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EL-15-2455 2G 1 s— 2, .?::--) s- Permt No. EL-9-15-2455 RE- Miami Shores Village Permit Type:Electrical-Residential .a .. 10050 N.E.2nd Avenue NE Per IWork Classification.Addition - - ""'T Miami Shores,FL 33138-0000 Permit Status:APPROVED Phone: (305)795-2204 TE\1N 4 FCORIUP' # Issue Date:3/3!2048 Expiration: 08/30/2016 Project Address Parcel Number Applicant 1055 N E 96 Street 1132060143710 Miami Shores, FL Block: Lot: PATRICE ROBINET Owner Information Address Phone Cell PATRICE ROBINET 1055 NE 96 Street MIAMI SHORES FL 33138-2551 Contractor(s) Phone Cell Phone Valuation: $ 2,500.00 CITY LIGHTS ELECTRIC, INC. (305)495-3198 .—-------- Total Sq Feet: 0 Type of Work:ELECTRIC FOR NEW GARAGE. Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning: 1 } Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# EL-9-15-57220 $3.38 DCA Fee $3.38 03/03/2016 Credit Card $ 189.56 $50.00 Education Surcharge $0.60 09/25/2015 Check#:1541 $50.00 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $2.40 3 Total: $239.56 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 i that all the foregoin i matiorl is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin Futh m9re-L authorize the ov na d con for to do the work stated. March 03, 2016 Authorifi4d Signatur Own / licant / Contractor / Agent Date Building Department Copy a March 03, 2016 1 + e. Miami Shores Village [R_-1C % � ---! Building Department SEP 5 2015 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 BY: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 e�J FBC 201"A BUILDING Master Permit No.�c– PERMIT APPLICATION Sub Permit No.-u. ( 5-.'q' q ❑BUILDING X ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:] CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1055 NE 96 Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-014-3710 Is the Building Historically Designated:Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Patrice Robinet and Elsa Gagnon Phone#:305-546-8088 Address: 1055 NE 96 Street City: Miami Shores state: Florida Zip: 33138 Tenant/Lessee,Name: N/A Phone#: Email: patricerobinet@hotmail.com CONTRACTOR:Company Name: City Lights Electric, Inc. Phone#: 305-495-3198 Address: 14026 SW 13 Street City. Miami state: Florida Zip: 33184 tQualifier.Name:� :Yb9_G3 CA QQ0(?_d Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Victor Bruce Phone#: 305-310-5030 Address:370 NE 101st StreetCity: Miami Shores State: FL Zip: 33138 .Value of Work'for'this Permit:'$.Cq, _" Square/Linear Footage of Work: Type of Work: ❑E Addition ❑ Alteration 7 New ❑ Repair/Replace ❑ Demolition Description of work: Electric for new garage Specify color of color thru tile:Submittal Fee$ co e Permit Fee$ Za CCF$ CO/CC$ Scanning Fee$ _ 60 Radon;Fee$ "3' DBPR$ Notary$ Technology Fee$ • HQ Training/Education Fee$ O'60 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) F Bonding Company's Name(if applicable) N/A 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 lam- Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20,/ .by day of 20 /S by . //� Z //I e o is personally known to e OQ d rte/ a -who is personally known to CZE .�ih -�O�G+' p Y me or who has produced =PL as me or who has produced FL Qr/U2lsas identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sigr Sign: /i aaa L Print: Print: 1W 1,17e//1- e! Pu Seal: Seal: °�;a�P;B� MARIA I.QUESADA X11� Notary Public State of Florida * 0." * MY COMMISSION#FF 075875 Joanna M Feliciano �� EXPIRES:January 23,2018 4 My Commission FF 082753 're Bonded Thru Budget Notary Services Expires 01/1212018 OF F, ######### ### ## # # ################################################################ APPROVED BY / Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) { Local. Business Tax Receipt . - --Mlami_-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY BUSINESS NAME/LOCATION RECEIPT NO. .E'XPIRE•S`- CITY LIGHTS ELECTRIC INC :RENEWAL SEPTEMBER 30, 2016 8236 NW 30 TERR 6110290 DORAL,FL 33122 ..must be displayed at place of business Pursuant to County Code Chapter 8A'=Arta 9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED CITY LIGHTS ELECTR:C.INC 196 ELECTRICAL . IIV TAX COLLECTOR JORGE CABRERA PRES CONTRACTOR 45.00 09/26/2615 Worker(s) 1 EC13007060 ECHECK-15-165114 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 most comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above inted be displayed an all commercial vehicles-Miami-0ade Code Sec Sa-276. ry®11=.AM For more information,visit www mismidade eor/taxeollector RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - ELECTRICAL