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WS-16-3051 Permit NO. WS-11-16-30'51 �s °Rus y Miami Shores Village ■ Permit Type:Windows/Shutters 10050 N.E.2nd Avenue NE I orkClassifrcation Window/Door Repiacem Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 <ORtDp' Issue Date: 11/10/2016 Expiration: 05/09/2017 Project Address Parcel Number Applicant 695 NE 93 Street 1132060141770 Miami Shores, FL 33138- Block: Lot: MARIANO CELANO Owner Information Address Phone Cell MARIANO CELANO 695 NE 93 Street (305)215-7236 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 13,000.00 CG CONSTRUCTION WINDOW COMPr (305)803-9211 _.... ... ___ .. ... .......... Total Sq Feet: 0 Type of Work:REPLACE 12 WINDOWS&1 DOOR Available Inspections: No of Openings: 13 Inspection Type: Additional Info:REPLACE 12 WINDOWS&1 DOOR Window Door Attachment Classification:Residential Final Scanning:3 Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.80 DBPR Fee InvOICe# WS-11-16-61989 $3.45 11/10/2016 Check#: 1912 $266.70 $0.00 DCA Fee $3.45 Education Surcharge $2.60 Permit Fee $230.00 Scanning,Fee $9.00 Technology Fee $10.40 Total: $266.70 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 ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTR A PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAV I c rti that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and i h rmore,I authorize the above-named contractor to do the work stated. November 10, 2016 Author/ a r . ner / Applicant / Contractor / Agent Date Building epartment Copy November 10,2016 1 z Miami Shores Village FIVE� Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: ' Tel: (305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-0949 FBC 2014 � h'1;, ILDING Master Permit No. 'I1:;1,1:1.hAIT APPLICATION sub Permit No. ?1.11LDING ❑ ELECTRIC E] ROOFING F-1 REVISION ❑ EXTENSION ❑RENE:W11/Q.. "'I 1AJMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR 1;,I:!' "i,DDRESS: Miami Shores County: Miami Dade Zip: 33J �____................ Iic,"ParceIM fi-- 3,.06 —,01 +— 1-7-70 Is the Building Historically Designated:Yes x.i.1.3ncy Type: Load: Construction Type: Flood Zone: BFE: FI-17:_ ..... rr V 1141: Name(Fee Simple Titleholder): A4A9-1/E1.00 i!""E Ayo Phone#: 11I, d 9s �yG_ q3 sT State: )=�Op f Do* zip: 33/.3 .-......_........ rr:Tr:/Lessee Name: Phone#_?0-C— .-.73.1.4 1."I"I`FL4PTOR:Company Name: �� G�d� V"�V-INtD+�w �u Phone#: .�as'-�a3-UU2(11 .r......._ M Ili"1 State: Zip: (I . IhfierName: G�Es71/� /�S,/�S.�y'l�il.� Phone#: 1'. al::: i::er-ification or Registration#: Certificate of Competency#: (J�,� ©0 6_7. i'1:i;i;9:i.+IVI:R:)krchitect/Engineer: Phone#: IrIIess:...,_ City: State: Zip --•-----......__....... '!I It::! of Work for this Permit:$�/�tjDl�.�� Square/Linear Footage of Work: ;II: c,f Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ElDemolition ic1:6.31 ion of Work: 96P�Ac-rl_ 12— wyjyowS I16r color of color thru tile: 9; Ihr;ii'tit sl Fee$ _Permit Fee$ CCF$ CO/CC$ __.-____•_.___.•__ .,ari ninl;Fee$ Radon Fee$ DBPR$ Notary " :ra^inn)logy Fee$ Training/Education Fee$ Double Fee$ ral Reviews$ Bond$ ---_-----__._-- TOTAL FEE NOW DUE$ :!- :ec02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City _ State Zip Mortgage Lender's Name(if applicable) _ k,',ort; age 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 inst;allati0r, hX i unamenced prior to the issuance of a permit and that all work will be performed to meet the standards of all lav%s rel u ,I rig. ci,nszruc:tion in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... O1NNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all .f,)plicable laws regulating construction and zoning. "1,kI,i1RI9ING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMM ENCIEN'11:1'41* 0l1,A6Y R:f,:SUl_T IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU Ilal' Ehl0 TO C EITAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." fktice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the apoilca,•rt rvn.rsi Ir.�mise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered ti the p,t!r or ry hose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the l:,.<.i tf: ln; i'he first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the fr,slar.crion will not be approved and a reinspection fee will be charged. Si"natUre. Signature ............... OWNER or AGENT CONTRACTOR I I i s fc r going instrument was ackn wledged before me this The foregoing instrument was ac=owledged before me this day of �� 20 by day f � ,20 ! by �� � Esprsona�nt o is persor�all�r b:�ovvr�, s, 1--"1,:!0r who has produced as me or who has produced as idi= tification and who did take an oath. identification andwho id take an oath. IN[CITA.RY PUBLIC: NOTARY PUBLIC-_ Sign: . / 1/? 1:11,int: Print: If� DARLING PEREZ 'Neal: Seal: ; ?. ,s MY COMMISSION#FF 222940 = i MY COMMISSION t FF 222940 -W EXPIRES:April 21,2019 EXPIRES:April 21.2019 '•R1�, S'<r Bonded ThN Notary Pubtie llndenmtae Bonded ThN Notary PLW IJWWWRea APPROVED BY V Plans Examiner Zc;n I-I:-' Structural Review Clerk (R c-vl>�!d 02/24/2014) S�IOREs G Miamishores village ` Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 FLORIDA Fax: (305) 756.8972 Inspection requirements for: Windows, Doors, Skylights or Fixed Glass (cladding) Permits Upon issuance of permits for the scope of work involving the removal,changing and/or replacement of any type of windows, doors, sidelites,skylights or fixed glass(cladding) the permit holder or qualifier bearing his signature on the permit application shall abide by the requirements of this department and comply with the following statement: Upon obtaining window and/or door permits for the installation of same, it is the responsibility of the permit holder to request window/door framing in-progress inspection, prior to concealment of any horizontal or vertical clip mullion,bucks,shims, etc. Inspector will also verify anchor type,edge distance,embedment and spacing. The purpose for this inspection, is for the verification of conformance with Product Approval (NOA). Acknowled ement: 1( 76 60� Qualifier/Owner Signature Date Print Name CG CONSTRUCTION WINDOW Co . November 8, 2016 State of FLORIDA County of DADE Before me this day personally appeared CHESTER GUYON who being duly sworn deposes and says: That he will be the only person working on the project located at 695 NE 93 Street Miami Shores, FL 33138. Sworn to and sul ribed before me this 8`h of November 2016 by CHESTER GUYON who is personally know f - NOTARt SIGNA E tw t 'PtY'i JARUNG PEREZ " MY COMMISSION#FF 222940 EecAo'J. EXPIRES:A0121,2019 , Bonded Thru Notary Pubfic Underwriters NOTARY STAMP viaORES 1.03., Ne Miami Shores ill ,9i, E IrIES I Building 0 10050 Miami Shores, Florid a :3:11:G,5 Tel: (305) Fax: (305) 756.1Q)11,E?2 Notice to Owner — Workers' Compensation Insurance Exei-n1Pi,-[-c,o,i, ............. .'Ir-rida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes, lila. sial:.. ...11o,,vs corporate officers in the construction industry to exempt themselves from this requirement for any construction t( .1,,.-1,r1irig 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 ol' 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 voluntary revocation is filed or the exemption is revoked by the Division. c ur contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she vi ill nc,ui, kly labor,,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that.ie or sh(:- I' the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require peri:is 111011 s:J1 r]�crs' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontriwtonz. 'Slt3NING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDE,rR,",TP,,'.Nr.) 4TS Owner tr I,:-of Florida co.Crxv of'Miami-Dade he 66regoing was acknowledge before me this'71V.day of who i personally-knownt e or has produced ­.