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MC-17-2152Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Pei Permit Typed lechanicel .Rssidentia! Work'Cl kation ,A4 Uti Peri `',Status: on/Alteration APPROVED Parcel Number Expiration: 03/28/2018 Applicant 123 NE 97 Street Miami Shores, FL 33138-2332 Owner Information JUAN R. DEL RIO 1132060132440 Block: Lot: Address 123 NE 97 Street MIAMI SHORES FL 33138-2332 123 NE 97 Street MIAMI SHORES FL 33138-2332 Contractor(s) CENTRY AIR DESIGNS INC Phone 305-883-0121 CeII Phone JUAN R. DEL RIO Phone Valuation: Total Sq Feet: Cell $ 3,000.00 0 Tons: Additional Info: NEW NC INSTALL MINI SPLIT Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved:: In Review Type of Work: Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $2.00 $2.00 $0.60 $105.00 $3.00 $2.40 $116.80 Pay Date Pay Type Invoice # MC -8-17-64988 08/24/2017 Credit Card 09/29/2017 Check #: 849 Amt Paid Amt Due $ 50.00 $ 66.80 $ 66.80 $ 0.00 Available Inspections: Inspection Type: Final Rough Duct Review Mechanical Underground , 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. o Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy September 29, 2017 Date September 29, 2017 1 O BUILDING PERMIT APPLICATION ❑ BUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING ❑ PLUMBING 'MECHANICAL PUBLIC WORKS JOB ADDRESS: 1\.)� ` Tar r. TED /\U r9 z [u,17 BY • N FBC 201 Lf l 'Q Master Permit No. YN`--,C0 - n -V D Sub Permit No.— ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: r\►OW! Miami Dade Zip: 53\'`e3 / Folio/Parcel#: t 1 ?J 2. Ca COO 3 2.1'4 0 Is the Building Historically Designated: Yes NO `� Occupancy Type: Load: OWNER: Name (Fee Simple Titleholder): Address: City: Construction Type: Flood Zone: kW 134 q% S� BFE: FFE: Phone#: 2 0S ''ASy' 0'10 c1 State: cZip: k341 • Tenant/Lessee Name: Phone#: (30q)10 10G Phone#: Email: Z1/4'J(4i. cs,4%.0 Q uM . X111 CONTRACTOR: Company Name: 0 e.fl - «,gf Y -r)__5\ \ Address: —1k City: ..J\.` C./1\A. -_ State: V QA410 Qualifier Name: V1dLJe C 0 Zip:1.0 lG1 Phone#: L.7' OSI Ss8 �OZ2 State Certification or Registration #: C PNC..... 0'63 020 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 'o 0 Square/Linear Footage of Work: Type of Work: 111Addition ❑ Alteration E New Reopair/ReplaceLL n Demolition Description of Work: �`fVki .$ iO Q. C 11Jf'r ..L La Specify color of color thru tile: Submittal Fee $ Permit Fee $ ` t, CF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 6, 6 °° (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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature AIL) \JoAm OWN R or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 3% day of iJ(2%)an The foregoing instrument was acknowledged before me this , 20 Vt , by 2j day of (rj,0. , 20 , by 'Sw `` otk , who is personally known to �okpNCA,- \I@ , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: fls::tiiti,,. ARTURO ALFONSO :4 MY COMMISSION # GG 075921 www .•,$ EXPIRES: February 22, 2021 :'...`.R•.Bonded Thru Nob>ry Public Undenrt,ters— 12,4,- • .** ********************** NOTARY PUBLIC: Sign: Print:'D\)Qevik.o. t c(\ande i Seal: APPROVED BY (Revised02/24/2014) PI ns xaminer SUSANNE M.HERNANDEZ MAY COMMISSION *FF139986 EXPIRES: JUL 08, 2018 Bonded through 1st Sta*te Innra pi *** * Zoning Structural Review Clerk STATE. t-. E J' LO t h L1'A DRPARTPIIENT OF BUSINESS AND PROFESSIONAL REGULATION I<ON y°' CONSTRUCTION INDUSTRY LICENSING BOARD 2601 BLA!R STONE ROAD TALLAHASSEE FL 32399-0783 VENTO. ROBERT CENTRY AIR DESIGNS INC 501 WREN AVE MIAMI SPRINGS FL 33166 uiations With this license you become one ofthe-neatiy Line million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque .-esteurants, and they keep Florida's ecur+o+a y strong. Even/ day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloricla}icense.corn. There you can find more information about our divisions and the regulations that impact •$cu, subscribe to department newsletters and learn more about Department's initiatives. mission at the Department is: License Efficiently, Regulate VVe constantly strive to serve you better so that you can serve your customers. -fhank you for doing business in Florida, and congratulations on your new license! (850) 45-/-1365 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND r ...ir IGI\IAL REGULATION CAC033620 tSSUED: 08/31/2016 CERTIFIED AIR GOND CONTR VENTO, ROBERT CENTRY AIR. DESIGNS INC (S GE.RTUF:EO undo tho p:ovisior.s of Ch.4as FS. Expiration date • AUG 31. 2018 L1608310001121 DETACH HERE ocM [wetness EK Receipt Miami -Dade County, State of F[orida -THIS IS NOTA BILL - DO NOT PAY 1428150 GUStfNESS NAME/LOCATION CENTRY AIR DESIGNS INC 501 WREN AVE MIAMI SPRINGS FL 33166 OINWER GENTRY AIR DESIGNS INC worker(s) RECEIPT NO. R2k 1EU AL 1428150 F [IRES 7 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 sEr.. T VPt. OF rir,6Cth F 196 SPEC MECHANICAL CONTRACTOR CAC033620 PAYMENT 14ECEIVt:D TAX coux.cTor. 5;49.50 10/25/2016 CREDITCARD-17-001980 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, pest, or a cer'df aatiea of the holders gtofi .caticn , to do I azincs. fielder most ca mpty with any geve mental or numgovernmentel regulatory laws and requisem+ents which apply to the husiness. The RECEIPT NO. above mug be displayed on alt cane erctat vehicles - Mimi -Dade Code Sec 8a-276. For more information, visit www.miamidade.o tancolhector AWRr. CERTIFICATE OF LIABILITY INSURANCE r r;ATE O/A/ CP/Yr/1 dt3d2311,7 THIS, CERTIFICATE' IS ISSUED ASA lMA11 ER OF INFORMATION ONLY AND ,CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY ORNEGATIVELY AMEND,, EXTENDOR 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 pollcy(ies) must be endorsed. If SUBROGATION 1S WAIVED, subject to the terms and condlfions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the cerci tca3e hol er in lieu of satctt endorserment:is). PROD Aff Insurance Services 1548 W. 37 St. Hialeah, FL 33012 .Phone (305) 822-4472 INSURED GENTRY AIR DESIGNS, INC 501 Wren Ave •Fax (305) 556-4354 Miami Spring R 331'66 (30'5)48$.3-0121 LONTACT NAM gr4305) 822-472 ,AD i S: jfemnandezCaz isrv:cem FAX 4305) 556-4354-1 4 INSURER B : INSURER($) AFFORDINGOOVERAGE ,., U ER A: GRANADA INSURANCE COMPANY NAIC:# INSURER C : INSURER D : INSURER.E.: INSURER F : CCNERAGES CERTIFICATE NUMEKFt REVISIONr. : THIS IS TO CERTIFY THAT THE POLICIES, OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPOLICY 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 AFFORDEDBY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE EXCLUSIONS AND CONDITIONS OF SUCH POUCIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE INSR D POUCY NUMBER (il M DD/YYFYY) (MMMIID EXP ILTR D/ ) UNC INSR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 I DAMAGE TO RENTED 100;000.00 iyf l COMMERCIAL'GENERAL LIABILITY PREMISES i(Ea occurrence) $ . CLAIMS -MADE r OCCUR NED EXP (Any one pen $ 5,000.00 ,r 0185f1000i7351-0 12/0W2D1S ?2408:2017 A TIERS/MAL 6 A DV11NJIIRY S ll+altYUD-420 .GENERAL AGGREGATE $ 2;600;000:00 ii GEN'L AGGREGATE 'LIMIT APPLIES: PER: POLICY PRO a LOC PRODUCTS - COMP/OP AGG $ 2;000;000.00 $ AUTOMOBILE LIASIUTY I 1 ANY AUTO ALL OWNED pi SCHEDULED AUTOS AVMS 7-1 NON-OWMED HIRED ALTOS AUTOS UMBRELLA um/'` 1 OCCUR' ' EXCESS UAB _. CLAIMS -MADE DED RETENTIONS WORKERS COMPENSATION I AND EMPLOYERS' LIABILRY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? r—, N / A (Mandatory in NH) Ifiyes. idesceee ander t DESCRIPTIO OF OPERATIONS be ow —t_ 1 (Ea acddent)SINGLE UMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGERae accident): $. '$ EACH OCCURRENCE AGGREGATE 7 WCSTATU— 0TH-' TQRY LIMIT -S f.- ER 1 $ $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ EA -DISEASE -:POLtCY19MIT 5 ) ) DESCRIPTION OF OPERAIBIONS ELOCATIONS /VEHICLES ,(Attach ACORD 441, AddttlaaaMestmks SakedaIe,,PRmOJO spacads%req/ Lred) LICENSE # CAC033620 CERTIFICA,TE HOLDER MIAMI SHORES VILLAGE 10050 NE 2nd AVE MIAMI SHORES, FL 33138 ACORD 25 (2040105)'QF CANCELLATION SHOULD ANY OF THE ABOVE DESCR18Ea POLICIESBE CANCELLEDLBEFORE THE EXPIRATION DATE THEREOF, ISIOT'ICE WILL BE DELIVERED IN L ACCORDANCE WITH THE POLICY PROVISIONS. NS. AUTHORIZED REPRESENTATIVE 0 1986,284f1.ACORD CORPORATION. At Nights aes4erved. The AOORDsnarne end logo are registered.marks of AOORD JEFF ATWATER CHIEF FINANICAL 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 Flonda Workers' Compensation law EFFECTIVE DATE: 312512047 PERSON: VENTO FEIN: 592476911 BUSINESS NAME AND ADDRESS: GENTRY AIR DESIGNS INC 501 WREN AVENUE MIAMI SPRINGS FL 33166 SCOPE OF BUSINESS OR TRADE: Lammed Gnat Comovro Hear vertlabon oe- Came1lonaq and Redtgerahon Sitttents 11,0311,0,nn ad Revs+ Strap Yard EXPIRATION DATE: 3125/2019 ROBERT 1MPtORTANT Pursuant to Chapter 440 051141 F S . aef macer of a corponocm who elects exertion from Una chapter by hang a Ofilttcre Weed= tater Pus secton may not revere, Ca mee% or compensation under this chapter Forward to Chapter 440 051 nal F s Certificates ot erection to be exesrist aepiY only mean the scope of the business et trade tasted on the notice of election to be exempt Pursuant to Chapter 440 05113t F 5 Wears of eietmn to be exempt and ceGfeates of eiectwn to be exempt shall be subplot to revocation a al any tame atter the filing d the nom of the Lasttane a 61 fie certtteate the person named on Ute note or certficale no brger meets Ute reaSaremerts of thLs semen tar issuance at a cerVi0tale The department shalt revoke a eentttsa3 m any tans tor ,Wane of the person named en ttte bettt rad to meet the requirements at ens seamen _DFS-F2-DWC-252-CERTIFICATE_OF_ ELECTION_T_O-BE EXEMPT REVISED 08-13 _QUESTIONS', (850;413.1609 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE VAN or+LOM! Berrumum OP [4[.0,11 61111101E11 01=160111 01ilsootnitS CONPeOW.O. Ceee111J11l011 =UST, 1 mrmun a reteru®1 PO sc®0 na FLEWS Lwras 03111.11111111,11 nrtirwt tare cars^ r FyMAnaa n►r. 0av o+0 1[1,11 44,11W11 lS.004/ ': Mit AeDA(LLai'.•s T.!4Tu�.et :4”fAr, rM 90, YlnLn Arriie OMYI Sf.-/NES WW1 lie 11,30•[11) OR MOM a� .a Lawamomp 0. Was -- rn ID li E R E IMPORTANT Pvr.00 a GT;b 444 CH414, 1 S an ata of • e.FPvYvi .eo ab Ys w6^6../onria Cftwolerb Pam. eaMlare ar eletscr ^raer en reams mei r.r. =,. CO se srex, 11,01P VMS ~CO Knurl to Owes KO VA 1?+ e 9 Cer0cerea 0 0.30x+1 to Ee exunt.e 0 ser .eve, est save e+en b.emeil a max tares or, ae mica c+ Maw to be moms [risme m 0111:1e 45!13, r, teems m nem, m se exmst are sputa aree:sof'b se OW be .0,, 4 MAX..., t eN.4 i!4^r O! 0013oft2^nonce a the 4.*u.r 4 eve c>F01(.re 00 L1Ls.as' r»rma (n e.ar MIKA 9t 2MiJle 9hone. 610O ap .4...e einft ® elf 1l4L7, 41 airYn® (0. BereeB01 fele R[!a7'ere QW moat ce,ttle a@ m erq. bee for e0e,rt Q tha proFT mimed 01711 d'tiffi eD ram Se oo*0 e,0 Ca e0 .e"ctem OFS-F2-D -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS', (8501413-1609 Ce_tryAir Designs: 7155 NW 53 Ter Miaimf, FL 33166 (305) 458-5022 Date -August 28, 2017 State of Florida County of IVliami Dade Berme rne this day personaffy appeared Robert Vento who, being dtifr sworn, deposes and says: That he or she wiffbe the only person working on the project locatetat 123 NE 97 St, Wank Shores, Ft 33238. Contractor"Signature Sworn to (or affirmedt and subscribed amore met is 29' Day of ikugust, 2037, `try "Ro' ed?t Vento. Personally Kraoex: X SUSANNE M. HERNANDEZ MY COMMISSIONFF139988 EXPIRES: JUL 08.2018 Bonded throw 1at State I r abut\6,0Q -A\3 Susanne Hernandez Print, Type or Stamp Name of Notary s Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation 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: (74—wner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of Ssucj , 20 Cl By ` PN,.0 who is personally known to me or has produced Qas identification. SUSNot ?°4.;rod°Gn ply��NN r #FF139986 rXP -! ` 8 2018 SEAL: "" Bowe! • `nsuFancs