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BPP-15-2065Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Pe Permit NO. BPP-8-1 5.2065 " M Permit Type: Pools/Whirlpools/Hot Tubs Work Classification: New Petmit'Statu: APPROVED Parcel Number Issue Date: 812 Expiration: 02/21/2016 Applicant 334 NE 101 Street Miami Shores, FL 1132060135300 Block: Lot: DALLAS BROWN Owner Information Address Phone Cell DALLAS BROWN 334 NE 101 ST MIAMI SHORES FL 33138 (305)762-6265 Contractor(s) SUNSET POOL AND SPA Phone (305)804-1068 Cell Phone Valuation: •Trotl tgFeet: $ 20,200.00 1103 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: Swimming Pool Additional Info: NEW POOL PAVERS DECK Classification: Residential Occupancy: Private Bond Return : Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $12.60 $9.09 $9.09 $4.20 $606.00 $9.00 $16.80 $666.78 Pay Date Pay Type Amt Paid Amt Due Invoice # BPP-8-15-56726 08/25/2015 Credit Card $ 666.78 $ 0.00 Available Inspections: In consideration of the issu pertaining thereto and in s accepting this permit I a required for ELECTRIC OWNERS AFFIDAV construction and zo Author! Buildin August 25, y 015 e ct co sume L, PL ion ify that therm o me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations ormity with the plans, dr ings, statements or specifications submitted to the proper authorities of Miami Shores Village. In esponsibility for all wor1.one by either myself, my agent, servants, or employes. I understand that separate permits are BING, CHANICAL, p INDOWS, DOORS, ROOFING and SWIMMING POOL work. e riz J.ing - or uthoriz=�, • e/r=:•wner pplicant epartme t Copy nfor n is accurate e-named contractor t Contractor nd that all work will be done in compliance with all applicable laws regulating do the work stated. Agent August 25, 2015 Date 1 BUILDING PERMIT APPLICATION 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 RECEIVE .:, AUG 142015 BY: FBC 20 Master Permit No.i� t ! - Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION /RENEWAL PLUMBING ❑ MECHANICAL 0 PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP n ' j� CONTRACTOR DRAWINGS JOB ADDRESS: 3 3 c(/ V. r • l 1 5/ City: Miami Shores / County: Folio/Parcel#: 3 2 lO 60135 300 Occupancy Type: Load: Miami Dade r � 3l 38' Is the Building Historically DesignateH.✓l,4sr NO Construction Type: ___ Flood Zone: BFE: 1,0 OWNER: Name (Fee Simple Titleholder): y9q� V�.Q,S UJ GOCc) 1\ Phone#: p Address: 3 -t'YL £ LID 1. 5 % City: V\k',OvLwi 514+GS State: Tenant/Lessee Name: Phone#: 4 1 �• Email: zip :33/3�{ os Phone#: CONTRACTOR: Company Name: c� MSS et- %a(S Ct�n CL 5 OS C_ — 111 Address: -, f'� V 5�3 S S i c� 1.3 3 Wit" - � City: . .- .,,..., Zip:� Qualifier Name: . r)6r`P_ G'DAdt°? •Phone#: State Certification or Registration #: C, C C' 0 ''t it 0 Certificate'of Competency #: DESIGNER: Architect/Engineer: Vil c fr)v. Se e/K.0 Aa ,1.-e? Phone#: i?a,S ' 7s 3 714 Address: City: State: Zip: Value of Work for this Permit: $ a•� f.200 Square/Linear Footage of Work: / `0 3 Type of Work: ❑ Addition ❑ Altera ' n ►�/ ew ❑ Repair/Replace ❑ Demolition /L4i'/- r 1t CL C E .Gt- .I ,• Description of Work: Sp l�jrgcp�Qr p,���lor, 4t'hru j� JUR S2SCE0 as rot soa Yam} t.TS ,� �,a 2?isq ,nT,c, ut Zr`✓: Sub ttAA,F�b$ ,. n h�raa�i P.erinit F: $ CC $ rang ..,.......,...,,cCO/CC $_ Scanning Fee $ Radon Fee $ D Alit . , ,.,...,. �,. ..„..,Nota,ty Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip MortgageLender's Name (if applicable) Mortgage Lender's Address r; <`t City e, f .1 V C• 4 r 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. `rr t • .. ' C _t, "WARNING TO `OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS'TO'YOURPROPERTY: IF YOU INTEND TO OBTAIVFINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR TI,CE 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 copyofthe recorded notice ofcomm ncement'must be' osted at job site P P Y 1 f� p 1 for the first inspection which occurs seven (7) days after the building permit is issued. In th absence of such posted no "ce, the inspection will not be approved and a reinsperticin fee will be charged. r Signature 4 OWNER or AGENT 1 *'c'' j+4 4. The foregoing instrument was acknowledged before me this ` a 4 + day of Signature/ • The forego'inrit NTRACTOR ment was acknowledg • ore me this 20/5 by to C.— r., 4 .'...4. 3 't ft. . . me or who has produced ` as me or who has produced as , 20 /5 , by, • /2. , who ersonally knowto " identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ********** CIF or F1.•• ••''mn Bonded Throug National Not an.� APPROVED BY j - Plans Examiner M BULNES Notary Public - State of Florida • _ My Comm. Expires Jun 23, 2017 **'C5#MHta ii6if'i iepe3d2'S7"* ********************* day of . , who identification and who did take an oath. NOTARY PUBLIC:-.r. Print: 1A41- 4'/e /3CI Seal: M BULNES s� Notary Public.- State of flori/at •: My Comm. Expires Jun 23, 2017 Commission # FF 030252,* ** Zoning Structural Review (Revised02/24/2014) Clerk Local Business Tax Receipt Miami —Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY ' 1904318 BUSINESS NAME/LOCATION SUNSET POOLS & SPAS INC 5355 SW 133 CT MIAMI, FL 33175 OWNER SUNSET POOLS & SPAS INC I Workers) i 1 RECEIPT NO. RENEWAL 1904318 • ` ; , SEC. TYPE OF BUSINESS 1196 n SPECIALTY BUILDING .' I: I CONTRACTOR 10 CPC044• 089 CHECK2114-072083 This Local Bus Tax Receipt only payment of the Loeai Business TeX. The Receipt is not a''cease I permit ora certifcetion of the holder's qualications, to do business. Holder most oomph with any govertpneMsl t or oongoretmnecml regulatory laws and 'requirements which apply to the business. 1 'EXPIRES SEPTEMBER 30, 2015 Must be displayed at place of business' Pursuant to County Code Chapter 8A - Art. 9 & 10 " sr PAYMENT RECEIVED BY TAX COLLECTOR 75.00 09/18/2014 The IiECEIPf N0. above exist be displayed on all commercial vehicles - Miami -Dade Code See is 2211 . miamma ; ' A For MOM information, visit gam&rgiailgaIWORNI1111Mli t i Local Business Tax Receipt Miami=Dade County, State of Florid a -THIS ISNOT ABILL -DO NOT PAY 41 1.1 1904318 BUSINESS NAME/LOCATION 'SUNSET POOLS & SPAS INC x 5355SW133CT... _ MIAMI, FL 33175 NER SUNSET ET POOLS & SPAS INC Worker(s) M c' RECEIPT NO.� i2ENEWAL 1904318 EXPIRES SEPTEMBER 30, 2016 Must be displayed at place of business Pursuant to County Code Chapter BA - Art. 9 & 10 • SEC_ TYPE OF BUSINESS 196 ' SPECIALTY BUILDING'' s i BY Arco c'r oe CONTRACTOR ' -` 75.00 08/10/2015 r_ 16 t CPC044089 i.0237-15-000120 This Local B- siness Tax'Bseeipt only warms payment of the Local Business Tax. The Receipt is not a rxease, permit or a certification of the holder's goaIifications, to do business. Bolder must amply with any govermoeutai or aongoreramermel regulatory laws and requirements which apply to the business. The RECEIPT NO. above most be displayed on dl cormirercial vehicles- Miami -Dade Code Sec 8a-27B. For more information, visit Ernasegmaidgdomdms RICK SC07, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER .11 The RESIDENTIAL POOL/SPA CONTRACTOR • Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GONZALEZ, JORGE ANTONIO SUNSET POOLS & SPAS:INC_ 5355 SW 133RD CT:, .^ MIAMI- -':,FL-331,75.=6151 �, �•^�"„ ISSUED: 08/18/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1408180001722 • 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: 3/2/2015 EXPIRATION DATE: 3/1/2017 PERSON: GONZALEZ JORGE A FEIN: 650051038 BUSINESS NAME AND ADDRESS: SUNSET POOLS AND SPAS INC 5355 S.W. 133 COURT MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: SWIMMING POOL CONSTRUCTION -NOT 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 compen6atiix i 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 '""�"^ate CERTIFICATE OF LIABILITY INSURANCE �+ DATE(Mit/DD/YYY1/) 08/10/15 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(es) 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 Tammy Insurance Agency 9821 S.W. 40th Street Miami, FL 33165 Phone (305)485-3999 Fax (305)485-3944 CONTACT NAMS Jessica Cancio PHONE 305 FAX A(CAto On ( )485-3999 (A/C, No): (305)485-3944 EMAIL Apptigss, tamrnyinsurance@yahoo.com INSURER(S) AFFORDING COVERAGE NAIC A INSURER A : Granada Insurance Company INSURED Sunset Pool And Spas Inc, 5355 SW 133 Ct Miami, FL 33175 (305) 804-1068 INSURER B : INSURER C : INSURER D : INSURER E INSURER F : • REVISION NUMBER' THIS IS TO CERTIFY THAT THE POUCIES 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 AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rLTR TYPE OF INSURANCE ADDLSUBR INSR WB POLICY NUMBER POLICY EFF (MMI �) UMITS A GENERAL LABILITY u COMMERCIAL GENERAL LIABILITY 0185FL00061743-0 09/23/2014 09/23/2015 EACH OCCURRENCE s 1,000,000.00 PREMISES Eaa�Tm onDerdce) $ 100,000.00 ■ ■ CLAIMS -MADE a OCCUR MED EXP (Any one s 5,000.00 S person) PERSONAL & AOV INJURY $ 1,000,000.00 1 GENERAL AGGREGATE S 2,000,000.00 GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 2,000,000.00 • POLICY • SECT • LOC Deductible BUPD Per Clal $ 500.00 AUTOMOBILE LIABILITY ❑ ANY AUTO ii AUTOS NED ■ ASCUITTRULED COMBINED LSINGLE LIMB ) S BODILY INJURY (Per Person) S BODILY INJURY (Per accident S III HIRED AUTOS II ITTOSWNEO PROPERTY DAMAGE JderN) $ II ill $ III UMBRELLA LIAO ❑ OCCUR EACH OCCURRENCE S ❑ EXCESS UAB NI CLAIMS -MADE AGGREGATE S • DED • RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E-1 (Mandatory In NH) (__I N desc NI A WC 3TATU- OTH- • TORY LIMrTS - ER E.L EACH ACCIDENT S EL DISEASE - EA EMPLOYEE S yyeess,, rbe under E.L DISEASE - POLICY LIMB $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remrrm Schedule, it more space is required) Pool Contractor License #: CPC 044089 III( CFRTIRICeTF Land nun _...--- . _—___ Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 I Fax: 305-756-8972 ACORD 25 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORQED REPRESENT Jessica Canso © 1982010 ACORD CORPORATION. All rights reserved. e AC RD name and logo are registered marks of ACORD