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EL-12-2195Description of Work: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical )(JOB ADDRESS: i 2 6 3 / I E J O L s /. City: Folio/Parcel#: Miami Shores RECEIVED DEC Ui 2013 BY: FBC 20 Permit No. E L_ 2- t 3 —1 Master Permit No. //. / 2- Z f g 5 County: Miami Dade Zip: 3 3 i 3 S Is the Building Historically Designated: Yes NO Flood Zone: XOWNER: Name (Fee Simple Titleholder): i v-1t410 e�r U-e-a. Phone#: 30 S —Z / % - Z 2 2 4, Address: J 2 6 j %/ E, J. O L 574. City: [1 i 2- i S.l1J rG 5 State: T ( Zip: 3 S' / _3 g Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: i11 Q WI Q�, L *' � it l,U tiff' Address: \0(') tw City: r(i10.YV1\ Qualifier Name:: C & L){ D . st State: F� Phone#: I86I S 43 - 6 o1 Phone#: Zip: 33114 981013ab - oqai State Certification or Re 'station #: E L t3Ob glo & o Certificate of Competency #: 1- _ Contact Phone: 1 to 543 - SD -Ito Email Address: �� Ql u� 1n goo10,-V�E�6 : iln DESIGNER: Architect/Engineer: Phone#: O% Value of'Work for this Permit: $ eOro Square/Linear Footage of Work: Type of Work: DAddress )(Alteration ❑New ❑Repair/Replace ❑Demolition ate 10filia 6/0r, ***************************************Fees******************************************** Submittal Fee $ Permit Fee $ 71 i m0 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 apyro P . an. ' reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day ofNpve,j3 y , 2013 , by C.1(tutICo 1t0 CIA)AA.eZ who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: ************************ APPROVED BY y Signature ontractor The foregoing instrument was acknowledged before me this 1 day of D l7Ce , 20 13 , by -Ol.nu vuto ayttA.1,0 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: o.aa. CHERIE JO FALLAH \S Nota!v public - State of Florida. .y Jii de My Conini Expires May 14,2017 *a.Atk*****O AV Pn* "490. e- 7sv Ions Examiner Sign: Print: TARY PUBLIC -STATE OF FLORIDA Natalia Jarquin Commission #DD973815 Expires: MAR. 23, 2014 BONDED THR[; ATLANTIC BONDING CO., INC. My Commission Expt �mY ********************************tat*9:************* Structural Review Zoning Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) gROWAREFCCIONTralCWCHUSINESSTAXREC Business Name: HI TECH ELECTRIC & FIRE CORP 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1,2013 THROUGH SEPTEMBER 30, 2014 Receipt #:ELECTRICAL/ALARMS/CONTRA Business Type: (ELECTRICAL CONTRACTOR) DBA: Owner Name: EDMUNDO I JARQUIN Business Location: 1500 SW 101 AVE MIAMI DADE COUNTY Business Phone:786-543-5216 Rooms Seats Employees 3 Business Opened:12/20/2004 State/County/Cert/Reg:EC13 0 0 2 6 0 8 Exemption Code: Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: EDMUNDO I JARQUIN 1500 SW 101 AVE MIAMI, FL 33174 This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet aII County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2013 - 2014 Receipt #03A-12-00012547 Paid 09/23/2013 27.00 OR THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK,' PATENTED PAPER<r4re:7 AC#6.23.7481 STATE OF FLORIDA DEPARTMENT `OFBUSINESS'AND PROFESSIONAL `REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD. SEQ# L12073102759 DATE BATCH NUMBER LICENSE 07/31/2012 128024843 EC13002608.; ta, The ELECTRICAL CONTRACTOR 1 j ,'" Y,h r Named. -below IS CERTIFIED '} , k n ,: ' Under the' provisions of Chapter d48j9 FSy . 4 .f ;; Expiration date: AUG 31, 2014 . ,.,tt{Y1 ,. JARQUIN, - EDMUNDO I ; HI -TECH -ELECTRIC & FIRE CORP 1500 SW 101 AVE - _ -,,,,e:i4,T MIAMI FL 33174 RICK SCOTT, GOVERNOR KEN LAWSON SECRETARY DISPLAY AS REQUIRED BY LAW AWRb® CERTIFICATE OF LIABILITY INSURANCE �� DATE(MM/DD/YYYY) 10/03/2013 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 MUTUAL INTEREST ASSURANCE ELIZABETH VERDURA 1295 CORAL WAY MIAMI, FL 33145 CONTACT ESTHER VIDAL PH NN . ExJ,305 860 2003 ac, No):305-860-0907 Mass: MUTUALAS@AOL.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:ASCENDANT UNDERWRITERS, LLC INSURED HI -TECH ELECTRIC & FIRE CORP 1500 SW 101 AVE MIAMI, FL 33174 INSURER B: ASCENDANT UNDERWRITERS, LLC INSURER C : INSURER D : INSURERS: 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 1MTH 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. INTRR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF {MM/DD/YYW) POLICY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL 1 CLAIMS -MADE LIABILITY X OCCUR GL-33642-4 9/23/2013 9/23/2014 EACH OCCURRENCE S 1 ,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 1,000,000 GEN'L AGGREGATE X POLICY LIMIT.APPLIES PRO - JECT JECT PER: LOC PRODUCTS - COMP/OP AGG $ 1 ,000,000 S AUTOMOBILE LAUTOS LIABILITY A AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) _ $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S S UMBRELLA UAB EXCESS UAB O OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / NER N / A WC-60808-4 9/23/2013 9/23/2014 X TORv LIMITSI T E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space Is required) ELECTRICAL CONTRACTOR CERTIFICATE HOLDER MIAMI SHORES VILLAGE BUILDING DEPT 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 REP ENTATIVE ACORD 25 (2010/051 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and Joao are reaistered marks of ACORD Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida:331,38 Tel: (805)779512204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. L - Z -- Owner's Name (Fee Simple Title Holder): C (rio gt,1Q,L Phone #:395_Z(�-ZZZ•� Owner's Address: 1�.�p.3 t t01 S . City: Mimi SV by ,5 State : Fl Zip Code: 33138 Job Address (Of where work is being done): t a.10$ OC I 0 I Sf . City: Miami Shores State: Florida Zip Code: 3313 $1 Contractor's Company Name: I -TWA A OeekY►- i- Pia Cm'q Phone #: (Igo f 3a6 - 0R3I Address: l50 0 SO to e,, City: N1ia.vit State: Fl Zip Code: 3319 `-I Qualifier's Name : Edaltkvvi0 atvi Architect/ Engineer of Record Name: Address: i I633 OE tt City:. _ Lic. Number: EC 1300,21D 0$ Ste►. s `' hone#: 305_ 3-to _"01 sp is GG I,cG 2.r State: ( Zip Code: 3 3) G. j Describe Work: liq s 'OA pilatt3, Slx1lk S i pir ctboard ,SIC Skkvi I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the i Shores harmless for all legal involvement. Signature ownedr•Agent• ' The foregoing instrument was aknbwiedged before me this day of gin/4'6'20g ,by G tt,) Who is personally known to me or who has produced as indentiflcation. Nota -u c: Sign: •v—e—' Seal: ♦ (el o CHERIE JO FAU.AR Notary Public State of F lorida. Comm. My om m. Expires May 14 . 2017 Ave: Commission N FF 015250 Signature -COntradtor • feet The foregoing instrument was a�wledgedbefore me this I dl day of _h\CAM1240 bby ndoZD,uIVj who is personally known to me or who has produced 1 L as indentiflcatIon. Notary P • iic: Sign: Seal: NOTARY PUBLIC -STATE OF FLORIDA Natalia Jarquin Commission #DD973815 ,,,,,,.,, Expires. MAR. 23, 2014 BONDED TIRE ATLANTIC BONDING CO., INC. MIAMIED COUtNT'r HOLD HARMLESS Re: Property located at (address and legal description) ( 2- L 3 (tic h) 1 ct. ►M I 4,4 0-e-5 / aL Regulatory and Economic Resources 11805 SW 26th Street Miami, Florida 33175-2474 786-315-2000 miamidade.gov/development Date: ILZ2L �3 Gentlemen: As legal owner of subject property, I request the cancellation of permit number (in full) b. I Z - 3 3 . issued to (name of previous permit holder) C Ps Li (G on (date) _/_J for the following reason A) 1 T — — Date of last inspection T' l/o vie-/ + \%c2 (mailing address) / O 0 it LL Z g z v. n: -•-�:� t 3)25. - - /-z-"")-'Q c:::(p I no longer authorize the previous writ holdeir trtproceed with the work covered by the permit I hereby apply as owner -builder, or authorize (new contractor) 14 . -Te-- t. j to apply for such permits to construct or complete the construction on subject property. 