RC-18-1292Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Project Address
Permit
Parcel Number
Permit NO. RC-5-18-1292
Permit Type: Residential Construction
Work Classification: Alteration
Permit Status: APPROVED
e Date: 6/8/2018
Expiration: 12/05/2018
Applicant
1700 NE 105 Street Number: 204
Miami Shores, FL
1122300500230
Block: Lot:
MARGARET JENKINS
Owner Information
Address
Phone
Cell
MARGARET JENKINS
1700 NE 105 ST #204
MIAMI FL 33138-2139
Contractor(s)
GLA ENTERPRISES INC
Phone
(786)443-5209
Cell Phone.
Valuation:
-Total Sq Feet:
$ 4,355.79
300
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Construction: REPLACING EXISTING KITCHEN C
Stories:
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Bond Return':
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
P&Z Review Fee
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$3.00
$2.00
$2.00
$1.00
$0.00
$130.67
$9.00
$4.00
$151.67
Pay Date Pay Type
Invoice # RC-5-18-67543
05/16/2018 Credit Card
06/08/2018 Credit Card
Amt Paid Amt Due
$ 50.00 $ 101.67
$ 101.67 $ 0.00
Available Inspections:
Inspection Type:
Final PE Certification
Window Door Attachment
Framing
Insulation
Drywall Screw
Window and Door Buck
Fill Cells Columns
Review Electrical
Review Planning
Review Building
Review Plumbing
Review Structural
Review Mechanical
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
constructi
I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
Futhermore, I authoerise above -named contractor to do the work stated.
June 08, 2018
rt�
orized Signatur . Ow r/ Applicant
/ Contractor / Agent
Date
Building Department Copy
June 08, 2018
1
PERMIT APPLICATION
❑BUILDING ❑ ELECTRIC
❑PLUMBING /❑ MECHANICAL
JOB ADDRESS: 1 ? 00 J.
City: Miami Shores
Folio/Parcel#:
Occupancy Type: ( 0 Lead: Construction Type:
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
j ,BC 20
Master Permit No. "1 1 C-1 ._I 2_9 2
Sub Permit No.
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑ PUBLIC WORKS ❑ CHANGE OF 0 CANCELLATION
CONTRACTOR
Z oL—/
(oS
County:
Miami Dade
❑ SHOP
DRAWINGS
Zip: 3i!,7a
Is the Building Historically Designated: Yes NO
C'k0'tilood Zone: BFE: FFE:
OWNER: Name (Fee4�`Simple Titleholder): 4 z9 a-c�N KI n�S Phone#: (✓ 7 —3 /rI • 3 .� Z
, Address: 00 uL . (05 5 `J 2 7
City: /I AA i i u. / 5 ho C" State: - d "1
rl - Zip: 3.35 3 O
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: .‘‘C Ev tr>rrS S LIt - Phone#: 9-e6 443 SLcs
bos 1 / 1 TVs z3o Loc-f-h Vitt l4. State: Zip: 33l S I
QJvV O L-
d�2� Phone#: 3-�C 443 -�?
State Certification or Registration #: CMG 15 o 753 Certificate of Competency#:
DESIGNER: Architect/Engineer: Phone#:
Address:
City:
Qualifier Name:
Address:
Value of Work for this Permit: $
Type of Work:
City:
O. 0 vO Square/Linear Footage of Work: _3-0°
❑ Additi ) '❑ Alteration ❑ New Repaaiir/R place ❑ Demolition
Description of Work: t` ��s1Ct�� 6f,��i',`'� - A C ' O4-2 aJ1,101F_g
fit, C 0 %.11��Q ( b `ri • .
-TO 6,-4 plac-r-expite.d pet 9)C1'-934
Specify color of color-thru tile:
W Submittal Fee $ Fc d Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
State: Zip:
J
(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 absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
OWNER or AGENT
The foregging instrument was acknowledged before me this
fo
O day of VVG.\/` + , 20 1 g , by
f(L�46„re.4 VATILi ► b ersonally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: YYLC MQ Xt• LPL
Print: Y 1 �C+.P�� VV r\Cc— 1�t
Seal:
MY COMMISSION i GG 005528
EXPIRES: September 5, 2020
/401404r Bonded Thrubudget NeteySobs.
******************************,+R*** *** *************
APPROVED BY
(Revised02/24/2014)
Signature
t
CONTRACTOR
The foregoing instrument was acknowledged efore me this
!/ day of L/.' 0 ,by
//
au;ilJJ enmo Lire , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Se
Of1 ° e,%, MICHAEL ROJAS 1
':1 r** •* = Notary Public - State of Florida
*fie * I—ri le***ft1menissitre9eN60. `15'99'fi3`**********
1 OF Fo? My Comm. Expires Dec 20, 2020
�
Plans Exami, Zoning
Structural Review Clerk
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
2601 BLAIR STONE ROAD
TALLAHASSEE FL 32399-0783
LOPEZ, GUILLERMO
GLA ENTERPRISES INC
15051 ROYAL OAKS LN
APT 2303
NORTH MIAMI FL 33181
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range
from architects to yacht brokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
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
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about
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
serve your customers. Thank you for doing business in Florida,
and congratulations on your new license!
RICK SCOTT, GOVERNOR
5-
r
wy
STATE OF FLORIDA-
DEPARTMENT OFaBUSINESS AND
q `sue' .-PROFESSIONAC'REGULATION
CGC 1509258 * I'JED D
�� .ISS�OS%04/2016
• CERTIFIED GENERAL•CONTRACTOR
LOPEZfiGUILLERMO
ENTERPRISES INC tt
IS,CERTIFIED der,.theyprovisions-of Ch 489'FS."
Ekpirationdate,',AUG31;2018- ""^ C1608040001387
DETACH „HERE
KEN LAWSON, SECRETARY
— a ; 4
STATE OF FLORIDA - ,.
DEPARTMENT OF' BUSINESS AND PROFESSIONAL'REGULATION•"
�, - CONSTRUCTION INDUSTRY LICENSING BOARD, - .,
*. i
CGC 1509258 ,
The"GENERAL` CONTRACTOR.-- _
Named below.IS CERTIFIED
-Under the provisions;.of Chapter 4891FS. ` :,
:Expiratiori•date' AUG ^ 31,•2018`- -.,
i. .0.. W
-" mayr
x ..r -.--
—�-
LSi ~R • « ,,'
-LOPEZGILERMO- , .„, ..
rGLA ENTERPRIES IN .-- >_, '-
-15051ROYAL-OAKS-LW ''.�. ""
-F-
...,APT 2303. L 4-`4� "
1.NORTH MIAMI FL,331�81'-'-'4.: ' `-'`
Aw•
S
El
CI
A .14I
.w__ — i_.a....
4
Local Business Tax Receipt
Miami —Dade County, State of Florida
-THIS IS NOT A BILL — DO NOT PAY
6590484
BUSINESS NAME/LOCATION
GLA ENTERPRISES INC
13899 BISCAYNE BLVD 124
NORTH MIAMI BEACH, FL
33181
OWNER
GLA ENTERPRISES INC
Worker(s)
RECEIPT NO.
RENEWAL
5831970
EXPIRES
SEPTEMBER 30, 2018
Must be displayed at place of business
Pursuant to County Code
Chapter 8A — Art. 9 & 10
SEC. TYPE OF BUSINESS
196 GENERAL BUILDING
CONTRACTOR
2 CGC1509258
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 must comply with any governmental
or nongovernmental regulatory laws and requirements which apply to the business. t,
The RECEIPT NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sec 8a-216.
MIAMEDAD 1 For more information, visit www.miamidade.gov/taxcollectot
PAYMENT RECEIVED
BY TAX COLLECTOR
45.00 '09/29/2017
0221-17-005358
ACCORD
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
10/31/2017
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 endorsement(s).
PRODUCER
JVS Insurance Agency
9600 SW 8th St.
Miami, FL 33174
CONTACT NAME: SANDRA PEREZ
INSURED
GLA ENTERPRISES INC.
15051 ROAYL OAKS LANE # 2303
NORTH MIAMI, FLORIDA 33181
PHONE 305 55 FAX
Jac, No Eat): ( ) 2 5250 I (A/c No): (305)552-5292
ADDRESS: SANDRA@JVSINS.COM
INSURER A :
INSURER B :
INSURER(S) AFFORDING COVERAGE
WESTERN WORLD INSURANCE COMPANY
NAIC N
INSURER C :
INSURER D :
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
LTR
TYPE OF INSURANCE
ADDLTSUBR
INSR
WVD
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
GENERAL LIABILITY
"EACH OCCURRENCE
S 1,000,000.00
X I COMMERCIAL GENERAL LIABILITY
DAMA4E-TO—REt T D
PREMISES (Ea occurrence)
S 100,000.00
I I CLAIMS -MADE
X I OCCUR
MED EXP (Any one person)
S 5,000.00
A
I
NPP8322713
11/18/17
11/18/18
PERSONAL s ADV INJURY
s ,1,000,000.00
GENERAL AGGREGATE
S 2,000,000.00
GEN'L AGGREGATE LIMIT APPLIES PER:
-
PRODUCTS - COMP/OP AGG
S 1,000,000.00
7 POLICY
I PRO-
JECT r I LOC
S
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
ANY AUTO
BODILY INJURY (Per person)
$
k
ALL OWNED
AUTOS
SCHEDULED
AUTOS
BODILY INJURY (Per accident)
S
,
HIRED AUTOS
NON -OWNED
AUTOS
PROPERTY DAMAGE
i (Per accident)
$
I I
S
LIAB
I OCCUR
EACH OCCURRENCE I S
I �UMBRELLA
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
t
I DED
I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
1 WC STATU-- t IOTH-
TQRY LIMITS 1 ER 1
ANY PROPRIETOR/PARTNER/EXECUTIVE
Y / N
N / A
-
_1
E.L. EACH ACCIDENT 1 S
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
E.L. DISEASE • EA EMPLOYEE
$
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT I ` $
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required)
GLA ENTERPRIES INC.,GENERAL CONTRACTORS.
