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WS-16-176 Miami Shores Village i JAN 2 ] 2015 Building Department 10050 N.F-2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762-4949 FBC 2014 BUILDING master Permit No. WS ► o- 1�1 fo PERMIT APPLICATION Sub Permit No. BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION RENEWAL F-1 PLUMBING MECHANICAL []PUBLICWORKS Q CHANGE OF ❑CANCELLATION E] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: -7 00 5*h 2 City' tMiami Shores q County Miami Dade Zip: 1 J Follo/Parcel#: i t 8 l Q Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): S/ SCSY- 61CZ Phone#: Address: 1 -7dG SAn4 no City: , -Shxe.- State C Zip: 3313 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:_?OXCIAc Se 5X' 10--f S Phone#-. 501 7317 C>3� Address: Z I t<k r(" pp- 6`Y c ,1 J T City: 'Nk^ Yl ��il�'.4c�,� Stater Zip: 33�-f 2(9 Qualifier Name: - i rx Yl x�1 '!&�. 1R'��Ypp Phone#: State Certification or Registration#:��. �6—[ Certifipte of Competency# DESIGNER:Architect/Engineer: Phone#: Address: Crty: State: Zip: Value of Work for this Permit:$ Square/Unear Footage of Work: Type of Work: ❑ AdditionAlteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �V?P�kJ C>A Specify color of color thm We: 11,, Submittal Fee$ Permit Fee$ ® J CCF$ CO/CC$ Scanning Fee$ Radon Fee$ 2 ' 0 DBPR$ Notary$ Technology Fee$ �' l ) Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ ( b c)` G (ReWsed02/24/2014) 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 fast 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 ctea Signature e'd OWNER or AGENT CONTRACTOR The forego' g instrument was acknowledged before me this The foregoing instrument was ac nowledged before me this day of o�� � .20 by day of .20 by r d,/&%16 II,//S J2 ZgA6��,who is personally known torJ 0 [�el C o is pe me or who has produ as me or who has produced as identification and who did take an oath. identification and who did take an oath. N Y NOTARY PUSUC: S' n• Sign• t: r� @�'l'�S� $��j\5�20201,9 �P JENNIFER NAJERA �. �•� 1 •'c MY COMMISSION#FF902810 EXPIRES.qdy 23,2019 7'.j+�1e!►Zc»k �- � s»s»»»s»»»*» sae »s» »»»»»s»»»»»»»» �Irg4�"fig»»»» �st» s»»at»»»»»»»:t»W&k*�cs� 16 Plans Examiner Zoning Structural Review Clerk (Revised02/24/20241 AC R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/20/2016 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 CONTAM NAME: Automatic Data Processing Insurance Agency,Inc. a No Ext): ac,No: 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC P INSURERA: NorGUARD Insurance Company 31470 INSURED INSURER B: PARADISE EXTERIORS LLC INSURER C: 2118 CORPORATE DR Boynton Beach,FL 33426 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 437482 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 A013L SUM PO LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER M-POLICY EFF MWD Y EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 1:1 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PROJECT F-1LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ as i HIRED AUTOS AUTOS Per dem UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _:JEXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY 100'000 ANY PROPRIETOCERIMEMBER/PXCLUDE/EXECUTNE YIN N I A N PAWC671384 12/19/2015 12/19/2016 E.L.EACH ACCIDENT $ 100'000 A OFFI(Mandatory In N )EXCLUDED? E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is requi eM Job Reference:SCC131150472 windows and doors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 no 2nd ave Miami Shores,FL 33138 AUTHORED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD �a Miami Shores Village � EC Building Department FE zo�� 10050 N.E.2nd Avenue,Miami Shores.Florida 33138 Tel:(305)791 ry?04'Fax:(305)756.8972 By, INSPECTION'S PHONE NUMBER:(305)762.4949 FSC 2010 BUILDING Permit Na. _-__- PERMIT APPLICATION Master Permit No(S-(5-14 Q 1) Permit Type: R00FWG JOB ADDRESS: 1700 NE 105 ST #110 City: Miami Shares County: Miami Dade 3 Folin?Parcel#: 11-2230-050-0100 J is the Building Historically Designated: NO Flood Zonae: MARICAR LUIZ SANCHEZ OWNER.Name(Fez Simple Titleholder). Phonet!: Addr"s:1700 NE 105 ST #110 City_MIAMI SHORES State: FL Zip: 33138 `fenant/Lessce Name: Phonet+: Email: CON TRACTOR:Company Name: Paradise Exteriors,LLC Phone#: 561-732-0300 Address: 2118 Corporate Drive City: Boynton Beach State: FL Zip: 33436 QualificrName: Dan Beckner Phone#: State Certification or Registration#: SCC 131150472 Certificate of Competency t!: Cnntacl Phanel#: Email Address. Paradiseexteriorsllc@gmail.com DESIGNER: ArchitecbTagineer: Phone#: Value of Work for this Permit: S 8000.00 Sgnure/Linear Footage of Work: Type of Work: ❑Addition (Alteration ❑New ❑Repair,+Replace ODemolition Description of Wark: Install 5 Windows and 1 Door Color dint We.- Submittal ile:Submittal Fee S Permit Fee&D .03 . CCF$ CO/CC S Scanning Fee S Rndon Fee S DBPR S Bond$ Notary S TruininWEducadon Fee S Technology Fee$ Double Fee`',n Structural ReAew S --- TOTAL FEF NOW DUE$ Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's None(if applicable) Mortgage Lender's Address...-.--- city State 7jp ................. 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 ELECTRICAL WORK,PLUNIBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONER%,ETC..... OWNEHIS AFFIDAVIT: I certify that all the foregoing information is accum,re and that all work will be done in compliance%qth all applit>iblv laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMM'ENCEMENT TVIAY 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." Arotire to Applicant: As a condition to the issuance of a building permit ulth au estimated value exceeding$2500, the applic-mir wifst .propiltve in gold faith that a copy of the notice qj*convnencvnient and construction fien late bruchim, ivill be delivered to the person whose properti,is Subject to atlachnient. Also, a cora ffied copy of the recorded notice oftopunenuetuent inust be posted at the job site for the first Inspecdon which occurs stwon (7) days qjier the building pernift is imnefL In the absence oj'stich posted notice, the Inspection will not be approved and a relaspectionpe will be charged. 0 oozo S Signature ignature eat 0 r or gent Contractor �1 The foregoing instrument s acknowledged before nae this Tho forcei in edged before me this day of FEB 15,byM 4�to,,rT� day or by -0 who is meorwho,W�l alces W110 is -r.s 11V o O me or who has produced As identitkation and who did take an ontli, as identification and who did take an oath. NOTARY PUBLIC- NOTARY PUBLIC: Sign: sigtt. Print, JAMES HOWELL Print o �®1 ,1 n M, v Conirnismion Expires: 9-2 2-2 015 My COMMIS-41 p#rowwol 0,(COMW mbof%I APPROVED BY Plans Exp- aminer Zonin (9 P lip 1 Structural Review fkeviwd 3115/09](Xvvism71W/2007) X C11'NL1OMINIUNI ARARTNIEN!6 WORK REQUEST APPLICATION Owner's Name ('_�,�' �� SGf'Yl�� Unit (� I hereby request approval from the Board of Directors for the following modification or alteration to my unit that will be_ performed by a licensed contractor. Electrical work Plumbing work Carpet installation **Windows Tile installation Other work Description of the workr,,f1G, ,��► Before you decide to upgrade your apartment(other than paint or carpet)you must obtain permission from the Board of Directors and/or Miami Shores Village. A copy sof the plans, specifications and permits, and a description of the Iicensed work to '.be performed must be submitted for consideration and approval by the Miami Shores Village Building Department(305-795-2204). 1 • It is the owner's responsibility to ensure that the contractor removes all excess 0a"Y', f construction material or building debris. It cannot be placed in the dumpsters. (:*--'Window frames must be gray in color to Iook Iike aluminum. Windows must be Two (2) panels over Two (2) panels. Glass must be clear color. I, as the unit owner acknowledge responsibility for any damage to the building or personal injuries that may occur during the project. The Shores Condominium Inc. its officers and employees are in no way responsible for damage or theft to my apartment or my belongings. (A $200.00 deposit is required and will be refunded if no damage to the property is reported.) I fully understand and agree to the statements made above. ---J c) S Unit oer's si ature Date Approved by: Date: l5 � ���� � i � � 010%ra is E X T E R 1 O R S sc)s DeACf WINDOWS AND DOORS (� V' 2118 Corporate Drive,Boynton Beach, J a QfflCe 561 732.0340 Fax 1-86666-721721--55 3312 State Spedaihy License#SCC13115"72 CONTRACT AGREE To: ( Date: Street nM 10 +3& s + 1 t 0 EmSn: G2 cv. ` i t w�P cote X31��'' Is me: Ittadiso ETxtenas agrees to measttre,fo¢riish and install the following pmdnas for rim amoum stipulated bdow. All work m be completed m wwb m Mm am=wwrding w Florida code and standard V==& Paradise exteriors wM haul away all job Talmud debris. Pamdise bomiots in not responsible fm etnovmg or mphudmg my ftt=shmgs,or haaSaW on interior or exterior walls.Ow year hom free service on wank performed. All maaufactwa•wem bes covided at eo VIedon. #=�,,�r 30A Approval Nmded:�No WoJM tsube delayed due to HOA approval; —Cimtiid It.)'Vlras your home bunt before Y No GRID PATIBRN: Q ty IC Location size Calor OUtfft= 0 PATIO ROOD O saDTTERs iv Z i p x Onble 2 PART==(Moir 9aPlT�T�CASMa :.; .. indvw k40 )C C ' SIMING PATIO DOOR ❑eFOOT osFOOT DtoPDOT C12FOOT WIId *W b1ANUBACrMtE; VYIlVDOWS C R G E O ONS USOFTLITE t`HRPAV�L�4TFffiR XAClGSASS �20.�' TOTAL NUM8FROPWDWOWSONTHISORIMU 0 STLVE '� . }Y.0 COLOA`�LJ TOTAL NUbMSROFDOORSONTHIS ORDER: # STYIB��L'2 COLOR_-r/� NOTES h�- j2t,tA WOO BUYER'S RIGHT TO CANCEL. TWAL SALE PRICE,y s BUYER MAY CANCEL THIS CONTRACT BY DELIVERING WRITTEN 6 er 5601 t C9 7 j NancE TO THE SELLER ANY TIME PRIOR TO MIDNIGHT OF THE LESS txltYat PAYMENT THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. BUYER MAY USE THIS CONTRACT AS THAT NOTICE BY WRITING 9 PAYMENT AT CM 0MCB 9WT $ HEREBY CANCEL"AT THE BOTTOM AND ADDING BUYER'S NAME AND ADDRESS.THE NOTICE MUST BE DELIVERED TO THE SELLER FK4LBALANM AT THE ADDRESS SHOWN ABOVE Lbw mammm.aro+ooawm�onaoahacsrom.waaaaana�newaan®aJ An rnmr al is Guaranteed to be as specified. All work IS to be completed In a woA willko marm acccaxong te standard Plawces,rds onaNaw Is valid ontq with proper slgmums. Pam Ex sdm Shall no be held respw dble for time and materiel delays,sMkm aces of God or any other matters beyond its rn¢ud.Owner ngeea tbnt ft equity in Chia is sect>my for this mut e L Siam this met calls for mads m order goods.it is m subject m emad istim accept as smt�abam Sten it'stu ion� weeks)from above dam.Verbal inamlas am thadfom this ooaunat the omite cmda�aadmS of the putits su and discomts aQot co ttrawisa shall be biadng.unless signed by both p� BUctiors Is m remove and ball away au job rc debla la oad Thank you for your aTtternl X-1/->-f/zo x 404NA - 7 B17MSIGNATURE DATE tA�rt� RIMSMATIVE SIGNATURE DA CFN:20150112399 BOOK 29508 PAGE 4233 DATE:02/20/2015 01:38:46 PM HARVEY RUVIN,CLERK OF COURT, MIA-DADE CTY NOTICE OF COMMENCEMENT A RECORDED COPY NWST BE POSTED ON THE JOB SITE AT TIME OF RBST INSPECTION PERMIT NO. TAX FOLIO NO.11-2230-050-0100 STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that&nprovements will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,the following Information is provided in this Notice of Commencement. Space above reserved for use of reeorditg oftloe 1.L al description of prooerty and street/address: 1 OQ NE 105 51 1110,MIAMI SHORES.FL 33138 THE SHORES COMINIUM APT I 1 =TFLOOCLLE 124472 2.Description of improvement: Install 5 Windows and 1 Dnnr 3.Owner(s)name and address: AFIICARMEN&JOSE LUIZ SANCHEZ 1700 NE 105 ST #110,MIAMI SHORES,FL 33138 Interest in property: Name and address of fee simple titleholder. 4.Contractor's name,address and phone number, Drive-2118 Comorate Trac33436-561-732-030Q S.Surety:(Payment bond required by owner from contractor,if any) Name,address and phone number. Amount of bond$ S.Lender's name and address: 7.Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1Xa)7.,Florida Statutes, Name,address and phone number. 8.In addition to himself,Owners designates the following person(s)to receive a copy of the Lienors.Notice as provided In Section 713.130)(b),Florida Statutes. Name,address and phone number 9.Expiration date of this Notice of Commencement: Phe m0tatlon date Is 1 year from the date of morOne unlass a differant date is speolfico WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13.FLORIDA STATUTE#,AND CAN RESULT IN YOUR PAYING TWIOE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND.POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signatur f Own er(sy Authorized Officer/Director/Partner/Manager BYBYPrint N ARIRM &EN J SE LUIZ SANCH Print Name STATE OF FLORID. MARICARMEN&JOSE LUIZ SANCHEZ_ Title/Office COUNTY OF MIAMI-DADE The foree�g.oing Instrument was acknowledged before me this 5 day of FEB 2015 BY __=,AxChA-ALw Stet, -7 cost ,_,6Ae9471_ L7151vidually,or .>as for (personally known.or 0 produced the following type of Identifloa Signature of Notary Public: Print Name: JAMES HOWELL (SEAQ VERIFICATION PURSUANT .0 SECTION 92.m.FLORIDA STATUTES Under penalties of perjury,I declare that I have read the foregoing and that the facts stated in it are true,to the best of my knowledge and belief. Pu51:a state of Flonfla : jsn ees Howell Signatures)of Owner(s)or Owner(s)'s Authorized Officer/Director/Partner/Man D S e bCV ton EE13MI �o:c�° rr'¢es 1'2712015 By names uor C. Gi . . nn.� Miami shores Village Building Department 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. `�' 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 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 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: latCkUk5e— 6ACyi0f'S BUSINESS ADDRESS: l �q colf CITY�� �STATE R, ZIP 3 4-Zb BUSINESS PHONE: 5( (e [ j -7 32' 03CO FAX NUMBER(?���) �� — 5332 CELL PHONE( ) QUALIFIER'S NAME: G� 1eC-�Y1�N QUALIFIER'S LIC NUMBER: CC �z� ` 5 C)4- Z N D 0 � I ,1 I OOT)v fiew �r�SS E -17 DANIEL Vv SFC3323 A SR 3323 A SOUTH FEU ' EL 33435-8612 O gOYNTON BEACH p06 2-i96 fl124tGi.64A - F5Si1Ett "'' 22'2026 -23-2613 - 0 a STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 N0we 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 BECKNER, DANIEL WAYNE PARADISE EXTERIORS LLC 2118 CORPORATE DRIVE BOYNTON BEACH FL 33426 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range ;`y. STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFES;SIb AL'R GULATION Every day we work to improve the way we do business in order to SCC131150472 ISSUED :Q7/02/2014 serve you better. For information about our services,please log onto �_ -,_ www.myfloridalicense.com. There you can find more information CERTIFIED SPECIALTY CONTRACTOR about our divisions and the regulations that impact you,subscribe BECKNER, DANIEL WAYNE to department newsletters and learn more about the Department's PARADISE EXTERIORS LL.C initiatives. SPECIALTY St"! CTD., ;CONTRACTOR Our mission at the Department is: License Efficiently, Regulate Fairly. �� ',c r ed 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! Expiratio9 date:AUG 31,2016 L1407020001371 DETACH HERE _..._... . ............ .........._. ... - RICK SCOTT,GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATIONr CONSTRUCTION INDUSTRY LICENSING BOARD S13115047 STRUCTURE CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 0 0 BECKNER, DANIEL WAYNE PARADISE EXTERIORS LLC- 2118 LC 2118 CORPORATE DRIVE BOYNTON BEACH_ - FL 33426 ISSUED: 07/02/2014 DISPLAYAS REQUIRED BY LAW SEQ# L1407020001371 . I ANNE M. G AN N Q N P.O.Box 3353,West Palm Beach,FL 33402-3353 **LOCATED pT** CONSTITUTIONAL TAX COLLECTOR www.pbctax.com Tel:(561)355-2264 Serving Palm Beach County 2118 CORPORATE DR Serving you. BOYNTO BEACH, FL 33426 TYPE OF BUSINESS OWNER I CERTIFICATION# REQEIPT#/DATE PAID AMT PAID I BILL# 23-0157 CERTIFIED SPECIALTY CONTR BECKNER DANIEL WAYNE I SCC131150472 U14.608906-07108/14 $27.50 1 840192540 This document is valid only when receipted by the Tax Collector's Office. STATE OF FLORIDA PALM BEACH COUNTY 2014/2015 LOCALUSINESS TAX RECEIPT PARADISE EXTERIORS LLC LBTR Numbe 201364736 PARADISE EXTERIORS LLC EXPIRES: SE TEMBER 30, 2015 2118 CORPORATE DR BOYNTON BEACH,FL 33426 This receipt grants the privilege of engaging in or I I I managing any business profession or occupation within its jurisdiction aAd MUST be conspicuously displayed at the placeof business and In such a manner as to be open to the view of the public. ATE AC Ra CERTIFICATE OF LIABILITY INSURANCE D02/19/20 5 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 endomement(s). PRODUCER CONTACT Rivard Insurance Agency,Inc. NAME: Teresa HernandezPHONE FAX 1014 Gateway Blvd Suite107 E Mal Exti: (561)739-8346 ac No:(561)739-8360 Boynton Beach,FL 33426 ADDRESS: themandez@rivardinsurance.net License#:A221221 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Risk Placement Services Inc INSURED INSURER B: PARADISE EXTERIORS LLC DANIEL BECKNER INSURERC: 2118 CORPORATE DRIVE INSURERD: BOYNTON BEACH,FL 33426 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 173 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. ITR TYPE OF INSURANCE IVSD WVD SUER POLICY NUMBER MMfo EFF POLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY CA00002066801 01/28/2015 01/28/2016 EACH OCCURRENCE $ 1,000,000 INTED CLAIMS-MADE FIOCCUR PRAEM SES G ToEa occurrence $ 100,000 MED EXP(Any one Person) $ 5,000 PERSONAL 8 ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO- LOC PRODUCTS-COMP/OP AGG $ 2,0 0 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident A X UMBRELLA uAB �( OCCUR XOVA883515 01/28/2015 01/28/2016 EACH OCCURRENCE $ 2,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STAT IALITE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E.L.EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A BPP NNS03881 01/28/2015 01/28/2016 LIMIT 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) State License#SCC131150472 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES,FL 33138 AUTHORIZED REPRES ATIVE TRH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are regis ered marks of ACORD Printed by TRH on February 19,2015 at 05:14PM • �c R CERTIFICATE OF LIABILITY INSURANCE DAT2/1912015 1� / 02/19/2015 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 NAME: Automatic Data Processing Insurance Agency,Inc. a/c°No Ext): ac No: 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: PARADISE EXTERIORS LLC INSURER C: 2118 CORPORATE DR Boynton Beach,FL 33426 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 313664 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 TYPE OF INSURANCEADDLISUOR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE El OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEC LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY C MBINED SINGLE LIMIT $ Ea acddent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERd $ ent TY DAMAGE Pacci HIRED AUTOS AUTOS er UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ST YIN N ATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? N/A N PAWC561788 12119/2014 12/19/2015 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ Ryes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space is required) State License#SCC131150472 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village BLDG DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores,FL 33426 AUTHORIZED REPRESENTATIVE --�( l � A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD