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PL-17-2228 Permit,NO. PL-9-17-2228 Miami Shores Village ' Permit Type: Plumbing-Residential 10050 N.E.2nd Avenue NE work Classification:Addition/Alteration Miami Shores,FL 33138-0000 Pen 1-t Permit Status:A Phone: (305)795-2204 APPROVED CORIDA -issue Date: 10123/2017TFpiratipn: 04/21/2018 Project Address Parcel Number Applicant 14,30 NE 102 Street 1132050240230 Miami Shores, FL Block: Lot: BROWSING 4 HOUSING LLC Owner Information Address Phone Cell BROWSING 4 HOUSING LLC 1430 NE 102 Street (917)703-6010 MIAMI SHORES FL 33138- 1430 3138.1430 NE 102 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 12,300.00 VEPCCO CONSTRUCTION &MANAGE (954)980-5786 Total Sq Feet: 3146 Type of Work:NEW PLUMBING LINES AND DRAINS AS PE Available Inspections: Type of Piping: Inspection Type: Additional Info: Bond Return Top Out Final Classification:Residential Scanning: 1 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $7.80 Invoice# PL-9-17-66073 DBPR Fee $6.46 09/06/2017 Credit Card $50.00 $415.07 DCA Fee $4.31 Education Surcharge $2.60 10/23/2017 Credit Card $415.07 $0.00 Permit Fee $430.50 Scanning Fee $3.00 Technology Fee $10.40 Total: $465.07 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity withthe plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonjKg.lFuthermore, I authorize the above-named contractor to do the work stated. October 23, 2017 'Au'MetzedS�gnal)ue:Owner / Applicant / Contractor / Agent Date Building Department Copy October 23,2017 ♦S�oREs y, Miami shores 'Village "" ""'t" Building Department ,, sa$' 10050 N.E.2nd Avenue e 04 F�ORIUp' 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: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 23rr-( day of r ,20 i By QCl o WiamR,<A who is personally known to me or has produced Byi \YkRV l 1( s identification. •5�:•."L�.,, YANADYPRIEi0 Notary: .'; ;= MY COMMISSION#FF 214031 EXPIRES:March 25,2019 Note Bonded Thru Public Underwriters SEAL: Notary I i Miami Shores Village SE 06 V Building Department BY: 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC200+ BUILDING Master Permit No.FA"_ �3 PERMIT APPLICATION Sub Permit No. TLR 1 - _422B BUILDING ELECTRIC, ROOFING REVISION EXTENSION RENEWAL T(PPLUMBING ❑ MECHANICAL [—]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 14'50 NZ 1 0'Z St- City: Miami Shores County: Miami Dade Zip: '3 13Fs Folio/Parcel#: l ' 'S2-O�j "O —02_3o Js the Building Historically Designated:Yes NO Loll Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder):_ tLQo X AQo5U_9.' i LLC- Phone#:(GL\=a�:-10"3(oI d Address: 6,0c) N C S`S Si' City: m WJA1 State: L Zip: 3313 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: V CCD �c2 x_r�Q� tAIS 661-_VP_4 Phone#:��`�� oS� 86 s Address: kI SO J,45V!SA14�1i� 1011— City: 011City: t(/�State: �rL Zip: 3331'j Qualifier Name:x 17 co Vl°i1 a Phone#: State Certification or Registration#Y [1I T2i 1 1�Z y?Fz Certificate of Competency#: {� DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: �91::iflf�'i�:a L il' !r' .t.t`Rt,• Value of Work for this�Permit:$ Square/Linear Footage of Work:is +?j\4b -5F1,,,' ' ti+G�Lr - + yr. � .� ; � i j ;'1Jt1;�l �" n Ci�}i;2i7l�lr+j� i• �h !:; Type of Work: ❑ AdditioA ❑� CAlteration '. ❑ New ❑ Repair/Replace :❑ Demolition Description of Work: �( t 7�vJ �yWM" Specify color orrfsl color thru tile: ��• Submittal Fee$�V Permit Fee$ �/• `'� CCF$ CO/CC$ Scanning Fee$ . 07 Radon Fee$ DBPR$ fe) Notary$ Technology Fee$ ))�40 Training/Education Fee$ 2 . 60 Double Fee$ i Structural Reviews$ 0 Bond$ / TOTAL FEE NOW DUE$ IS lJ� (Revised02/24/2014) + 's 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 Signature _-&V, LL� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this l day of 8Q00-* 120 IA by A day of Ay&:>'ST 26" \�A by tGtJta�n \J%L cx� ,who is personally known to 1?Qp0Lr-4Q V 2�A who is personally known to me or who has produced bkL1OE�S 444'-" as me or who has produced bt%g�� W�-eN?t; as identification and who did take an oath. identificati , ho did Ricardo Dominguez 1"d .; guez N/1 Ri NOTARY 1 NOTARY r'= Commission# FF958686 _ Commission # FF958686 =f *= Expires:February 8,2020 Expires:February 8,2020 = t Bonded thru Aaron Notary u Aaron Notary , ---� ,. Sign: '"���i� Sign: Print: Print: 11Z(�'�7 Z11b36k Seal: Seal: APPROVED BY '� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) A o CERTIFICATE OF LIABILITY INSURANCE DATE /YYY1� 088/04//04/17 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(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 endoreement(s). PRODUCER I CONTACT NAME: LUCIA Estrella Accurate PHONE (305)226-8727 FAX M No. 'Ac 0): (305)226-8767 26-8767 8300 West Flagler Suite 114 ADDRESS IuciaesVeliaQbeilsouth.net Miami,FL 33144 INSURERS AFFORDING COVERAGE NAIC p Phone (305)226-8727 Fax (305)226-8767 INSURER A: Convington Specialty Insurance Company INSURED INSURER 8: _ Vepcco Construction and Management INSURER C: 11881 Hermitage Drive INSURER D: Plantation, FL 33325 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, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDUSUBRI POLICY EFF POLICY EXP f LTR TYPE OF INSURANCE WVQ POLICY NUMBER MMMD/YYYY MM/DD LIMITS GENERAL LIABILITY ( EACH OCCURRENCE $ 1,000,000.00 a COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 I PREMI ES(Ea ocauren I $ ❑ ❑ CLAIMS-MADE 0 OCCUR VBA535356-00 MED EXP(Any one person) $ 5,000.00 A ❑ N 05/10/2017 05/10/2018 I I PERSONAL&ADV INJURY $ 100,000.00 ❑ j GENERAL AGGREGATE s 2,000,000.00 GEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 POLICY ❑ jEC ❑ LOC s AUTOMOBILE LIABILITY _ I COMBINED SINGLE LIMIT $,. ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ AAUTOOS ❑ AUTOESULED BODILY INJURY(Per accident) $ j j ❑ HIRED AUTOS ❑ NNOWOSWNED PROPERTYDAMAGE $ Per eaident ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE I $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE s ❑ DED ❑ RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ❑ I ❑EL, ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) i E.L.DISEASE-EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERATIONS below I _ E.L.DISEASE-POLICY LIMIT I $ I I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) General Contractor License# CGC1520378 Plumbing License#CFC1429282 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 Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 Lucia Estrella ©1988-20 0 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD name and logo are registered marks of ACORD { VEPCCO CONSTRUCTION & MANAGEMENT CORP August 23rd, 2017 State of Florida County of Miami Dade Before me this day personally appeared RODOLFO VERA who,being duly sworn,deposes and says: That he will be the only person working on the property located at 1430 NE 102nd Street Miami Shores FL 33138. Sworn to (or affirmed) and subscribed before me this`Z3day of 20 1�, by_ AnQ v I Personally.Known OR Produced Identification Type of Identification Produced C Ricardo Dominguez Commission # FF958686 ,s Expires:February 8,2020 a Bonded thru Aaron Notary Print,Type or Stamp Name of Notary 4 t R 11881 Hermitage Drive,Plantation,FL 33325 i