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE
Buiilding Department
10050 NE 2nd Ave
MIAMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05)
@ 1 :: -201 /' ORD ' ORPORATION. All rights reserved.
The ACORD name and logo are registered marks of A
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: 5/4/2018
PERSON: GUILLERMO LOPEZ
FEIN: 200001034
BUSINESS NAME AND ADDRESS:
GLA ENTERPRISES INC.
15051 ROYAL OAKS LANE APT 2303
MIAMI, FL 33181
SCOPE OF BUSINESS OR TRADE:
Licensed General Contractor
EXPIRATION DATE: 5/3/2020
EMAIL: GLAUSAINC@GMAIL.COM
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
0
GLA ENTERPRISES INC., General Contractors
15051 Royal Oaks Lane #2303, North Miami, FL 33181
Phone: 786 443 5209 Fax: 305 356 5432 Email: glausainc@gmail.com
Date: 06/03/2018
State of Florida
County of Miami Dade
Before me this day personally appeared GiAtc? (opeq- who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at 1°0 ("I 10
.411"-r 2-04 , air]; Stnotros , Ft— SS t e
Sworn to (or affirmed) and subscribed before me this 6' day of , 2ca , by
Personally know
OR Produced Identification
Type of Identification Produced
,-Pri , Ty e or Stam
MARCO GALARZA
Notary Public - State of Florida
Cormission # GG 175705
My Comm. Expires Jan 16. 2022
GLA Enterprises Inc. — 2018 glausainc@gmail.com
M iami- Sores Viilage
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (3051795.2204
Fax: (3051756.8972
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 1
allows corporate officers in the constnuction 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 pan -time or full -dine
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:
t . 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 I O 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
he the only person allowed to work on your projeet.•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.
I BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
I
Signature V DoU .•-� o''i Vl -Y t /. �tr
Owner.
I State of Florida
County of Miami -Dade
bThe foregoing was acknowledge before me" this day of , 20351
iBy�C�� Cyr «.{_-S�t� ph, i -S who is personally known to me or has produced
as identification.
Notary: \i ' `
MARYJANE SMITH
SEAL: �' •''�`� •
* MYt ISSION#000065211
e -EXPiRES: Septa bars, 2020 -
'► y t+ona.anvueute.iN 7ii.�a:�
WORK REQUEST APPLICATION
Owner's Name MAR ( WET JEU K 1 45
I hereby request approval from the Board of Directors for the following
modification or r alteration to my unit that will be performed by a licensed
contractor.
Unit G
Electrical work X Plumbing work j<
Carpet installation **Windows
Tile installation Other work J( k' i TG
lA
Description of the work CQFjI M EvS
Before you decide to upgrade your apartment (other than paint orcarpet) you must
obtain 'permission from the Board of Directors and/or Miami Shores Village.
A copy 'of the plans, specifications and permits, and a description of the licensed
work to be performed must be submitted • for consideration . and approval by the
Miami Shores Village Building Department (305-795-2204).
It is the owner's responsibilityto ensure that the contractor removes, all excess'
construction material or building debris. It cannot be placed in the dumpsters.
**Window frames must be gray in color to look like aluminum. Windows must be
Two (2) panels over Two (2) panels. Glass must be clear color.
I. as the unit owner acknowledge responsibility for any damage to the building or
personal injuries that may occur during the, project., The Shores Condominium Inc.
its officers and employees are in no way responsible for damage or theft to my
apartment or my belongings. (A $200.00 deposit is required and will be refunded if
no damage to the property is reported.)
I fully understand and agree to the statements made above.
Sr/ 0- a .; 1'» 7
Unit ovener's signath
Approved by:
Ck40:
e
ggo
Date
Date: 6 9 /