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FW-17-2230Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 332 NE 92 Street Miami Shores, FL Owner Information Permit Permit NO. FW -9-17-2330 Permit Type: FencelWall Work Classification: Iron/Ornamental Permit Status: APPROVED Issue Date: 10/10/2017 Expiration: 04/08/2018 Parcel Number Applicant Address 1132060136460 Block: Lot: JEAN MARIE & MARILYN PARE Phone Cell JEAN MARIE & MARILYN PAREL JEAN 332 NE 92 ST -- - - - - -- • - •• • - -- MIAMI SHORES FL 33138-3134 (305)776-0616 Contractor(s) AUTHENTIC METALS LLC Phone CeII Phone (786)409-4327 (305)525-2761 Valuation: Total Sq Feet: Approved: Comments: Date Approved: : Date Denied: Type of Construction: Other Classification: Residential Additional Info: GALVANIZED FENCE AND GATE PA Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Wire & Wood Scanning Fee Technology Fee Total: Amount $2.40 $2 00 $2.00 $0.80 $100.00 $9.00 $3.20 $119.40 Pay Date Pay Type Amt Paid Amt Due Invoice # FW -9-17-65185 10/10/2017 Check #: 1020 $ 119.40 $ 0.00 Available Inspections: Inspection Type: Final Foundation Review Planning Review Building Review Building 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 const�7uetion an51 z: i . , Futhermore, uthorize the above-named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy October 10, 2017 Date October 10, 2017 1 BUILDING PERMIT APPLICATION 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 C_,=1 r L. p28t01? FBC2014 Master Permit No.' I -2330 Sub Permit No. 0BUILDING 0 ELECTRIC 0 ROOFING 0 REVISION 0 EXTENSION El RENEWAL ❑PLUMBING 0 MECHANICAL 0PUBLIC WORKS CHANGE OF 0 CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 332- M i I Z. i City: Miami Shores County: Miami Dade Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: /\' Load: Construction Type: Flood Zone: BFE: FFE: Zip: 33 3, OWNER: Name (Fee Simple Titleholder): 444,( /l / /tea/rE'C._ Address: 33 Z- N 2-- 5 -1-- City: \r(\ r• A-4 S State: Tenant/Lessee Name: Email: mi"senq'--e)t-1i CAvv) Phone#:.2US - 7-127— zip: Zip: '3 ). 3 7 11 Phone#: CONTRACTOR: Company Name: V 1 ,4L 1) 1 C- Vv\ - Address: rhas \ T '3 LLQ Phone#: -0-4 d9 `i 3z City: ---V-i -r\- State: F_— Zip: 3 3(5 1 2. Qualifier Name: b.N . Cab -S Phone#: -3c 5 " 5Z3 "-Z State Certification or Registration #: I -13 0O351,0 Certificate of Competency #: 12.g 5 0 6 3 5122 DESIGNER: Architect/Engineer: Phone#: Address: Value of Work for this Permit: $ *"*e`°cf D D O� pa .� y, ^...A.'1, 1 .� .t,_41 ri Typetof Work: ❑ A'ddition's E" ite1ation Description of 1Xlork:'' (il"mac:'( ljQ`/U/ % EP) City: State: Zip: ./. • ,.-- %,..- . •'\, -.:..0., , o.. *y „ . ,: 0.. r s I Square/Linear Footage of Work:-. .Ab ' New /'e i7Ce PAi Nrt fotA r IL r % „ ; t' Repair/Replacesk ❑l,Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ (06 Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ I -p2 DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I l + 14.) 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 he absenc of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature ., .4-1_._,,_ Signature OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing instrument w s acknowledged before me this day of G. Ct �Qtt, � 20 %) by .3- 1 day of,,243- Xi , 20 i 7 , by f who is personally known to 6^ CU I v1/�a �aJ� p Y me or who has pro9uced-d- 47# P( y -S ya - as me or who has produced identification an • _ -CI identification and who did take an oath. P(o20 - 3b_(gS- d k4r-D CONTRACTOR y� G , who is personally known to as NOTARY PUBLI NOTARY PUBLIC: Sign: Print: Seal: &-- \ 4/ .� //2OZ 0 ................................ .... . ................................................................. APPROVED BY (Revised02/24/2014) 11 Plans Examiner Structural Review Zoning Clerk Miami Shores Village Building Department CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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 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: A(.5 1 0> -Fl C --- BUSINESS BUSINESS ADDRESS: 1 S— Wt 3) PL CITY �1 )-V STATE ZIPT330J 2, BUSINESS PHONE: ( ) C9 - 432 FAX NUMBER ( ) CELL PHONE ( 305) Z i QUALIFIER'S NAME: .,Uva Q O la QUALIFIER'S LIC NUMBER: t1 -C114 O O 3 SZo CT B Construction Trades �oall n . BUSINESS CERTIFICATE OF COMPETENCY 12BS00356 AUTHENTIC METALS LLC D. B.A.: PORRAS JUAN R Is certified under the provisions of Chapter 10 of Miami-Dade.County+ Miami -Dade County - Building and neighborhood Compliance Office Page 1 of 1 Horne Product Control I Contractors Building Officials I Contact us Contractor Number: Contractor name: Address: City, St, Zip: Phone: Other Phone: Fax: Email: D/B/A: Contractor Status: Contractor License Information 12BS00356 AUTHENTIC METALS LLC 54 NORTHWEST DRIVE MIAMI (305) 261-6419 AUTHENTICMETALS@YAHOO.COM ACTIVE FL 33126 Class Category Category Description Expiration Date BLDG 35 ORNAMENTAL IRON 09/30/2018 BLDG 49 METAL GUTTER/DWNS 09/30/2018 CONTRACTOR INQUIRY COMPLETE BCCO Contractor Inquiry and Complaint Search 1 BCCO Home Pane 1 State License Search Menu 0 Home 1 About 1 Phone Directory 1 Privacy 1 Disclaimer © 2001 Miami -Dade County. All rights reserved. http://egvsys.miamidade.gov:1608/W W WSERV/ggvt/BNZAW941.DIA?CNTR=12BS003... 9/28/2017 001006 -Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6817226 BUSINESS NAME/LOCATION AUTHENTIC METALS LLC OPERATING IN DADE COUNTY OWNER AUTHENTIC METALS LLC Worker(s) 1 L RECEIPT NO. RENEWAL 7445555 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED 12BS00356 BY TAX COLLECTOR $82.50 10/27/2016 CREDITCARD-17-002206 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The!.ICEIPT NO. above must be displayed on all commercial vehicles- Miami -Dade Code Sec 8a-276. For more information, visityvww.miamidade.gov/taxcollector 000700 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6817226 BUSINESS NAME/LOCATION AUTHENTIC METALS LLC OPERATING IN DADE COUNTY RECEIPT NO. RENEWAL 6612866 OWNER SEC. TYPE OF BUSINESS AUTHENTIC METALS LLC 213 SERVICE BUSINESS Employee(s) 1 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $82.50 10/27/2016 CREDITCARD-17-002206 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For more information, visit www.miamidade.gov/taxcollector '4 IY CERTIFICATE OF LIABILITY INSURANCE DATE(MW201 ) 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 POUCIES 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(ies) must have ADDITIONAL INSURED provisions or 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 Pandora Insurance 3520 West 18th Ave Suite 155 Hialeah, FL 33012 Phone (305) 231-9898 Fax (305) 675-8034 CONTACT Jacqueline Lamas NAME: PHONEAX an(305) 231-9898 rac, No): (305) 675-8034 AD AIL Jacqui@pandorainsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Covington Specialty Insurance Co. N INSURED AUTHENTIC METALS LLC 1745 W. 31st PL Hialeah, FL 33012 INSURER B : 11/21/2016 INSURER C : EACH OCCURRENCE INSURER D : ❑ CLAIMS -MADE d OCCUR n $500 BI/PD Ded. INSURER E : $ 100,000 INSURER F : $ 5,000 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 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 LTR TYPE OF INSURANCE ADDLSUBR INSR 4WD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A n COMMERCIAL GENERAL LIABILITY N N VBA502456-00 11/21/2016 11/21/2017 EACH OCCURRENCE $ 1,000,000 ❑ CLAIMS -MADE d OCCUR n $500 BI/PD Ded. DAMAGE TO PREMISES (EaENTED occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 ❑ PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: RO JECT LOC ❑ POLICY ❑ PRO- JECT ❑ OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ❑ ANY AUTO OWNED ❑ SCHEDAUTOS ❑ AUTOS ONLY HIRED ❑ NON -OWNED ❑ AUTOS ONLY AUTOS ONLY ❑ ❑ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N / A IN PER STATUTE m OT ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Metal Work. Contractor Coverage Extension Endorsement- Blanket Additional Insured - Owners, Lessees, or Contractors; Primary and NonContributory ; Blanket Waiver of Transfer of Rights of Recovery Against Others To Us. CERTIFICATE HOLDER CANCELLATION I MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) QF ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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: 2/8/2016 EXPIRATION DATE: 2/7/2018 PERSON: PORRAS JUAN R FEIN: 452042286 BUSINESS NAME AND ADDRESS: AUTHENTIC METALS LLC 54 NORTH WEST DRIVE MIAMI FL 33126 SCOPES OF BUSINESS OR TRADE: WELDING OR CUTTING IRON OR STEEL: SHEET METAL WORK - FENCE INSTALLATION NOC AND DRI ERECTION FRAME INSTALLATIO AND REPAIR - Pursuant to Chapter 440.05(14), F.S.. an officer of a corporation who elects exemption from this chapter by firing 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 10 be exempt shall be subject to revocation if, at any time after the Ming 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 confiscate. The department shall revoke a DFS -F2 -DW -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 • AUTHENTIC METALS LLC Date: State of County of -� Before me this day personally appeared duly sworn That he or she will be the only person working on the project locate at: 332- m 9.Z ST VA. l -r 514005 f 3 3 / who,being Contr ctor Signa Sworn to or affirmed) and subscribed before me this day of h -120 ± ) by triCin itrraS Personally Know Or Produced Identification K. Type of identification Produced Pb2 0 ..1,3()-CaS ©gr -0 Print,Type or stamp name of Notary Miami Shores Village Building Department 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade The foregoing was ack je before me this .97 day of ,20 who is personally known to me or has produced as identification.