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RC-15-1788 Permit NO. RC-7-15-1788 `y�oREs y� Miami Shores Village Permit Type:Residential Construction 10050 N.E.2nd Avenue NE Pen ' Work Classification:Alteration 1 " Miami Shores,FL 33138-0000 Permit Status:APPROVED =^ Phone: (305)795-2204 GORIDP' Issue Date: 1114/2015 Expiration: 05/02/2016 Project Address Parcel Number Applicant 161 NE 106 Street 1121360060380 SECTION M INC Miami Shores, FL 33138-2036 Block: Lot: Owner Information Address Phone Cell SECTION M INC 3821 EL PRADO Boulevard (786)408-3661 MIAMI FL 33133- 3821 EL PRADO Boulevard MIAMI FL 33133- Contractor(s) Phone Cell Phone Valuation: $ 9,800.00 FAM CONSTRUCTION (305)298-3216 (305)335-7823 _._..,.._.�__„ _ __.... .. ....... _ Total Sq Feet: 250 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved:: In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction: KITCHEN&BATHROOM RENOVAT Occupancy:Single Family Framing Stories: 1 Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Electrical Certificate Date: Additional Info: Review Electrical Review Plumbing Bond Return: Classification:Residential Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Plumbing CCF $6.00 Review Planning DBPR Fee $4.41 Invoice# RC-7-15-56375 Review Building DCA Fee $4.41 11/04/2015 Check#: 1031 $277.82 $50.00 Review Building Education Surcharge $2.00 07/17/2015 Check#:909 $50.00 $0.00 Review Structural Permit Fee $294.00 Review Mechanical Scanning Fee $9.00 Technology Fee $8.00 Total: $327.82 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#Futher �l going information is accurate and that all work will be done in compliance with all applicable laws regulating construction a Hing. the above named contractor to do the work stated. November 04, 2015 Authorized Signplicant / Contractor / Agent ate Building Deopy November 04,2015 1 1 Miami Shores Village JUL 17 .203 Building Department BY: __ ► 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F(B��C�� 20 (u BUILDING Master Permit No.yus - T PERMIT APPLICATION Sub Permit No. OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP / `/V/rLi6 �E/ �r�- CONTRACTOR DRAWINGS JOB ADDRESS: a/ G / uT City: Miami Shores County: Miami Dade Zip: (f3� 3� Folio/Parcel#: //--2136 ` Ob� ' �� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):5LR117 6NAVA S� PDN M r/vc. Phone#: Address: 32Zp / EL / A-010 BI-Val IAMI FL- 3313,3 City: NJ/AAS State: FL Zip: 331.3 3 Tenant/Lessee Name: /V ti Phone#: Email:MCP/�/�G2fysQLUT/a�cG'se 9H/}/L •t�/`-i CONTRACTOR:Company Name:��M C0A/ss/-WCl/0&0 Phone#: 3W 3 2-/6 Address: Fzwo SW Ccs 4✓C— J- 3 City: A IAA-41 n State:" Zip: 4 -30j-2 Qualifier Name:fEQM/� . M 4z/,y(5-z / Phone#:-30j^2qY -34Z16 State Certification or Registration#:C4q1Cd1q 7 `► Certificate of Competency#: DESIGNER:Architect/Engineer: AJ Phone#: Address: City: State: Zip: Value of Work for this Permit:$ � Square/Linear Footage of Work: ZSO Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: kITG'lh=,N E 134 N"2CD/t{ AEA& Atl z)A✓• A-PLA c c-h c-Atry#' of eeh'rA sW l7Cl jf S� �J Specify color of color`thru tile: Submittal Fee$ 'C-n Permit Fee$ v 'i• w CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ r, 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. "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 NE Jo AGENT CONTRACT The foregoing instrument/was acknowledged before me this The foregoing instrument was acknowledged before me this day of 1(%G2 0�� by day of i ULij 20 by who is personally known to 3 EaM 1 1 R E1_w_ho is personally known to me or who has produced as me or who has produced as identificationeouelnsul a3a1S is 14 Ag h identification and who did take an oath. � p NOTARY PUB C: 6WZ`vNflf'S3HIdX3 NOTARY PUBLI ZM-,3*NOISSI 09litlY�0 !!VW Sign: Sign: Print: S S� 1�J CNA- CU Print: /�l2 b• Seal: Seal: MARY D.CAMARG oar r� MY COMMISSION#Ff242221 EXPIRES:JUN 21,2019 Bonded through 1st state Insurance ************************************************************* ******************* APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ..Property Search Application - Miami-Dade County Page 1 of 1 --AE OF TvnJN E PRI `�`IPERTV AP,r__*`,flAV3"EP1, av�F C 0 Summary Report Generated On:7/7/201! Property Information t Folio: 11-2136-006-0380 Property Address: 161 NE 106 ST �`` x �E Owner SECTION-M'INC 3821 EL PRADO BLVD x � Mailing Address MIAMI ; FL 33133 Primary Zone 1000 SGL FAMILY-2101-2300 SQ ._.