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PL-16-240Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -1-16-240 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 6/14/2016 Expiration: 12/11/2016 Parcel Number Applicant 175 NW 109 Street Miami Shores, FL 33168-4316 1121360030170 Block: Lot: JCAS FUND CORP Owner Information Address Phone Cell JCAS FUND CORP 5600 SW 135 Street FL (786)444-2945 Contractor(s) LUIS QUALITY PLUMBING INC Phone Cell Phone (786)256-2210 (786)444-2945 Valuation: Total Sq Feet: $ 1,780.00 1400 Type of Work: REPLACE ALL FIXTURES Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.20 $3.38 $3.38 $0.40 $225.00 $3.00 $1.60 $237.96 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -1-16-58487 06/14/2016 Cash $ 237.96 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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 respo•=•fslity for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUM= IG, ECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS A construc he foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating e, I authorize the above-named contractor to do the work stated. nature: Owner / Applicant / Contractor / Agent ding Department Copy June 14, 2016 Date June 14, 2016 1 QQ, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-251824 Permit Number: PL -1-16-240 Scheduled Inspection Date: September 20, 2016 Inspector: Hernandez, Rafael Owner. Job Address: 175 NW 109 Street Miami Shores, FL 33168-4316 Project <NONE> Permit Type: Plumbing - Residential Inspection Type tdergreend----/ Work Classification: Addition/A teration I/ Phone Number (786)444-2945 Parcel Number 1121360030170 Contractor. LUIS QUALITY PLUMBING INC Phone: (786)256-2210 Building Department Comments REPLACE ALL FIXTURES Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Infractto Passed Comments INSPECTOR COMMENTS Inspector Comments .1i/v/1 False BUILDING PERMIT APPLICATION ❑ BUILDING 4 Miami Shores Village Building Department ED JN 2.8 20t6 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 li Y; Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: I/ AM) L l O Sk. City: Miami Shores County: FBC 2019 -- Master Permit No. 8-0-1 J 2P19-3 Sub Permit No.FL \ b 2 -1 0 ❑ REVISION ❑ CHANGE OF CONTRACTOR ❑ EXTENSION ❑ RENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):'( ,f)'' lid S' (Ci Address: S &cc 'W 1 350. City: X CXYA r State: 1-( Phone#T7 q 2-9 Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR Company Name:44 �j 6)0/1-1 Address: City: % %r State: Pt-- Zip: 33/ Z . Qualifier Name: L�/7 5 4i/Q/7/j! State Certification or Registration #: /G S 91-0'..c."Certificate of Competency #: */ -.C6066 .3 . Phone#: Phone#1:1.Y C. zsi DESIGNER: Architect/Engineer: Phone#: Address: l City: IValue:of Work for this Pe`rrnit $ 1 ��S v Type of Work: ❑ Addition Description of Work: ❑ Alteration c State: Zip: SCuare/LinearFootage of W k: t Oa New repair/Replace ❑ Demolition ep4' Cf Gi/Yit/�� Specify color of color thru tile: I e Submittal Fee $ 0 Permit Fee $ 5i 2-5. CCF $ 1 ` 2-6 CO/CC $ 4 Scanning Fee $ 3. w i Radon Fee $ • -Sg �( DBPR $ a • Se Notary $ CiS Technology Fee $ 1, G Q Training/Education Fee $ O' 0 Double Fee $ Structural Reviews $ Bond $ 75 TOTAL FEE NOW DUE $ • 9 (Revised02/24/2014) 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 buildirig 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 d felivered 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 n approved and a reinspection fee will be charged. Signat Signatu OWNER or AGENT C WTRACTOR The foregoing instrument was acknowledged befor me this The foregoing instrument was acknowledged befy M e this yday:of )6/(01a1 , 20 /j , by �Cc.iu C • G� ett; who is personally known to ay of ,• ! , 20 me or who has produced as me or who has produced as identifica , by who is personally known to NOTARY L•�4T10��' HEIDY CERTAIN Notary Public - State of Florida ct 3, 2016 E 840251 Sign: Print Seal: APPROVED BY (Revised02/24/2014) .e/ 11: -I identification and who did:take an oath. NOTA tgn: Print: Seal: Plans Examiner Structural Review /7 Zoning Clerk RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSRUCT ONEINDUSTRYR LICENSING BOARD LICENSE NUMBER RF0037205 The PLUMBING CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2017 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HERNANDEZ, LUIS LUIS