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RC-06-2427 ARENAS CONSTRUCTION INC Date: 4 '1 ` 2�Ko State of County of m 1p�Mk --D*r E) Before me this day personally appearedio"IL �N��;Ao,being du y sworn, deposes and says: That he or she will be the only person working on the project located at: 99 42 `f kyE' M,4,„ sw) , °�- 3313� Sworn to(or affirmed) and subscribed before me this 4 day of l..- . 20 (/bby Personally know OR Produced Identification Type of Identification Produced �k Print,Type or Stamp Name of Notary =Publiclic State of Floridaarezssion FF 15675003/2018 �LG, --c�\--o� N,,. Rollo?" Miami shores Village- Building Department tOR1pA 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: (/u Qom,- �, w Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of rn042-4-k ,20 BII.So'.3 who is personally known to me or has produced Alltt91i Notary' o i SEAL: = `' Permits By Contractor Permit Number Application Date Expiration Date Status ARENAS CONSTRUCTION Phone: (305)300-3103 n* E i CC-2-08-332 02/27/2008 01/01/2999 CLOSED CC-3-08-532 03/26/2008 09/13/2016 CLOSED 3t1 _ � DEMO-4-08-564 04/01/2008 01/01/2999 CLOSED DS-12-05-1167 12/09/2005 01/01/2999 CLOSED Y BP2002-1068 06/10/2002 01/01/2999 CLOSED BP2003-1370 08/19/2003 01/01/2999 CLOSED BP2003-558 04/09/2003 01/01/2999 CLOSED BP2004-1075 08/09/2004 01/01/2999 CLOSED BP2004-346 03/15/2004 01/01/2999 CLOSED BP2004-372 03/18/2004 01/01/2999 CLOSED BP2004-946 07/13/2004 01/01/2999 CLOSED BP2005-1195 08/12/2005 01/01/2999 CLOSED BP2005-694 05/10/2005 01/01/2999 CLOSED BP2005-713 05/16/2005 01/01/2999 CLOSED BP2005-909 06/16/2005 01/01/2999 CLOSED filfth fj4 ' PL-12-05-1151 09/21/2005 01/01/2999 CLOSED 33� d 3 BP2005-1368 09/21/2005 01/01/2999 CLOSED RC-2-10-228 02/16/2010 01/01/2999 CLOSED RC-2-12-324 02/27/2012 12/10/2013 EXPIRED RC-4-06-913 04/10/2006 01/01/2999 CLOSED Thursday,April 14,2016 Page 1 of 2 „ Permit Number Application Date Expiration Date Status RC-4-16-1005 04/14/2016 10/11/2016 APPLIED RC-5-15-1239 05/26/2015 07/17/2016 APPROVED RC-6-14-1249 06/13/2014 01/01/2999 CLOSED RC-7-06-1953 07/20/2006 01/01/2999 CLOSED RC-9-06-2427 09/27/2006 09/16/2007 EXPIRED W1 $ h Mo r v WS-2-14-220 02/05/2014 01/01/2999 CLOSED WS-4-16-1002 04/14/2016 10/11/2016 APPLIED Thursday,April 14, 2016 Page 2 of 2 Miami Shores Village Building Department g p 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax:(305)756.8972 Z BUILDING ��P Permit No.�� PERMIT APPLICATION 2 �� 6 Master Permit No. FBC 2004 BY.---- _- Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) A f f 2-, a4,,( l)on H o �J (fo--, Phone# Owner's Address 9 �L(L IV. c. Y44 W 0A.( City! A�"+r 5 o r�r State F C Zip 33 Sp Tenant/Lessee Name Phone# _C or) 7 s o f n Job Address(where the work is being done) Y2_ Al. f f X4 h 44 e o Q City__ Miami Shores Villaee County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO Contractor's Company Name76n Phone# Contractor's Address City State Zip Qualifier Name Phone# State Certificate or Registration No. Certificate of Competency No. Architect/Engineer's Name(if applicable)_��+,/0 w r c 4,14e c /f Phone# (3 e) l — l o s S— Value of Work For this Permit Square/Linear Footage Of Work: .Z Type of Work: [:]Addition Iteration ❑New ❑ Repair/Replace ❑Demolition Describe W`o/rk: C �n U P f ( lZ A fn Submittal Fees Z,'�O .