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RC-17-2990Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Parcel Number Petartit=iNo. RC-12-11-2990 Permit Type: Residential `Construction Won( Ctassificatian: Alteration Permit Status:'APPRO1/ED Expiration: 09/02/2018 Applicant 8705 NE 4 Avenue Road Miami Shores, FL 1132060460680 Block: Lot: RAFAEL FELIZ Owner Information Address Phone Cell RAFAEL FELIZ 6100 N BAY Road MIAMI FL 33140- 6100 N BAY Road MIAMI FL 33140- Contractor(s) Phone QUINTERO GENERAL CONSTRUCTIO (786)487-5738 Cell Phone Valuation: Total Sq Feet: $ 2,100.00 0 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: REMOVE AND NEW EXTERIOR W 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 Notary Fee Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $2.00 $2.00 $0.60 $5.00 $100.00 $9.00 $2.40 $122.80 Pay Date Pay Type Invoice # RC-12-17-65967 03/06/2018 Credit Card 12/21/2017 Credit Card Amt Paid Amt Due $ 72.80 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Fill Cells Columns Window and Door Buck Review Planning Review Electrical Review Building Review Building Review Building 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 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 the above -named • r to do the work stated. Authorized Signature: Owner / Applicant / ' •ntractor / Agent Date March 06, 2018 Building Department Copy March 06, 2018 1 Address: Miami Shores Village Building Department �G{\ \1 v, INSPECTION LINE PHONE NUMBER: (305) 762-4949 � ���� FBC 20 B IL 1 n_ 7t"� �J U DING 2 d �+� Master Permit Nod 14 G PERMIT APPLICATION �� Sub Permit No. 'BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL C 21 2017 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: g osE Vie /e0j City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: /13 Z 0 6 Q 5/6 06 SO Is the Building Historically Designated: Yes Occupancy Type: Load: �iCoonst�ruction Type: OWNER: Name (Fee Simple Titleholder): /�,€9 '4 � / Z Address: 6 ©o N t �/ 4A-4 p� City: /�-,•�is / State: �"t Flood Zone: BFE: NO FFE: Phone#: 411, S S . 6796 Zip: 3 3/e%0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: i t),)�%_ PR [ eti�i',6•JT 4c -A) 6,90 Phone#: eyO/ 40.) lea City: State: Qualifier Name: ge/1.-2dQ-44)r7a� ,,ncr State Certification or Registration #: e-C�� �t� /�/ sa% oZ DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ Ada 0. O ° Zip: �3O f f Phone#: 416 f'} S3 3 Certificate of Competency #: Type of Work: ❑ Addition ❑ Alteration Description of Work: ArSi 'a 62Ol1 AA / % woo a� .�,✓® Jag' Square/Linear Footage of Work: State: Zip: ,n New J1 Repair/Replace n Demolition u`D,J U%ob A02 /+Jlo✓ i4i ,5,404 , 7✓0 Specify color of color�trh�ru tile: Submittal Fee $ IPD Permit Fee $ kY) Scanning Fee $ Radon Fee $ & - on Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ a ' Q Notary $ - 00 Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ 2-- • cT Bonding Company's Name (if applicable) Bonding Company's Address a City . i j 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 g7einspection fee will be charged. Signature OWNER or The foregoing instrument was acknowledged before me this 1day of Pee z d o2 me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: AP MARIJAIR RAVELO Notary Public - State of Florida jei**iritceinn i I *Ftor*6*.****ss***** s,z4gr .= My Comm. Expires May 5, 2C i ''�° Bonded through National Notary Assi Signature ENT CONTRACTOR The foregoing instrumentnsumwas acknowledged before me this , 20 / 4 , by 2 ( day of—� C�� 4-10", 20 by , who is personally known to �.A cJIN t whopersonally known to as me or who has producedT "1-A-CM identification and who did take an oath. NOTARY PUB L: Sign: Print: A shy, f'dtiFv., b..Y .� Seal:; �SIY P(� Notary Public State of Florida ' ' Sindia Alvarez y, �aQ My Commission FF 156750 `r for .' Expires0910312018 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ACORfi CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/15/2017 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 Florida Bankers Insurance 6874 SW 8 ST Miami, FL 33144 Phone (305) 266-6493 Fax (305) 262-0679 CONTACT MARTA ALONSO NAME: PHONEo EA). (305)266-6493 Fax(Arc, No): (305)262-0679 E-MADDRESS: marta@floridabankersinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : UNITED SPECIALTY INSURANCE CO. INSURED QUINTERO GENERAL CONTRACTOR CORP. 8801 NW 112 Ter HIALEAH GARDENS FL 33018- INSURER B : INSURERC: 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 ADDL$UBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DDIYYYY) LIMITS A n COMMERCIAL GENERAL LIABILITY N N B-172225 12/13/2017 12/13/2018 EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS -MADE 'a OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 ❑ PERSONAL 8 ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: O- ,POLICY ❑ JET ❑ LOC ❑ OTHER GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED ❑ SCHEDULED AUTOS = AUTOS HIRED AUTOS NON -OWNED ❑ ❑ AUTOS ❑ ❑ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ ❑ UMBRELLA LAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LABILITY - Y I N ANY PROPRIETOR/PARTNERFJ(ECUTIVEnE.L. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A ❑ PER SfATUTE ❑ OTERH- EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION LIC OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) t/ CGC1515292 # CFC1428973 #CCC1329992 CERTIFICATE HOLDER CANCELLATION 1 VILLAGE OF MIAMI SHORES VILLAGE - BUILDING DEPARMENT 10050 NE 2 AVE MIAMI SHORES, FL 3313811_414Y-4-") 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 c.,, ACORD 25 (2014/01) QF © 1988-2014 ACORD CORPORATION. All rights reserved. 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: 1/23/2018 EXPIRATION DATE: 1/23/2020 PERSON: QUINTERO BERNARDO FEIN: 261569856 BUSINESS NAME AND ADDRESS: QUINTERO GENERAL CONTRACTOR CORP 8801 NW 112 TERRACE HIALEAH FL SCOPE OF BUSINESS OR TRADE: 33018 Licensed General Contractor Licensed Plumbing Contractor Licensed Roofing Contractor 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 illk tQuin-tett General Contractor, QUINTERO GENERAL CONTRACTOR CORP Bernardo Quintero 8801 nw 112 terrace Hialeah Gardens fl 33018 Date: 01/12/2018 State of florida County of dade Before me this day personally appeared Bernardo Quintero who, being duly sworn, deposes and says: That he or she will be the only person working on the project locate at 8705 ne 4 th av road Miami shores Sworn to (or affirmed ) and subscribed before me this 14 day of jan 2018 , by Bernardo Quintero Bernardo Quintero Personally know Or produced identification Type of identification produced MARIJAIR RAVELO Notary Public - State of Florida Commission # FF 206163 %lFaF��°,'� My Comm. Expires May 5, 2019 ,,,,,,,,, Bonded through National Notary As,, - Print, type or stamp name of notary Miami Shores Village Building Department 10050 N.E.2nd Avenue 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 Z" day of C c , 20 / . Not 4 SEAL as identification. MARIJAIR RAVELO +° `1 `b'= Notary Public - State of Florida '' Commission # FF 206163 ,N IIII jFoes,: My Comm. Expires May 5, 2019 e or has produced