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CC-16-1564 (2) I s s 1 1 e _ Permit No. CC-6-16-15164 �s rt"rys y Miami Shores Village 'Pen t PenvitType:Commercial Construction 10050 N.E.2nd Avenue NE Work Classification:Alteration Miami Shores,FL 33138-0000 ' Permit Status:APPROVED Phone: (305)795-2204 FLORiDp` Issue Date: 11/2912016 Expiration: 05/28/2017 Project Address Parcel Number Applicant 9501 NE 2 Avenue 1132060133920 Miami Shores, FL 33138- Block: Lot: DVS LLC Owner Information Address Phone Cell LVS LC 9400 NE 2 Avenue (305)756-3711 MIAMI FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 27,985.00 G&A CONTRACTORS INC (305)970-3262 (305)970-3262 Total Sq Feet: 1214 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction: NEW PARTITION WALLS;NEW CE Occupancy Load: Tie Beam Stories: Exterior: Slab Front Setback: Rear Setback: Termite Letter Left Setback: Right Setback: Framing Plans Submitted:Yes Certification Status: Store Front Attachment Certification Date: Additional Info: Insulation Bond Return: Classification:Commercial Drywall Screw Window and Door Buck Scannin : 13 Gelling Grid Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Fill Cells Columns CCF $16.80 Review Electrical CO/CC Fee $12Invoice# CC-6-16-60078 Review Electrical $ .00 06/06/2016 Credit Card $50.00 $1,258.53 DBPR Fee $12.59 Review Planning DCA Fee $12.59 11/29/2016 Credit Card $ 1,258.53 $0.00 Review Building Education Surcharge $5.60 Review Building Permit Fee $839.55 Review Structural Plan Review Fee(Engineer) $160.00 Review Mechanical Scanning Fee $39.00 Review Plumbing Technology Fee $22.40 Review Plumbing Total: $1,308.53 Review Planning 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 AVIT: k certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a d zon' g,hut re,I authorize the above-named contractor to do the work stated. j November 29, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 29,2016 1 I Miami Shores ViII age p RECEI'v7ED BuildingDepartment JUN 06 2016 ^ n` 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: l t Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 `3 S+i1 FBC 2014 BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. M/BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION ❑ SHOP /� ii Q� CCJONTRAlCTOR �7 DRAWINGS JOB ADDRESS: 2 I 1 rs;/_A 'S� 1 S07 Ij c- 2 _Av, p Citv• Miami Shores Q n County: Miami Dade Zia: 33j30 Folio/Parcel#: (1-32O�D-�13�3l L� Is the Building Historically Designated:Yes NO Occupancy Type: Load: ,C/onstruction Type: Flood Zone: BFE: FFE: �7 OWNER:Name(Fee Simple Titleholder):�1) V'S . LL C_ Phone#: 3 US_7 51-2-22D Address: 9501 ME ad A/P City: I a�� �✓jjC��� State: PL_ ./ Zip: -33139' Tenant/Lessee Name: /'n'-i ��1"I I Ilei LL6 �%!)�GQe/SA~� MQ✓l1 z Phone#:3u5-cN5-(vS%0 Email:4P-e eS0-RT�te✓✓�cQ{'►�yK2�Y1Ol-�'RQ G�Q� �/►'1 CONTRACTOR:Company Name:, (-3 ka l'GK�YGG1o(�i F11no• Phone#: 305-9�o-3aCn� Address: q I c-4o q Jlkd City:T State: _R _ Zip: 13a'OCI Qualifier Name: 0."Y% ha—zyw n Phone#: State Certification or Registration#: Ie 1;15�4�0 Certificate of Competency#: DESIGNER:Architect/Engineer:\k+be- 3 .B CR-- + PhoneMS015-3 10-SO-30 Address: 3_70 N-6 10l A. City:�°�IRfrli S'hw-e -5 State: EL Zip: 331 138' Value of Work for this Permit:$_�� �flJ ' Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration /❑ New ❑ Repair/Replace Demolition / Description of Work: ( ( � • g , S Specify color of color thru tile: 1, �r� Submittal Fee$ Permit Fee$039, CCF$ t CO/CC$ w Scanning Fee$ 3q �( Radon Fee$1 '59 2 • C DBPR$ 12 • 5f Notary$ "r� Technology Fee$ ) Training/Education Fee$ J ' o Double Fee$ Structural Reviews$ � Bond$ Jy TOTAL FEE NOW DUE$ i 253• �� (Revised02/24/2014) r 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 w7not-be- d-ar i ction f will be charged. Signat� Signature OW or AGENT CONTRACTO The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of x— 20 14 by /if day of M c 20 /c by � —1 d-aQ-k_PY!i g who is personal) known nownn o �QM,4 4 �-20.,o 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 did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: r- Sign: Print: ` Print: TANAYRA REYEJ H ELORRIq� Seal: `•:+ •:�= My Comm.Expires Jul Seal: MY COMMISSION#FF"3� "o; Commission#EE 1 roi -0• EXPIRES January 25. 