(CJ Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ See Reverse side- 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 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 and a reinspection fee will be charged Signature/ )L, "//? /U,�,, Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this!!!� " I The foregoing instrument was acknowledged before me this day of [d ,20___,by [ ek�-N W1 I day of .20_,by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY UB C: NOTARY PUBLIC: Q Del Expires: Sign: per nding Co,G i Print: My Co ission Expires: My Commission Expires: APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised Ov08/06) t Y • Q�g /� I Miami Shores village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 BUILDINGD ��MET Permit No. Rcol-z4q PERMIT APPLICATION DEC 0 7 2006 Master Permit No. FBC 2004 BY:.�-W�' �� 2 ` ........ Pernkit Type(circle): uilding Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) Phone Owner's Address _61Cl 41- City- 4 —S State Zip 3 '� Tenant/Lessee Name Phone# Job Address(where the work is being done) S O\ Cc_S Q�) City Miami Shores Village County Miami-Dade Zip FOLIO/PARCEL# Is Building Historically Designated YES NO__94 Contractor's Company Names �C �1S1 CZE Phone# Contractor's Address �`Z.'3 �� C.-j Ste' State �'1 . Zip 33 N > Qualifier Name Phone k%3) -.too la4 o 2 State Certificate or Registration No. � 06�? Certificate of Competency No. Architect/Engineer's Name(if applicable) Phone# Value of Work For this Permit Square/Linear Footage Of Work. Type of Work: ❑Addition &Alteration ❑New ❑ 'Repair/Replace ❑Demolition Describe Work- It NIS Q Submittal Fee$ Permit Fee$ F$ i CO/CC ISO NotaryAA ,$ �J Training/Education Fee$ `�-- Technology Fee$ Scanning$ ' Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ Structural Review.$ Total Fee Now Due$ �® See Reverse side-� /U 3V JAN I PAID ♦ ' i' J 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 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 nonce of commencement must be posted at the job site for.the first inspection which occurs seven (7) days of ter the building permit is i sued In the Bence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature.- l — Signature Owner or Agent Contractor �l The foregoing instrument was acknowledged before me this 'f The foregoing ttrument was acknowledged before me this day of Chttly�20 &by Wgran 4•Wilso✓1 day of TXC .20�by I'639a, Aws , who is personally known to me or who has produced who is personally known to me or who has produced [I. N)tlJ?j As identification and wh�,dt�l t��lid. W2D q(2ND as identification and who did take an oath. NOTARY PUBLIC: NOTAR *0 /2d"2010 Sign: - 10TAP IUR i sign: A IPZ Print: i gra✓1 J'' . DO�aS�6 Print: elttf� eSQN p0 s ° n�. l of ►b� 20� My Commission Expires: ��Z�l!0 ''�i,,F Of F� My Commission Expir ,x,r•�,��,t,�,r,�,rrtar,�,�*,�,t,�,t�,r�r,�,t��,�,�r�r��r�r,�,�t*,��rxt,�,��,r*w,r*�r*,r�r�,ta�rt,�,�•�,r,��r,��r,�,��r*��•,�,� �k�i� �•,�•�a,r,��*�,r�� APPLICATION APPROVED BY: Plans Examiner Engineer Zoning (Revised 02/08/06) PERMIT# - 2l4 Z,-:� CONTRACTOR: SUBMITTAL DATE: RESUBMITAL DATES: PC PROJECT TYPE: TIli DD)T I0,,j a ZONING FIRE STRUCTUR L / IMPACT FEES ELECTRICAL HRS/DERM —PLUMB VN . NOC MECHANICAL BLD