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RF-19-228 (2)u RFol-19-ZZg ' Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 —L rr,t-, !jT-wL , " Issue Date: 02/06/2019 Location Address Parcel Number 8700 BISCAYNE BLVD, Miami Shores, FL 33138 1132060201030 Contacts Permit NO.: RF-01-19-228 Permit Type: Roof Work Classification: Gutters Permit Status: Approved Expiration: 08/05/2019 Miami Shr Sery Station LLC Owner A-1 USA GUTTER CORP Contractor 9701 Biscayne ALBUERNE EDUARDO Business: 3053192114 Description: REPAIR GUTTERS & DOWNSOUT Valuation: $ 9,200.00 Inspection Requests: 305-762-4949 TotalSq Feet: 480.00 Fees Amount Application Fee - Other $50.00 CCF $6.00 DBPR Fee $3.75 DCA Fee $2.50 Education Surcharge $2.00 Roofing Fee $200.00 Scanning Fee $3.00 Technology Fee $6.25 Total: $273.50 Building Department Copy Payments Date Paid Amt Paid Total Fees $273.50 Credit Card 02/06/2019 $273.50 Amount Due: $0.00 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 AFF VIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating conprultion and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date February 06, 2019 Page 2 of 2 231112019 OFFIOER Gj41EF �liVr�Tili At e350a85b-t)621-4d25-bo5b-8doo933bO5f7.JPG STATE OF -INFpLNOVRVADL4 SERInCES DPARWFWORKERVCMPECAlION DIVISIO tcccv cuEXEMPT MOM FLORIDA FI-ECTION TO BCERTIFICATE Of: -- f%wj won f-ANSTF CTION 1NDUS`TF1Y E)(E:Mt'11 has elected to be exempt from COMpEt4SA-q0N LAW Florida Worws' corverlsatiorl law. divildual listed bed I Zm 912020 This certifler, that the In VXpISATtON DArE- GMAIL-COM EMCIMI)4TE- 1,2J20W18 EMAIL: GUTTEfk'6-"& PFRSDo AtBL)EpNE ON. EDUAR � FFIN: 814545652 p AN,) AIDIDRESS-. US,tT-Ss t4AME A-, t JSA r.UTTEF1 C-0119 9-740 E -,GTH AVE pj,ALEA�4� FL 33013 "COPE OF BUSINESS OR -TRADE' metal ,Q,,llabor & —Cgtes of 'on "n to tAll on who beds g40.05( 12), F - '40t� `* offtw of a1,40 0503" th k, 440.05(14)- F-S- an ttjs & rward to (�t`pw at to chapW - .2pw. Pu orw pursua notce of ID be 0 t;;n, At er ft flRn1j 0 'e dePall refits or Ajre 'd at any ok Waver ade 11stsd on tj-.q rK *)n 1� .... .1 - ubject tD rewc ed'W W lss ,,.Cj,rjn FlIVY 11 bui—*ss O'�_T,— hall be s --Amts N thts - . oj*sse�-tran- soope eq JV-ji4Dn to bL rit mm"— ot u-, cif pirate nO h ror* n2ined on d* ce ame" -I e �,Me Ot ..V�rs �tt aly 2 - T WICATE OF ELECTION To Be E)(EMfYT FE,4jFFD og-13 S.r2.aWC-252 CER f. , BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 8700 BISCAYNE BLVD Master Permit No. RS15-1809 Sub Permit No. F 1� ` DI ` l 7�� ❑ REVISION ❑ EXTENSION RENEWAL Q CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: 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): MIAMI SHORES SERVICE STATION LLC Address:9701 NW 89TH AVE City: MEDELY State: FL Phone#:305-884-0008 EXT 231 Tenant/Lessee Name: Phone#: Email: MIANTENANCE@URBIETAOIL.COM 33178 CONTRACTOR: Company Name: 4 _ J- (/SA E� U 7- e% are! • Phone#: Address: l' 7�0 !!5- iP 7C/ Alz City: 111,41e,+w F State: Zip: 3 3l�13 1-2 Qualifier Name: ✓R r Ui � P' Phone#: - 65'- . State Certification or Registration #: Certificate of Competency #: n9ii5o 93 DESIGNER: Architect/Engineer: hone#: Address: City: State: Zip: Value of Work for this Permit: $� Square/Linear Footage of Work: '7 Type of Work: ❑ Addition ❑ Alteration ❑ New [ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ _ DBPR $ Notary $ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ _ (Revised02/24/2014) U f V Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 OWNER or AG T CONTRACTOR The foregoing instrument dwas /acknowledged before me this The foregoing instrument was acknowledged before me this day of lJ J yJ V 20 by -f nday of -� AN 20 by 'EdJCA' n UcIvIJO I b v NO ( I ) U I (4(Q l` , who is personally known to CYKwho is personally known to me or who has produced identification and who did take an oath. NOTARY PU as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: ' ' �"" KG/ 1 rr Sign:( Y U Print: ^ r Print: C \ Seal: 'y' Seal: 001(h* Notary Public State of Florida �,•►r"'^ Notary Public State of Florida Estefania Ramirez Estefania Ramirez My Commission GG 199994 My Commission GG 199994 '?�a�' Expires 03/25/2022 4ta n Expires 03/25/2022 APPROVED BY r�/1 1 Plans Examiner as *********** Zoning (Revised02/24/2014) Structural Review Clerk WO ConstnaO Trad iates Q Board INESS CERTIFICATE OF COMPETENCY USA,GUTTERCORP Local Business Tax Receipt Miami -Dade County, State of Florida zTHIS IS NOT A BILL — DO NOT PAY 7218903 BUSINESS NAMEILOCATION A-1 USA GUTTER, CORP 2740 E 1 OTH AVE MIAMI FL 33013 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2019 7503214 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS A-1 USA GUTTER, CORP 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED C/O EDUARDO ALBUERNE 09BS00673 BY TAX COLLECTOR $45.00 07/31 /2018 Worker(s) 1 CREDITCARD-18-058267 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec &a-276. For more information, visit www.miamida de.moyhaxcollector Notice to Owner - Workers' Com Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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: UP" - Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 3 I S4 day of J on I 20) 9 By gnnc((l g U Y.hlew who is pe onal Ano meor has produced A as identification. Notary: SEAL: e�lr. Notary Public State of Florida f AW Gnfofania R2mirw7 k My commission CiC I Expires 03/2512022 A-1 USA GUTTER, CORP FEBRUARY 6, 2019 STATE OF FLORIDA COUNTY OF MIAMI DADE Before me this day personally appeared Eduardo Albuerne who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 8700 Biscayne Blvd. Contractor Signature #�� Sworn to (or affirmed) and subscribed before me this &I day of February 2019 by Eduardo Albuerne. Personally know W" OR Produced Identification Type of Identification Produced ISABEL RODRIGUEZ SR .�* State of Florida -Notary Public =* *c Commission k GG 212424 :h ,a;� My Commission Expires 'q�� August 19, 2022 Print, Type or S",amp Name of Notary