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PL-15-1793
\�"ck" 6 aF Miami Shores Village 10050 N.E.2nd Avenue NE FL 33138-0000 y Miami Shores, N+smiKA Phone: (305)795-2204 WN, CQRYFt IR Expiration: 02/14/2016 Project Address Parcel Number Applicant 3 NE 110 Street 1121360040310 Miami Shores, FL 33161-7043 Block: Lot: LUCKY 13 HOME INVESTMENTS Owner Information Address Phone Cell LUCKY 13 HOME INVESTMENTS, INC 8004 NW 154 Street (305)219-8267 MIAMI LAKES FL 33016- 8004 NW 154 Street MIAMI LAKES FL 33016- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 EF DESIGN &CONSTRUCTION (305)409-4581 �..�.�..., u. __...... .. ..� ... , .. Total Sq Feet: 0 Type of Work:REMOVE AND REPLACE KITCHEN AND BATH Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return Final Classification: Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 DBPR Fee $a.5o Invoice# PL-7-15-56380 DCA Fee $4.50 08/18/2015 Check#: 1515 $265.20 $50.00 Education Surcharge $0.40 07/17/2015 Cash $50.00 $0.00 Permit Fee $300.00 Scanning Fee $3.00 Technology Fee $1.60 Total: $315.20 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore, I authorize the above-named contractor to do the work stated. August 18, 2015 Authorized Signature:TDwner / Applicant / Contractor / Agent Date Building Department Copy August 18, 2015 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)7564972 Inspection Number: INSP-247607 PermitNumber: PL-7-15-1793 Scheduled Inspection Date: November 13,2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: INVESTMENTS,INC,LUCKY 13 HOME Work Classification: Addition/Alteration Job Address:3 NE 110 Street Miami Shores, FL 33161-7043 Phone Number (305)218-8267 Parcel Number 1121360040310 Project: <NONE> Contractor: EF DESIGN&CONSTRUCTION Phone: (305)409.4581 Building Department Comments REMOVE AND REPLACE KITCHEN AND BATHROOMS n ct o passed comments AND ANY OTHER PLAN RELATED TO PLUMBING FOR INSPECTOR COMMENTS False INTERIOR RENOVATION nspector Comments Passed EDCREATED AS REINSPECTION FOR INSP-239333. Failed C Correction - 3✓j Needed ll Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 12,2015 For Inspections please call: (305)7624949 Page 30 of 44 I Miami Shores Village � fa = Building Department JUL 17 Z01� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 _ INSPECTION LINE PHONE NUMBER:(305)762-4949 ( . FBC120 1 `�} BUILDING Master Permit No. l(:-; - 1-: I PERMIT APPLICATION Sub Permit No. 2 ' __ 3 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL LP UMBING ❑ MECHANICAL F-1 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: :5 Ab k ° 1)0!;+ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes - NO Occupancy Type: Load: Construction Type: +Y�(, onot Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): L'(n C lC� V? )4e,i - T-ivC S4 m e" S Phone#:3af Z 19-007� Address: 9do fj W • /&-q f� u City: ✓►'1(4Mi L"a CrL S State: l:L . Zip: 3.3o!6v Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 11 yl ft CO 11 S+rU dj t) Phone#:_200 S-LJ i45_'81 Address: iti l S2 qv� City: j a lth o CO9/'� State: rc Zip: 330 0--oo Qualifier Name: FD's 10 e- Fa J 6 rp(0 Phone#:_20S r 4/0`?ly S�/ State Certification or Registration#: L' FC 1 y 2 8 z Z / Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ a i CW ., Square/Linear Footage of Work: S_0 41 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Q e rnm_ ono( R eP,4Ge- W-1 �e w e h &o f-two o ot_r :(2- ) 64 d aplan ce(a u vvvb r' Specify color of color thru tile: �• �` p+s0 , Submittal