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EL-15-1247Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 RECEIVED OCT 082015 BY: FBC 20 I 0 BUILDING Permit No.�L�l PERMIT APPLICATION Master Permit No. ( L TI A€ oFN i (Z�U� �2 Permit Type: E" tri cal JOB ADDRESS:�J' �C (0 City: Miami Shores County: Miami Dade Zip: I3/5 Folio/Parcel#: Is the Building Historically Designated: Yes NO iC Flood Zone: OWNER: Name (Fee Simple Titleholder): <eL,iS4 IP Phone#: , 6 S6/ J� /5/ Address: -Po 30z 3-) /36 / D kt:c Zip: 3 3 / ? q Tenant/Lessee Name: / _,c:Phone#: R61-64 / 5/ V Email: %O Com- / eHQ ,vl . ✓ 57' [ n"xi< ee <-f CONTRACTOR: Company✓Name: 14 CGA Phone#: (?'t) B2b52.06 City: State: Address`: I2- S 2. k '3 \1J 71 Awe.. t City: "4,tA -•,1 ,,//��i-a,K � S //�� State:te/cL Zips. .33t ( Qualifier Name: 4Qi 6-1 Dt S K f_ -`1Z -.S — p,NVU.QW Phone#: (3D.1) 4x20- S20s . State Certification or Registration #: �— COO 17 2.8 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 3QtT _ 80 Square/Linear Fo tage of Work: Type of Work: ❑Address ❑Alteration ❑New Repair/Replace ❑Demolition Description of Work: R ()Ai Q k\"i Qt-PAtA .t,tc`la. szQ.)iec ***************************************Fees******************************************** Submittal Fee $ Permit Fee $ t. evl, 'F $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 9 . �j • 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 A ► RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an es promise in good faith that a copy of the notice of commencernent and construction whose property is subject to attachment. Also, a certified copy of the recorded not for the first inspection wh'ccurs seven (7) days after the building permit inspection will n t be app oved . a reinspection, fee will be charged. Signature Signatu Owner or Agent The foregoing instrument was acknowledged before me this n day of 20 i , by day of eT , 20 /am, by 6 ctmLQ. S ated value exceeding $250 ien law brs hure will be del ement must be absence of su , the applicant must vered,to the person t the job site d notice, the Contractor rr�, The foregoing instrument was acknowledged before me this W me or who has produced whoersona y wn to me or who has produced U As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Mt1ATO Sign:Q.•\ �ON2XPj'7.% r. -�k�R ll1s ce Print:�t' •% <? My Commission Expires: ' • o " PU BUG **** **: ********************fiberori *******************: *********** ************************************* Sign: C STEPHAN a+$ sici COMMA 1 FF 19797 Irf EXPIRES: February 10, 2019 {'R;gyp Bonded Thin Notary Public Underwriters APPROVED BY &IP," �05—Gr7,--e—Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL. REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICE \ISE NUMBER EC0001728 The ELECTRICAL CONTRACTOR 1, Named below IS CERTIFIED 1 Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ' • - ! . . . . • • - • • . ,.. . . . • DE LOS REYES-GAVILANdkR011ba i - .-- : - .- MEGA ELECTRIC,. INC, ::,. -.......:.1,7,_ . • -...: .. . . i. - -MIMI LAKE -S ,--EL-a3o14 . ....,_.. . ...,... . • ..... t‘,..- - .,---„.... • - 1 ... -,......-.:-, ..,,.....,.. ,,z,..1.„,.-... ,. •...,. ,...,... ,...., ...... . . , .: . t - .••• 46262 NW 79TKAVENI.I.E4-',--,... -":•::,--1,-K4',,i: ",--.--;:.---',':'.,-...,-,- ' . . -• ' . , • SEQ 0 L1408120002302 6601 Main Street Miami Lakes, FL 33018 (303) 312-7132 Address of Licensee: MEGA ELECTRIC, INC. 16252 NW 79 AVENUE MIAMI LAKES, FL 33016 License Categories: CONTRACTOR - SPECIALTY Town of Miami Lakes Business Tax Receipt License Effective: From: 08/27/2014 To: 09/30/2015 Licensees: ARISTIDES REYES GAVILAN (305) e28 -SM CONTRACTOR / SPECIALTY LICENSE NO. BTR2015-2117 $40.00 TOTAL FEE PAID: 540.00 CERTIFICATE OF USE: U2004-1381 08/27/2014 Date of Issue This license MUST BE DISPLAYED IN A CONSPICUOUS PLACE IN YOUR BUSINESS ESTABLISHMENT. The Town of Miami Lakes must be notified of any changes of use, address or ownership. This License is not transferrable and is subject to revocation. This License must be renewed on or before September 30 of each year. MIAMMADE 5295324 DBA/BUSINESS NAME: MEGA ELECTRIC INC BUSINESS LOCATION: 16252 NW 79 AVE MIAMI LAKES, FL 33016 OWNER/CORP. MEGA ELECTRIC INC PHONE # 305-828-5205 16252 NW 79 AVE MIAMI LAKES, FL 33016, NAICS CODE: 23821 MIAMI-DADE COUNTY - STATE OF FLORIDA LOCAL BUSINESS TAX 2015 - 2016 APPLICATION N/A October 08, 2015 RENEWAL RECEIPT: 5532669 STATE # EC0001728 BUS. COMMENCEMENT DATE: 04/01/2004 SEC TYPE OF BUSINESS ELEC ELECTRICAL CONTRACTOR 6 APPLICATION DETAILS FEE AMOUNT Receipt Fee 30.00 UMSA Fee 0.00 Beacon Council Fee 15.00 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi -Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 Transfer Fee 0.00 Doing Business without a License Penalty 0.00 Late Penalty 0.00 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 45.00 TOTAL AMOUNT DUE: 0.00 If no longer in business, please notify us in writing. Review and correct the information shown on this application. A 25% penalty will be assessed to anyone found operating without a paid local business tax, in addition to any other penalty provided by law or ordinance (Sec 8A-176(2)). A Certificate of Use and/or City Business Tax Receipt may also be required. To pay online go to www.miamidade.aov/taxcollector To pay by mail, make check payable to: Miami -Dade County Tax Collector Business Tax 200 NW 2nd Avenue Miami FL 33128 To pay in person go to: 200 NW 2nd Avenue (305) 270-4949, fax (305) 372-6368 A service fee of not less than $25.00 up to a minimum of 5% will be charged for all returned checks. t RETAIN FOR YOUR RECORDS t MIAMI-DADE COUNTY - STATE OF FLORIDA LOCAL BUSINESS TAX 2015 - 2016 APPLICATION 5295324 BUSINESS LOCATION: 16252 NW 79 AVE MIAMI LAKES, FL 33016 OWNER/CORP. MEGA ELECTRIC INC i MEGA ELECTRIC INC ARISTIDES REYES GAVILAN PRES 16252 NW 79 AVE MIAMI LAKES, FL 33016 DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT 11 11 11 11 11 1 N/A October 08, 2015 RENEWAL RECEIPT: 5532669 STATE # EC0001728 BUS. COMMENCEMENT DATE: 04/01/2004 SEC TYPE OF BUSINESS ELEC ELECTRICAL CONTRACTOR 6 APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION OR OCCUPATION DESCRIBED HEREON. I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. I I SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE Please pay only one amount. The amounts due after Sept 30th include penalties per FS 205.053. If Received By Oct 31, 2015 Nov 30, 2015 Dec 31, 2015 Jan 31, 2016 Please Pay $0.00 $0.00 $0.00 $0.00 7000000000000000000000005532669201600000004500000000000001 ,A4G74'."2>1? ra7 