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RRV-18-275
BUILDING PERMIT APPLICATION 1 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 UMBER: (305) 762-4949 ® FBC 2011 Master Permit No. k -C. -I (O " 12l. Sub Permit No. 12-1131/ 275' RECEIVED FEB 02 2018 BUILDING ❑ ELECTRIC ❑ ROOFING El REVISION ❑ EXTENSION ❑RENEWAL PLUMBING n MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5 NE 105 St. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO no Occupancy Type: SF Load: Construction Type: cbs Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Group 10 Capital Phone#: 305-479-9857 Address:1480 Michigan ave City: Miami Beach State: FL Zip: 33131 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: JRH General Service corp Phone#: 305-970-8802 Address: 26240 SW 130 Ave City: Homestead State: FL Zip: 33032 Qualifier Name: Fabian Perez Phone#: State Certification or Registration #: cac1817574 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Phone#: City: State: Zip: Square/Linear Footage of Work: Type of Work: Addition ❑ Alteration 0 New ❑ Repair/Replace n Demolition Description of Work: _,n j-� Cr() An (CP }-'° Specify color of color thru tile: 0 Submittal Fee $ Permit Fee $ �`% I v �-' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (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: 1 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 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 1 day of February Sam Soriero . 20 18 . by , who is ersonally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: OPpr�`e^ :r `. ALjA M PELEGRIN MJ OMMISSION #FF178894 .,, or r�,.='' tAYirtts November 23, 2018 (407) 398-0153 FloridallotaryService.com ********************* APPROVED BY (Revised02/24/2014) *** 1 day of Februrary 20 18 by , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Fabian Perez Sign: Print: Seal: ,'�. IA M PELEGRIN Y COMMISSION #FF178894 EXPIRES November 23, 2018 (407) 398-0153 FloridallotaryService.com ************M******************************************************************* c? 1 Plans Examiner Zoning Structural Review Clerk A/C SUBSTITUTION LETTER DATE: JANUARY 31, 2018 TO: MIAMI SHORES BUILDING AND ZONING DEPARTMENT. MIAMI FL RE: GROUP 10 HOUSE RENOVATION ADDRESS: 5 NE 105 ST MIAMI SHORES FL PERMIT # - DEAR SIRS: JOSE R CONDE R.A. PLEASE BE ADVISED THAT THE FOLLOWING SUBSTITUTION OF SPECIFIED NC EQUIPMENT, IS AN ACCEPTABLE ALTERNATIVE AND COMPLY WITH FMC 2014 AND LOADS CALCULATIOS. THE NEW A/C UNITS ARE:: 1) CONDENSING UNIT: GOODMAN GSX160421FG 2) AHU: GOODMAN ASPT47C14AC CAPACITY: SENSIBLE LOAD CAPACITY: 31,200 BTUH TOTAL LOAD CAPACITY: 41,000 BTUH SEER: 14 SHOULD YOU HAVE ANY QUESTION OR NEED ANY ADDITIONAL INFORMATION PLEASE DO NOT HESITATE TO CONTACT ME. SINCERELY, JOSE RAU ONDE, R.A REG #, 0010924 r - ,\':_L F ,))LI?AL 4 8306 MILLS DRIVE 109 MIAMI FL 33183 , TEL 305 594 0686 EMAIL: conarchi@bellsouth.net STATE R LORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORMERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIOA VirORKE RSCOMPEN.SATIORII CONSTRUC r PON INDUSTRY EXEMPTION TN. carbide The Ihe irCINNIuml itIod bolo* ham 04**N141 11)� 010,01:14 fer(xvi kii961 W1:411.441" EFFECTIVE DAT/: law EXPiRATION DATE: 4)1 1/2119 PERSON: PEREZ FABIAN FEI011: 65CS595111 SUSINIESS NAME AND ADDRESS: J.R H. GENERM StrcisCES,'CORP ?6240 SW 1X1 MAMA HOMESTEAD SCOPE OF WANNESS OR TRADE. 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" 144"44 16/ CA44414 444-0941411 PA- C4#44641111411114401:0» r aaorvit - I4444 *Om 414I 44410* t40 NMI** kir*****a 01**404.4.11 otiootAisr fAr wok,14,4 104,101114 Chow *Wel In $4, NOW. ;110-110,44 *NI WIA614611 of 41.01441 14. drderopi W'.14s40.1440I ino-sA44.