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WS-16-3051 (2) Miami Shores Village - �= Building Department FE s 20,E 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 By. Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949h FBC 201 BUILDING Master Permit No. PERMIT APPLICATION sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP /e CONTRACTOR DRAWINGS JOB ADDRESS: [�1� 1j,6, cis S I" City: Miami Shores County: Miami Dade Zip: 331 3 8 Folio/Parcel#: 1I -.?,Z D D 1,6e— 17-10 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: //�� Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): jlA gLA P 0 JAU CTO e551-AJJD Phone#:3115 1 g-73q., Address:_ L�> .1 'L 3 City: MIA") IAO 12. 5 State: Zip: 5313 S Tenant/Lessee Name: Phone#: Email: /VtML44)pGj5;.APD a Ap rNiL4D q CONTRACTOR:Company Name: G�eA1�A� IZS GOI?—!� Phone#: 305 �.4•0 j,—/3 17— Address: 7— Address: 16 L 6 IIIb 0-t 4v-( Su 1�C 4.0 City: VORA &W V14AC-E State: J�� Zip: 33141 Qualifier Name: Phone#: 3D5— 8d �I State Certification or Registration#: Q;4- a' Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ D 00. Qb Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ['Repair/Replace ❑ Demolition Description of Work: 72E aM GE 11 W'11JDa W s 0 J POOP. - , Specify color of color thru tiler CC� Submittal Fee$ ! - Permit:Fee$..»f��.�' •b CCF$ CO/CC$' Scannin F $ �.C� %r ci::t. , g ee Radon Fee$ DBPR$ _ •Notary Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$�7�'�� (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. i "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$2 00, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of thb recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 4 y Signature Signature OWNER or AGENT CONTRACTOR. The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged-before me this 3 day of !n �,iilair 1 20 14 by n� 3 l-day of ��„(A M 20 1 9' by V,WLl L CtlA K-o who is person_ ally kna�e�n.to C� �Y� a�JD�S� i who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who dio take an oath. , •X NOTARY PUBLIC: NOTARY PUBLIC: Sign: abt,(.Pit. c7byluu2l Sign: 0- '��ii�,,.�i�(R- • lc�/ Print: 11"lbl�.�� C� 01M 24.w Z Print: 00A 2-4, �Z VP Seal: Seal: ' MARIA ELENA GONZALEZ .►`"` 4:s Commission#GG 8935 MARIA ELENA GONZALE:1 'ss �►` My Commission Expires Commission#GG 8935 , July 06, 2020 July 06, 2020 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ,416 r ♦SNoRFs Gid M 1 - 1 iami shores Village Building Department ��OR1Dp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N.WS -U-3a Sl Owner's Name (Fee Simple Title Holder): /LlA1Z(AP0 i,,�E94J,D Phone#: -?6.5'-7q 9- 7.3 9 Owner's Address: 46-Ts- "E 3 .$ T City: A41A µ1 S H O"S State Zip Code: 3 313 g Job Address (Of where work is being done): (Q.<, P15 q3 S7" City: Miami Shores State:—Florida Zip Code: -3.3 1 3 Contractor's Company Name: LO Phone#:_30.$0..$D3 .9 a-t( Address: 7839' SLV / $ 2-10' E City: M lArM 1 State: Zip Code: <.C- Qualifier's Name :. Z k5 ?e0jL- IZg-W,(- (�y%1oN Lic. Number: 0 SS' 13 S DD 6 7Z Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: Jwpwc- 11 1, nipi w9' / Do01z- hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless of all legal involvement. Signature Signature Zid-- ,�/i"X -- Owner or Agent Contractor or Architect The foregoing instrument was aknowlYed�ed before me The foregoing instrument was aknowledged ,befcor_e 'm-eI this 1�i day of 9,2011,by f—W A AIL cl C4AOL OLo this Vb day of �h , 201�by 0,aS �( 0SAS Who is personally known to me or who has produced who is personally known to me or who has produced as indentification. as indentification. Notary Public: ((�� Notary Public: /I-- -- - Sign: iil�A UDl�2K�.�,'Z Sign: Gti. l:x, ctkAAA� 0"to Lt Z Seal: Seal: �.o • MARIA ELENA GONZALEZ �Am pl- MARIA ELENA GONZALEZ * Commission N GG 8935 + Commission N GG 8935 My Commission Expires My Commission Expires ®` Jul 06, 2020 ';►,,, July 06, 2020 Y f � STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ""�ooaE1 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ROSAS-GUYON, CHESTER ANDRES A.G. CONTRACTORS CORP. 1666 KENNEDY CAUSEWAY SUITE 401 NORTH BAY VILLAGE FL 33141 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range{" += STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. ; -- - PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CGC1504445 ISSUED: 06/23/2016 to serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more CERTIFIED GENERAL CONTRACTOR information about our divisions and the regulations that impact you,subscribe to department newsletters and learn more about ROSAS-GUYON, CHESTER ANDRES the Department's initiatives. A.G. CONTRACTORS CORP. Our mission at the Department is:License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expirationdate:AUG31.2016 U6062300D0931 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - - CONSTRUCTION INDUSTRY LICENSING BOARD CGC1504445 -he GENERAL CONTRACTOR lamed below IS CERTIFIED Inder the provisions of Chapter 489 FS. :xpiration date: AUG 31, 2018 - 'y