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BPP-17-1904 (2)Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address 1050 NE 107 Street Miami Shores, FL 33161-7374 Owner Information GABRIEL MARTIN KUSKUNOV Address P�� t NO. BPP-7-17-1904 Permit Type: PoolsANhirlpools/Hot Tubs ermi Issue Date:12/512017 Work Classification: New Permit Status: APPROVED Expiration: 06/03/2018 Parcel Number 1122320280520 Block: Lot: 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) SUNSET POOL AND SPA Phone CeII Phone (305)804-1068 Phone Applicant GABRIEL MARTIN KUSKUNOV Cell Valuation: Total Sq Feet: Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Work: Swimming Pool Additional Info: BUILD A NEW POOL Classification: Residential Occupancy: Bond Return : Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $10.80 $8.10 $5.40 $3.60 $540.00 $3.00 $14.40 $585.30 Pay Date Pay Type Invoice # BPP-7-17-64684 07/26/2017 Check #: 102 12/05/2017 Check #: 105 Amt Paid Amt Due $ 50.00 $ 535.30 $ 535.30 $ 0.00 $ 18,000.00 538 Available Inspections: Inspection Type: Fence Final Pool Deck Wall Steel Review Planning Review Building Review Plumbing Review Electrical 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 permi I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTR A PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: - ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. � rmore I authorize the above -named contractor to do the work stated. December 05, 2017 Authorized Signatu _i Owner / Applicant / Contractor / Agent Date Building Department Copy December 05, 2017 1 AV° BUILDING PERMIT APPLICATION •BUILDING ❑ ELECTRIC ❑ ROOFING PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 1050 NE 107 ST Budding 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 FBC 20 Master Permit No. B?PR no 1 Sub Permit No. ❑ REVISION • EXTENSION • RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores Folio/Parcel#:11-2232-028-0520 Occupancy Type: RES Load: County: Miami Dade Zip: Is the Building Historically Designated: Yes Construction Type: REMODEL Flood Zone: OWNER: Name (Fee Simple Titleholder): GABRIEL MARTIN KUSKUNOV Address: 1050 NE 107 ST NO X BFE: FFE: Phone#: 786-488-8315 Co:, MIAMI SHORES State: FL Tenant/Lessee Name: N/A Email: GABRIEL@NATURALISTONE.COM Phone#: Zip: 33161 CONTRACTOR:jCompany`*ame:.+ NSA C��1 b. Address: 5 S Sly - k33CT- Phone#: 7%L- ZSS- 1 I Z. City: \\M O\V i State: )a,r i e.51 c, Zip: -&3 1 7S Qualifier Name: bCC\Q.�tJZg1cZ Phone#: State Certification or Registration #: CGC1523422 Certificate of Competency #: DESIGNER: Architect/Engineer: JUAN FERNANDEZ BARQUIN P.E Phone#: 786-336-0881 Address: 2520 NW 97TH AVE City: DORAL State: FL Zip: 33172 Value of Work for this Permit: $ 65,000 Type of Work: ❑ Addition ❑■ Alteration Square/Linear Footage of Work: 2,344 SF ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: NEWPOOL.(renuew permit `!G "RW,Lio 1542,2_1. r: y • '`fir. 1 f f V, 1n11,' v", .i(tf(t'.5 ,,,I i )* Specify color of color thru tile: --Yw ,•, t, y •}- Permit Fee $ ,.LIO ` W CCF $ n - CO/CC $ Scanning Fee $ 3 . C/Q Radon Fee $e ' 10 DBPR �$\V , 10 Notary $ ----la----- Technology Fee $ ( CI- 4 Training/Education Fee $ 3 - i (DO Double Fee $ 19 Bond $ c JU•�j00 Submittal Fee $ Structural Reviews $ Bonding Company's•Name (if applicable) Bonding Company's Address City State Zip t Y C_i• 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 val e exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien la b ochure will be delivered to person whose property is subject to attachment. Also, a certified copy of the recorded notice of co m • cement must be posted a e job site for the first inspection which occurs seven (7) days after the building permit is issued. In he absence of such post: n'rice, the inspection will not be approand a reinspection fee will be charged. Signature OWNER or AG T Signature NTRACTOR The foregoing instrument was acknowledged before me this The foregoin instr . ment was acknowledged bef 13 day of J JV..) ( t e\ �qr r1 , who is personally known to me or who has produced c11.•Ners \c Ph S . as identification and who did take an oath. ,20 1- ,by 1` d 20 1 - , by -zs=k\. who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Print: Seal: Q ipb;4,„, •� z" "Commission # FF 225758 al My Comm. Expires Aug 18. 2019 ''' OF d; Bawled through National Notary Assn. CARY M RODRIGUEZ Sign: Print: Seal: GAMY M HUUHIGUEI ;•'r°os Notary Public - State of Florida ( ; �t'ip •= Commission el FF 225758 ±,F�,sa�c' My Comm. Expires Aug 18, 2019 � b`�s Bonded through National Notary Assn. • ************************************************************************************************************ APPROVED BY Plans Examiner Zoning State License and Occupational License - edwin garcia https: //outlook live. com/owa/Yvlewmoael=KeaalVIessageltemdc1tem1... RICK SCOT T,- GOVERNOR •=1 !t'i l I41 KEN LAWSON: SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CPC044089 The RESIDENTIAL POOL/SPA CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter'489 FS..._ Expiration date:-AUG'31, 2018 -- GONZALEZ, JORGE ANTONIO' SUNSET POOLS &"SPAS INC° 5355 SW 133RD CT a'`;,..;' MIAMI " 'FL 331754 • ny ISSUED 09040016 DISPLAY AS REQUIRED Eli LAW SFa # L1609140004191 Local Business Tax; Receipt Miami -Dade County, State of'Florida THIS IS NOT A BILL -DO NOT PAY 1904318 BUSINESS NAME/LOCATION' SUNSET POOLS & INC 5355 SW 133 CT MIAMI FL 33175 °wrap R SUNSET POOLS '& SPAS INC C/O JORGE A GONZALEZ QUALIFIER War1ter(s) 10 RECEIPT NO. EXPIRES RENEWAL •SEPTEMBER 30, 2017 1904318 Must be displayed at place of business Pursuant to County Caste Chapter 8A -- Aft 9 & 10 SEC. TYPE OF BUSINESS - PAYMENT RECEIVED 196 SPECIALTY BUILDING CONTRACTOR BY TAx COLLECTOR CPC044089 $75.00 09/15/2016 CHECK21-16-125897 This Loco{ Business Tax Receipt only cmtlirma pays cor of the Local Business Tax. The Hamill. is oat a license permit, ora:cenHicadanalthe holder 'slpralificetioas.todehotness- Raider awn cmnpIEWith aii gime/NO tal or nongovernmental regulatory laws and regniremeaB which apply to the business., Tbo RECEIPT NO. above mast he derpleyed en alt cmamerciai vehicles —Miami-Dade Cade Sec 8a 27& for more information, smi yi, 0 ti IELEGYdaReltltel1Qr of 2 4/20/17, 11:02 PM AGC °D vcR I IrR..A 1 t u1' LIABILITY INSURANCE I DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER3THIS 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 5 the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the t certificate holder in lieu of such endorsement(s). PRODUCER Tammy Insurance Agency CONTACT NAME: Jessica Cancio 9865 S.W. 40th Street PHONE FAX _(A/c, No Extl (305)485-3999 i (NC No): (305)485-3944 E-MAIL Miami, FL 33165 _ADDRESS Y surance tamm In @yahoo.com Phone (305)485-3999 Fax INSURER(S) AFFORDING COVERAGE NAIC # (305) 485-3944 INSURED INSURER A : Granada Insurance Company Sunset Pool And Spas Inc, INSURER B : INSURER C : 5355 SW 133 Ct INSURER D : Miami, FL 33175 (305) 804-1068 INSURER E : COVERAGES I INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE I INDICATED. CERTIFICATE , EXCLUSIONS INSR POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDLSUBR INSR P�LTR EFF GENERAL LIABILITY MD POLICY NUMBER IMM/DDY 1 JMM DD/YYYY) LIMITS V COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 ❑ CLAIMS -MADE d OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000.00 A, 0185FL00061743-1 09/23/2016 09/23/2017 MED EXP (Any one person) $ 5,000:00 a 9 IIPERSONAL _ & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 ❑ POLICY ❑ JE_CT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 Deductible BI/PD Per Clai 1 $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) 500.00 $ ❑ AALL UTOS NED •■ SCHEDULED BODILY INJURY (Per person) $ 111 AUTOS -OWNED HIRED AUTOS in BODILY INJURY (Per accident) $ ANON ❑ PROPERTY DAMAGE L(Per accident) $ $ $ -MADE E DED RETENTION$ AGGREGATE $ I WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE WC STATU- OTH- _TOBY ❑ _ER__ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A E.L. EACH ACCIDENT ACCI $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1. $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I Pool Contractor 1 License #: CPC 044089 CERTIFICATE HOLDER r,AMr.,. , ,-r,,,,, Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 iFax:305-756-8972 ACORD 25 (2010/05) QF Jessica Cancio 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 -dL�(1_ 1 88-2010 ACORD CORPORATION. All rights reserved. The CORD name and logo are registered marks of ACORD • 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: 1/20/2017 EXPIRATION DATE: 1/20/2019 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: LICENSED POOL CONTRACTOR Pursuant to Chapter 440.05(14), F.S.. an officer d a corporation who elects exemption from this chapter by filing o certificate of election under thla section Xlw reoorerbsoelila o under @ds dtapter. Pursuant to Chapter 410.05(12), F.S., Credo:etes of election to be exem within the scope d the business or trade listed on the notice of eloc ion to bo tit:. tioplyobey exempt and certificates of rdeedon to be exempt shaft be to revocatio be subject Q%e^'t� Purswnt to CRap>tsr 440.05(19). F.S.. Notices o/ dect� Oa be theexempt person named on then If, a any dine after the ling d the notice orate Issuance of the certificate,notice or certificate no longer meets the requirements of this secdon for issuance of a certificate, The deparbnent shag revoke e DFS.F2-0WC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850j413-1609