CONTRACTORS LICENSING BOARD y EC13007060 The ELECTRICAL CONTRACTOR Named belowIS CERTIFIED sed Under the provisions of Chapter 489 FS. Expiration'date: AUG 31, 2016 CABRERA; JORGE A , CITY LIGHTS ELECTRIC;INC 16136 SW 66 TERRACE`4t" sJ®rp MIAMI -F,33191- S � a.. :. i ' err. t✓.i. f <:� a .: :+-, I ISSUED: 10/07/2015 DISPLAY AS REQUIRED BY LAW SEQ# L1510070000348 i '�CC7iRl��' CERTIFICATE OF LIABILITY INSURANCE DA�02/23/1i6) THIS,CER+TiFICATE 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 poiicy(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 i certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAdIE: Lucia Estrella Accurate PHONE , (305)226-8727 F� U.I: (305)226-8767 8300 West Flagler Suite i 14 ADDRESS luciaestreilaQbelisouth.net j Miami.FL 33144 (NSU S AFFORDING COVERAGE NAI 9 Phone (305)226-8727 Fax (305)226-8767 INSURER A, Granada Insurance Company j INSURED INSURER 8: City Lights Electric Inc INSURER C 16136 SW 66 Terrace INSURER D: Miami,FL 33193 (305)496-3198 INSURER E: i 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 13Y 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. LTR TYPE OF INSURANCE HADDL�SUBR POLICY NUMBER POLICY EFF POLICY EXP I �511)lAL1® �(MM/DDrYYYY_j M LIMITS GENERAL LIABILITY II EACH OCCURRENCE $ 500,000.00 DAMAGE TO Q RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,000.00 A ❑ ❑ CLAIMSWADE qJ OCCUR Y 05/06/2015 05/06/20160185FL00070081 t MED EXP(Any one person) $ 5,000.00 1 F-1 i I PERSONAL 8 ADV INJURY $ 500,000.00 GENERAL AGGREGATE _ $ 500,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500.000��00 JJ POLICY ❑ PRO- ❑ LOC i $ JECT AUTOMOBILE LIABILITY } I COMBINED SINGLE LIMIT $ ❑ ANY AUTO I BODILY INJURY(Per person) ° $ ❑ AUTOSS WNED E] AUTOSULED P BODILY INJURY(Per acddent S E] AUTOS NON-OWNED " ` 6 ! CPR�OPERdI AMAGE $ ❑ HIRED AUTOS f ` ❑ UMBRELLA LIAR ❑OCCUR $ EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE S ❑ DEO ❑ RETENTION$ i $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN f ❑TORY ITS ❑ER ANY PROPRIETOPJPARTNER/EXECUTIVE l OFFICERIMEMBER EXCLUDED? ❑NIA i E.L.EACH ACCIDENT $ (Mandatory in NH) ; ? EL.DISEASE-EA EMPLOY S it S6 describe under a DESCRIPTION OF OPERATIONS below __ j E.L.DISEASE-POLICY LIMIT" $ I iw DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Romarks SchWula,Unwin sp2co Is requirod) EC Number:EC13007060 Contract License#0611000935 I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE ERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS ,Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE 1350-756-8972 Lucia Estrella ©1988-2010 ACORD CORPO O All rights reserved. ACORD 26(2010105)OF The ACORD name and logo are registered marks of ACORD r JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION f **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: 7/11/2014 EXPIRATION DATE: 7/10/2016 PERSON: CABRERA JORGE FEIN: 203310924 BUSINESS NAME AND ADDRESS: CITY LIGHTS ELECTRIC INC 16136 SW 66 TERRACE MIAMI FL 33193 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may y not recover benefits or compensation under thls chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...appy 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 to be exempt shall be subject to revocation if,at any time after the filing 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 certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(650)413-1609 i r I i CITY LIGHTS ELECTRIC, INC. 14026 SW 13 Street Miami, Florida 33184 Date: r State of Florida County of Miami-Dade Before me this day personally appearedG who, being duly sworn, deposes and says: .r That he or she will be the only person working on the project located at 1055 NE 96 Street, Miami Stiores, Florida 33138. Sworn to (or affirmed) and subscribed before me this IS day of September, ;2015 by I Personally know i OR Produced Identification Identification Produced brly vs Print, Type or Stamp Name of Notary MARIA I.QUESADA * * MY COMMISSION#FF 075875 o EXPIRES:January 23,2018 crMzr;rhras:udplWary Services t ,SNORES ANG If31 Boom J ..,..►� Miami Shores Village ly k �e Building Department �tORiDp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Com ensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid'for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature:--A Ow State of Florida County of Miami-Dade The foregoing was acknowledge before me this�_day of ��� '20_45 BY tri-Co Cj 6,/-7 e I-- who is personally known to me or has produced as identification. Notary: I .W Notary Public State of Florida 1 SEAL: ;� Joanna M Feliciano My commission FF 082753 OF w Expires 0111212018 - 4