CERTIFICATE OF LIABILITY INSURANCE 6/TI0MMF5DiYY3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. PRODUCER Floridian Consultants Insurance 9371 S.W. 40th St. Miami, FL 33165 Phone (305)225-9711 Fax (305)225-7477 INSURERS AFFORDING COVERAGE NAIC it INSURED MEGA ELECTRIC INC 16252 NW 79 Ave Miami Lakes, FL 33016- (305) 828-5205 INSURER A: SCOTTSDALE INSURANCE COMP INSURER s: PROGRESSIVE INSURANCE COMP INSURER C: COMMERCE & INDUSTRY INSURANCE INSURER D INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NONVITHSTANDING 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 POLIdIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1INSR LTR ADD'; INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMDDIYYYY POLICY EXPIRATION DATE (MM/DDIYYYY) UNITS GENERAL UABIUTY '�/TED . COMMERCIAL GENERAL LIABILITY L_ J CLAIMS MADE 1!--1] OCCUR I ; -• 05/11/2015 06/11/2016 EACH OCCURRENCE 1,000,000 P REMISES Ea oAMAGE TONccurrence) 100,000 MED EXP {Any ane person) 5,000 PERSONAL & ADV INJURY 1,000.000 GENERAL AGGREGATE 2,000.000 PRODUCTS-COMP/OPAGG 2;000.000 GEN'LAGGREGATE LIMIT APPLIES PER: .`1 POLICY 7 PROJECT 0 LOC B _ AUTOMOBILEUABIUTY ANY AUTO ALL OWNED AUTOS vJ SCHEDULED AUTOS 'V HIRED AUTOS A NON OWNED AUTOS 05351579-4 03/2512D15 03/25/2016 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 BODILY INJURY (Per parson) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accidert) GARAGE LIABILITY L' ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESS/ UMBRELLA LIABILITY ✓I`-1 OCCUR 7'CLAIMS MADE ;! DEDUCTIBLE J RETENTION 5 EBU026045296 06/11/2015 06/11/2016 EACH OCCURRENCE 1,000,000 AGGREGATE 1,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE YINj OFFICER i MEMBER EXCLUDED? (Mandatory In NH) !rySPEs.C deAL PRObe uISIO SPECIAL PROVISIONS t>elpvr j \' VJC STATU• OTW-' :TORY LIMITS — ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ELECTRICAL WORK WITHIN BUILDING 30 DAYS NOTICE OF CANCELLATION EXCEPT 10 DAYS FOR -NON PAYMENT OF PREMIUM rCoTCIfn a -e LIAO Reef ` Miami Shores Village 10050 N . E. 2nd Ave Miami Shores, Fl, 33138 AffAOff 9L LertM „f,. �, SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO T E1E-a-FT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER,. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE FELIPE GOMEZ ©1988- 0 ORD GPORATION. All rights reserved The ACORD n e and logo are registered marks of ACORD 10/08/2015 15:54 FAX 3058286484 IJ 001/001 AILVRQ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/D0/YYTY) 10/8/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subjoct 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 Keyes Coverage Insurance 5900 Hiatus Road Tamarac FL 33321 INSURED 13425 Mega Electric, Inc. 16252 NW 79th Avenue Miami Lakes FL 33016 r rtvcoAr_CC rte... ,r......... ...._-__ CONTra NAME_._._._Michellita_M.ercado_.. PHONE :..__........._......._.__---------- .J*at) 9b-MAIL.5�Z24. 7QQO I FAX - ............ ................. NAIL t! . .,No)94:724.-7024. AooREsstOlmeLGs'tCl.o@keyescetzverSgr 2111 INSURER(S) AFFORDING COVERAGE INSURER A :g@tallFlrt_tD$.t.iran .0 ?ria) any_ — - INSURER 8 INSURER C : - — - INSURER D INSURER E : INSURER F : •2063695487 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 HERF!N tS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADSL SUSR .. ' . "". ' ' POLICY EFF POLICY EXP I INSR LTR LMM/QD/YYYYj (MMVDD/YYY TYPE OF INSURANCE INSR WVD POUCY NUMBER Yti GENERAL UABIUTV _LCOMMERCIAL GENERAL LIABILITY --- CLAIMS -MADE I— _ OCCUR G EN'L AGGREGATE LIMIT APPLIES PER: POLICY F.__1PRO- JECT LOC LIMITS EACH 0," ! iRRENCE S I. C,Ais t.C'(- srD'RENTED ._.____.... 1-i?Eves;_,`; (Eaocwnence), _ $ I ME.I-,F;:c (Anyone mon) T.$ Phrci .c.)NA,,. 3 ADV INJURY S 1 : ENE7r.,.!. AGGREGATE $ I'I?::'I 'Ji:'!:_. - COMP/OP AGG S ' AUTOMOBILE LIABILITY • ANY AUTO ALL OWNED AUTOS HIRED AUTOS AUTOS SCHEDULED AUTOS NON -OWNED $ C,: wtll.iz r JINGLE LIMI r jriE accRintli S !N,!uRY (Per person) $ URV (Per accident) $ Pk 1Pr-:Riv DA.M.AGE — -- S ac/:went! UMBRELLA LIAB I EXCESS LIAR f DED I I RETENTIONS OCCUR CLAIMS -MADE A I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N I A 1 (Mandatory In NH) If yes, describe under I DESCRIPTION OF OPERATIONS below 1 E.A..H G::;E:URRENCE : I520-47840 5/27/2015 5/27/2016 $ !$ }N.":: 1 ATU. FOTHT 1.E ! EA'.:!'': : CIDENT 51,000000 : ASE" - EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more apace la required) `Except 10 days notice of cancellation for non-payment of premium License Number (EC0001728) i CERTIFICATE HOLDER Ei!S@: `.,`iE - POLICY LIMIT ; S1,000,000 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores FL 33138 CANCELLATION 30 Days` 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 !y ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MESA Mem hrothens Inc. ELECTRICAL CONTRACTORS Commercial & Residential / Electrical Repairs & Installations/Air Conditioning & Refrigeration Miami Shores Village Building Department 10050 N.E. 2nd Ave Miami shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 RECEIVED AUG :13 2015 State License No. EC -13001870 Ref: 5 NE 105 Street -Rd Electrical Permit #EL -5-15-1247 To Whom It May Concern: We are requesting a cancelation of this permit, because the owner does not want to continue With the project. If you have any question or concerns you can contact us at any time. Thank you for your cooperation in this matter. Raul Mesa President Qualifier of Mesa Brothers, Inc. c2 �uNANCCYMISSIQTNEJJAADA teE�.�t'AN'2 28x8 B Bonded rough 1st State Insurance 5215 S.W. 103 Avenue • Miami, Florida 33165 • (305) 630-2549 • fax: (305) 630-2699 BUILDING PERMIT APPLICATION ❑ BUILDING ❑ PLUMBING JOB ADDRESS: 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 gELECTRIC ❑ ROOFING RECEIVED MAY 4 2015 BY' FBC20(0 Master Permit N4Zr_ 5-59 1 Sub Permit No. EL - 0 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:. Is the Building Historically Designated: Yes Occupancy Type: S.,' Construction Type:.. - Flood Zone: OWNER: Name (Fee Simple Titleholder): K -Ce, � F �t4 L NO BFE: FFE: Phone#: Address: Po i/k � T (3 ) 3 13.-7 City: / �/4/C 5 2J�'L� State:. Tenant/Lessee Name: Phone#: Email: q2.4f6-6 r1X' Zip: CONTRACTOR: Company Name: Address: 4c)— /O..34xLe• Phone#: �lel�L City: / Qualifier Name: � / Phone#: State Certification or Registration #: ' :(.300/87 ) Certificate of Competency#: EC°—1 'd/J7i State: Olrz'c2 DESIGNER: Architect/Engineer: Phone#: Address: City: "Value of Work for-thinPermit: $ h .000 Type of -Work: ❑ Addition ❑ Alteration J D� ascription of Work: G rc, Q p _ o (CI CV; e State: Zip: Square/Linear Footage of Work: ❑ New Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee'$(31 Permit Fee $ Ov Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ CIO • 4) f fc 4 a Bonding Company's Name (if applicable) r � � 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 OWNER or AGENT The foregoing instrument was acknowledged before me this 5O1' day of , 20 /6— , by 'Jr / —_. //peiZes- -746f A,57 gq(who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: (,Ur S&,fjcz- `P.• • • LUIS FERNANDEZ MY COMMISSION # EE 838180 EXPIRES: November 7, 2016 ter' Fo 030 Bondad Thu Budget Notary Services CONTRACTOR The foregoing instrument was acknowledged before me this 3D •day of ")/', 20 l ' , by /2a v/ — —;who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: I- • L Seal: r 2.A..14iV as * 1JF0 Ftp LUIS FERNANDEZ * MY COMMISSION # EE 838180 EXPIRES: November 7, 2016 Bond:d Thr Budget Notary Services *********************************************************************************************************** APPROVED BY (Revised02/24/2014) Plans Examiner Structural Review { Zoning Clerk RICK SCOTT, GOVERNOR KEN LAWSON, SECRETE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1....T, 0-E,LECTRIGALGOINIIFTZADCTOR ...gcnfiNe7rVgli5n-g: orCtiEepter.489 FS c:--piolrd:tior1.016: AUG 31 , 2016.. • • .• - , . • 7... • ••'•....',•• • •• *hi, • •-•• -sqt°44:7:. • " • • . . •... ••,, "•. .••• \\'‘, •-• \:\ • DISPLAY AS REQUIRED BY LAW ISSUED: 06/10/2014 •••• \ • SEQ # L1406100001578 000136 , • • • ./owNyx,?, MESA ak.,i)ii-IERS INC ' VtletrWr 0 SEC. TYPIW.,OrBUSINESSi'"'" . :•,:,..; 3,..:•,.,,;:q 196 ELE'OVAL CO,NTRA6T9 PAYIVIEfirRECEIXE .. C130011V6 ..::.. : •75.00 m • ElY TAX deLLECT:111, U,i•6/21/2614-• ds_,,, . C11 EC K2Ti''.-14-053605 ',......4. :r.:5%.i fz•l".'', ThismokBusinestlitOoceipt otil4nfirms payn)ent of the Ltioal BusIntiSs Tax. The ReOalfilis not a Ii.eAtii(giA i pertMION eartitica0,0* the holthat4pe I ificutions to do business. Holder mot fil!slply,WitiVany paYer1M01144, 0ctZ,,..".',Wr to ifornmontaqoAlutotory lawsfp,,nd.t:equireinants which apply to the ouattyiaa,,,,.:,!, , ,,.,;. , i:,,t,&•:.?-.AA, L. • ..,:.5,..A.'„:-.',XltaIRECEIPT NO;:bbove m u0 liCliSpl a yed oi6i0iiiiii"i4irliiia I vehicliii.'4141O041344Ctitl a Sc 8a476. For nii0OJI:116Inotion, vide Olitpidad0,00Viti Ofor,,;,'. .- . . .... . • ... .. ...., ARE CERTIFICATE OF LIABILITY'INSUI ANCE MESAB-1 OP ID: Yr DATE(MM/DOITYYY) 12123/2014 /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 pollcy(ies) 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 Global Risk LLC 5959 Blue Lagoon Dr Suite 101 Miami, FL 33126 EDUARDO R PORTAS INSURED Mesa Brothers Inc. 5215 SW 103 Ave Miami, FL 33165 NAME: Yolanda Yolanda Mendez PHONE 305.455-7250 INC. No, Ext): E-MAILSS: mailHglobalrisklIc.com FAX No): 305-455-7251 INSURER(SLAFFORDING COVERAGE INSURER A : Wesco Insurance Company INSURER B : NAIC q INSURER C : INSURER D: INSURER E : INSURER F : COVERAGES CE -- - ENG: v101V11 IvuIvIDCr'.. 