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CC-16-1806 (2) �� s� ro °.' Miami Shores Village '' P�1x1�lI T,ypB ��mmero onst ttion 10050 N.E.2nd Avenue NE U t�CIOifica i .Alteration •" ""' Miami Shores,FL 33138-0000 =� R0"St8tct*APPR0VED e— s Phone: (305)795-2204 �xoR�oA Expiration: 11/07/ 017 Issue date:S11412017 � Project Address Parcel Number Applicant 9806 NE 2 Avenue 1132060132241 MIAMI SHORES CENTER, LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell MIAMI SHORES CENTER, LLC 210 71 Street MIAMI BEACH FL 33139- 210 71 Street MIAMI BEACH FL 33139- Contractor(s) Phone Cell Phone Valuation: $ 10,000.00 V UNITED CONSTRUCTION ENGINEERII (954)588-9723 Total Sq Feet: 0 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Window Door Attachment Date Denied: Tie Beam Type of Construction:CHANGING TOILET/SINK AND DIS Occupancy Load: Slab Stories: Exterior: Termite Letter Front Setback: Rear Setback: Framing Left Setback: Right Setback: Store Front Attachment Plans Submitted:Yes Certification Status: Insulation Certification Date: Additional Info: Drywall Screw Bond Return: Classification:Commercial Final PE Certification Window and Door Buck Scannin :3 Gelling Grid Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Fill Cells Columns CCF $6.00 Review Building DBPR Fee $4.50 Invoice# CC-6-16-60381 Review Building DCA Fee $4.50 06/29/2016 Credit Card $50.00 $284.00 Review Building Education Surcharge $2.00 05/11/2017 Check#:10812 $284.00 $0.00 Review Plumbing Permit Fee $300.00 Review Plumbing Scanning Fee $9.00 Review Plumbing Technology Fee $8.00 Review Planning Total: $334.00 Review Electrical Review Structural Review Mechanical 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 t work n compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor o t rk s ed. May 11, 2017 Authorized Signature:Owner / Applicant / Contractor / Date Building Department Copy May 11,2017 1 1:31-R � Miami Shores Village Building Department MA�_k6 2017d 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC2014� BUILDING Master Permit No. cc. 1(0-- GtI6 PERMIT APPLICATION sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS G@ CHANGE OF ❑ CANCELLATION ❑ SHOP JOB ADDRESS: -1 ®00 (f 1, CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: {Gt i�>n eke ((.e �MceS �f T — OWNER:Name(Fee Simple Titleholder)- L Phone#: Address: I ` 4� J I City: Vt�OA'1 CAG State: L Zip:: ��1 Tenant/Lessee Name: e ✓N 1 �'✓� Phone#: )U QV RA/4 Email: ns CONTRACTOR:Company Name: XU.yI lAe_� W)1Sfr-0c!1 'DA J_1'9.r,o Vim hone#: Address.:` 2 3 C_re.sce,va� CWc City: W e z-f o'A_ State: Fk Zip: 3 3,3Z6 Qualifier Name:_ ?°tre 1 fres. Phone#: / /� r� a2• ®� g 0*3 �L7 f1 - State Certification or Registration#: ��0 �� ° Certificate of Competency#: Q� o DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 2 ,T00 Square/Linear Footage of Work: Type of Work: ❑ Addition r❑ Alterati n/ ( El New a Repair/Replace ❑ Demolition Description of Work: iG�I�Y GG `( 6e Specify color of color thru tile: � rr�� Submittal Fee$ '�J Permit Fee$'�� ° CCF$ ff(O •W CO/CC$ Scanning Fee$ Radon Fee$q. DBPR$ `t'• Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ C�'i e c+ (Revised02/24/2014) r � a 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 ckl/ Signat e OWNER or AGE;T CON AC OR The foregoing instrument was acknowledged before,me this The foregoing instrume t was acknowledged before me this day of6(�V1GL�`�,20 \� ,by , ay of .�� 20 ` 1 by r who isE��as o who is personally known to me or who has produced 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 C Sign i c ooh II I i t : 0 Q a I fkl� Print: Print: a� •."9�. ORITMIMOUN Seal: w !, 'b_ !AYCOMMISSION#FF064212 Seal: � ar , YOLIMA L. DE AVILA a= XPIRES:Derember 14,2017 �o�' u°�;'� * *e Commission 4 GG 34869 =,•„� Bended 1'hm Notary Public Undenvrders d �r My Commission Expires fem er UA-IM * ******* *** **wxx * **** ** * ****** * ******** * ***** ** ** APPROVED BY (A Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 41940 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 � NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PEREIRA, FREDDY R UNITED CONSTRUCTION ENGINEERING INC 723 CRESCENT WAY WESTON FL 33326 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 of range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque DEPARTMIENT1 OF BUSINESS AND restaurants,and they keep Florida's economy strong. `^ % PROFESSION, GULATION Every day we work to improve the way we do business in order CGC1509797SUED` 06/19/2016 to serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more CERTIFIED GEIV CONTIATOR information about our divisions and the regulations that impact PEREIRA,FRED '�R you,subscribe to department newsletters and learn more about UNITED CONS#R'tTION ENTERING IN the Department's initiatives. '% , r 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! E)n' n aat AUG 31,2018 L1608180M1232 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ,_. C13C1509797 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 