*-1 rol oev *rho 00)10141 *NI iho Rim ES al kommtiosd 0,4 c4,04c400_ wan mood woo forar atorml*** rakrger '0444 t* .414*****410 otiteot4 11110.1nO• of 1 To. dimirthw IAA rinftwe C410444444 44 Oft 4.44 Ow ISOM 4411Nrosmo irwv.os v•N Itst 0.466#94, miteot on, off#Alsonersh ,6416 wow% RTIF 1LCT)4 04,1e $1tOtiti 3- I tAl Arlenis Silvera From: Arlenis Silvera Sent: Wednesday, September 06, 2017 2:27 PM To: 'hugo@ajfulton.com' Subject: 5 NE 105 ST Good afternoon Mr. Hernandez, This email is in regards to the address mentioned above. Due to the hurricane Irma the Village of Miami Shores is reaching out to all contractors with ongoing projects, to notify that all portable restroom and dumpsters needs to be remove, secure all tools, debris, construction material, etc. If you have any additional questions please do not hesitate to contact us. Be safe. Best Regards, Arlenis Silvera Permit Clerk Supervisor Miami Shores Village 10050 NE 2 AVE Miami Shores, FI 33138 305-795-2204 www.miamishoresvillage.com 1 N't°. cA''?`k\fr°U BUILDING PERMIT APPLICATION BUILDING C ELECTRIC -]PLUMBING n MECHANICAL JOB ADDRESS: 5 ne 105 st 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 n ROOFING Master Permit No. Sub Permit No. n REVISION n PUBLIC WORKS 7 CHANGE OF CONTRACTOR FBC 201 Z5-6 n EXTENSION ❑ RENEWAL CANCELLATION n SHOP DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11- Lt.N0D6--✓05o Occupancy Type: 5A-44, Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Address: Io Is the Building Historically Designated: Yes CbS Flood Zone: C'Pl'rt, NO X BFE: FFE: Phone#: City: /11 a V\/• 15e4.4. -t - State: Zip: { , Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: 3 '^ I � Com 1�� -h Address: l H o'i I SL) S Z Sl Phone#: 305-'-i City: %)'1 i !^ a w, c i State: Qualifier Name: 6'-/C/e+ct 11 ke (" t- Zip: '33027 Phone#: 3°C-cj -r o "`"°7 - State "°7 - State Certification or Registration #: DESIGNER: Architect/Engineer: Address: City: 6 c.,c- (5 ( 2 S Certificate of Competency #: Phone#: State: Zip: Value of Work for this Permit: $ v t -7(P, 71Square/Linear Footage of Work: 20L Type of Work: I I Addition ❑ Alteration n New Q Repair/Replace I 1 Demolition Description of Work: y'^ 11 G; o.^-, Specify color of color thru tile: Submittal Fee $ • 03 Permit Fee $ 2,301' 6 3 CCF $ -[ 6,21D CO/CC $ Scanning Fee $ 3 CJ. Radon Fee $ 3 k--(,S-S Technology Fee $ G i Structural Reviews $ (60 -00 (Revised02/24/2014) Training/Education Fee $ cA DBPR $ 3 S'3 Notary $ rn Double Fee $ C CIO Bond $ 5OO TOTAL FEE NOW DUE $ .3, I ;} 2 .9 9 • r. 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. W 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 NER or AGENT Signature /TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this J" r1 day of , 20 , by `i—i,l, l day of 7 i , 20 ! , by 5�,..., So rrero , who is personally known to Yi une,vr P 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. NOTARY PUBLIC: identification and who did take an oath. NOTARY PUBLIC: Sign:s•• ' • Sign: PELEGRIN Print: '* Mf' t�OVW>SS1 N #fF178B94 Print or „o EXPIRES November 23, 2018 Seal: Seal: (407) 390-0153 FlorldallotaryService.com -At1CIA M PELEGRIN MY,WMM(SjPN #Ff 178894 ,,,(+.= or�°P EXP1Ht5 NOVemtierL3, 2018 (407) 390.0153 FlorldallotaryService.com ******************************************************************************************************* APPROVED BY 1 ��1 / 1 Y Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk d FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Detail by Entity Name Florida Limited Liability Company GROUP 10 CAPITAL MANAGEMENT, LLC Filing Information Document Number L13000102738 FEI/EIN Number 47-2348417 Date Filed 07/19/2013 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 06/01/2015 Event Effective Date NONE Principal