QUALITY PLUMBIN 245 NW 59TH COURT MIAMI FL 3312 ISSUED: 08/16/2015 DISPLAY AS REQUIRED BY LAW SEQ # L1508160002062 CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 04P000065 LUIS QUALITY PLUMBING INC D.B.A.: HRNANDE UIS DOMINGO Is certified under the provisions of Chapter 10 of Miami -Dade County local Business Tax Receipt: Miami -Dade County, Stafie AY of Florida -THIS IS NOTA BILL - DO NOT P 50$178:'. BUBINU8 NAME/I.00AT1ON LUIS QUALITY PLUMBING INC. 245 NW 69 CT MIAMI, FL' 33126 OWNER LUIS QUALITY PLUMBING INC CIO LUIS HERNANDEZ Worker(s) 10 This Local Businose Tax Receipt only cot Imes paymont of the local Business Tax. Tho Raoeipt is sXicense, permit, or a certification of the holder's qualifications, to do business. Holder must oomph. with any Dove ntel ornongovemmontai regulatory laws and requirements which apply to the business, The RECEIPT N0. above must be displeyod on ail commercial vehicles- Miami -Dada Code Sao Se -276. For moro Information, visit a lyvw.minmidadesavitezoolloatSL FES NO. RaNEWAL 603178 • • SEC. TYPE OF BUSINESS 198 PLUMBING CONTRACTOR 04P000065 LBT EXPIRES SEPTEM.. ER 30; 2016 Must be displayed et place 4f business Pursuant to County 'Code Chapter 8A - Art. S 8t 10 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 09/21/2015 0223-15.006542 MI•M AAA Municipal Contractor's Tax Receipt Miami-DTaadIS County, otnaioePov Florida CC NO: 00000065 LUIS QUALITY PLUMBING NCN 245NW59CT MIAMI, Ft. 33126 OWNER LUIS QUALITY PLUMBING INC C/O LUIS HERNANDEZ MIAMFOADE RECEIPT NO. 7472213 TYPE OF BUSINESS PLUMBING CONTRACTOR EXPIRES SEPTEMBER 30, 2016 Pursuant to County Code Sec 10-24 PAYMENT RECEIVED BY TAX COLLECTOR 200,00` , 09/21/2015 0223.15.006542 This receipt Is not valid In the Iollowing Municipalities Aventwa; Doral, Hialeeh, Hoy Biscayne, Miami Gorden, Miami Lakes, Palmetto Bay, Pineoreat, Sunny isles Beach, Town of Cutler Bay. For marc Information, visit Report Viewer Page 1 ett 1 JEFFJEIVIIA713t °IMF FOIRNICIALOFFICBt STATE OF FLORIDA DEPARTMEtff OF FINANCIAL MERCER ENVISION OF WORKERS' COMPENSATION "CEITIWICATE OF SECTION TO BE EMEMPT FROM R.ORIDA WORKERS' COMPENSATION LAIN" CONSTRUCTION INDUSTRY EXTEINIPTICM1 llis cedillas Smiths individual tided below haS elected- lo be exempt tram Amide lAbtkess• Ccaapensallaa EFFECTIVE oii-r• sums EXPIRATION DAM W17/2017 PERSONt HERNAt4DEZ LUIS Mt 200422434 BUSINESS NAME AND ADDRESS: LUIS QUALITY PLUMBING INC 2(5 MAW COURT IRANI FL 33120 SCOPES OF BUSINESS OR TRADE: PLUMBING ROC Al•ID DRIVERS rtms...11.0*MagallaRVILIF.a.aialierstatugaallemirelecisaiNiOli•Ilmalsea=rogiferreedeciremmierlilsienim =Lie= belZanswlealtalsialilieslibeenompt.4=titleWill=a—aig= marriaidanIllobselderksieberaswil 11.111malpstimpoixissItaltangilmallenlis etibearthelmmeasterealliedb. aspeemmanallustiveadkoweitaimmotsorsmossaftempimoriesalllitsiellashresi' OFSMIONC,ISKERTIFICICIEOFELEC11CM1108E1903111RISEIVIED0543 OUGSTIONS7(11150)413-10011 https://appsg_fldcom/crreportviewerheportViewer.aspx?data—lcdvpginc9D7Q3gH6TElt6... 9/15/2015 Miami Shores Village Building Department 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.. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signatur Owner State of Florida County of Miami -Dade 0y11 The foregoinw cknowledge b ore me thisO day of (jYt , 20 . By �J / / who is p ►. J. t• as ident. v `= IDY CERTAIN as ident a. - Notary Public - State of Florida Notary: F� ?el�y ► ►► ► 016 Notary: SEAL: rnrxsti, SEAL: me or has produced Contractor State of Florida County of Miami -Dade The fore•oing was acknowledge bore me this ./ •Z day of By ,20 . 6 771/ who is perso all known to me of has produced Y HEIDY CERTAIN blic - State of Florida fir' 3,2010 ion # EE 840251 LUIS QUALITY PLUMBING INC Date: 01/27/2016 State of Florida County of Miami -Dade Before me this day personally appeared Luis Hernandez who, being duly sworn, deposes and say: That he will be the only person working at the property locates at: 175 NE 109 Street. Miami Shore, Florida 33161 Sworn to (or affirmed) and subscribed before me this 2 P4P 20 (L, by 1.V►5 Nerroan0e2 1 ay of SOL( Vaal Personally Knows OR Produced Identification Type of Identification Produced HEIDY CERTAIN Notary Public - State of Florida My Comm Expires Oct 3, 2016 Cr nn ss,on # EE 840251 Print, Type or Stamp Name of Notary 245 NW 59th Court Miami, Florida 33126. Telephone: 305-788-5625