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MC-16-1571 Permit NO. MC-6-16-1571 �sNO1Es i, Miami Shores village Permit Type:Mechanical-Commercial 10050 N.E.2nd Avenue NE rlill work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 FLORIDA Issue Date: 11/2212016 Expiration: 05/21!2017 Project Address Parcel Number Applicant 9501 NE 2 Avenue 1132060133920 Miami Shores, FL 33138- Block: Lot: DVS LLC Owner Information Address Phone Cell DVS LLC 9400 NE 2 Avenue (305)756-3711 MIAMI FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 8,260.50 DANAJO INDUSTRIAL GROUP INC (786)543-0200 Total Sq Feet: 1214 Tons:5 Available Inspections: Additional Info: Inspection Type: Classification:Commercial Ventilation Approved:In Review Final Comments: Date Approved::In Review Rough Date Denied: Type of Work: INSTALL A 5 TON UNIT INSTALL NEV Rough Duct Scanning: 1 Review Mechanical Duct Detector Test Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $5.40 DBPR Fee Invoice# MC-6-16-60085 $4.33 06/06/2016 Credit Card $50.00 $264.81 DCA Fee $4.33 Education Surcharge $1.80 11/29/2016 Credit Card $264.81 $0.00 Permit Fee $288.75 Scanning Fee $3.00 Technology Fee $7.20 Total: $314.81 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 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. Futhermore, I authorize the above-named contractor to do the work stated. November 29, 2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy November 29,2016 1 s Miami Shores Village JUN 06 2016 Building Department LBY: 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 201L/ BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ' f BUILDING ❑ELECTRIC F] ROOFING REVISION EXTENSION MRENEWAL PLUMBING (MECHANICAL MPUBLICWORKS CHANGE OF CANCELLATION M SHOP ,� p '// CONTRACTOR DRAWINGS JOB ADDRESS: 2/1 �' / S�' p� City Miami Shores County Miami Dade Zia•3-3130 Folio/Pgrcel#:II—320(p — 012 —322(9 Is the Building Historically Designated:Yes NO_ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): C Phone#:305--75)." P-2.2o Addresssq J �I 'VG // d City: 44tal , r� State: �L Zip: 33p3 0 Tenant/Lessee Name: ve, L� �r'S �� Phone#: '30-5-7&-7-6 p l Email: /� C Z'2 &- �h'ta-"F a n 2 - cb C-r!Gr►-4) Lj CONTRACTOR:Company Name:ba r&1 O k/nCSII 1 r C- Phone#: Address:& 7o A J �lAve, 4ot. //as a� City: (C!'f'YJ/ State: >r� Zip: 33I a Qualifier Name: Phone#: State Certification or Registration#: CMG 12 S 00 q(O Certificate of Competency#: DESIGNER:Architect/Engineer: ylC4-%3.—�( �• ��C� ry( Phone#:30S^3/0•'S030 Address:3-70 �C /yt �/ _City:4IGir17l LS)r&13 '331-3of Value of Work for this Permit:$—&.2—(P 0 • SO Square/Linear Footage of Work: 1,2261' S,T Type of Work: F-1 Addition Alteration El New / ElRepair/Replace ❑�D1e�molition Description of Work:. �/7 `/ /!Mf r/ (�,h �`C ff L,02 - /ns-1t.40 flit rJ ZU fie/ welr/s aq C'0 12AA"- Specify color of color thru tile: Submittal Fee$ 50,00 Permit Fee$ (� fr CCF$ T CO/CC$ scanning Fee$ •w Radon Fee$ `7• - DBPR$ 1433 Notary$ Technology Fee$ �1 -0 Training/Education Fee$. , 9C) Double Fee$ Structural Reviews$ Bond$ � u TOTAL FEE NOW DUE$ (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 I 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 j YOUR NOTICE OF COMMENCEMENT." I 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 ap reinspection fee will be charged. i Signature Signature t OWNER or AGE CONTRACTOR 4 The foregoing instrument was ack ledged before me this The foregoing instrument was acknowledged before me this —�—day of 1I-i� —20 by _�day of 20 t�,# by who is personally known to J(Y4e- r"►0 P tIO (,who is personally known /tto as me or who has produced =&::: t me or who has produced —T c r identification and who did take an oath. identification and who did take an oath. 3 d NOTARY PUBLIC: NOTARY4PUI1L t Sign: Sign:Print: +� 4Print: � Seal: ELIZABETH ELORRIAGA Seal: y SHgRpN FELDAIAN 'i MY COMMISSION#FF953536 'c MY COMMISSION#FF902928 EXPIR95 January 26.2020 EXPIRES July 23.2019 rrsssssssss essssssasssssssssssss ��k4iisssss �srrar •erg APPROVED BY 61 a Examiner Zoning I Structural Review 4s Clerk j R -r2/24/2014) tr SNOR ones �� Miami Shores Village TES I" Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 756.8972 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: -v C A. ACOPY OF QUALIFIER'S STATE LICENCES B. t/ COPY OF LOCAL BUSINESS TAX RECEIPT C.� OPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION S TION 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: ,�iA� r�lijs Q�j�� nC BUSINESS ADDRESS: / fLd11V,41 J�CITY /)19r, STATE ZIP BUSINESS PHONE: ( ) FAX NUMBER(__) CELL PHONE 55 � -0,200 QUALIFIER'S NAME: r�� QUALIFIER'S LIC NUMBER: 002604 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY toil 6588694 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES DANAIOINDUSTRIAL GROUP INC RENEWALSEPTEMBER 30, 2016 670 NW 114 AVE 103 6859343 Must be displayed at place of business Pursuant to County Code SWEETWATER FL 33172 Chapter SA-Art.9&10 SEC.TYPE OF BUSINESS AYMENT RECEIVED DANAJO INDUSTRIAL GROUP INC OWNER 196 GENERAL MECHANICAL CONTRACTO'by TAX COLLECTOR CMC1250046 $45.00 08/06/2015 Worker(s) 1 CREDRCARD-15-039958 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a License, er must permit,or a certificatio ulathe laws a�req rementsualifications,to d basin yes .the businHold asscomply with any governmental or nongovernmental reg The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec sa-276. For more information,visit wvj-wjni idade aov/toxcollector RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD111114,I&IT".;14z CMC1250046 '�,_ a. The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 D' 'D MOLINA, JORGE DANAJO INDUSTRIAL GROUP INC 670 NW 114TH AVE APT 103 MIAMI FL 33172 ISSUED: 05/29/2014 DISPLAY AS REQUIRED BY LAW SEC# L1405290002492 UH 1 C(MM/UU/T T T T) =02, CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A&D ALL-LINES INSURANCE ASSOC INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5600 SW 135 Ave, Ste 106 ALTER THE COVERAGE AFFORDEDBY THE POLICIES BELOW, Miami, FL 33166 (3051463-6781 INSURERSAFFORDING COVERAGE NAIL# INSURED DANAJO INDUSTRIAL GROUP, INC. INSURERA LLOYDS OF LONDON INSURER B NORMANDY HARBOR INS CO. 670 N.W. 114 AVE. # 103 INSURER C: MIAMI, FL 33172 INSURER D: INSURER E RAGES 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 ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. LTR NSRD POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000.0 IJAMAI'tPI L)KhN I Mr- COM M ERCIAL GENERAL LIABILITY $ 100,000 CLAIMSMADE OCCUR MED EXP(Anyone person) $ 51000 A CIBFL0034631 03/23/16 03/23/17 PERSONAL BADVINJURY a 1,000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000, 00 ri POLICY M PRO- JFrT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Peraccident) $ PROPERTY DAMAGE $ (Peraccident) GARAGELIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTOEA ACC $ OTHER THAN AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE $ b DEDUCTIBLE $ RETENTION $ $ W TATU- TH- WORKERSCOM PENSATION AN D EMPLOYERLITY NEFL142584 08/08/15 08/08/16 100,000 ANY PROPRIETOR/IETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT b B OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 K .desmbeg,ler LA PR IONS below E.L.DISEASE-POLICY LIMIT $ OTHER a. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS AIR CONDITIONING INSTALLATIONS, SERVICE, AND REPAIRS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF MIAMI SHORES DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN BUILDING DEPARTMENT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT AILURE TO DO SO SHALL 10050 NE 2ND AVENUE IMPOSE NO OBLIGATION OR LIABILITY OF N T (SURER,ITS AGENTS OR MIAMI SHORES, FL 33138 305 756-8972 REPRESENTATIVES. Fax: AUTHORIZED REPRESENTA ACORD 25(2001/08) Ntho&D CORPORATION 1988 RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY I STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD fid, CMC1250046 The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 01 MOLINA, JORGE r % DANAJO INDUSTRIAL GRQU�,MC r r 670 NW 114TH AVE AP-r f 0:7— MIAMI FL 33172.,` a ■ r SEQ# L1607240002220 ISSUED: 07/24/2016 DISPLAY AS REQUIRED BY LAW ♦S RET t? shores mail "1 Irliami Village Building Department ORivp► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305) 756.8972 Notice to Owner - 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 AM—NoW.LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. /. Signat owner `11Y�3✓1 e/>icMZ�`sl State of Florida �' S• �� County of Miami-Dade The foregoing was acknowledge before me this day of �(�-�t.�� '20 1 (o . By _I Wr( V�2 S1} � Ct V� 1` who is personally known to me or has produced as identification. ELIZABETH ELORRIAGA Notary: T"� •= MY COMMISSION#FF953M EXPIRES January 25.2020 SEAL �+on sn�-0 si Fiawwo►e gar DANAJO INDUSTRIAL GROUP, INC STATE LICENSE#: CMC-1250046 PHONE: 786 543 0200 MECHANICAL CONTRACTOR E-MAIL:danajogroup@acomcast.net OFFICE:305 804 5172 670 NW 1 14T"Ave,# 103 FAX:305 554 0381 Miami, Fl 33172 DATE: 11/25/2016 Before me this date personally appeared Jorge Molina who, being duly sworn, desposes and says: That Jorge Molina, will be the only person working on this project located at: 211 NE 95 St, Miami Shores, FL 33138 _X 4*b Signature of Qualified STATE OF FLORIDA DADE-COUNTY STATE O -COUNTY SWXrn to(or affirmed)and subscribed before me this �rn to(or a armed)and su cribed before me this /Vo✓1,.,�,�,� day of 2 .20 16 by j vU� day of.�,20_L(a by LA h (Print,Ty e or Stamp Qualified's Name) (Print,Type or Stamp Notary's Name) Type of Identification SHARON FELDMAN My COMMISSION 0 FF902928 • EXPIRES July 23,2019 "153 .=,