PL-15-2539 (2) R
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-245099 PermitNumber: PL-10-15-2539
Scheduled Inspection Date: December 16,2015 Permit Type: Plumbing - Residential
Inspector: Diaz,Osvaldo Inspection Type: Final
Owner: , Work Classification: Addition/Alteration
Job Address:40 NW 111 Street
Miami Shores, FL 33168-4322 Phone Number (786)251-2263
Parcel Number 1121360030360
Project: <NONE>
Contractor: SANTINACHO ENTERPRISES INC Phone: (786)443-9590
Building Department Comments
PLUMBING FOR KITCHEN AND BATH REMODELATION. Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
❑ - 1� I
�t
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid
December 15,2015 For Inspections please call: (305)762-4949 Page 21 of 51
a l
Rs Miami Shores Village �Tzf{#7ypeiifttifti )LFIt1s ,
�a 10050 N.E.2nd Avenue NWPAl WO .
Miami Shores,FL 33138-0000 .......... Pert7dtStstw PROW
Phone: (305)795-2204ON
'd. ; ,
40RIDA " ..'_ w `
; i 3 Expiration: 04/05/2016
Project Address Parcel Number Applicant
40 NW 111 Street 1121360030360
Miami Shores, FL 33168-4322 Block: Lot: 4040 GROUP CORP
Owner Information Address Phone Cell
4040 GROUP CORP 40 NW 111 Street (786)251-2263
MIAMI SHORES FL 33168-
9660 SW 72 Street
MIAMI FL 33173-
Contractor(s) Phone Cell Phone Valuation: $ 1,850.00
SANTINACHO ENTERPRISES INC (786)443-9590 Total Sq Feet: 0
Type of Work:PLUMBING FOR KITCHEN AND BATH REMOD Available Inspections:
Type of Piping: Inspection Type:
Additional Info: Top Out
Bond Return: Final
Classification:Residential Scanning:1 Review Plumbing
Underground �JE
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
DBPR Fee Invoice# PL-10-15-57335
$3.38 10/08/2015 Check#:1016 $ 187.96 $50.00
DCA Fee $3.38
Education Surcharge $0.40 10/06/2015 Check#:1014 $50.00 $0.00
Permit Fee $225.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $237.96
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 infoVenlractor
ccurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhermore,I authorize the above to do the work stated.
October 08, 2015
Authorized Signature:Owner / Applicant ractor / Agent Date
Building Department Copy
October 08,2015 1
Miami Shores Village g OFT 0 G 2075
Building Department
10050 N,E.2nd Avenue, Miami Shores,Florida 3313
Tel:(305)795-2204 Fax:(305)756-3972 —,k
INSPECTION LINE PHONE NUMBER:("05)762-4949
BUiLUING Master Permit No.
PERMIT APPLICATION Sub Permit
N®°�
[]B ILDING M ELECTRIC Ej ROOFING 0 REVISION E EXTENSION RENEWAL
PLUMBING M MECHANICAL MPUBLICWORKS M CHANGE OF CANCELLATION `El SHOP
C--}} CONTRACTOR DRAWINGS
S 4
JOB ADDRESS: `� N V V
City: Miami Shores County• Miami Dade zip: 33 I BOE)
Folio/Parcel#: I r 2 " 3 U,_ 00 O� (00 Is the Building Historically Designated:Yes NO X
Occupancy Type:SF P. Load: Construction Type: x'66 Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):_ 40N D Cil V)yD f)G Phone#:JOU Z5 1- Zl k03
Address:— 1000 So -112
City:_MYYl l State: L° Zip: �
Tenant/Lessee Name:, N Phone#:
Email: M 1 k�SCJ G 1�g i 1 C��m
CONTRACTOR:Company NameS--Y- )i VICs 6,h,- Phone#:
Address: D-'11110i
City:01\�Cr'\', b'yyC State:
Qualifier Name: At'1-F�n)0 �a��l �" Phone#:,')6(.'-`I\-A"�����(�
State Certification or Registration#: C-]E C_ ! 12_%X56ZD Certificate of Competency#:C--Fc— °12 b °
DESIGNER:Archite�ctL/Engineer: ��bTQ,��(') Phone#: 3o5-cp(.913655
Addre`s's_ ��°-I SW � ( {�IYd�I Sy( , (Q, City: �.��t�111 State: PL_ Zip:
Value of Work for this Permit:$ f �cG% Square/Linear Footage of Work:
Type of Work: 0 Addition jp Alteration -{- (,[] New 21 Repair/Replace [ Demolition
Description of Work:_r�i 1 10�l�� �"1 �` 1 I 1 L 1-)cjtj,\J
Specify color of color thru tile:
Submittal Fee$._ Permit Fee$ ` s�J., f/ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ 'Training/Education Fee$ Double Fee$
Structural Reviews$ Bond,$
TOTAL FEE NOW DUE$ 1
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 installatidn 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection whic occurs seven ) days after the building permit is issued. In the absence of such posted notice, the
inspection be appro d and a reinspectio ee will be charged.