0 ;�FOF ,op,, Bonded Through National N >I�wro.ear APPROVED BY Plans Examiner ` Zoning Structural Review Clerk (Revised02/24/2014) Detail by Entity Name Page 1 of 2 FLORIDA DEPARTmENT OF STATE Detail by Entity Name Florida Limited Liability Company DVS, LLC Filing Information Document Number L10000129579 FEI/EIN Number 80-0670481 Date Filed 12/20/2010 Effective Date 12/17/2010 State FL Status ACTIVE Principal Address 201 N.E. 95th Street MIAMI SHORES, FL 33138 Changed: 04/14/2013 Mailing Address 201 N.E. 95th Street MIAMI SHORES, FL 33138 Changed: 04/14/2013 Registered Agent Name &Address CACCAMISE, THERESA 201 N.E. 95th Street MIAMI SHORES, FL 33138 Name Changed: 04/14/2013 Address Changed: 04/14/2013 Authorized Person(s) Detail Name &Address Title Authorized Member, Manager CACCAMISE, THERESA 201 N.E. 95th Street MIAMI SHORES, FL 33138 Title Authorized Member, Manager http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/6/2016 Detail by Entity Name Page 2 of 2 CACCAMISE, RICHARD 201 N.E. 95th Street MIAMI SHORES, FL 33138 Annual Reports Report Year Filed Date 2014 01/13/2014 2015 03/12/2015 2016 04/25/2016 Document Images 04/2512016 --ANNUAL REPORT View image in PDF format 03/12/2015 --ANNUAL REPORT View image in PDF for 01/13/2014 --ANNUAL REPORT View image in PDF for 04/14/2013--ANNUAL REPORT View image in PDF for 03/20/2012 --ANNUAL REPORT View image in PDF format 05/16/2011 --ANNUAL REPORT View image in PDF for 12/20/2010 -- Florida Limited Liability View image in PDF for coyvwitit 17 and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 6/6/2016 SNxOc.i Boom tl Miami Shores Village Building Department RNA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. r✓ COPY OF QUALIFIER'S STATE LICENCES B. ✓ COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: C�o C BUSINESS ADDRESS: S1 SW 'f) '�-k CITY t\cMandct le STATE -'�L ZIP BUSINESS PHONE: ('-mss j 91D- Saco a FAX NUMBER( �s y— c4s 5 5 CELL PHONE(-�)M ) 0110- QUALIFIER'S NAME: _ Oct&-Q'&I V--) (-DuLt2 m0-Yn QUALIFIER'S LIC NUMBER: C(6C 1 a51LIL4y RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT-OF.BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTIO,N..INDUSTRY LICENSING BOARD CBC1251440 The BUILDING CONTRACTOR Named below.IS CERTIFIED- Under the provisions of Chapter 489"FS.. <, Expiration date: AUG,31;2016 " ^ GUZMAN-MADELYN a G&A CONTRACTORS.INC' "` r 491 SW .7TH STREET.,. - HALLANpAL- ' Ft=33009 +ro.Z .. ISSUED: 07/13QO14 DISPLAY AS REQUIRED BY LAW SEQ# L1407130oo1067 1 Lit-im�i I i IL-1'%L- RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD g�,,�-•�,r f CBC1251440 The BUILDING CONTRACTOR I Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 I GUZMAN, MADELYN G&A CONTRACTORS INC 491 SW 7TH STREET i HALLANDALE FL 33009 i � r MID-it, ISSUED: 06/30/2016 M� DISPLAY AS REQUIRED BY LAW SEQ# L1606300000580 i I I F BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 . 8 + DBA: Receipt& A CONTRACTORS INC Receipt#:G80- A 7369 rzuRrtat. CONTRACTOR (BUILDING t Business Name: Business Type:cONTRp,cTOR) ¢ Owner Name:MADELYN GazmAN Business Opened:o9/10/2009 ' I# Business Location:491 SW 7 ST State/County/Cen Reg:CBC1251440 P HALLANDALE Exemption Code: 4 Business Phone:305-970-3262 { 1 3 Rooms seats Employees Machines Professionals { t� 2 For Vending Business Only t { Number of Machines: -Vending Type: t Tax Amount Transfer Fee NSF Fee nait Wior Years, Colke ick Cosa Total Paid 27.00 0.00 - 0.00.. ;b.00 _. 