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RC-15-3014 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-248733 PermitNumber: RC-12-15-3014 Scheduled Inspection Date: December 23,2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: , Work Classification: Solar Job Address:9301 NE 9 Place Miami Shores, FL Phone Number Parcel Number 1132050070060 Project: <NONE> Contractor: CUTLER BAY SOLAR SOLUTIONS Phone: (786)457-5958 Building Department Comments INSTALLATION OF ROOFTOP PHOTOVOLTAIC SYSTEM Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 22,2015 For Inspections please call: (305)762-4949 Page 24 of 59 r � � � - � + " »s t Miami Shores Village@17i?II 7y R+ ��i�tl con&tructton o i 10050 N.E.2nd Avenue NE5 r r l V#lvrk `tassiff� � � Miami Shores,FL 33138-0000 � � � F Phone: (305)795-2204 ,E �r 12l' 1/201 ," Expiration: 06/06/201 Project Address Parcel Number Applicant 9301 NE 9 Place 1132050070060 Miami Shores, FL Block: Lot: JONATHAN S CROSS&W&JEN Owner Information Address Phone Celt I JONATHAN S CROSS&W&JENNIFER 9301 NE 9 PL - --- - - MIAMI SHORES FL 33138-2973 Contractor(s) Phone Cell Phone Valuation: $ 8,977.50 CUTLER BAY SOLAR SOLUTIONS (786)457-5958 ._ w. . Total Sq Feet: 00 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Solar Type of Construction:INSTALLATION OF ROOFTOP PHO Occupancy:Single Family Review Electrical Stories: Exterior: Review Building Front Setback: Rear Setback: Review Structural Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted:Yes Certificate Status: Certificate Date: Additional Info: Bond Return: Classification:Residential Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $5.40 Invoice# RC-12-15-57929 DBPR Fee $4.04 DCA Fee $4.04 12/11/2015 Check#:2222 $370.81 $50.00 Education Surcharge $1.80 12/03/2015 Credit Card $50.00 $0.00 Permit Fee $269.33 Plan Review Fee(Engineer) $120.00 Scanning Fee $9.00 Technology Fee $7.20 Total: $420.81 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-napAed contractor to do the work stated. December 11, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy December 11,2015 1 0� Miami Shores Villa e0 E 'TvEn�A� � g DEC 0 � X095 Building Department BY: 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/// ' BUILDING Master Permit No;; lC/J PERMIT APPLICATION Sub Permit No. FO-IBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9301 NE 9pl City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3205-007-0060 Is the Building Historically Designated:Yes NO Occupancy Type: Owner Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Jonathan S Cross Phone#: Address:9301 NE 9th pl City. Miami Shores State: Florida Zip: 33138 Tenant/Lessee Name: Phone#: Email: jcrossy@gmail.com CONTRACTOR:Company Name: Cutler Bay Solar Solutions Phone#: 786-457-5958 Address: 8301 SW 184 LANE City: Cutler Bay State: FL Zip: 33157 Qualifier Name: Raul Vergara Phone#: 786-457-5958 State Certification or Registration#: CVC 56957 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$8977.50 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Installation of rooftop photovoltaic system Specify color of color thru tile: Submittal Fee$ <0,) Permit Fee$ 9° CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee 0- Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 4 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. ��✓` Signature � Signature F� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of 1�9 e)VP(n bC I 20 15 by _®�dlayyy of IVU' JCI��►^ 20 I � by 20 0 d Uo 5y who is personally known to UYa'a who is personally known to me or who has produced Fl— On;&6 � as me or who has produced �L rye- L,te6'-' as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: TT�i _ a Print: TC4 y�I t v Print: Yl ;,.a...�,,,, a iego Seal- ; �� ,; Jeff Diego seal: ��. �,� +c � COMMISSION # FF181160 COMMISSION # FF181160 % EXPIRES:December 4,2018 �o� EXPIRES:December 4,2018 ~��''��,9;,,, � �►WW.AaRONNI)TARY.COM �.1�* APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) - -- Po ' t Local,-Business T. ReGeifatMimi -flade urihy; Stere' of Rod I _TM Is'WTA MLL —:DO NOTPAY X174395 LB auq"w NA" "" .aebiupr aa, EXPIRES � CUTLER BAY SOLAR SOLUTIONS WMALSEPTEMBER-30,2048 OPERATING IN DADE COUNTY '4I?i9$ 7' Must be B aged-at ism of tin s Pursuant tb Couray Cods Chapter 8A—Art a&10 w _ _ Gomm. OP so#hVkmr '1AR 2,p T LE"ONAL PROP DLR v TAX 19-05336 to jtai Tbsdew we • #� �i1fO1f0611� Y�1d0l�f-mss, , cufler -- in SAutk nay 4 :1110 the-s-u-ni VT - vamue 11-16-15 State of Florida County of Miami-Dade Before me this day personally appeared Raul Vergara who, being duly sworn,deposes and says:That he will be the only person working on the project located at:9301 NE 9th place Miami Shores, FL 33138. Sworn to (or affirmed)and subscribed before me this 16fday of November 2015, by Raul Vergara. Produced: FL Driver's License Jeff Diego COMMISSION # FF181160 EXPIRES:December 4,2018 WWW,AAmNOTARY,COM P& &�� WWW.CUTLERBAYSOLARSOLUTIONS.COM (786)457-5958/(305)299-5624 8301 SW 184 LANE CUTLER BAY,FL 33157 RAULC@CUTLERBAYSOLARSOLUTIONS.COM / JEFF@CUTLERBAYSOLARSOLUTIONS.COM $NOREs �, tNc.193a G,� Miami shores Village Building Department CpRipA 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. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: �— Owner State of Florida County of Miami-Dade 9 The foregoing was acknowledge before me this `� day ofy©VCS M&f ,20J�_. By )Ott 6�i`hU�� C rO)�7 who is personally known to me or has produced 1Le �f � Y j L•ce to g e, as identification. Notary: � I�.,iT-T� �t Diego SEAL: COMMISSION # FF181160 o, EXPIRES:December 4,2018 �`' www.AAR