-....._........._...._._..-_,._.- ` T 4T 0101 RESIDENTIAL-SINGLE � .�� dam► Primary Land Use * j', FAMILY: 1 UNIT Beds 1 Baths/Half 3/2!0 s �" ' . ,� Floors 1 Living Units 1 Actual Area 2,442 Sq.Ft Living ,Area 1628 S Ft q' 2014 Asrial Photography 200ft Adjusted Area 1,854 Sq.Ft Lot Size 9,225 Sq.Ft Taxable Value Information Year Built 1941 2015 2014 2013 Assessment Information County Year 2015 2014 2013 Exemption Value $0 $0 $0 Land Value $163,894 $154,253 $87,509 Taxable Value $281,002 $221,491 $201,356 School Board Building Value $116,370 $113,052 $113,091 _____._.._..._.__...._........__ ..__._._.-_. - Exemption Value $0 $0 $0 XF Value $738 $747 $756 Taxable Value $281,002 $268,052 $201,356 Market Value $281,002 $268,052 $201,356 _..._._._.._........_.- _.__.�______ __..._...........--- .__....._.._._._._.. City Assessed Value $281,002 $221,491 $201,356 Exemption Value $0 $0 $0 Benefits Information Taxable Value $281,002 $221,491 $201,356 Benefit Type 2015 2014 2013 Regional Exemption Value $0 $0 $0 Non-Homestead Cap Assessment Reduction $46,561 Note: Not all benefits are applicable to all Taxable Values(i.e.County, Taxable Value $281,002 $221,491 $201,356 School Board,City,Regional). Sales Information Short Legal Description Previous Price OR Book- Qualification Description DUNNINGS MIAMI SHORES EXT NO 2 Sale Page PB 41-78 11/18/2014 $270,400 29397-0850 Corrective,tax or QCD;min LOT 14 BLK 208 consideration LOT SIZE 75.000 X 123 2008 and prior year sales;Qual by OR 20535-4401 07 2002 1 07/01!2002 $286,000 20535-4401 exam of deed 10/01!2001 $198,000 19950-1021 2008 and prior year sales;Qual by exam of deed 03/01/1979 $63,500 10333-0179 2008 and prior year sales;Qual by exam of deed The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at htta://www.miamidade.gov/info/disclaimer.asp http://www.miamidade.gov/'propertysearcli/ 7/7/2015 Detail by Entity Name Page 1 of 2 A .ti Taiw4ag"0 r.; Detail by Entity Name Florida Profit Corporation ECTTQN,M'I_NC) Filing Information Document Number P09000079226 FEI/EIN Number 271198848 Date Filed 09/23/2009 Effective Date 09/21/2009 State FL Status ACTIVE Principal Address 3821 EL PRADO BLVD MIAMI, FL 33133 Changed: 04/29/2010 Mailina Address 3821 EL PRADO BLVD MIAMI, FL 33133 Changed: 04/29/2010 Registered Agent Name &Address Saba, Seraj 3821 EL PRADO BLVD MIAMI, FL 33133 Name Changed: 04/10/2015 Address Changed: 04/10/2015 Officer/Director Detail Name&Address Title P S7AB7Z,7SERAU7 3821 EL PRADO BLVD MIAMI, FL 33133 Title VP MESTRE DE SABA, MARIA B http://searcli.sunb iz.org/Inquiry/CorporationSearch/SearcliResultDetail?i.nquii-vtype--Enti.ty... 7/7/2015 `Detail by Entity Name Page 2 of 2 3821 EL PRADO BLVD MIAMI, FL 33133 Annual Re orts ORCE'"Year Contact t.Isiled Date Filing Services Document Searches Forms Help 2013 03/28/2013 2014 04/16/2014 2015 04/10/2015 Document ima es 04/10/2015 --ANNUAL REPORT View image in PDF format 04/16/2014--ANNUAL REPORT View image in PDF for 03/28/2013 --ANNUAL REPORT View image in PDF format 05/10/2012 --ANNUAL REPORT View image in PDF for 04/16/2011 --ANNUAL REPORT View image in PDF for 04129/2010--ANNUAL REPORT View image in PDF format 09/23/2009-- Domestic Profit View image in PDF format _pynh�p and Pr..iva..c..y._P.gl c.e5 State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationS earch/S earchResultD etail?inquirytype=Entity... 7/7/2015 "DRIVER LICENSE CLASS t- � t ;.r M635-L 1-35-371-G FERMIIJ ANTONIO MARTINEZ 5360 SVJ 65 AVE ART 3 " MIAMI,FL 33143-0000 <a` Z,OE 10-11-19350 SP�t MEWED 09 28= T 5-11 ?.xeIRES 10.11-207' REST: E"t*RSE: CEL u.wvwe Gs L+> STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 We 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MARTINEZ, FERMIN A FAM CONSTRUCTION CORP 8340 SW 65 AVE#3 MIAMI FL 33145 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 rangee� STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CGCO19440 -ISSUED: 07/02/2014 serve you better. For information about our services,please log onto _ www.myfloridalicense.com. There you can find more information CERTIFIED GEN,ERAL;CONTRAC_ TOR about our divisions and the regulations that impact you, subscribe MARTINEZ, FERMIN:A% to department newsletters and learn more about the Department's FAM CONSTRUCTION`CORP--=-- initiatives. 