PEREIRA, FREDDY R ®� ■ UNITED CONSTRUCTION�G- EERINP INC d 723 CRESCENT WAY - WESTON FL-33326 ISSUED: 06/19/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1606190001232 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 12/27/2015 EXPIRATION DATE: 12/26/2017 PERSON: PEREIRA FREDDY R FEIN: 202847734 BUSINESS NAME AND ADDRESS: UNITED CONSTRUCTION ENGINEERING, INC. 723 CRESCENT WAY WESTON FL 33326 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED ROOFING CONTRACTOR CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,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 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 '#C CERTIFICATE OF LIABILITY INSURANCE oar 30�91� 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 policypes)must be endorsed. B SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain poHdes may require an endorsement A statement on this certificate does not confer rights to the G ""Rafe RotBer in of ti o efcd&wvwq . PRODUCER ffe�CT Jessica Perez trance Pr Ccmsuftaf-is .P (3435)2734s343 F N .- (34 )273-44M 10481 SW 88TH ST STE D204 E'er jessica@ipen.com MIAMI;FL 3317&-1528 ct�ERaeE Iia Phone (305)273-4530 Fax (305)273-4409 INSURER A: Endurance insurance Company INSURED SER g United Construction Engineering,Inc INSURER C: 723 Crescent Way INSURER 0. W ESTON,FL 33326- (9554)59723 INSURER E: 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 MICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITM OF ANY CONTRACTOR OTHER DOCAMENT WITH RESPECT TQ W HFC#P 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. LTR TYPE OF INSURANCE POLICY NUMBER Y POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TORENTED 1oi�,oc�r.Ot7 W1 COMMERCIAL GENERAL LIABILITY PREMISES Me occurrence E] ❑ CLAIMS-MADE Q OCCUR CBC10000117702 MED EXP(Any one person $ 5,000.00 A El PERSONAL Y 02/14/2017 .02/1412018 PERSONTAL 6 ADS/INJURY S ?130X3 00iL00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS=COWIOP'AGG S- 1,000,000.043 ❑ POLICY © JECT PRO- ❑ LOC $ AUTOMOBILE.LIABILITY COMBINED BI_ SINGLE LIMIT ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTO& ❑ AUTF% ❑ HIRED AUTOS ❑ AUTOS NED PpeOr a�RIdTY AMA� $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAS ❑CLAIMS-MADE AGGREGATE ❑ DED ❑ RETENTION s $ WORKERS COMPENSATION ❑WC STATU- ❑OTH- AND EMPLOYERSLIABILITY Y!N ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? ElNSA dato (Manry In NH) E.L.DISEASE-EA EMPLOYE $ Ifr% under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF ORERATNMI LOCATIONS/VENNAJM tAMb ACORD M,Addillow FWNWIN sehadaw D arenas ROOFING AND GENERAL CONTRACTOR CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BttfLf3fRIG DEPARTMENTACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE NARlfii SHORES,FL 33138 610&2818 ACORD CORPORATIOI(t. Aif rights Nerved. ACORD 25(2010105)OF The ACORD fame and logo are registered marks of ACORD Vis ,w ?u � : BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954831-4000 ?` VALID OCTOBER 1,2016 THROUGH SEPTEMBER 30,2017 DBA: Receipt#:GENERA8L9CCONTRACTOR (GENERA Business Name: UNITED CONSTRUCTION ENGINEERING Business T e: . �= INC YP CONTRACTOR) s: Owner Name:FREDDY R PEREIRA Business Opened:05/30/2006 Business Location:723 CRESCENT WAY State/County/CerttReg:CGC1509797 WESTON Exemption Code: Business Phone: ', Rooms seats Employees Machines Professionals z 1 For Vending Business Only Number of Machines: Vending Type: r Tax Amount Transfer Fee NSF Fee Penaity Prior Years Collection Cost Total Paid , f 27.00 0.00 0.00 1 0.00 1 0.00 0.00 27.00 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 a; 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 it is in compliance with State or local laws and regulations. f Mailing Address: UNITED CONSTRUCTION ENGINEERING IN, Receipt #03A-15-00009726 723 CRESCENT WAY Paid 09/12/2016 27.00 WESTON, FL 33326 k 2016 - 2017 N 0Df%1A/A 0r% f%f%l IAITV 1 f%f%A l QI IOIKICQC TAY 0Cf%CI01r _. 6". - - UNITED cs�crae Qr+�u c��+ccasa� UNITED CONSTRUCTION ENGINEERING C G C 1509797/C C C 1328270/Q B 43056 PHONE: (954)588-9723 April 20,2017 STATE OF FLORIDA COUNTY OF DADE COUNTY BEFORE ME THIS DAY PERSONALLY APPEARED � WHO, BEING DULY SWORN, DEPOSES AND SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT 9806 NE 2ND AVE, MIAMI SHORES, FL 33138 SWORN TO (OR AFFIR ) �SU .CRI BEFORE ME THIS Z'9 DAY OF '91 2017, BY PERSONALLY KNOWN OR PRODUCE IDENTIFICATION wJ TYPE OF IDENTIFICATION PRODUCED JOSE A DELGADO MY COMMISSION N FF227905 EXPIRES July 04.2019 i4C130G0'a3 iMxiOrNoPa:sar.rx can• PRINT,TYPE OR STAMP NAME OF NOTARY ♦S ORFS. 1'I l Miami shores Village "" Building Department 10050 N.E.2nd Avenue �LORIDp' 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: A4 A44 Ali Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of C� ,20_J7) By !?JW 7,K4 who i ersonally kn to or has produced as identification. :B,,M,,d.d OR(TMIMOUN COMMISSION ri FF 064212 Nota IRES:December 14,2017 ry: %;..... Thru Notary Public Underwlter: SEAL: