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RF-15-650 r 7" 1 r a'aEL �4�1 fl'11 G - a F� � Miami Shores Village REc0D Building Department -MAR 3 z 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-3972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F BC 201 BUILDING Master Permit No. Rt- PERMIT t - PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFINGS ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WpRKS ❑ CHANGE OF ❑ CANCELLATION [—] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I/ S C- City: Miami Shores Cougt: Miami Dae Zip: 3 fie Folio/Parcel#: is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Iood Zone: BFE• FFE: OWNER:Name(Fee Simple Titleholder): ✓�I — Phone#:� d qq I I C D Address City. Aq A.-v► 5 � _sufd. ��,� �� r` Zip: 33 1-:Y — Tenant/Lessee Name: y Phone#: Email: ' �n ,ter �o l Q Gj CONTRACTOR:Company Nam ' 'v 0�""t 6 Phone#: Address: I/AZZ I City: state: Zip, Zip: Qualifier Name: Q Phone#: State Certification or Registration#: 66 C ��� l 3�' Certificate of Competency#: i DESIGNER:Architect/Engineer, Phone#: Address: City: State. Zip: wm:7 Value of Work for this Permit:$ f Square/Linear Footage of Work: / o� e Type of Work: 1:1Addition ❑ Alteration i L3New ❑ Repair/Replace ❑ Demolition wip Description of Work: 00104 Q_ Z I'C-AV'S (1j -1;_(�L(--T(LI5 Mab LV6C171©9 1 S Specify color of color thru tile: 1211FT Submittal Fee S OD Permit Fee$ CCF S CO/CC$ Scanning Fee$ Radon Fee$ DBPR S Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews S Bond 5 (X�� {� � 7 d.ni1 Bonding Company Name(if applicable) Bonding Company's Address - City State zip i Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State_ Zip_ i 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 th�t 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 ihformation 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 I�IPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITS YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." j Natke to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$1500, the applicant nfust 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 certiff copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) bays al er the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee w T/be charged. 1 Signature I / Signature The foregoing instrument was acknowledged Ware ine this The foregoing instrument was acknowledged before me this day of zo ® by day of A 201 , by y who is personally known to o is personally known to me or who has produced me or who has producedPer' -6 as identificat' d who did tak an oath. identification •nd who did take an oath,. :^0T P L �e NOTARY LI . >. ALIJANM awm ALIJA�NN 0 Si Nogry►i>►u�e Ot Flor a Si Notap Phi:• N fbd0a 2018 91 Comm. Commission f FF 101837 Pr P�. Commission N FF 101837 wwwwsssssssssssssssaSssw+Mww�.,bwwwww www wwww,rwawwwas�:ssssssmaass+ass*.Arw,r*4*w*+k+�wwwwwswwwsr,s:,:kassasassssMasssM APPROVED BY Plans Examiner _ Zoning c;'rI 5,,R: .i , WE 11 1 Miami 2 +< . ti Pr - Miami shores Village urge '1 Building Department �CQ10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305) 756.8972 Notice to Owner — WorkeW Compensation Insurance Exemption 1 Florida Law requires Workers' Compensation insuran> a coverage under Chapter 440 of the Florida Statutes. Fla.. Stat. § 440-05 1 allows corporate officers in the constriction industry to lexempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the.Londa Divlision of Workers`Compensation Employer Facts Brochure: An employer in the construction *ustry who employs one or more part-time or full-time employees,including the owner,mustlobtain workers'compensation coverage. Corporate officers or members of a limited liability co> pany (LLQ in the construction industry may elect to be exempt if: I � 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.,Die Sion of Corporations;and 3. The corporation is registered and listed as active with the. Florida Department of State,Division of Corpolations. I No more than three corporate otlieer per cor;>oration or limited liability company members are Cowed to be exempt. Construction)exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemptionis revoked by the Division. i i Your contractor is requesting a permit under this workercompensation exemption and has a.aknowledge 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 subeoniractors. BY.SIGNINYG BDY.OW YOU ACKNOWLEDGE THAT YOU HAVE READ TMS NOTICE AND U9DElZSTANID rr$ CONTENTS. Signature: Owner State of Florida Couuly of Nfiami-Dade 1 The foregoing was aelzxowledge,before me this day of ,20_[f' By / ��' `�vho is personally known to me or has produced No ry: rtil'M�M M"Pok-NIM M Pill" S ,p.E � r MY Cason.tt Jim 10.tole '; t,. Commission/FF 101637 f PROPOSAL - CONTRACT HORACIO A. UNZUETA STATE GENERAL CONTRACTOR COUNTY ENGINEERING CONTRACTOR 1422 S.W.82nd Ct Miami,FL 33144 Gustavo Ballestas License Number CGC-006936 PH-(786)223-1222 Ph(305)2646444 Cell(305)989-8023 March 20th.,2015 SUBMITTED TO JOB NAME Willie Taylor Roof Repair STREET E-mail JOB ADDRESS 9640 Biscayne Blvd same CITY,STATE&ZIP CODE PHONE LEGAL DESCRIPTION JOB PHONE Miami,FL.33138 WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATE FOR: Roof Repair .... ........................................................... A�ddliuCi SCOPE OF WORK: TILE ROOF LEAK REPAIR Remove tiles and roofing materials in area of leak Install new#30 tin ca Install Pol stick TU Pius cap sheet Re-install tiles using foam adhesive TOTAL FOR ROOFING $1,200.00 EXCLUSIONS: Anv other work not enumerated above. Temporary water and power during construction. SCHEDULE OF PAYMENTS: 1 so% Upon signature of Contract 21 5o% Up on completion TOTAL PRICE FOR ABOVE WORK $1,200.00 We propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: ONE THOUSAND TWO HUNDRED DOLLARS Payment and Work Completion to be made as follows: See above schedule Work completed in approx..3 days from permit All materials are guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications involving Authorized extra costs will be executed only upon written orders,and will become an extra charge over the Signature estimate.All agreements contingent upon strikes,availability of materials,accidents or delays beyond our control.Owner to carry fire,tomado,builders risk and any other insurance requirements Note:Void if not by his mortgage carrier or others. Our workers are fully covered by Workmen's Compensation& accepted by Us within 15 days General Liability Insurance. Upgrades to new code requirements,if needed will become extra charge. ACCEPTANCE OF PROPOSAL- The above price,specifications&conditions are satisfactory Signatures: and are hereby accepted.You are authorized to do the work as specified Payment will be made Owner/s: outlined above. Date of Acceptance: Contractor: