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MC-17-702Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 77 NE 95 Street Miami Shores, FL Permit NO. MC -3-17-702 Permit Type: Mechanical - Residential ' Work Classification: A/C Replacement Permit Status: APPROVED Issue Date: 4/3/2017 Expiration: 09/30/2017 Parcel Number 1132060130720 Block: Lot: Applicant PABLO NUTA Owner Information Address 77 NE 95 Street MIAMI SHORES FL 33138-2706 77 NE 95 Street MIAMI SHORES FL 33138-2706 Phone Cell Contractor(s) Phone GARP CONSTRUCTION GROUP INC (305)506-5068 CeII Phone Valuation: Total Sq Feet: $ 4,000.00 0 Tons: Additional Info: REPLACE A/C UNIT 5 TON Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved:: In Review Type of Work: REPLACE A/C UNIT 5 TON Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee Scanning Fee Technology Fee Work without Permit Fee Total: Amount $2.40 $2.10 $2.10 $0.80 $5.00 $140.00 $3.00 $3.20 $140.00 $298.60 Pay Date Pay Type Invoice # MC -3-17-63323 04/03/2017 Check #: 187 03/16/2017 Check #: 992 Amt Paid Amt Due $ 248.60 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 1 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. April 03, 2017 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date April 03, 2017 1 BUILDING PERMIT APPLICATION ❑ BUILDING ELECTRIC ❑ ROOFING ❑ REVISION PLUMBING S•MECHANICAL\ ❑PUBLIC WORKS ❑ CHANGE OF CONTRACTOR 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 Master Permit No. Sub Permit No. JOB ADDRESS: `i N g C SC-' City: Miami Shores County: Miami Dade 31 3a Folio/Parcel#: 1k-- 320Q - O 3— 0/W Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: .0 E \JE MARI5 2017 BY Fsczoi4 6*" SCI(, -3366 Mc (1-70z ❑ EXTENSION ❑RENEWAL 0 CANCELLATION 0 SHOP DRAWINGS Zip: OWNER: Name (Fee Simple Titleholder): P431o. vr4k Address: 4-1- NE (4`14.1 4 -Nr BFE: FFE: Phone#: ?f�� 2(Z (733 City: Mk Q tw► Sko47-1 State: Zip: 3313, Tenant/Lessee Name: Phone#: Email: kip +Zvt . MS h . cov. CONTRACTOR: Company Name: Ga .4 Cotk.5 ‘- 8o C.-71-6%) ,Phone#: (o$) cZ - 0473 2 .S1 \A) 00 s "&u A Address: City: \ Gt..kO�\A State: Lo 2c & Qualifier Name: J i/ k T.2 - Phone#: State Certification or Registration #: C- kC— 10 V10(02. Certificate of Competency #: Zip: "330i(o DESIGNER: Architect/Engineer:/:9 Phone#: Address: Com City: State: Zip: Value ofWork for this -Permit �$ Square/Linear Footage of Work: Type of Work: ❑ Addition n Alteration ❑ New Repair/Replace Description of Work: -ga-N `cCQ /G. .) vet y S --Nr\) n Demolition .....�.....4 �..�- ..•.•, ..• Specify color of color, thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $ Permit Fee $ 0L Radon Fee $ ' Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ L • U,�1O DBPR$ Z. it/ .30 CO/CC $ Notary $ Double Fee $ t 0 Bond $ TOTAL FEE NOW DUE$ Z.CAC50 • 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 inspe ion which occurs seven (7) days after the building permit is issued. In thence of such posted notice, the inspection will not . approved and a reinspection fee will be charged. Signatur OWNER or AGENT Signature CONTRACTOR The for goin: ument was acknowledged before me this The foregoing instrunint was acknowledged before me this , 20 1C0 , by i J day of \ �)INCo.A.r , 20 XI , by yNJNe: Ro te_.: Z , who is personally known to day of DCC b1 Q . f\ nc. o is personally known to me or who has produced CO. 1-32, as me or who has produced as identification and who did take aann oath. NOTARY PUBLIC: Sign: Print: Seal:trE , MY COMMISSION # ""'11; EXPIRES: November 2, 2020 v. or F,d,to Bonded Thru Notary Public Underwriters • ******************* APPROVED BY (Revised02/24/2014) ************** /) 11/ identification and who did take an'oath. NOTARY PUBLIC: Si Print: Seal: Notary Public - State o Florida . My Comm. Expires May 19, 2018 �'.;; .;•' Commission # FF 106782 *************************************************************** l-1 Plan j Examiner Zoning Structural Review Clerk s • 0 IAI C Ur rLURIUA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 PEREZ, JAVIER A GARP CONSTRUCTION GROUP INC 7530 SW 36 ST MIAMI FL 33155 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every 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.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. 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, and congratulations on your new license! RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT -OF BUSINESS AND PROFESSIONAL REGULATION CAC1817062 fSBUED: 09/01/2016 CERTIFIED AIR COND,CONTR' PEREZ, JAVIER A - GARP CONSTRUCTIONGROUPINC IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31, 2018 L1609010001893 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CACI 817062 The CLASS B AIR CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 PEREZ, JAVIER A GARP CONSTRUCTION.GROUPINC 7530 SW 36 ST - MIAMI FL 33155, ISSUED: 09/01/2016 DISPLAYAS REQUIRED BYLAW .T SEQ # L1609010001893 012413 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY /180197 BUSINESS NAME/LOCATION GARP CONSTRUCTION GROUP INC 7530 SW 36 ST MIAMI FL 33155 OWNER —.ARP CONSTRUCTION GROUP INC /t; FERNANDO ARIAS JR PRES Worker(s) 1 RECEIPT NO. RENEWAL 7460544 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter BA — Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR CAC1817062 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/25/2016 CREDITCARD-16-043586 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 holder's 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 Ba -276. For more information, visit www.miamidade.gov/taxcolloctot AICcmor CERTIFICATE OF LIABILITY Ir ain.-. INSURANCE ' DATE(MM/DDIYYYY) 03/15/17 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 (leu of such endorsement(s). PRODUCER Jvs Insurance Agency 9600 SW 8th St, Suite 27 Miami, FL 33174 Phone (305) 552-5250 Fax (305) 552-5292 CONTACT (LIANA CASTANEDA NAME: PHONE(Q, Ext) (305)552-5250 FAX NQ): (305)552 5292 MAIL ILI@JVSINS.COM ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ESSEX INSURANCE COMPANY N INSURED GARP CONSTRUCTION GROUP, INC. 7530 SW 36 St Miami, FL 33174 (305) 506-5068 INSURER B : 04/10/2017 INSURER C : $ 1,000,000.00 INSURER D : DAMAGETO RENTED PREMISES (Ea occurrence) INSURER E : MED EXP (Any one person) INSURER F : PERSONAL & ADV INJURY 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. NSR LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS AMI GENERAL LIABILITY N N 0020986 04/10/2016 04/10/2017 EACH OCCURRENCE $ 1,000,000.00 Q COMMERCIAL GENERAL LIABILITY II • CLAIMS -MADE 0 OCCUR DAMAGETO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 • GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: • POLICY • jRa • LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY • ANY AUTO AUTOS NED • SUTOSULEO ll HIRED AUTOS ii NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE accident $ _(Per $ • UMBRELLA LIAB • OCCUR • EXCESS UAB • CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ • DED . RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A • TORYTATU- • ERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) CERTIFICATE HOLDER IS ALSO LISTED AS AN ADDITIONAL INSURED AS TO GENERAL LIABILITY CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF TH ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION D THEREOF, NO CE WILL BE DELIVERED IN ACCORDANCE WIT POLICY PRO SIGNS. AUTHORIZED REPRESENT4 ACORD 25 (2010/05) QF ©19?' 2 1 •O DCGRPORATION. All rights reserved. The ACOA r name a d ogo are registered marks of ACORD Miami Shores Viiiage 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 acknowledge before me this 1S day of .94,6.y.2\0 J k 71 - Owner By Notary: SEAL: RNANDO ARIAS JR tary Public - State of Florida %; ,,,,, Commission # FF 106782 —ILA , 20 1 . who is personally known to me or has produced tification. GARP CONSTRUCTION GROUP INC. MECHANICAL CONTRACTOR 2357 W 80 ST BAY 4 Hialeah FL 33016 LIC: CAC 1817062 Licensed & Insurance Fax: (305) 602-0481 Phone: (305) 602-0400 Date: March 15, 2017 State of Florida County of Miami -Dade s - 0.� Before me,thisrday'personally appeared Javier Perez who, being duly sworn, deposes and says: -�., That he wirbe th'e onlyipersonworking on the project located at 77 NE 95 ST Sworn to:(oraffirmed)'and subscribed before me this 15 of March 2017 by Javier Perez Personally know 1' Notary: FernandoArias ,;' ... FERNANDO ARIAS JR Notary Public - State of Florida My Comm. Expires May 19, 2018 ?:' Commission # FF 106782