PL-18-1090 Permit NO. PL-4-18-1090
Miami Shores Village t PefMit TyPe.Plumbing-Residential
h T 10050 N.E.2nd Avenue NW Per I Addition/Alteration
Miami Shores, FL 33138-0000 Permit Status:APPROVED
Phone: (305)795-2204
N
F�OR1Dp'
issue Date.5/1/2018 Expiration: 10/28/2018
Project Address Parcel Number Applicant
269 NW 111 Terrace 1121360010360
Miami Shores, FL 33168- Block: Lot: BLESSED MANAGEMENT GROL
Owner Information Address Phone Cell
BLESSED MANAGEMENT GROUP LLC 269 NW 111 Terrace
MIAMI SHORES FL 33168-3324
269 NW 111 Terrace
MIAMI SHORES FL 33168-3324
Contractor(s) Phone Cell Phone Valuation: $ 200.00
PRECIADOS GENERAL CONTRACTOI (305)763-5393,.
___ . . ...,. ..�_ Total Sq Feet: 0
Type of Work:REPLACE KITCHEN CABINETS Available Inspections:
Type of Piping: Inspection Type:
Additional Info:REPLACE KITCHEN CABINETS Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground
,
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# PL-4-18-67293
$2.00 05/01/2018 Credit Card $213.60 $0.00
DCA Fee $2.00
Education Surcharge $0.20
Notary Fee $5.00
Permit Fee $100.00
Scanning Fee $3.00
Technology Fee $0.80
Work without Permit Fee $100.00
,
Total: $213.60
r
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. c }
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 zoning. Futhermore, I authorize Te above-named contractor to do the work stated.
q May 01, 2018
Authorized i u e:Owner / Ap icant / Contractor / Agent Date
Building Department Copy
May 01, 2018 i 1
Miami Shores Villagec �, r -
Building Department AT2210050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY:INSPECTION LINE PHONE NUMBER:(305)762-4949
�FFBC 2011
BUILDING Master Permit No. y lC.—"\- "\�' a-b�
PERMIT APPLICATION Sub Permit No. �L- 16 — 10 9 l7
❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
15fiLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
•�ll__q �., " CONTRACTOR DRAWINGS
JOB ADDRESS:
City: Miami Shores County: Miami Dade zip:3313k
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER:Name(Fee Simple Titleholder): %eSt)� l_Whone#: f-*b t4P�a-Np`''k
Address: 2 '550 D5W ao3' ONrl
City:�Q gsenA C State: Zip:
Tenant/Lessee Name: Phone#: 0 %
Email: rei J
2
CONTRACTOR:Company Name: Pr LOLnkrA 0 ��d OKPhone#: J05 H3 D�3
Address: 301 sw /3Z d V
City: State: Zip:
_ 3 1'75
f
Qualifier Name: ! tx eC/ Y0__j 1, p Phone#:
State Certification or Registrati #: (:' EC, �7 27 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work:
i
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
Description of Work:
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
It
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$ (00
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: 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 a ce of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature MVV\ Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this The foregoing instrument as acknowledged before me this
day of 1Pr0Y 1 20\X by day of ��r+ 20 by
Vtc� ro"le L who is personally known to Fnr4,)e poen dos who is personally known to
me or who has produced as rrte or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign: --�A
Print: - -S Print.
Seal: o4XI pe®G Notary Public State of Florida Seal: =o1aa Pue:::]ate of FloridaDouglas Montas asMy Commission FF 173045 a �! ;73045OF f� Expires 1013012018 OF F� •�1g # # # ############
APPROVED BY �' 'i�''IOi Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
COMPANY LETTER HEAD
Date:
State ofe P&,/ Zo%
County ofi�i/i
Before me this day personally appeared � 1" who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at:
r �
ty'ctlo-r-li&a t u re
Sworn to (or affirmed) and subscribed before me this ZS day of 1,VP,111120
by&ZOZa✓F
Personally know
Produced Identification
Type of Identification Produced
an Sabetela
missio W3060
ire 20,2020
Aaron Notary
Print,Type or Stamp Name of Notary
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S�ORFS
s� Miami shores Village
.n.
Building Department
'res 10050 N.E.2nd Avenue t
��ORIDp' 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:
1V Vl h
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of �1^��pY \ ,20\)L.
By \-`C,%,f(� who is personally known to me or has produced
;vey t as identification.
Notary: YANADY PRIETO
' ',,. '"= Ml'COMMISSION#FF 214031
SEAL: ?I a= EXPIRES:March 25,2019
•;e dF•y�d� Bonded Thru Notary Public Underwriters
' DATE(MMIDDIYYYY)
CMW CERTIFICATE OF LIABILITY INSURANCE
~°'`• 04125/2018
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 have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terns 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).
- CONTACT
PRODUCER 305-418-8411 305-418-8413 -NAME,_ ._-Ma link Perez w µ _ ...
PHONE FAX _.__..
Westward Insurance Services, Inc > I�I>a 30 .-4418-8411 _.�. . ,[,tmgmol_305-418 8413, --
4905 NW 72nd Ave E-MAIL Westwardins@belisouth.net
Suite 5 .�__.__....._.. I
"NS____URER�S)AFFORDINgCOVERAGE _. NAIC_q...__�.