Address 1680 MICHIGAN AVE, PH 4 MIAMI BEACH, FL 33139 Changed: 08/31/2015 Mailing Address 1680 MICHIGAN AVE, PH 4 MIAMI BEACH, FL 33139 Registered Agent Name & Address NANEVA CAPITAL LLC 1413 20TH ST 409 MIAMI BEACH, FL 33139 Authorized Person(s) Detail Name & Address Title MGR DAVID HALABU 1413 20TH ST # 409 MIAMI BEACH, FL 33139 Title MGR SORIERO, SAM 11 ISLAND AVE 1507 MIAMI BEACH, FL 33139 Annual Reports Report Year 2014 2015 2016 Filed Date 01/09/2014 01/11/2015 03/08/2016 Document Images 03/08/2016 -- ANNUAL REPORT 06/01/2015 -- LC Amendment 01/11/2015 -- ANNUAL REPORT 01/09/2014 -- ANNUAL REPORT 07/19/2013 -- Florida Limited Liability View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Copyright © and Privacy Policies State of Florida, Department of State IMPORTANT MESSAGE The Property Appraiser does not send tax bills and does not set or collect taxes. Please visit the Tax Collector's website directly for additional information. Address Owner Name Folio SEARCH: 5 ne 105 st PROPERTY INFORMATION Folio: 11-2136-006-0090 Sub -Division: DUNNINGS MIAMI SHORES EXT NO 2 Property Address 5 NE 105 ST Miami Shores, FL 33138-2030 Owner GROUP 10 CAPITAL MANAGEMENT LLC Mailing Address 1680 MICHIGAN AVE PH 4 MIAMI BEACH, FL 33139 Primary Zone 1000 SGL FAMILY - 2101-2300 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY : 1 UNIT Beds/Baths/Half 3/2/0 Floors 1 Living Units 1 Actual Area 1,795 Sq.Ft Suite 4 STATE OF FLORIDA 5 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HERNANDEZ, HUGO HUMBERTO A.J. FULTON CONTRACTORS, LLC 14041 S W 52ND ST MIRAMAR FL 33027 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 leam 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 CGC1512815 ISSUED: 03/21/2016 (850) 487-1395 CERTIFIED GENERAL CONTRACTOR HERNANDEZ, HUGO HUMBERTO A.J. FULTON CONTRACTORS, LLC IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31, 2016 L1603210000791 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CGC1512815 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 HERNANDEZ, HUGO HUMBERTO A.J. FULTON CONTRACTORS, LLC 14041 S W 52ND ST MIRAMAR FL 33027 ISSUED: 03/21/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1603210000791 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA: Business Name: AJ FULTON CONTRACTORS LLC Owner Name: HUGO HERNANDEZ Business Location:440 S DIXIE HWY HOLLYWOOD Business Phone: 954-925-8934 Rooms Seats Employees 6 Receipt#•180-260385 GENERAL CONTRACTOR Business Type: Business Opened:o2/11/2014 State/County/CertlReg:CGC1512 815 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: HUGO HERNANDEZ 440 S DIXIE HWY HOLLYWOOD, FL This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Receipt #1CP-14-00017211 Paid 07/22/2015 27.00 33020 07/21/2015 Effective Date 2015 - 2016 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA: AJ FULTON CONTRACTORS LLC Business Name: Receipt #: 180-260385 Business Type:GENERAL CONTRACTOR Owner Name: HUGO HERNANDEZ Business Opened: 02/11/2014 Business Location: 440 S DIXIE HWY State/County/Cert/Reg:CGC1512815 HOLLYWOOD Exemption Code: Business Phone: 954-925-8934 Rooms Seats Employees 6 Machines Professionals Signature Number of Machines: For Vending Business Only Vending Tvae: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 Receipt #1CP-14-00017211 Paid 07/22/2015 27.00 07/21/2015 Effective Date ACORO CERTIFICATE OF LIABILITY INSURANCE moi. DATE(MM'DD/YYYY) 04/14/2016 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 lieu of such endorsement(s). PRODUCER Lugones Insurance Group LLC 18331 Pines Blvd, #244 Pembroke Pines, FL 33029 CONTACT Josh Lugones NAME: PHONE 954-501-0103 FAX (A/C, No, Ext): (A/C, No): E-MAIL josh@linsg.