- O����� as identification. JARLING 1111, My COMMISSION#FF MW 0 EXPIRES:Apdl 21,2019 Bw*d Thru Notary Pubk Undenrriten Municipal Contractor's Tax Recei pt Miami-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY M C CC NO: 058SO0672 BUSINESS NA M E/LOCA TION RECEIPT NO EXPIRES CG OONSTRICTION VNNDOW COMPANY SEPTEMBER 30, 2 017 7835 SN 18 T9RR 7498231 MIAMI,R_ 33155 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS PAYMENT RECEIVED CG CONSTTA3CTTON VNNDOW g�IAL,TY BUILDING CONTRACTOR BY TAX COLLECTOR COMPANY 37.50 11/0912016 0223-17-000952 Restricted to City of Miami Shores MIAMf._- For Rare Inforrret1ion,in sit!wwvjxOf O&k.wOW;dMQ t41 JEFF ATWATER CHIEF FINANCIAL.OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DA'T'E: 1/10/2015 EXPIRATION DATE: 1!912017 PERSON: ROSAS-GUYON CHESTER FEIN: 201401068 BUSINESS NAME AND ADDRESS: C G CONSTRUCTION WINDOW COMPANY 7835 SW 18TH TERR MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: CARPENTRY NOC GLAZIER AWAY FROM SHOP AND DRI Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,certincates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any lime after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 4COR T aDATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 10/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). RODUCER CONTACT NAME: Robert J Kaleita Insurance Agency, Inc P"CN o 561-687-3761 FAX No):800-790-4065 11924 W Forest Hill Blvd Suite 1 OA-312 ADDRESS: bob@rkaleita.com Wellington, FL 33414 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Preferred Contractors Insurance Company ISURED INSURER B: C.G. Construction-Window Company INSURER C: 7835 SW 18th Terrace INSURER D: INSURER E: Miami FL 33155 INSURER F: :OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR ADDL SUBR POLICY EFF POLICY EXP LIMITS rR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS-MADE ❑X OCCUR PC0705134 04/13/16 04/13/17 PREM SES Ea occurrAMAGE TO ence) $ 50000 MED EXP(Any one person) $ 5000 PERSONAL&ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 X JE LOC PRODUCTS-COMP/OP AGG $ 2000000 POLICY F] OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NO OWNED PeOr PE dent DAMAGE $ HIRED AUTOSAUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED 7ETENTION$ $ WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEF-1 N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory'.n NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CLASS & GLAZING CONTRACTOR .ICENSE NO. 05-BS00672 :ERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING & SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ZONING DEPT. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FI 33138 AUTHORIZED REPRESENTATIVE @ 1988-2013 ACORD CORPORATION. All rights reserver ,CORD 25(2013/04) The ACORD name and logo are registered marks of ACORD CTB Construction Trades ualifying Board BUSINESS CERTIFICATE OF COMPETENCY .. 05BS00672 CG CONSTRUCTION-WINDOW COMPANY D.B.A.: ROSAS-GUYON CHESTER Is certified under the provisions of Chapter 10 of Miami-Dade County 007515 Local Business Tax Receipt Miami—Dade County,.State of Florida -THIS IS NOT A BILL-DO NOT PAY LBTI 5599528 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES CG CONSTRUCTION WINDOW COMPANY RENEWAL SEPTEMBER 30, 2017 7835 SW 18 TERR 5839825 Must be displayed at place of business MIAMI FL 33155 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS CG CONSTRUCTION WINDOW COMPANY196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED 05BS00672 BY TAX COLLECTOR Worker(s) 1 $75.00 07/19/2016 CHECK21-16-091738 This Local Business Tax Receipt only confirms payment of the fecal Business Tax.The Receipt is not a license, permit,ora certification of the holder's qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above most be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-276. For more information,visit www.miamidade.gov/taxcoIIectQf