1 agree to hold Miami -Dade County, its agents and authorized personnel harmless and relieve them from any responsibility or liability for any legal action or damage, cost or expense (including attomey's fee) resulting from the cancellation of the existing permit or the issuance of a new permit. I furthermore assume responsibility for the correction, if required, of work performed under the permit for which I am requesting cancellation. In die event there has been a change of ownership of the property, the new owner assumes the responsibility for notifying the previous owner of his or her intent to transfer the permit. STATE OF FLORIDA COUNTY OF MJAMI.OADE: The person whose signature appears above, deposes that he/she is the legal owner of the above property. SWORN TO AND SUBSCRIBED before me this - day of by C—v47\ v \\"111111111107 ,T off; Cn SEAL) 'el "%lj'et PRINT, TYPE OR STAMP NAME OF fARY \\��\`� U111��`\ Personally known or Produced Identification Type of Identification produced PRIME CO there i CEOR (only if Su of qualifier) holds the permit or if AVG 6L— fl 'i F2a STATE OF FLORIDA COUNTY OF MIAMI-DADE The person whose signature appears above deposes that he/she is the Prime Contractor for the above. SWORN TO AND SUBSCRIBED before me this /7 day of L y" by JEANNIrE RAMIREZ MY COMMISSION # DD 937199 EXPIRES: December 15, 2013 Bonded Thru Notary Public Underw, tern , 20 / 3 SEAL) PRINT, TYPE OR STAMP NAME OF NOTARY Personally known X or Produced Identification Type of Identification produced ""*DEPARTMENT USE ONLY'*" Not= Hold Harmless letter must be signed by the owner of the property and the General Contractor in case of subsidiary permits or change of qualifier. Date Issued (original): _ J_I Change Date: JJ Fee: Last Valid Inspection: 123_01-138 3n3 Address: City: Qualifier Name: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762A949 BUILDING PERMIT APPLICATION FEB2 5 2013 FBC 20--C� Permit No. (—1 — 5-13 Master Permit No. G L. Z— Z. t 1 S Permit Type: Electrical / JOB ADDRESS: 1 23 /Vt /at S1----- City: Miami Shores County: Miami Dade Zip: 3 ( 3 e Folio/Parcel#: Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): (1 Lc.* gle 70 Qekr-1,_.1...�2_, Phone#: S _ Z 6 �, L 2 Address: ► 2 G. 3 ►U 1� I-O 5�s- � City: Oct. S kczt2S State:LED Zip: '3 (3 $ Phone#: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: 1600M-J h'> 14 vY1 l CPS g(' a � .J-j ' & . Phone#: 63 S'S 70 2` '4— State: FL— Zip: 71-Pt2aA'AI C 1.-. // State Certification or Registration in Contact Phone#: DESIGNER: Architect/Engineer: stration #: A M"A4► 1 Phone#: go Email Address: 5-�-eGTal-L- c Z , 5 pp, , t 11 $ : l �-t t. S i t.� ��r� Phone#: S o '5_ 3 1 —/ L 6 7 Q s Q Value of Work for this Permit: $ / 7 S Cad G Square/Linear Footage of Work: Type of Work: DAddress VAlteration New ORepair/Replace ❑Demolition Description of Work: t`c... �; '�cLco ,� , L /)- f I ,c-.4 v a>S , 111�� t' �w0,..�c4 V 6w tf ids (4,11,.�. Q I i7 :.-►,s Lt, a �+Sa. V--r -i c.� 4. �-`4-7-4/E%z_h ) 9j c�C:�,'PEA. 5, p '2.,G'A " P�n�/'%; ***************************************Fees******************************************** Submittal Fee $a JC-) Permit Fee $ CCF $ S CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 a/}e1-rrrginspection fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me day of %"4.1.-t , 201-9 , by e c > lthkbint Signature who is personally known to me or whOtas prpduced /�'s� who y o, ''"-�`- As identifica G' NOTARY PUBLIC: Sign: Print: ��innutn�� My Commission Expires: Contractor :oin: instrument was acknowledged before me this25 , 20/3 , by Atile! P0,n2 rsonally known me or who has produced as identification and who did take an oath. NOTARY APPROVED BY C�!�/1 L�c3L , NALR Ins Examiner Structural Review Sign: Print: My Commission E Zoning Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/1Q/2009)(Revised 3/15/09)