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL s INSURER A : Seneca Specialty Insurance Company LIABILITYEACH COMMERCIAL GENERAL LIABILITY INSURED A. J. Fulton Contractors, LLC 440 South Dixie Highway Hollywood, FL 33020 INSURER B BAG -1032595-1 INSURER C: 09/11/2016PERSONPLxADVIwuRY INSURER D : $ 1,000,000 INSURER E : 100,000 $ INSURER F : 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. NSA LTR TYPE OF INSURANCE ADDL INSR SUER wvo POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MWDD/YYYn LIMITS A GENERAL j V LIABILITYEACH COMMERCIAL GENERAL LIABILITY BAG -1032595-1 09/11/2015 09/11/2016PERSONPLxADVIwuRY OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence 100,000 $ CLAMS -MADE / OCCUR MED EXP (Any one person) $ 5,000 $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT MIT APPLIES PER: 7 POLICY JE 7 n LOC PRODUCTS - COMP/OP AGG $ 2'000'000 $ AUTOMOBILE '—'—" LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS ' SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea ecciderk) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) 0 PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE I j OFFICER/MEMBER EXCLUDED? U (Mandatory In NR) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A WC STATU- OTI+ TORY LIMITS ER 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, M more apace la required) Evidence of Insurance. Re: License #CGC1512815 CERTIFICATE HOLDER CANCELLATION Miami Shores Building Department 10050 NE 2nd Avenue Miami Shores Village, 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. AUTHOREED REPRESENTATIVE ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 01$88-2010 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE Date I 4/14/2016 Producer: Plymouth Insurance Agency 2739 U.S. Highway 19 N. Holiday, FL 34691 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 policies below. (727) 938-5562 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. & Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer e: Holiday, FL 34691 Insurer C: Insurer D: Insurer E: Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance yP PolicyNumber Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Commercial General Liability Each Occurrence $ Damage to rented premises (EA occurrence) $ Claims Made Occur .,,. Med Exp $ AMINIL Personal Adv Injury $ General aggregate limit applies per: 3 Policy ❑ Project ❑ LOC General Aggregate $ Products - Comp/Op Agg $ AUTOMOBILE mom om'Bodil wow LIABILITY Any Auto At Owned Autos Scheduled Autos Hired Autos Non-Owned Autos Combined Single Limit (EA Accident) $ Bodily Injury (Per Person) $ In ur Y 1 Y ( Per Accident $ Property Damage (Per Accident) $ EXCESS/UMBRELLA LIABILITY ROccur ❑ Claims Made Deductible Each Occurrence Aggregate A Workers Compensation and Employers' Liability Any proprietor/partner/executive officer/member excluded? NO If Yes, describe under special provisions below. WC 71949 01/01/2016 01/01/2017 X I WC Statu- I tory Limits 1OTH- ER E.L. Each Accident $1,000,000 E.L. Disease - Ea Employee $1,000,000 E.L. Disease - Policy Limits $1.000.000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/LocationsNehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 91-67-612 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": A.J. Fulton Contractors, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: HUGO HUMBERTO HERNANDEZ, LICENSE NUMBER CGC1512815 AS QUALIFIER. ISSUE 04-14-16 (AF) Begin Date 1/6/2014 CERTIFICATE HOLDER CANCELLATION CITY OF MIAMI SHORES BUILDING DEPARTMENT 10050 NE 2ND AVE. MIAMI SHORES VILLAGE, FL 33138 Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. • L/,.4),....'..s...- AJ FULTON CONTRACTORS 14041 SW 52 St. Miramar, FL 33027 Email:hugo@hhremod.com AS FU 2 J FOR: CONTRACT Sam Soriero Group 10 Capital Management 1680 Michigan PH 4 Miami Beach FL 33139 GENERAL: TEL: (305) 970-8802 3/16/16 Property Address: 5 NE 105 St Miami Shores, Fl 33138 0 2016 AJ is responsible for all work provided in the scope. Any changes thereafter to work schedule will be processed through a change order. 1. AJ will schedule all inspections with building and zoning department if required. Customer will be responsible for payment of any schedule engineer/architect or special tests or inspections required by building officials. 2. AJ will order all materials upon acceptance of this proposal to avoid losses due to fluctuations in costs. 3. AJ is not responsible for the condition of the existing structure. Contract Amount • $120,670.00 Payment Schedule 1. Deposit of 20% due at signing of contract. $24,134.00 2. 2nd payment of 30% due once permit is approved. $36,201.00 3. 3rd payment due once drywall is installed. $36,201.00 4. Final of 20% due once job is complete. $24,134.00 WARRANTY: On all workmanship: 1 yr. Contractor SHALL NOT BE LIABLE FOR SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES. The acceptance of this proposal by the Customer signifies his agreement that this warranty shall be and is the exclusive remedy against Contractor for all defects in workmanship furnished by Contractor. Repairs by unauthorized personnel, perforations to the roof made by others will void warranty. IN WITNESS WHEREOF, the parties execute this Agreement on the dates stated below: FOR AJ FULTON CONTRACTORS: By: Hugo Hernandez FOR CUSTOMER: By: ,M Sv i e -r o Date: 3/16/16 Date: 1 ESTIMATE FOR Contractor: AJ FULTON CONTRACTORS Email: hugo@hhremod.com 14041 SW 52 St. Miramar, FL 33027 Property Address: 5 NE 105 St. Miami Shores Square Footage: 1856 Bed/Bath: 3/2 Owner: Sam Soriero Date: 3/15/2016 Construction Duration : 30 Days TOTAL AMOUNTt Exterior 120,670.00 Sq.foot / Description QTY Total Labor Total Mate Total Doorbell Install new 1 11.00 16.50 181.50 Landscaping package shrubs and mulch 1 352.00 - 352.77 Landscaping Cleanup Structural clean trees, weed kill driveway 2/5.00 275.00 Groout filled cells as per drawings 49 8,085.00 - 8,085.00 Floor ioists New 58 2.552.00 1.276.00 3.828.00 Floor Fill in and pour concrete slab in garage 270 2,376.00 2,376.00 Floor New sheething and durock floor 70 5,005.00 5,005.00 JLUI.I.0 Repa�� " 1,650.00 Wood fence New 200 3,960.00 3,960.00 Wood deck New 1000 1,650.00 1,100.00 2,750.00 Exterior doors Impact 3 825.00 2,475.00 3,300.00 Exterior windows New 14 2,310.00 6,930.00 9,240.00 Paint - Exterior; Walls, Trim Per Sq. Foot. Minor prep included. 1858 1,226.28 510.95 1.737.23 Soffit new 250 825.00 825.00 1,650.00 DEMOLITION Demo/Trash 30 YD garbage dump (includes filling 3 3,135.00 3,135.00 ROOF Roof Tiles Per square (tile itself not included) 25 8,745.00 8,745.00 PLUMBING Lines AH new plumbing lines to whole house 1 4,400.00 2,750.00 7,150.00 "r)TA I Cal 1R7 7R C1 S RR1 aS HVAC Description QTY Total Labor Total Mater Total Change out New unit (condenser and AHU) 1 1,650.00 2,200.00 3,850.00 Duct Work Per Duct 8 1,980.00 1,980.00 New lines Refrigerant lines 1 165.00 165.00 Electrical Box 1 165.00 165.00 Thermostat New 1 33.00 33.00 66.00 OTAL $ 3,993.00 $ 2,233.00 Interior Description QTY Total Labor Total Mater Total Paint Includes minor drywall repairs, primer 1850 1,424.50 610.50 2,035.00 Walls Insulate attic and waiis 1,425S.UU L/S.UU 1,/bU.UU Page I ESTIMATE FOR Contractor: H&M Contractors Email: hugo@hhremod.com 14041 SW 52 St. Miramar, FL 33027 Property Address: 5 NE 105 St. Miami Shores Square Footage: 1856 Bed/Bath: 3/2 Owner: Sam Soriero Date: 3/15/2016 Construction Duration : TOTAL AMOUNT ❑ 30 Days t 17n n7n nn Exterior Sq.foot / Description QTY Total Labor Total Mater Total Doorbell