Sig Signature
O or A CONTRACTOR
The foregoing ins urns was acknowlgdged before me this The foregoing instrument was acknowledged before me this
da of20 by aLt —day of 2J 5 by
who is personally known to Atiy(.�:Fv n who i ersonally known to
me or who has produced a me or who has produced as
identification and who did ake an oath. identification and who did take an oath.
NOTARY PUBLIC: - NOTARY PUBLIC:
Sigma-- _ -__ ` Sign.
Print: 42.aer�e ASA FERNAMEZ Print: ru ANTONIO E.GOMEZ
t V� 10NO.FF0024 Seal:
Seal: � � �$�• XPIRES:AUG 25,2019
,� \o: F_)PIRS Oetolret°f8,2017 WB�ondad through 1st State Insurance
+11,01, Bm*dThruBudgetSoka
APPROVED BY �!��'� Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
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ISSUED: 08/2412014 DISPLAYAS REQUIRED BY LAW SEQ# L1408240003253
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Village Of Miami Shores
Building Department
10050 Ne 2 Ave
Miami Shores,Fl 33138
SEP-30-2015 11:14A FROM: TO:3057568972 P.1
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STATE OF l:LORIDA
CHIEF FINANCIAL Ol
DEPARTMENT OF FINANCIAL.SERVICES
DIVISION OF WORKERS`COMPENSATION
"•CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW
CONSTRUCTION INDUSTRY EXEMPTION
This cerdftea that therIndividtml tfefad below Kee elected to be exempt-from Florida Workere'Compansel(on taw.
EFFECTIVE DATE: 2/3C•ID15 EXPIRATION DATE; 2/2/2017
PERSON: LUVARA ANTONIO
FEIN: 470132733
i
OU41NE48 NAME AND ADDREOS;
SANTINACHO ENTERPRISES CORP
i
i
4156$W lab AVENUE
MIAMI EL 33165
SCOPE$OF BUSINESS OR TRADE:
LICENSED GENERAL. LICENSED PLUMING PLUMBING NOC AND HEATING,VENTILATION,
CONTRACTOR CONTRACTOR DRIVERS. AIR-COND
Pursuant to Chapter 44Q.05(i 4),P.3,on effiear ofa.corporation.MOO 618M exampdanfromdhls chapter by I1hng a NOWe of elootlon under Oft eeaaan
may not recover benefas or c ompon"ban under this chapter.Purauantto ChapWr440.06(12j,F.$.,Cadifkatasofoloation to bo 6x"pt„apply only
wltbin the spapp of the IxWness or trade hated on the notka bf eleshoa lobe exempt Pursuant to Chapter 440,06(18)',F.0:,Nellon'of slotlon to he
aYempl er►d,oemfic$es of election to.bo pxetnpt 6bWt be sublact to ravmven W.at any time eftwthotong or the notate ar the tsouanoa of ma cartitmllate,
the Person named on the alas or oerHhcata'no ranger made the mulmnwts cf this aeWoa for tawanoe of a oafdlbate,The department shall revoke a
0FS-F2-OWC-W CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08,13 QUESTIONS?(85M41$100
Santinacho Enterprises Corp
Cfc 1428288
4156 Sw 96 Ave
786-443-9590 / 786-360-5499
Miami FI 33165
Date : 30 Sep 2015
1 Antonio Luvara qualifier Santinacho Enterprises Corp Certify will be the only
person working on the project located at :40 Nw 111 st. Miami Shores.
Re ds,
4tiolLuvara
Before me this day personally appeared Antonio Luvara who, being duly sworn,
deposes and says :
That he will be the only person working on the project located at : 40 Nw 111 st.
Miami Shores FI.
Sworn to and subscribed me this 30 day of September 2015 by, Antonio Luvara
(:::Personally Know
Or Produced Idenification
Tyoe Of Identification Prooduced ANTONIO=d"'r,u`'n W COMMISSORES:Bonded throug
SuREs pl
l.,. ,,,,,m Miami Shores Village
Building Department
XOR � 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 ACKNONYLED E THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Own
State of Florida
County of Miami-Dade
The foregoing w/as a(c�kr1oowledge before me this _day of O' ,20�.
By�1�i VISL J j4gt, /N wh personally known to or has produced
as identificaion.
Notary: --�
SEAL: o'll..¢ �* Alyssa Hernandez
f COMMISSION IFF916795
www.AARoNWTARY.COM