Shores, FL 33138. Sworn to..(or aff `d)and subscribed before me this 25 Day of February, 2015, by Uonardo Acuna uard Roj Personally known_ Produced identification Type of Identification A"0*-'e Print Typeror Stamp Name of Notary Jacobo Kligman , ":k" :Commission#FF 061271 s `=Expires: Oct 09,2017 '• wwwAmoNNarARY.Wm 906 W Hallandale Beach Blvd,Hallandale,FL 33009—Ph(305)864-9218—Fax(305)861-2609