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EL-16-1712 �s y� Miami Shores Village P6 1� E� �� esidentla( 10050 N.E.2nd Avenue NE 'sun ff— er pf }{� Qtl Miami Shores,FL 33138-0000 P81rttJl Staff Al�P _ Miami Shores Village c� -tTIV 75 Building Department JUN 2 0 NIS 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BYs � Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 sA-L-,, FBC 20N BUILDING Master Permit No. -- 1049 PERMIT APPL CATION Sub Permit No. d(0 — t 7 i z ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP � \\ CONTRACTOR DRAWINGS JOB ADDRESS: ODS ��/ 'T I4�V.er1Vw IGS L[/Nf tqODS City: Miami Shores Countv: Miami Dade Zia: 33138 Folio/Parcel#: 1132. 0(0 0+ 1100.3 0 Is the Building Historically Designated:Yes NO Occupancy Type:�_Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): C.hn5+D I\PX C.UX"-h- v &. 6164 one#: 3Qs- 1;S• /_1 S Address: 3410, Pierce- `J-. City: State: Ir�. Zip: 33 0A I 4 Tenant/Lessee Nle: n nq pzftz- Phone#: &4(e-"0--67814 Email: CONTRACTOR:Company Name: I'll �-G Phone#: T94- ip%3'86 Address: "IAtl� qV W1(1.1'Cl.f*'' 6 l w 61 V',�. City: �,( /,n t,[ State: Zip: 3317X Qualifier Name: Z Phone#: 7216 &83-25310 State Certification or Registration#: N Certificate of Competency#: DESIGNER:Architect/Engineer: , T�. Phone#: ���P' • �O !��- Address: J�� �(N `710 It VP�f1 L)2 City: t>&AAA t P State:��• Zip: �3. 32 Value of Work for this Permit:$ 1! ®o Square/Linear Footage of Work: (PO Type of Work: ❑ Addition ❑ Alteration ❑ New M Repair/Replace ❑ Demolition] Description of Work: %&4MG e :o; Specify co/dr roft' or thrtl'tile• Submittal Fee$ :e Permit Fie$ ���i®� CCF$ C$ Scanning Fee$ 1 0z Radon Fee$ DBPR$ —Notary$_ Technology Fee$ Training/Education Fee$ Double Fee$ I d Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) t Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City state Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. -IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first-inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OW ER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of �! (J/�L'. 20 /4 ,by tqq day of -J C_ 20 / 6, , by C,Gj,��sTo hey Cu.P�/S ,who is personally known to 10 D�iP/GI Z.who is personally known to me or who has produced> C632-10V-75:-z1/7—bas me or who has produced as identification and who did take an oath. identification and who did take an oath. NOT a N TA Sign• SIg �1 Print T Print Seal: Seal: dose Ae10enro Ferment _ _Jose A09016 Ferment 1� ;,I CO�IbNSSI�IIIm8ft � ran�asssloal ��ls EXPIRES.Ocobm t,X18 t *rw***��*sir*��x�x�****:***�r**+e* ***�N90'�i�P: *�***�*:****r��► APPROVED BYPlans Examiner Zoning Structural Review Clerk (Revised02/24/2014) QB Co�ction Traties QuaTifV"Bowd —BUSINESS CERTIFICATE OF COMPETENCY j 12E000265 M &C ELECTRICAL INC ROD GUEZ ROBERTO i-[fade�� Is cergW under the Provisions of Chapter 10 of Mram STATE OF FLORIDA p€PARTIIII NT OF BUSIM-SS AND PROFESSIONAL REGULATION EL_CTRICAL CQN'[RACTORS LICENSING BOARD ' r f The ALARM-SYSTRM CONTRACTOR t Named below.HAS REGISTERED Under the provisions of Chapter 41311 Ecpiraiaon deter AUG 31 20 ,6- ., (INDIVIDUA-MUST Ml E—TALL1t00AL LICENSING REQUIREMENTS-PRIOR TO 0M,TRACTING IN ANY AREA) ato RODRIGUEZ, ROBE— r M$�C.€LECTRI' AL U�1C .. G 9�5t1 FONTAIN EAD.>'L D A T MIAMI usi IWVIW .r90Z 1dv.(JK1� nt I93NMt35Zf � 'n (t13W ANd NI 6ki . 1N©0..01901114 S1N3W3211(10321 ONISN3Oil-Ib' Ol'11V13 1.Snw'idnutAtaNj 9I:(IZ tt-V_:a;ep uollt�%dx3 surnsJAcdd atu japun D3i<# LSI tH ►p1aci p"BN 2101OKt#l,NO3 94j- C 02110/08 JNISN31311 S 10# ►21J.1 O'�1.'IKOIN:1.03- y NOLi11-in931�'1�►NoisS330Sd 0NV SS3NISn8 30 IN3lAli dd311 tfa11d01:1-30 31VIS L OFFICE STA CHHEF F6 OF FINANCIAL SERVICES DIVISION OF WORKERS!60MPENSATION TION LAW" � ..CERTIFICATE OF ELECTION TO Be EXEMPT FROM FLORIDA WORKERS'COMPENSA CONSTRUCTION INDUSTRY EXEMPTICIN m be exempt from Florida Workers'Ci n lawn. This certifies that the individual fisted below Inas elected EFFECTIVE DAIS: 3AM16 EXPIRATION DATE: 31WO18 SR ROBERTO PERSON: RODRISUIZ FEIN; 455238895 BUSINESS NAME AND ADDRESS: M&C ELECTRICAL-INC 9250 FONTAINEBLEAU BLVD APT 205 MIAMI FL 33172 SCOPES OF BUSINESS OR TRADE: CCONENTRAED C ORGTRICAL PLmM1Wty 44oL1r14),F.S.MOM= Fa themChele�toba�'aMVfiwC-(�`j'�n"MtrF�6a �1�F.a �a � tieesmPa huclue mynaimmmbeneMw �OadvO beail [flvarB,ataY a 8e�9 eta Th. for ��eYdea dtabadeBd3dsa+lWn for IhePemnnern�m8+e ndiaear ama� � CiuinaTjotw(a5D)413.1609 DFgP2-DW1252 CERT11CATE of O.EcTtoNTo BE SOMPT RE40M 08-13 006237 Local Business Tax Receipt Miami-Dade County, State of--Florida THIS IS NOTA BILL - DO NOT PAY 7016074 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES 2016 M&cE�EcrwcAl INC RENWAL SEPTEMBER 30, 7291891 Must be displayed at place of business 9250 FONTAINEBLEAU BLVD 205 Pursuant to County Code MIAMI FL 33172 Chapter SA-Art.9&10 SEC.TYPE OF BUSINESS PAYMENT RECEIVED OWNER 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR M&C ELECTRICAL INC 12E000255 $75.00 07/09/2015 Worker(s) I CHECK21-15-083516 This Local Bceicess Tax;Receipt only confirms p V wa ct the Local Badness Tax.The Receipt is not as"c I ssqq Holder most comply with any g permit,or a cer10i�6 ry�oauv�srand rreelquui �Which ab appl *a bastiNss. at nongoverm reg all commercial vehicles-Miami-Dade Code Sec 8a-27& The RECEIPT N0.above must he displayed oa For more Informetioa visit 's min—'W 'c -letter I ' " 1 OP ID:JS CERTIFICATE OF LIABILITY INSURANCE m ums TTIIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO INGFRB UPON E HO,DER.THUS CERTIFICATE DOES NOT AFFIRMATIV RLY OR NEGATM&Y AMEND, EXTEND OR ALTER 711E COVERAGE AFFORDED BY THE POLICIES t BELOW THIS CERTIFICATE OF INSURANCE DOHS NOT CONSTITVM A CONTRACT BEYYWEN THE ISSUING INSURER(S),AUMMIZED I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: N the ce=tlNoate holder Is an ADDITIONAL INSURED,the poltcy(ies)must be end. U SUBROGATION 18 WANED,Gutted to the tw al ural conditions of the pofky,eertaM Poffctes may mqulm an a ndomament A stent on this willicale does not coater FWAs to the certificate folder M Rau s PaoarceR 'Tropical InsummeA IIn— jMfami.FL 3174Wastillatif3t Conde Lageyre ' MB�CEL.EC M8 C Etetstrit:ai lito HMO 9250 Fontainebleau Bivt,SMA: Instl�encs compeer . . . 1 A UML FL 33172 s' -•-- ._ ._...._-_-. COVERAGESgaMFICATE NU : I I+IS IS TO C ERM THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN iss"TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANOilfK3 ANY REOUGiE1HENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHM THIS CER rIFICATE MAY BE ISSUED OR MAY PEWTAK THE INSLIRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SIM POLICIES.LOUTS SHOWN MAY HAVE BEEN REDUCED BY PAD CAM 1rPeOFa ._.. oma.uaelun �10C s 1,� I A X co.mmERm mm&L num I 0185FL0883UH 08H6�418�41915r=7 �ae , s moo CIAlAIB AAADE X i j ' etED°cP(Nfj'°'mp"'ea') ter+A6 Og1@Ld�iRAPALIESPER i tt �Paaoltcrs-COMPAW �. POLFLY AUTDNOMLI ARM j t f DS8�1E1aCT i i AWAUTO "OWNWMIT05 I I 1 BODIIYHiAlAYIPe►P U i BO1YaIJURYtPereootder6y i SCNEDLA.EO1tl7TOi 11 -•.. . ... .... f � j jlYOWMAe6 uvs u►uae IOGM ! HO a gXC�L� - j _ . DeDItcTM.e + WORRY ccup8mim I yri F.LFJ4CnACl�D1DIr i ozrLexcwMM nra E ----•►---- ( r!'In� i i ELOI�ASE-FAOYf� i { EL DLRGIISE- I.UYNT -DESCHMMOFOPIRATIMILOCA1 1 ACM 16I.AdBMW ftmuftG w*ftlfineaIoelsmkoeCq 1£T80MC.AL CONTRACTORS 1i 002SS CEIMMPAZ H AAmSIf SHOULD ANY OF THEABOYE DESCRIBED POLK=BE CANCELM BEFORE THE EXPIRATION DATE THEREOF. NOTICE VVILL BE 0HJVERED IN nagli Shores NilMg®BLDG Dept ACCORDANCE WITH UM POLICY PRCWWuM 10060 WE 2nd avenue AVRWRMFAMMOVIAME Miami Shores,FL 33138 Cwft Lag"Te .M.~ C0IMMIX)ACORD CORPORATION. Ail dgft rew nd. ACORD 26(2C MUM The ACORD name and bgo are fired nwb of ACORD MSG F��tt�rt�t. I� 9250 Fountainebleu Blvd Apt 205 Miami, FI 33172 April 10, 2015 State of Florida County of Miami Dade Before me this day personally appeared Roberto Rodriguez who, being sworn, deposes and says: That he or she will the only person working on the project located at: 9005 NE 4 Avenue, Unit#9005 Miami Shores, FL 33138 Swom to (or afflrmed) d subscribed before me this 10 day of April 2016 by Roberto Rodriguez X Personally know Produced Identification Type of Identification Produced Jose Antes Forment _� �s CJkUdIISSfQh#X165002 WIRES:NoW 1,2018 WWW.AARONNUARY.L M Print,Type or Stamp Name of Notary i 1.93 Miami Shores Village -=Bull " Building Department 10050 N.E.2nd Avenue �L0R1DP► 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 l. 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: (bfier State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of "0 ,20 By who is personally known tom or has produced 7 S- —D as identification. Nota -D . SEAL: J1 U0 Aft Foant 57 �« a►� Q��1�ItSS1QN/R1is0� MIW*AAWft1AftW