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. I IR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY EFF POLICY NUMBER (MM/DD/YYYY) POLICY EXP (MMIOD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E 1,000,00' $ 100,00' S 5,00 _ _1 CLAIM[X I OCCUR WPP122167400 01/01/2015, 01/01/2016 PREM SES eocccurFOrenco} MED EXP (Any one person) PERSONAL & ADV INJURY E 1,000,00, GE AGGREGATE LIMIT APPLIES -7 PER. GENERAL AGGREGATE E2,000,001 X POLICY [ PELT LOC PRODUCTS. COMP/OP AGG $ 2,000,001 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT LEO accident) $ ANY AUTO ALL OWNED —^ SCHEDULED BODILY INJURY (Per person) $ AUTOS AUTOS WNED NHIRED BODILY INJURY (Per acGdenl) E AUTOS NO Og OPE RTYWAM7 (Per accident) $ $ UMBRELLA LIAB ] OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N PER I RH, 1 STATUTE ER E ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A E L EACH ACCIDENT S (Mandatory In NH) If yes, describe under LEL. DISEASE • EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT S �ca�.nIPT10N OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Electrical work within buildings CERTIFICATE HOLDER CANCELLATION MIAMII1 Miami Shores Village 10050 Northeast 2nd Avenue 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 �IV ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/Y THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS, UPON THE CERTIFICATE HOLDER.THIS01• 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(ies) 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 1 certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT Stonehenge Insurance Solutions., Inc. NAME: 888-925-2990 Ext. 20834 P.O Boz 3442 PHONE 561'746'5027 FAX Tequesta, FL 33469 (NC, No, Exp:(A/C, No): EMAIL Certs r ADDRESS: Cep ogressiveempl0yer.Com INSURED Progressive Employer Management Co. Inc. and all its affiliates and subsidiaries For Co -employees oI Mesa Brothers Inc 6407 Parkland Dr Sarasota, FL 34243 COVERAGES INSURER(S) AFFORDING COVERAGE INSURER A :Technology Insurance Company, Inc. INSURER B : INSURER C INSURER 0: INSURER E : INSURER F : NAP 423, CERTIFICATE NUMBER:6Gxrs5zv 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 ADDL SUER LTR TYPE OF INSURANCE POLICY EFF POLICY EXP INSR WVD POLICY NUMBER (AIM/DD/YYYY) (MM/DD/YYYYL LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ei OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: F-1 POLICY 11 P)ECT n t.00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB SCHEDULED AUTOS NON -OWNED AUTOS EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ee occurrence) $ MEI) EXP ,Any one porson, $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE S PRODUCTS • COMP/OP AGG $ $ COt BINEDSINGLELIMIT (Ea acc dent) •• $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE . $ 'leer aCCidonl) $ EXCESS LIAB DED n RETENT ONE A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED", (Mandatory in NH) oyes, describe under DESCRIPTION OF OPERATIONS below OCCUR • CLAIMS -MADE Y/N N/A TWC3431595 EACH OCCURRENCE $ AGGREGATE $ 09/15/201410/01/2015 U ORY LIIMITS l�_,JO811 E L. EACH ACCIDENT $ 0 L DISEASE • EA EMPLOYEE $ E L DISEASE • POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 11 more space Is required) Coverage is extended to Co -employees but not subcontractors of Mesa Brothers Inc License #EC13001870 CERTIFICATE HOLDER $ 1,00 .00, 1.001 CANCELLATION Miami Shores Village 10050 Northeast 2nd Avenue miami, FL 33138 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i • Page 1 01 I ©1988.2010 ACORD CORPORATION. All rights reserve The ACORD name and logo are registered marks of ACORD