Fee$ (So' C0 Permit Fee$ jam• CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 3 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 a bse of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CO RACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 4 S 20 1 S- by day of I S� 20 ( � by who i ersonally know o C[n✓ FA�a v cQ© ,who i personally k_now�r to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign:� � r � Sign: alviR-6m-e�d Print Print: "'°��1;�,, SANDY ROMERO Seal: =rte �� Notary Public State of Florida Seal My Comm.Expires Jul 26,2015 ',; SANDY ROMERO Commission #EE 116040 r w Notary Public-State of Florida My Comm. Expires Jul26,2015 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) EF IEW & CONSTRUCTION, INC. 297 NW 152"°AVENUE PEMBROKE PINES, FU 33026 AFFIDAVIT I, Edgar M. Fajardo, will be the only person working on the project at 3 ne 110th St Miami Shores, FL 33150-1214. Edgar M. Fajardo (305) 219-8267 daviddapc@gmail.com Signature: le449 The foregoing int m t w acknowledged before me this day of , 20 By who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Signature: Print: Seal: SANDY ROMERO Notary Public-State of Florida MY Comm. Expires Jul 26,2015 Commission#EE 116040 APC Engineering Enterprises,Inc. 9 9 p , 2150 West 10th Avenue•Hialeah, FL 33010•Phone:(305)885-5371• FAX: (305)885-5073 apcengineering@gmaii.com Page 1 of 1 SNo193 D,t also ,,,,, Miami shores Village Building Department ES IN$ �ORiDA 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 i£ 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. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: r y (- p, , -c� Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this {`t'� day of l(o ff ,20 Q K_ . By i2tGL•ar J 4e G+0(Z_ who is rsonally kno me or has produced as identification. Notary: SEAL: , ,!Y " ,r �'< SANDY ROMERO Notary Public-State of Florida ". My Comm. Ex Commission #EE 116040 Jul 21 15 09:24a EF Design&Construction 9544506099 p.1 513/2015 Report Viewer i wi 1- JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COM E P N SAT!ON "*CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW' CONSTRUCTION INDUSTRY EXEMPTION This cer5fies ihatthe'ndividuali listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 4,12412015 EXPIRATION DATE: 4123/2017 PERSON: FAJARDO EDGAR M FEIN: 270946010 BUSINESS NAME AND ADDRESS: EF DESIGN&CONSTRUCTION INC 297 NW 452 AVE PEMBROKE PINES FL 33028 SCOPES OF BUSINESS OR TRADE- LICENSED GENERAL LICENSED PLUMBING CONTRACTOR CONTRACTOR Rysuat b CNPLL 44C.05(14).F.S,an c f4 o!a corporatM Whp elect ate/PdM from his leper ybyy Rling a cer+ifiuta of elec>m t»dv this secim 3 may mt raowor lxAerits a oart+P'a-dadrn trader Ws cMNar_Fnas sr2 to Chapter 440.05112}.F.S.,Carh'f.cates cfefMaim to ba azamCt.•e Y ardY with L�sccpo at the bsinessar Yale listedmthe ms® cfelmbco b Se exp_RrI£uatto Chapin4eQ05(13),F.S.,Naixs cfemvc !o peexempt and ' rswtcaees afalecllm b be exempt 51-vil be stt:eci lu revwwm if,at arty time after:he rilkQ of fie"ce m the issuanx d tha cerfifrc 1_the persm namW on ttt roticsncarGtrahe:n Impmaeis sta/ether/esta crthis sec8m for'sstsnce of a W-dicate.The deatrnem shalt revoke a c Wsicsea at ' OFS1`2-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 0&13 CUESTIONS?(856u13.16L9 htlps://apps8.flchS.z romicrreportviewerlrepc,rt\riewer.aspx?data=kdvpginc9D7Q39H6TER6eP1KMZ%2fSz5bXKYfBXkrekeESoP'Jy1v4NPOPN4ZXEirDRGXVU/... 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