The URL can be used to link to this page

REV-17-277 Miami Shores Village BuildingDepartment p FEES t2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 BY. + FBC 20 BUILDING Master Permit No. KC- `1 -- 15 -2355 PERMIT APPLICATION Sub Permit No. m G - 2=� ---+' ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1 0 S S ALC 9 6 1- City: . Miami Shores County: Miami Dade Zip: 33 13$ Folio/Parcel#: 1 V5 ZD k 0 193 7 10 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Poapr-,Le Rob;F,e--, Phone#: 3oS- S 46- 3©B$ Address: 1055 NE 16 5'-/- City: 'fCity: /Yllg►,n, Sho!'e.� State: F� Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#: --3a25 786-Z81-310S Address: 16 136 Su/ 6 4, Tern City: X:'WI 1 State: PL Zip: 3,3 1 c13 Qualifier Name: Phone#: s State Certification or Registration#: E 6(3007260 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: } "State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition I 1 Description of Work: 2a�k room rennode� ^1n�A it1 ,r6t11oJ1' n of ` kgnkleSs wAfc!" Ne-4&rt 53.1r.-1J J X+ASR*n►!11 ii Specify color of color thru tile: Submittal Fee$ Permit Fee$ CO/CC$ Scanning Fee$ 1 Radon Fee$ DBPR$ Notary$ Technology Fee$ • �O Training/Education Fee$ 2O Double Fee$ Structural Reviews$ Bond$ 7/ ' (O TOTAL FEE NOW DUE$ Z'q (Revised02/24/2014) T 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature i Si e �7OWNE or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 1 by / day of 20 / 7 by who is personally known to Y5Je_ who is personally known to me or who has produced ZSS-Zw—'A Z {OCa als:::, me or who has produced FC. Q�^71iRrs �i L't�Se as identification and who did take an oath. identification U e r`S identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si " Sign: :222 -'i MAHAM K.GONZALEZ Print: 9MMISStoblerrQ44602 Print: l�JA2iA{ -�'� QGfeY7a(� '* EXPIRES:November 2,2020 =otPav P�B� MARS Seal: `` Pum;oundervrrfters Seal: '"••'° I•QUESADA a: ar; Bonded Thru Notary * MY COMMISSION#FF 075875 .off; • EXPIRES:January 23,2018 FOS FIOQ" Bonded Thru Budget Notary Servlces v_y ############################################################################################################ 7 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) S�VIC*19 oRES t s� Miami shores Village Building Department a% o0050 E.2nd Avenue �LORIDp` Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption t 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-tune 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 aylahor,part=timesemployees-or-subcontractors-foryour-project—T-he-contractor-has-provided-an-affidavit stating that he-or-she-wil 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 rr The foregoing was acknowledge before me this�_day of ,20 l By E�S C( _6�6igY)0n who is personally known to me or has produced ZS,S- — - 0 L/ as id h'fica'On Notary: (9*!;� i MAHARAI K.GONZALEZ SEAL: MY COMMISSION#GG 044602 it' EXPIRES:November 2,2020 Bonded Thru Notary Public Underwriters a i r CITY LIGHTS ELECTRIC, INC. 14026 SW 13 Street Miami, Florida 33184 Date: State of: Florida County of: Miami-Dade Before me this day personally appeared Jorge Cabrera who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at 1055 NE 96 Street, Miami Shores, Florida 33138. f Sworn to (or affirmed) and subscribed before me this 3/ day of January, 2017 by Jorge Cabrera . Print:-JCS o �1i 1 Signature-. Identification Produced ,C�L 11",7se Print, Type or Stamp Name of Notary MARIA I.QUESADA * * MY COMMISSION 8 FF 075875 s EXPIRES:January 23,2018 ,1°r Bonded Thru Budget Notary Services RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD EC 13007060 3 .