,iUll rT1J FL FL 331_6._. __._- _.._ INSURER A: Evanston Insurance Company.____.__
INSURED
INSURER a
_.....
Preciados General Contractor LLC INSURER C: _ _ _.._....I_........................_
4701 SW 132 Ave INSURERo
Miami, FL 33175> I.WkUREa_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 TYPE OF INSURANCE ADDL S B POLICY NUMBER MMIDD�YY MMIDD Y LIMITS
LTR — -.._.__ . . __.
COMMERCIAL GENERAL LIABILITY I EACHUURRENCE 1 $ 1.000.000
.._......_ ��� i `t?AMAC "ITEti
A ;
I CLAIMS-MADE !.�J OCCUR i I PREMISES Ea occurrence)._?_...� � 000 ._..___.....
_....
B106959 110112/2017 i 10/12/2018 3 MED EXP(Any nns person)
......._._.
PERSONAL&ADV INJURY $ 1,00,000
I GEN'L AGGREGATE LIMIT APPLIES PER- i GENERAL A
AGGREGATE s Z 000.L....000 _
......... ... .. ........,..,. ..._
JE
PO-
POLICY LOC PRODUCTS-'COMP/OP AGG s2,000,000
-.
OTHER: $
UMBINEDIN L LIMIT $
i AUTOMOBILE LIABILITY Ea accident; __
i
BODILY INJURY(Per person) $-.............1 ANY AUTO ? � i -
I
r OWNED SCHEDULED BODILY INJURY(Per acc:ident)1$ � ^^
!.AUTOS ONLY AUTOS I••-_....
.. .....
i HIRED NON-OWNED PROPE�2TYDAMAGE�- - -$ .
I AUTOS ONLY i AUTOS ONLY (Per accident I w„w.._
I i $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _..
._
EXCESS LIAB I _ CLAIMS-MADE AGGREGATE $ ...........
DED I RETENTION$ I $ m..
!iWORKERSCOMPENSATION ( I STATUTE FOR
AND EMPLOYERS'LIABILITY y N I — I
ANYPROPRIETORIPARTNERIEXECUTIVE l i E L EACH ACCIDENT $
OF
riCERlMEMBEREXCLUDE37
(Mandatory in NH) E L DISEASE EA EMPLOYEE'$ _
If yyes,describe under
DESCRIPTION OF OPERATIONS below i I i E-L”DISEASE-POLICY LIMIT $
I I
I t
t
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Certified General Contractor CGC 1525687
Certified Plumbing Contractor CFC1429914
I
CERTIFICATE HOLDER Fax 305.792.1567 CANCELLATION
Miami Shores Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, FL 33138
AUTHORIZED REPRESENTATIVE
Maylin Perez
C 1988-2015 ACORD CORPOR TION. All rights reg6irved.
ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD
JIMMY PATRONIS
CHIEF FINANICAL 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: 8/11/2017 EXPIRATION DATE: 8/11/2019
PERSON: PRECIADOS ENRIQUE
FEIN: 822185986
BUSINESS NAME AND ADDRESS:
PRECIADOS GENERAL CONTRACTOR LLC
4701 SW 132 AVE ,
MIAMI FL 33175
SCOPE OF BUSINESS OR TRADE:
Contractor-Project Manager,
y Construction Executive,
Construction Manager or
Construction Superintendent
IMPORTANT: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 not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply
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 08-13 QUESTIONS?(850)413-1609
t
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aLocal Business Tax fecei`pt
Miami-Dade County., Stateof`Florida f
-THIS IS NOT A BILL-DO NOT PAY
•7233264 BT
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BUSINESS NAM E/LOCATION RECEIPT NO. .� EX PIR'ES
PRECIADOS GENERAL NEW BUSINESS SEPTEMBER 30, 2018
CONTRACTOR LLC 7518908
4701 SW 132 AVE .a Must be displayed at place of business
MIAMI, FL 33175 -Pursuant to County Code '
Chapter 8A-Art.9&'1o'
OWNER S V SEC.TYPE OF BUSINESS "
PRECIADOSGENERALs "PAYMENT RECEIVED
196 )GENERAL BUILDING` BY TAX COLLECTOR.
CONTRACTOR'LLC _ CONTRACTOR
FNPlnI IF PRFRIAnn.q r' % .175.00 10/13/2017
Worker(s) t 1 CGC1525687 !
i 0237-18-000{179
`This Local$Business Tax Receipt only con"rrts payn>ant of the Local Business Tax. pt is
The f�cei ' "
rat a l icense,
permit
or a certi"cation of thehddeesquali"cations,to dobusiness.HilderIi-St complywithartygovernmental
&rwoovernmental re�ulatorylaws and
reglaremlentswhichapplytothelxuirless.'
r The SilM Pi No.a"must be displayed on all ibrrrrsra6 vehicles Miami�Dade Code Sec 8a-278.
MIAMFWID !' "
1 For more informstion,visit www.mamidade pQ auoallectn
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STATE OF FLORIDA
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DEPARTMENT O� AVVN Ma
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DETACH HERE
wR# JONATHAN 4ACJ4M ZfCRFTAW
STATE OF FLORIDA
CrEPARMENT Of SUSWESS AND PROFESSIONAL REGULATION
CONSTRUCTION MOUSTRY LICENSING BOARD
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