0.&L ' XO.60 27_.00 ; t THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS i x THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You"must meet all County and/or Municipality planning s WHEN VALIDATED and zoning requirements.This Business Tax Receipt must be transferred when i ' the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that 1 it is in compliance with State or local laws and regulations. 1� Mailing Address: G & A CONTRACTORS INC Receipt #lCP-14-00018332 491 SW 7 ST Paid 07/27/2015 27.00 i HALLANDALE, FL 33009 s { ii - _- - 2015 - 2016 -_- k .. I; BROWARD,COUNTY LOCAL, BUSINESS TAX RECEIPT ve f Rm.A_100, Ft,Lauderdale, FL 33301-1895—954,831-4000 11,6, §�7 Pdlews A THROUGH SEPTEMBER 30,2017 l VALID'OCTOBER 1 20]6 r� Receipt#:I80 227369 i DBA Q A CG lt'9 ACTORINC Buslnesfs Type;°o R' coRNTP OR (gUILr)Irig �* ...-Business"Name Yr _ .R Business Opened:09/10/2009 Owner_Nsme l YN .cvtMh State/County/Cert/Reg;caC12S144o Business Location 49140 7 ST Exemption Code: 1 1IALLANAAUE a: Business Phone:305-970-3262 I Seats Employees' Machines Professionals Rooms 2 For Vending Business Only Vending Type: Number of Machines: Prior Years . Tax Amount. Transfer Fee NSF Fee Penalty Collection Cost Total Paid 0_00_ 4 0.00 27.00 0_.00.. 0- _ - _ - 0.00 THIS RECEIPT,MUST BE POSTED CONSPICUOUSLY.IN,-YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the°privilege of doing business within Broward County,and is non regulatory in:nature You.must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements',-This Business Tax Receipt must be transferred when the business is sold,'':business name has`changed or you L have moved the:,,. business`location.This receipt does not indicate that the business is legal or that It is in compliance with' ' ate or;local laws and regulations. th St Mailing Address: _ G & A CONTRACTORS INC- # 1 Receipt#1CP-15=00017164 491 SW 7: ST N Paid:08/02/2016 27.00 HALLANDALE, FL 33009 �� - M'x5 26" 2017k F miiiim �� ;r :k s about:blank Page 1 of 1 l ORU® CERTIFICATE OF LIABILITY INSURANCE DA�05/18/16 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 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 endomement(s). PRODUCER CONTACT AME: Massimo Pulcini Southeast Insurance Agency IPAIC (954 680-2255 FAX N : (954)680-3208 5001 S University Drive Suite K ADDRESS, southeastinsuran@bellsouth.net Davie,FL 33328 INSURER(S) AFFORDING COVERAGE NAIC# Phone (954)680-2255 Fax (954)680-3208 INSURER A: ESSEX INSURANCE COMPANY INSURED INSURER B: G&A CONTRACTORS,INC. INSURER C: 491 W 7th St INSURER D: HALLANDALE,FL 33009- (305)970-3262 INSURER E: 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 CONTRACTOR 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. ILTR TYPE OF INSURANCE ADD 02/28/2017 UB POLICY EFF POLICY EXP LIMITS VArD POLICY NUMBER MM/DD MWDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 100,000.00 COMMERCIAL GENERAL LIABILITY PREMISES Ea oxu,re-ce $ F—] F-1 CLAIMS-MADE © OCCUR 3ED6055 MED EXP(An one person $ 1,000.00 A F-1PERSONAL02/28/2016 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PERDUCTS-COMP/OP AGG $ 1,000,000-00 El POLICY PRO- 1:1 LOC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea asc n ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED BODILY INJURY(Per accident; $ AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ NOAUTOSN-OWNED PP Oa¢R�de DAMAGE $ ❑ ❑ $ ❑ UMBRELLA UAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB [I CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC STATU-PIYLIMITS ❑OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? F-] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) LICENSE#CBC1251440 