` The ELECTRICAL CONTRACTOR Named below IS CERTIFIED `., Oil Under the provisions of Chapter 489 FS. - �` Expiration date: AUG 31, 2018 , " CABRERA, JORGE A ^ CITY LIGHTS ELECTRIC `f 16136 SW 66 TERR,AC 4 MIAMI -FC : . P i..q oi I., v • • . . ISSUED: 08/25/2016 DISPLAY AS REQUIRED BY LAW sEQ# L1608250002679 s ID4185 Y "calReceipt si s3 Tax. MI _ Mia Dade County State of Florida IS IS NOT A BILL—DO NOT PAY 5858908 t3U8tNE88 NAME/LpCgfipN CITY LIGHTS EEK RIC INC R IPr No. EXPIRES 8236 NW 30 TERR RMEWALs SEPTEMBER 30, 2017 DORAL FL 33122 Must be displayed at place of business Pursuant to County Code Chapter 8A—Art. 9& 10 OWNER SEC. TYPE OF BUSINESS CITY LIGHTS ELECTRIC INC 196 ELECTRICAL CONTRACTOR PAYMENT yBp JORGE CABRERA PRES EC13007060 _ BY TAX COUACTOR Worker(s) 1 $45.00 09/26/2016 CREDITCARD-16--057715 Ibis;Local Businoas Tax Iioceipt only coMirna payment of the Local Business Tax. The Receipt is act a lice�te. permit,or a kation of the holder's-wlificadons,to do badness. Holder aeM 1 with any or nagom0meowl repulawry laws. ngvl"n ats which 8P*to the brheec, no RECEIPT NO.above must be displayed on all cammerciai vehicles-Miami-Dade Cods Soc u-,M For awe information,visit WM 11s, A . JEWAMRIM CHEF FLVANcuu.oFFiCER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES OMSION OF WORKERS'COMPENSATION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAME'• CONSTRUCTION INDUSTRY EXEMPTION Ibis oertHies that the indhAdmi listed below has elected to be exwnpt*om Fkxida V tkas'Cotttpensabml law. EFFECTIVE DATE 7/1012016 EXPIRATION DATE: 7/10/2018 PERSON: CABRERA JORGE FEW: 203310924 BUSINESS NAME AND ADDRESS: CITY LIGHTS ELECTRIC. INC. 16136 SW 66 TERRACE FL 33193 MIAMI SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR PuraLmdw41Q8X14tF.S.aadior4*auftd s *Mobd*Mr aa�MaW4f ea�dlrwTsa�dfoa n"not reoovsrbaneiDt or oormpsraaiiaw under*�U to Maiitf�.F oNM�EF.SYw�tabrs��a� "i the scope of the bu skum a ta�de bbd W IIr+1®otddedim b fr PrwYrrtit M.Milos d b� s�wrytan0ocrticaeesdeiscdontsMrM be � dot � efd4 llr door@"** e pWW terth tned on e mics a thariti f noIarPr DFS.F7-MY CER�►TEOF TO DE FJIEMPTa QUEST IONB�( 13.1d� i '`� CERTIFICATE OF LIABILITY INSURANCE °ATE08/11/16' 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: ff the certificate holder Is an ADDITIONAL INSURED,the poffcy(fes)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 CONT Lucia Estrella N Accurate HONE -Ext): (305)226-8727 (AIC,No): (305)226-8767 8300 West Fiagier Suite 114 M luciaestrella@belisouth.net Miami,FL 33144 INSURERS AFFORDING COVERAGE NAIC# Phone (305)226-8727 Fax (305)226-8767 INSURER A: Granada Insurance Company INSURED INSURER B City Lights Electric Inc INSURER C: 16136 SW 66 Terrace INSURER 0: Miami,FL 33193 (305)496-3198 INSURER E: 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. ILTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER MMroDY (MOLIC EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000.00 Q COMMERCIAL GENERAL LIABILITY DAMAGE To RENTED REMISES Ea occurrence $ 100,000.00 ❑ ❑'CLAIMS-MADE Q 05/06/2016 05/06/2017 OCCUR 0185FL00070081 MED EXP(Any one person) $ 5,000.00 A ❑ N N PERSONAL&ADV INJURY $ 500,000.00 ❑ GENERAL AGGREGATE s 500,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 500,000.00 POLICY ❑ PRa ❑ LOC 1 $_ AUTOMOBILE LIABILITY (COaxI EDtSINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident), $ F-1 AUTOS ❑ AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS Per accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC STATU-S ❑ORT EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? El I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ Ues describe under Sd RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) EC Number:EC13007060 I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONSATION. *All Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE 350-756-8972 Lucia Estrella ©1988-2010 ACORD CORPrights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD i