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REV-16-2006 Miami Shores Village r Building Department s 2016 s 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 $Y: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 t FBC 20 ly BUILDING Master Permit No. zC- G-6 -15�j1 PERMIT APPLICATION Sub Permit No.R1 ((- ?mL ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING - MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP (� A CONTRACTOR DRAWINGS JOB ADDRESS: ' !a V� `z 1�P,U City: Miami Shores County: Miami Dade Zip: 'F�721,�d Folio/Parcel#: 1 Is the Building Historically Designated:Yes NO Occupan oad: Construction Type: Flood Zone: y BFE: Qa FFE: OWNER: Name(Fee Simple Titleholder): N� � �1 d1. Phone#: � �" 6U-M/63 Address: � l_ 9 City: <U. ` State: Zip: —53 I C Tenant/Lessee Name: v"- Phone#: Email: CONTRACTOR:Company Name: v\T\tI� C ,� Phone#: Address: City: State: zip: 33 $ Qualifier Name: Phone#:r 7��— -{4'z- 19.4T State Certification or Registration#: (05*j` Certificate of Competency' #: ect/ g neer: �� C,C\� at Phone#:. 7SIlot DESIGNER:Archit En in • Address:�L7. Ctrl City: State: zip:-3�-! Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace , ❑ Demolition Description of Work: Jmm IN 1c, y.... R.5 A.iy a d'�.t'w'L -s,.+..• z •.c.•,:i i .k:�' lr -'st ti 9 +R`o!` !S3 " rrrtf dtS fie: as cm. r/�i, '. ( �. Specify color'of color thru-tile: Submittal Fee$ ;.� Permit Fee$ �, CCF$ _ •. MSR CO/CC$N.�•..•�F��j Scanning Fee$ Radon Fee$ DBPR$ Notary$ a Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) "1 Bonding Company's Name(if applicable) Bonding Company's Address _ City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City'_ ' - t ' ' 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. y s , "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$2500,;the'applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property iss°ubject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whi rs seven (7) days after the building permit is issued. In the,absenee,of such posted notice, the inspection will not be ap eve n a reinspection fee will be charged. , r Signature Signature aO N or AGENT CONTRACTOR ; The foregoing inst m as acknowledged before me this The foregoing instrument was acknowledged before me this Vi I day'of 20 , by day of y u`��20�J by C\0 �who is personally known towho is personally known to me or who has produced�'B, D!tt$ as me or who has'pro'duced UCC-1) as ide6tification'and who did take an oath.' �' identification and who did take an oath.' NOT RY 1 C: NOT Y_pUB Si n: Sign: ' Print Print: Seal: '• MY COMMISSION N FF935000 MY COMMIggpN a FF Seal: EXPIRES 935000 ... EXPIRES November 09.2019 .�•,��,�ie-0 s3 I'1o�mber 09.2019 *********************** *** ****** ****** ****************************************************************** APPROVED BY i t6 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA z,^ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ,. j` CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 I 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 3 ALBERTO, LAZARO K ULTRA WEATHER CORP i 17851 SW 152 CT MIAMI FL 33187 4 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and r =,it STATE OF FLORIDA Professional Regulation. Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque l DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. "-•<' PROFESSIONAL REGULATION CAC1816585 i SSUE : 07/17/2016 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 CERTIFIED AIR (iJQCONTR - information about our divisions and the regulations that impact ALBERTO,LAZAPb'K you,subscribe to department newsletters and learn more about ULTRA WEATHER'Co l?' ~ 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 IS CERTIFIED under the provisions of Ch.489 FS. serve your customers. Thank you for doing business in Florida, Expiration date.AUG 31 2018 1-1e07Vocoo939 r and congratulations on your new license! 4 I DETACH HERE t RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA + DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC 1816585 The CLASS B AIR CONDITIONING CONTRACTOR Y . Named b elow IS CERTIFIED �``` Under,the provisions of Chapter 489 FS. Expiration date: AUG'31 2018'1', ALBERTO,=LAZARO K ULTRA WEATHER COFtI 17851 SW 152 CT MIAMI ,tom: • I F ACO O 8/15(/2016) CERTIFICATE OF LIABILITY INSURANCE 11 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 BLOW. 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 gcceQrtificate holder in lieu of such endorsement(s). IF J ECONTACT INSURANCE CORP NAME: 12525 W Okeechobee Road PHOA/C,NoEXl: n/c,NO:(305)221-8049 Hialeah Gardens, FL 33018 AODRESS:carmen@cjginsurance.com INS U ER(S AFFORDING COVER/10E NAICY UttINSURER A: INSURED � Lazaro INSURER B 17851 SW 152nd Ct INSURER C: Miami, FL 33187— INSURER D: (786)229-4364 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. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD VNO POLICY NUMBER MMDD/YYYY MM DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE r"1_I OCCUR000 PREMISES Ea occurrence $ r GL 48859-1 07/26/16 07/26/17 MED EXP(Any one person) $ A PERSONAL&ADV INJURY $ 1,00 '000 GEN'L AGGREGATE LIMIPRO-T APPLIES PER: GENERAL AGGREGATE $ CIPOLICY JECT CI JECLOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY (LOMBINED SINGLE LIMIT accident) ccident $ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED P PERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ F�EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? �_ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) AC SERVICE INSTALLATIONS AND REPAIR CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE grid AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD i , JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION 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: 8/10/2016 EXPIRATION DATE: 8/10/2018 PERSON: ALBERTO LAZARO K' ,FEIN: 272728717 F BUSINESS NAME AND ADDRESS: ULTRA WEATHER CORP i r I 17851 SW 152 CT t MIAMI FL 33187 I SCOPES OF BUSINESS OR TRADE: r HEATING VENTILATION, AIR-GOND Pursuant to Chapter 440.05(14);F.S..an otrwer of a calpolatlart who eletls exemption trorrt dtis ehaper by t�rlg a arfircab of ekdion under lhis section mrnasyy not recover benefits rn tzerlpensation under Cris chap0er.Pursuant to Chapbr 440.0.5(12},F.S.,Certllk>roa of eke5on b be e�rompt.. Yritltirt efe seeps of the buattess rn trade faded on Oro notice of ek�tion b be Pursuant b Citap�440.05(13),F.S.,Notices of akrJlal�bye exampl 7rW oertrfit�ees of ebctlm b be exempt shat be sut>Hct b rava�6on IT,at any iKr,e aitrn Cts ung M the noLce or the iaw�ce of the oertificxhe ' dte person named on the rp0ce rn b m forger meets the roqukernents of this secfai for issuance of a certificaN.The departrnant shat rovoks a j. a DFS-F2-DM- 2 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13' QUESTIONS?(850)413.1809 ' k A9 t 1 1 • x + 1 '