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVENUE MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE MASSIMO PULCINI ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD f ��l t - 05-06-2015 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: 06/20/2015 EXPIRATION DATE: 06/19/2017 PERSON: GUZMAN MADELYN FEIN: 061687159 BUSINESS NAME AND ADDRESS: G & A CONTRACTORS INC 491 SW 7 STREET HALLANDALE FL 33009 SCOPES OF BUSINESS OR TRADE: 1- LICENSED BUILDING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 051141, 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 440.05021, 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 440.05031, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, 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. QUESTIONS? (850) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES ` , DIVISION OF WORKERS'COMPENSATION Pursuant to Chapter 440.05(14{, F.S., an officer of a corporation who CONSTRUCTION INDUSTRYelects 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 D chapter. EFFECTIVE: 06/20/2015 EXPIRATION DATE: 06/19/2017 Pursuant to Chapter 440.05(121, F.S., Certificates of election to be PERSON: MADELYN GUZMAN H exempt.. apply only within the scope of the business or trade listed on FEIN: 061687159 E the notice of election to be exempt R BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13}, F.S., Notices of election to be exempt G & A CONTRACTORS INC and certificates of election to be exempt shall be subject to revocation 491 sw 7 STREET if, at any time after the filing of the notice or the issuance of the HALLANDALE, FL 33009 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 BUILDING 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 10091 Hopon JEFF ATWATER CHIEF RNANCIAL 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 DATE: 11/2712015 EXPIRATION DATE: 11/26/2017 t PERSON: RODRIGUEZ JULIO FEIN: 061687159 BUSINESS NAME AND ADDRESS: G&A CONTRACTORS,INC 491 SW 7 STREET HALLANDALE FL 33009 SCOPES OF BUSINESS OR TRADE: LICENSED BUILDING I CONTRACTOR Wreura lo Chapter 440 06(14).F.S.an Wer d■eorpvetlon ane 4teera a:empbn tam OMs drpta bbyy Yn!•cnsfrara d 4ledan uM�eMf section raq M pwmv bn ffs a a01MMS"an wdw tW doom pnl jw4 b(7lapter 440.06(17).F.3-CaWMw d etetlion lobe Mara—sooty" l arCnh Oro some d to zaniness d"ft lard on me MOM of 460e4M to I,,— ..7 Purtrt i0 Qupt�440 06a:&.Neft"d 4N ii00e escarp ntd wO00Mn d etedm lobe cmv*t Shea be ugea b nvorafw� ary Ime ater Ota Yn0 d Me der wwrrc0 of Un wfka*. t ihe person named M sr mwe d eememe w ww meet ale mgz'mWft days secom for issue da cetsfoeb.Tho depats W4 t1W revoke s I I DFS-F2-MC-252 CERMICATE OF ELECTION TO BE EXEMPT REVISED 03-13 OUEST"W(35014131908 t k k hs/.pp. *ft Vd po�ftWr.Uwec..WMa`kdvpgln.-"WHJ7UrV"44NkcVl�2bK UeCQrjOgk%2bFG%2UO96TSSxsICMJDUVW3XAS63d%3d Pag*i of 2 lBoza, Monica M. (RER) Subject: FW: Building official's meeting- reminder of Imapct fee procedures. From:Romito,Donna(RER) Sent:Friday,May 20,2016 3:30 PM To:Salas,Juliana(RER)<JHS1@miamidade.gov>;Goolsby,Michael L.(RER)<MG045@miamidade.gov>;Byers,James(RER)<byersj@miamidade.gov>;Guerrero, Cristian(RER)<GuerrCh@miamidade.gov> Cc:Shinhoster,Charmaine(RER)<cmc@miamidade.gov>;Byers,James(RER)<byersj@miamidade.gov>;Erml-Martinez,Christa(RER)<E134311@miamidade.gov>; Soza,Monica M.(RER)<MONICAB@miamidade.gov>;Perez,Nancy(RER)<CMP@miamidade.gov>;Bestard,Angelique(RER)<BestaA@miamidade.gov> Subject:RE:Building official's meeting-reminder of Imapct fee procedures. Below is the language we placed in our report to the auditors with reference to how a municipality should confirm that Impact Fees were paid. These procedures were reviewed at a Building Officials meeting in 2014 so all building officials would be aware of the changes. At this time we should only be doing Impact Fes assessments with "M", "C" or"N" process numbers. Municipal Building Officials are prohibited under the Miami Dade County Code (Code) to issue permits without verifying payment of Impact Fees to Miami-Dade County. The provisions of the Code to this respect are periodically placed in the monthly Building Officials' meeting agenda for discussion. Additionally, the Miami Dade County Permitting and Inspection Center introduced procedural changes in 2014 related to the processing of Municipal Applications that should prevent the issuance of permits in Municipalities without the required Impact Fee assessment and collection. Specifically, the Impact Fee review is currently systematically prompted upon the filing of a Municipal Application; therefore, upon completion of the initial review the applicant is notified of the Impact Fee that is owed to Miami Dade County. Further, for Municipal Applications Miami Dade County issues a Municipal Approval card and requires that Municipal Building Officials check for that card as a condition to release permits. The issuance of this card is the indicator to Municipal Building Officials that all Miami Dade County requirements were satisfied and all fees - including the Impact Fees - were paid. Miami Dade County provided workshops to Municipal Building Officials to disseminate this information. Thank you Donna Donna M.Romito,Business Architect Miami-Dade County Department of Regulatory and Economic Resources Permitting and Inspection Center 11805 SW 26 Street Miami,Florida 33175-2474 786-315-2335 o www.miamidade.aovldeveloment "Delivering Excellence Every Day" From:Salas,Juliana(RER) Sent:Friday,May 20,2016 3:24 PM To:Goolsby,Michael L.(RER)<MG045@miamidade.Rov> Cc:Shinhoster,Charmaine(RER)<cmc@miamidade.aov>;Byers,James(RER)<bversi@miamidade.gov>;Erml-Martinez,Christa(RER)<E134311@miamidade.aov>; Romito,Donna(RER)<DMR@miamidade.Rov> Subject:Building official's meeting-reminder of Imapct fee procedures. For the month of June, I would want to have Jim and Cristian do a presentation remind BO of the Impact fee and DERM review process for municipal permits. This was implemented in 2014, we should not be processing any municipal applications without an M number. Donna, do you have the language that was placed in the Audit report to remind everyone? Thanks! Juliana H.Salas,P.E. Assistant Director,Construction Permitting and Building Code Miami-Dade County Department of Regulatory and Economic Resources 11805 SW 26 St,Room 214 Miami,FL 33175-2474 Phone:(786)315-2334 www.miamidade.gov/building `A please consider your environmental responsibility before printing this e-mail or any other document 1 ADE) MIAMI-DADE COUNTY 1A 182 MUNICIPAL IF-2 CT I ON_,,,REQU I REQ.NTS ORD 11/04/20I 6 MUNICIPAL NO. 2017-006378 FOLIO 1132060133920 ,JOB SITE ADDRESS 2- L�F -fj;_j_� 9501 N PROPOSED USE OFFICE - Pr' ILF -I_oNAAA JyPqlL-D_I-N /� T_NTERIOR ATERATIONS S- 29 LEGAL MIAMI SHORES SEC t Zali--t 7, 7- T TER-r APPLICATION TYPE ALTER tN R, .1 UNITS I FLOORS OWNER NAME DVS LLC CONTRACTOR QUALIFIER PERMIT TYPE MUNICIPAL Bin CATEGORIES OCA01 MUNICOA G � E'-kA glfil�6'jo 3-, .firDATE: 11/04/2016 PROCESS W 0.16011 8;1 NEW *AMOUNT PAID 603. 48 DERM T' R I ASBESTOS REYI 179t-000-161E I INDUSTRIAL WA 300. 00 DERM 1 UP FRONT FEE- 80. 00 D RM I MIN COMM REV { 90. 00 FIRE 63000 ALTERATIONS & 152. 80 FIRE 63000 FIRE UPFRT FE 34. 32 FRWK 1 1ST FIRE MINO 79. 00 UPMU I UPFRONT FEE F 25. 00 C) 0 L o i T M 05-06-2015 1 .. ,TEFF 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. r EFFECTIVE DATE: 06/20/2015 EXPIRATION DATE: 06/19/2017 PERSON: GUZMAN MADELYN FEIN: 061687159 c BUSINESS NAME AND ADDRESS: G & A CONTRACTORS INC 491 SW 7 STREET HALLANDALE FL 33009 SCOPES OF BUSINESS OR TRADE: 1- LICENSED BUILDING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05114!. F.S., as officer of a corporation who elects exemption from this chapter by fills9 a certificate of election under this f the section may onr recover benefits er compensation Midst this chapter. Pursuant to Chapter 440.05025. F.S.. Certificates el election to be exempt... apply only 1 scope of the ouslaess or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S.. Notices of election to be exettlpt ue/ certificates of election to be exempt shall be subject to revocation It. at any time after the filing of the Notice ur M issuance of the csrtifiute. Ms parson named lu the notice er certRlcate on longer meet: the requlratnents of this section for IaaaanCe of a certificate. The department shall revoke a certificate at any time for failure of the Purses named on the cenilicats to meet the requirements of this section. QUESTIONS? (850) 413-. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 I PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTIb1ENTOFFINANCIAL SERVICES F Pursuant to Chapter 440.05(14), F.S., Ott officer of a corporation who [DIVISION OF WORKERS'COMPENSATION CONSTRUCTION INDUSTRY elects exemption from this chapter by filing a certificate of electionERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under thl ORKERS'COMPENSATION LAW D chapter. 08/20/2015 EXPIRATION DATE: 06/19/2017 Pursuant to Chapter 440.05(12), F.S.. Certificates of election to be EFFECTIVE PERSON: 06/20/2MADELYN GUZb1AN H exempt.. apply only within the scope of the business or trade listed E the notice of election to be exempt FEIN: 061687159 R BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of election to be exeml G & A CONTRACTORS INC and certificates of election to be exempt shall be subject to revocat 491 SW 7 STREET if, at any time after the filing of the notice or the issuance of the' HALLANDALE. FL 33009 certificate, the person named on the notice or certificate no longer 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 section. I- LICENSED BUILDING COMMACTOR QUESTIONS7 (850) 413- CUT HERE • Carry bottom portion on the job, keep upper portion for your records. C-251 CERTIFICATE OF ELECTION TO-BE EXEMPT REVISED 01-11 G & A CONTRACTORS, INC CBC1251440 & INSURED 491 SW 7 STREET HALLANDALE BEACH, FL 33009 305-970-3262 / 954-454-6595 FAX aacontractorsinc@ad.com Date: 5/18/16 State of Florida County of Broward Before me this day personally appeared Madelyn Guzman who, being duly sworn, deposes and says: That Madelyn Guzman and Julio Ariel Rodriguez will be the only persons working on the project located at 211 NE 95 Street Miami Shores, FL 33138 OS-18-.)DI M delyn G (Qualifier) Date """'••, TANAYRA REYES Notary Public-State of Florida My Comm.Expires Jul 24,2016 Commission#EE 197176 Rondedaryn. Notary ignature Date G & A CONTRACTORS, INC CBC1251440 & INSURED 491 SW 7 STREET HALLANDALE BEACH, FL 33009 305-970-3262 / 954-454-6595 FAX gacontractorsinc@aol.com Proposal Date: 6/2/2016 Owner: Artsy Hive LLC Project Address: 211NE 95St Miami Shores-Fl- 33138 hores-FL33138 1 propose to perform the following to the project address listed above including labor and materials as per blue prints: Project: Remodeling - Demolition of existing Ceiling,carry out garbage. - Supply and install new Insulation R-30 for ceiling and 5/8" Fire code sheet rock. - Smooth finish for ceiling. - Build up side walls at 20"H entry way with 6" Wood stud. Includes dry wall,plaster and finish. - Build new walls at water fountains back side and front as per plans from floor to ceiling. Includes drywall,plaster and finish. - Build new wall at the back for N and reinforce it for N mounting.Includes drywall,plaster and finish. - Build new walls for bathroom.Includes drywalls,plaster and finish. - Build new Curve wall at the center.lncludes drywall,plaster and finish. - Build small partition walls as per plans. - Supply and Install new ceramic the floor 24"x24". Includes material and grout. - Supply and Install new interior doors, metal frame fire retardant by code and plans. - Supply and apply primer and 2 coats of paint. Notes: Price includes delivery of materials ordered by Owner. What is not written in this proposal is not included. G&A Contractors, Inc. is not responsible for any work or damage from Subcontractors that are not contracted by G&A Contractors, Inc.directly.The Owner agrees to pay, in addition to the contract price,the cost of any supplementary work that is requested by the Owner and which is agreed to by both parties. This agreement is subject to delays caused by strikes, accidents or delays beyond the control of the Contractor and/or its subcontractors which could not have been anticipated through reasonable diligence by the Contractor and/or its subcontractors. The Contractor will not be responsible for any acts of God,fires,or faults which cannot be attributed to faulty materials,workmanship,negligence or the willful conduct of the Contractor and/or its subcontractors. TOTAL: $34,790.00 Acceptance: (In r Date (Contr ctor) Date FLORIDA HOMEOWNERS CONSTRUCTION RECOVERY FUND PAYMENT MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT,WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW BY LICENSED CONTRACTOR.FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM,CONTACT THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS:Construction Industry Recovery Fund 1940 North Monroe Street,Suite t G & A CONTRACTORS, INC 491 SW 7 ST Hallandale Beach-FL 33009 305-761-0316/305-970-3262 CUSTOMER:Artsy HIVE LLC ESTIMATE:AZ-2016-010 ADDRESS:211NE 95ST DATE:6/1/2016 Miami-FL 33138 DESCRIPTION SQ/FT COSTO TOTAL Permitting processing. City fees. PRELIMINARY WORK Demolition of existing ceiling and concrete floor. 1,400 $ 1,250.00 PLUMBING WORK Demolish concrete floor to run new piping for water fountain. Run new water line for bathroom. Ventilation system. Install new water fountain. Install new faucets and fixtures. (Provides by client) Install new toilet. (Provides by client) Install new sinks. (Provides by client) $ 4,650.00 STRUCTURAL WORK Supply and install new insulation R-30 for ceiling and 1,250 5/8"fire cored sheet rock. Smooth finish for ceiling. 1,250 Build up side walls at 20"H entry way with 6"Wood stud. Includes dry wall,plaster and finish. Build new walls at water fountains back side and front as per plans from floor to ceiling. Includes drywall,plaster and finish. Build new wall at the back for TV and reinforce it for TV mounting.Includes drywall,plaster and finish. t Build new walls for bathroom.Includes drywalls,plaster and finish. Build new Curve wall at the center.lncludes drywall,plaster and finish. Build small partition walls as per plans. Supply and Install new ceramic tile floor 24°x24". 1,400 $ 27,390.00 Includes material and grout. DOORS Supply and Install new interior doors, metal frame fire 4 $ 3,100.00 retardant by code and plans. ELECTRICAL WORK Relocate existing electrical panel. 1 Run new line 240V/60A and Install disconnect box on 1 the roof top for.AH U. Run new line 240V/60A and Install disconnect box on 1 the roof top for CU. Run 2 new lines 240V/50A and Install disconnect for 2 both ovens(KILN). Furnish and Install 6 GFI on dedicated lines. 6 Furnish and Install 6 appliances outlets on dedicated 6 lines. Furnish and Install 15 regular duplex receptacles. 15 Furnish and Install 10 regular switch. 10 Run 1 new 3 way switch line from front door to the 1 counter switches. Furnish and Install 24 ceiling/wall J.boxes for future 24 light fixture. Furnish and Install 3 emergency lights and 1 EXIT 4 Light. Connect 2 bathroom exhaust fan to light switch. 2 Run empty conduit with pull string for the door 1 buzzer. Supply Install 24 light fixtures. ( Lights provides by 24 client). Run TV cable(RG-16)and internet wire CAT-5 to 5 24 $ 12,210.00 locations. AIR CONDITIONING Install new A/C 5TONS 16SEER Air Handler. New sheet metal duct not insulated. New programmable thermostat. New refrigerant lines and insulation. New auxiliar drain pan with float switch. All requirements by plans and codes. $ 9,480.00 PAINT AND FINISH Supply and apply primer and 2 coats of paint. $ 4,300.00 TOTAL: $ 62,380.00 s Danaj o Industrial Group Inc CMC1250046 670N 114 Ave,#103 Miami, FI 33172 Phone: 786-543-0200/305-761-0316 Email: danajogroup@comcast.net PROPOSAL Customer:Artsy Hive LLC Address: 201 NE 95St Miami Shores FL-33138 Date:5/25/2016 1-Provide and Install Spiral Double Wall 1" for all Round Air Conditioning Ductwork. 2- Provide and Install Galvanized Sheet Metal G90 for all Rectangular S/A and O/A Ductwork. 3- Provide and Install Air Distribution Grille according to drawings. 4- Provide and Install Smoke Detector in S/A Ductwork according to drawings. 5- Provide and Install Snap lock Pipe for all Round Exhaust Air Ductwork. 6- Provide and Install two (2) Bathroom Fan 50 CFM and two (2) Exhaust Fan 250CFM. 7- Provide and Install four(4)Wall Cap according to drawings. 8- Provide and Install one (1) Motorized Control Damper in O/A Ductwork. 9- Provide and Install one (1) Manual Volume Damper in O/A Duct. 10- Provide and Install Refrigeration Lines and Line Jack. 11- Install Split System Unit. Provide by other. a 12- Provide and Install Stands. 13- Price is not included any material or labor not specifically described above. TOTAL COST. $9,480.00 Payment method: 50% deposit required, 40% rough inspection, 10% upon com- pletion. /0 SignatureV Date Signature Date 253 172 str.#216 DATE 4/14/2016 SUNNY ISLES BEACH, FL 33160 PROJECT Artsy Hive (786)399-1900 211 NE 95th.Street dolcheinc@yahoo.com License# EC13004399 QTY DESCRIPTION RATE TOTAL 1 Relocate existing electrical panel $ 800.00 800.00 1 Run new line 240V/ 60A and install disconnect box on the roof top for AHU 650.00 650.00 1 Run new line 240V/ 60A and install disconnect box on the roof top for CU 650.00 650.00 2 Run 2 new lines 240V/50A and install disconnects for both ovens(KILN ) 350.00 700.00 6 Furnish and Install 6 GFI outlets on dedicate lines 120.00 720.00 6 Furnish and Install 6 appliance outlets on dedicate lines 100.00 600.00 15 Furnish and Install 15 regular-duplex receptacles 70.00 1,050.00 10 Furnish and Install 10 regular switches 80.00 800.00 1 Run one 3way switch line from front door to the counter switches 180.00 180.00 24 Furnish and install 24 ceiling/wall J.Boxes for future Light fixtures 70.00 1,680.00 4 Furnish and Install 3 Emergency lights and one EXIT light 160.00 640.00 2 Connect 2 bathroom exhaust fan to the light switch 60.00 120.00 1 Run empty conduit with pull string for the door buzzer 140.00 140.00 24 Install 24 light fixtures-on high ceiling 60.00 1,440.00 5 Run TV cable(RG-16)and internet wire CAT-5 to 5 locations 120.00 600.00 TOTAL $ 10,770.00 THANK YOU FOR YOUR BUSINESSI 6z.,6o, RC PLUMBING LLC CFC1429033 201 West Park Drive Miami, FI 33172 Phone: 754-235-3828/305-761-0316 Email: rcplumbingcontractor(a,gmail.com DATE:6/l/2016 PROPOSAL: - Demolition of concrete floor to run water lines. - Installation of 2 new water fountain. - Installation of 3 new Sinks. - Relocate toilet connection. - Installation of 1 new toilet. - Installation of Faucets. - Ventilation system. TOTAL COST: $4,650.00 Signature Date Signature Date