ROSAS-GUYON, CHESTER ANDRES 0 Q A.G. CONTRACTORS CORP 1666 KENNEDY CAUSEWAY SUITE 401 NORTH BAY VILLAGE FL 33141 f ISSUED_ 06/230016 DISPLAY AS REQUIRED BY LAW ecn 003465 Local Business Tax Receipt Miami Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY ay07368 LBT - BUSINESS NAN&LOCATION RECEIPT NO. EXPIRES 1 G CONTRACTORS CORP RENEWAL SEPTEMBER 30, 2017 1666 79 ST CS 401 4079745 NORTH BAY VIL AGE FL 33141 Must be displayed at place of business Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS A G CONTRACTO RS CORP 196 GENERAL BUILDING CONTRACTOR PAYMENT RECEIVED r-/O CHESTER A OSAS—GUYON QUAURMC1504445 BY TAX COLLECTOR Worker(s) $45.00 07/26/2016 CREDITCARD-16-043743 This Local ElusinossTax Receipt only confirms payment of the Local Business Tax The Receipt is nota license, permit,or certification of the holders qualifications,to do business.Holder must comply with any governmental or nongove ramental regulatory laws and requirements which apply to the business. The IECOPT No.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276. For more information,visit vvww miamidade oor/rax Mle mr -AC RZ> CERTIFICATE OF LIABILITY INSURANCE D�l`R �MYM 017 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). PRODUCER CONTACT-- ,. David M. Lopez Eastern Insurance Group, Inc. PHONE (305)595-3323 a NON(305)595-7135 9570 SW 107 Avenue ADHD �amanda@easterninsurance.net Suite 104 S AFFORDING COVERAGE NMC S Mid FL 33176 INSURERACaemini Insurance Comany 10833 INSURED INsuRERBStarstone National Insurance Co. 25496 A.G. Contractors Corp. INSURER C- 1666 Kennedy Causeway INSURER D. Suite 401 INSURER E N Bay Village FL 33141 INSURER F- COVERAGES CERTIFICATE NUMBE110aster 16-17 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. INSR DL POLICY EFF POLICY EXP LTR TYPE OF INSURANCE JAISD POLICY NUMBER MM/DDIYYYY) fummalyym LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTEu— PREMISES Ea ocwrrence $ 50,000 VIGPO17574 5/22/2016 5/22/2017 MED EXP(Any one person) $ Ezeluded PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYF-1 LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED DAMAGE AUTOS Per accident $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ 2,000,000 B X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,00 000 DED RETENTION$ 76146PI61ALI 5/22/2016 5/22/2017 $ WORNERS COMPENSATION PER OTH AND EMPLOYERS,LIABILITY YIN STA ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFRCER/MEMBER EXCLUDED? F-1 N/A E.L EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Mas describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more apace is raqutr&M Painting and concrete restoration contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 Northeast 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE David Lopez/AMANDA ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I1MS025 001Ani i A`R O CERTIFICATE OF LIABILITY INSURANCE °"TEOMDor"M 2/10/2017 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(les)must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WANED,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). PRODUCER SUNZ Insurance Solutions, LLC. ID: (Howard) AME. Sondra Kell c/o Howard Leasing Inc. PHONE 941-761-7704 a No; sal 7s1-nos 6302 Manatee Ave.SIV Bradenton, FL 34209 ADDRESS. skelley@howardleasinainc.com INSURERS AFFORDINGCOVERAGE NAIL# INSURER A: SUNZ Insurance Company 34762 INSURED INSURER B. Howard Leasing, Inc. Howard Leasing II, LLC. Howard Leasing III, Inc.; INSURERC: Howard Leasing IV, Inc. Howard Leasing V, Inc. INSURER D: 6302 Manatee Avenue West, Suite K INSURER E: Bradenton FL 34209 INSURER F COVERAGES CERTIFICATE NUMBER: 34198730 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. TSR TYPE OF INSURANCE AD UBR POLICY NUMBER POLICY FF POLICY EXP MLIMITS COMMERMALGENERALLIABILITY EACH OCCURRENCE $ DAMAGETO CLAIMS �OCCUR PREMISESEa-c=Dnee $ MED ERCP(Any one per) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) $ $ UMBRELLA UABHCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS UAB AGGREGATE $ DED I I RETENTIONS $ A woRNFRscoMPENsmioN WCPEOD000040 07 5/14/2016 5/14/2017 PER OTH- AND EMPLOYERS'LIAMUTY YIN -ER WCPE00000040 06 5/14/2015 5/14/2016 STATUTE ANYPROPRIETORIPARTNER/EJ(ECUTIVE EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? NI NIA E.L. Ifges(Mandescribe In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,()0 0 If yes describe under DESdRIPTION OF OPERATIONS bebw EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddlUrmal Remarks Schedule,may be attached it more space Is required) Coverageprovided for all leased employees but not subcontractors of: A.G.CONTRACTORS CORP Location Effective: 12/28/2016 CERTIFICATE HOLDER CANCELLATION 2214 Miami Shores SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 Northeast 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ..0"";: f+. Glen J Distefano g '7 ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 34198730 1 Master Certificate WCPE0000o04o 07 1 receptionist 1 2/10/2017 4:56:06 PM (EDT) I Page 1 of 1