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! Expiration date: AUG 31,2016 L1407020001234 DETACH HERE RICK SCOTT, GOVERNOR J KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD all CGCO19440 The GENERAL CONTRACTOR Named below IS CERTIFIED A wa � Under the provisions of Chapter 489 FS. _- Expiration date: AUG 31, 2016 Y - _ tet . MARTINEZ, FERMIN A FAM CONSTRUCTION COR 8340 SW 65 AVE#3 MIAMI -FL 33-145 \`• �' ❑� 1 ISSUED: 07/02/2014 nISPI AY AS RF01JIRFD BY LAW SEQ#1 L1407020001234 Local Business Tax Receipt Miami—Dade County, State of FloridaLBT -THIS IS NOT A BILL-00 NOT PAY 5622130 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES F A M CONSTRUCTION CORP RENEWAL SEPTEMBER 30, 2015 8340 SW 65 AVE 3 1535062 Must be displayed at place of business MIAMI,FL 33143 Pursuant to County Code Chapter BA-Art.9&10 I SEC.TYPE OF BUSINESS � OWNER PAYMENT RECEIVED , F A M CONSTRUCTION CORP 196 GENERAL BUILDING BY TAX COLLECTOR CONTRACTOR 75.00 09/22/2014 Worker(s) 10 CGCO19440 0224-14-007070 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is nota license, permit,or a certification of the holders qualifications.to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requiremems which apply to the business. The RECEIPT N0.above must he displayed on all commercial vehicles-Miami-Dade Code Sec Ba-276. MAW For more information,visit wwwmiamidade aovhaxcollector 1 A`ORO® CERTIFICATE OF LIABILITY INSURANCE DATE(707/115/1515/15YYY) 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 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 Maikel Wong Franklin Insurance Group PHONE . (305)630-3923 1 (FigNo): (305)675-5964 7190 SW 87th Avenue,Suite 407 A-MAILODRESS* tranklingroup®bellsouth.net Miami,FL 33173 INSURERS AFFORDING COVERAGE "NCO Phone (305)630-3923 Fax (305)675-5964 INSURER A: COLONY INSURANCE COMPANY INSURED INSURER S: FAM Construction Corp/Fermin A Martinez INSURER C: 8340 sw 65 ave Apt#3 INSURER D: INSURER E: MIAMI FL,33143 INSURER F: COVERAGES 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. INSR ADDLSUSR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MIDD M/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 GE TO © COMMERCIAL GENERAL LIABILITY PREM SES EaENTED occurrence $ 100,000.00 ❑ F-1CLAIMS-MADEQ Y 03/12/2015 03/12/2016 OCCUR GL3655794A MED EXP(Any one person $ 5,000.00 A BI/PD DED 500 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY © PRO- ❑ LOC $ AUTOMOBILE LIABILITY CEa aBIN.deMSINGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL AUTOS OWNED ❑ SCHEDULED BODILY INJURY(Per accioenl)AUTOS $ ❑ HIRED AUTOS ❑ AUTOSWNED PROPERTY DAMAGE $ Per accident ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS UAB [:1 CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑W RSTLIMS ATIIT- [:]ER OTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? F-] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,i(more space Is required) Contractors Licence#CGC019440 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BLDG DEPT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE.2ND AVE MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE MAIKEL WONG-AGENT ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105)QF The ACORD name and logo are registered marks of ACORD 77/1 •� '% t< ) s 09-18-2014 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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 DATE: 09/17/2014 EXPIRATION DATE: 09/16/2016 PERSON: MARTINEZ FERMIN A FEIN: 201750462 BUSINESS NAME AND ADDRESS: FAM CONSTRUCTION CORP 8340 SW 65TH AVE #3 MIAMI FL 33145 SCOPES OF BUSINESS OR TRADE: 1- LICENSED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 0504►, 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 440.05112), F.S., Certificates 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 it, at any time 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1601 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICESIMPORTANT DIVISION OF WORKERS'COMPENSATION FPursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this Section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW I* D chapter. EFFECTIVE: 09/17/2014 EXPIRATION DATE: 09/16/2016 