Install new 1 11.00 16.50 181.50 Landscaping package shrubs and mulch 1 352.00 - 352.77 Landscaping Cleanup clean trees, weed kill driveway 1 275.00 - 275.00 Structural - - - Groout filled cells as per drawings 49 8,085.00 - 8,085.00 Floor joists New 58 2,552.00 1,276.00 3,828.00 Floor Fill in and pour concrete slab in garage 270 2,376.00 - 2,376.00 Floor New sheething and durock floor 70 5,005.00 - 5,005.00 Stucco Repair 1 1,650.00 - 1,650.00 Wood fence New 200 3,960.00 - 3,960.00 Wood deck New 1000 1,650.00 1,100.00 2,750.00 Exterior doors Impact 3 825.00 2,475.00 3,300.00 Exterior windows New 14 2,310.00 6,930.00 9,240.00 Paint - Exterior, Walls, Trim Per Sq. Foot. Minor prep included. 1858 1,226.28 510.95 1,737.23 Soffit new 250 825.00 825.00 1,650.00 DEMOLITION - - - Demo/Trash 30 YD garbage dump (includes filling 3 3,135.00 - 3,135.00 ROOF - - - Roof Tiles Per square (tile itself not included) 25 8,745.00 - 8,745.00 PLUMBING - - Lines All new plumbing lines to whole house 1 4,400.00 2,750.00 7,150.00 TOTS, $47,382.28 $15,883.4S HVAC Description QTY Total Labor Total Mater Total Change out New unit (condenser and AHU) 1 1,650.00 2,200.00 3,850.00 Duct Work Per Duct 8 1,980.00 - 1,980.00 New lines Refrigerant lines 1 165.00 - 165.00 Electrical Box 1 165.00 - 165.00 Thermostat New 1 33.00 33.00 66.00 TOTAL $ 3,993.00 $ 2,233.00 Interior Description QTY Total Labor Total Mater Total Paint Includes minor drywall repairs, primer 1850 1,424.50 610.50 2,035.00 Walls Insulate attic and walls 1 1,485.00 275.00 1,760.00 Page 1 Flooring Porcelain tile troughout 2000 4,400.00 4,400.00 8,800.00 Walls/Ceilings Drywall New 1850 4,070.00 6,105.00 10,175.00 Doors Interior 6 495.00 660.00 1,155.00 Doors Closet 6 231.00 396.00 627.00 Baseboards 450 495.00 495.00 990.00 Final Clean 1 247.50 - 247.50 512.848.00 $12.941.50 Electrical Description QTY Total Labor Total Mater Total Coverplates and Outlets 40 220.00 132.00 352.00 Coverplates and switches 25 137.50 82.50 220.00 Ceiling Lights 16 264.00 176.00 440.00 Hihats 18 693.00 693.00 1,386.00 New panels Interior and exterior and all 220 1 3,850.00 2,750.00 6,600.00 . _-;,- $ 5,164.50 $ 3,833.50 Kitchen Description QTY Total Labor Total Mat. Total Cabinets - Uppers 7 385.00 1,540.00 1,925.00 Cabinets - Base 9 495.00 2,475.00 2,970.00 Angle stop and braided lines 1 27.50 27.50 55.00 Disposal System 1 38.50 110.00 148.50 Sink and waste connections Reuse 1 82.50 137.50 220.00 Faucet and trap Reuse 1 27.50 110.00 137.50 Countertops - Granite Per Slab Island 1 440.00 715.00 1,155.00 Countertops - Granite Per Slab Regular 2 550.00 715.00 1,265.00 Backsplash Glass tile 18 297.00 297.00 594.00 Dishwasher 1 44.00 385.00 429.00 Range 1 27.50 550.00 577.50 Fridge w/ water line 1 44.00 1,320.00 1,364.00 Microwave 1 44.00 330.00 374.00 Connections Hoses, electrical lines etc. 1 - 110.00 110.00 > 8,822.01 Hall Bathroom Description QTY Total Labor Total Mater Total Mirror 30" 1 33.00 132.00 165.00 Vanity Cabinet & Top 30" 1 55.00 385.00 440.00 Vanity Sink 1 - 44.00 44.00 Faucet & Trap 1 - 44.00 44.00 Angle Stop and Braided Lines 1 - 27.50 27.50 Toilet, T -Stops and Supply 1 - 132.00 132.00 Tub 1 275.00 - 275.00 Shower/Walls Durock and tile (Per SF) 70 308.00 462.00 770.00 Shower/Tub Hardware 1 110.00 110.00 220.00 $ 781.00 $ 1,336.51 Master Bath Description QTY Total Labor Total Total Mirror 36" 1 22.00 66.00 88.00 Vanity Cabinet & Top 36" 1 55.00 495.00 550.00 Faucet & Trap 1 - 44.00 44.00 Angle Stop and Braided Lines 1 27.50 27.50 55.00 Page 2 Toilet, T -Stops and Supply 1 - 132.00 132.00 Shower Doors 1 110.00 385.00 495.00 Shower/Walls Durock and tile (Per SF) 100 660.00 660.00 1,320.00 Shower/Tub Hardware 1 - 110.00 110.00 TOTAL $ 874.50 $ 1,919.50 Page 3