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: FERMIN A MARTINEZ H exempt.. apply only within the scope of the business or trade listed on FEIN. 201750462 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: FAM CONSTRUCTION CORP E 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 e3ao SW 65TH AVE a3 if, at any time after the filing of the notice or the issuance of the MIAMI, FL 33145 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 certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- LICENSED GENERAL CONTRACTOR section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 IfAM CIUNSTIQUCTIC CCIQUO 8340 SW 65 Ave#3 Miami FL 33145 PHONE (305) 298-3216 C.G.C. 019440 ----------------------------------------------------------------------------------------------------------- Date :07/13/2015 State Of Florida Miami DadeCounty Before me this day personally appeared FERMIN A. MARTINEZ who, being duly sworn, deposes and says : That he will be the only person working on the project located at 161 NE 106 Street Miami Shores FL Sworn to and subscribed before me this "` day of ' QAV 2015, by -�'ek M i,oA• A)4y-.r1,v C'z- FERMIN A. MARTINEZ C.G.C.01440 Personally Know MARYD.CAMA My COMMISSION#FF242221 EXPIRES:JUN 21,2019 Bonded through rwe e ) . Print,Type or Sta me Of:No#a _ 5t�oR�S y 0�I" Miami shores Village umn� . . Building Department OR1DA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owrier — 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: L-.. �' Own State of Florida County of Miami-Dade y The foregoing was acknowledge before me this_�day of 20 ci By - —<ZrPJ7 who is personally known to me or has produced as identification. Notary: MA C SEAL. '°�� Icy COMMISSION#FF 42221 @9RES:JUN 21,2019 80nded through 1st State Insurance 2016 details - Business Tax Account F A M CONSTRUCTION CORP - TaxSys - Miami-... Page 1 of 1 tam Kjacie.wv7' Tax Collector Home Search Reports Shopping Cart Please do not include any special characters in the name,address,and e-mail field such as#,&,hyphens,comma, dashes. We have moved.Our new address is: 200 NW 2nd Ave,Miami,FL 33128 The information contained herein does not constitute a title search or property ownership. 2015 Tax Bills are Payable on Sunday, November 1,2015. 2016 Details using Tax Acmunt F A M CONSTRUCTIONCORP Business Tax Account#5622130 Account details " ?Account history 2016 2015 2014 2013 ... 2010 _...._._ _ _...._......._._._..._.__.__.__...._ _ _.._.. __........._................................. PAID PAID PAID PAID PAID Account number: 5622130 Owner(s): F A M CONSTRUCTION CORP Business start date: 08/29/2005 8340 SW 65 AVE 3 Business address: F A M CONSTRUCTION CORP MIAMI, FL 33143 8340 SW 65 AVE 3 Mailing address: F A M CONSTRUCTION CORP MIAMI, FL 33143 FERMIN A MARTINEZ PRES Physical business location: UNIN DADE COUNTY 8340 SW 65 AVE 3 MIAMI, FL 33143 O` Print account application (PDF) Receipts,And upati n 1 of t 1536062 PAID 2015-09-23$75.00 Contracting 10/01/2015 NAICS code: Receipt#CREDITCARD-15-048798 d Print GENERAL BUILDING —09/30/2016 2389 this bill CONTRACTOR Units: 10 Additional documentation required:CGC019440 State/County License or Certificate https://www.miamidade.county-taxes.com/public/business_tax/accounts/5622130 11/4/2015 IKEA Home Plainer Printout Page 4 of 8 "vQ kl no appliances-Plan View All measurement in inches. �!K E 0000-8.33:1-3650 r 104 7:4_ 115a;; 83 7iS i !T 71 - i 4 i I I I I � ) 79$f" r—� I • • •••• •••••• •••••• •• •••••• • •••• • ••••• •••••• ••• • ••••• •• •• •• •••••• • • • • • •••••• http://k-itchenplanner,ikea.com/us/UI/Pages/Printouts/VPUISummaryPrintout.htm 4/1512015 IKEA Home Planner Printout Page I of 8. k1 no.appliances-'West Wal: All measurement in inches 0000-8331-3654 _ 1 t3 971 - -r ifr• i I { � �. i LI • • •••• •••••• ADD SMOKE/CARBON MONOXIDE DETECTORS. •• •••. : '. ANY ,AND Ad CLOTH AND RUBBER •••••• •••••• INSULATED CONDUCTORS TO BE REPLACED ""'• .... . ..... ...... ... . ..... .. .. .. ...... •••••• • BATHROt�"� 20 AMP CKT ' ' RECEPTACLE ON •••••• AND G.F.I PROTECTED .. • . • NO POINT ALONG 011_INTER''()BE MORE THAN '"Yt- 2 FEET FROM G.f-I "`:OTEC?ED RECEPTACLE. PUT DM R'~CE'P-ACLS I INDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS. 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