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PL-17-1965Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PL-8-17-1965 Permit Type: Plumbing Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 12/5/2017 Expiration: 06/03/2018 Parcel Number Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 1122320280520 Block: Lot: GABRIEL MARTIN KUSKUNOV Owner Information Address 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) A&C PORTELA PLUMBING INC Phone (786)547-4611 CeII Phone Phone Valuation: Total Sq Feet: Cell $ 13,300.00 0 Type of Work: PLUMBING SUB PERMIT 02-1/2 BATHROOM Type of Piping: Additional Info: PLUMBING SUB PERMIT 02-1/2 BATHROOM Bond Return : Classification: Residential Scanning: 1 Fees Due CCF Change of Contractor Fee DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $8.40 $75.00 $6.99 $4.66 $2.80 $465.50 $3.00 $11.20 $577.55 Pay Date Pay Type Invoice # PL-8-17-64752 12/05/2017 Check #: 105 08/01/2017 Credit Card 08/01/2017 Credit Card Amt Paid Amt Due $ 452.55 $ 50.00 $ 75.00 $ 125.00 $ 75.00 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 1 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 c-. ify th- •regoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ize the above named contractor to do the work stated. Authorized Si•Fat .tom. ner / Applicant / Contractor / Agent December 05, 2017 Date Building Department Copy December 05, 2017 1 Miami Shores Village BUILDING PERMITAPPLICATION ❑BUILDING ❑ ELECTRIC PL�� UMBIN Q MECHANICAL ma ADDRESS: 1050 NE 107 ST City: Miami Shores Folio/Parcel#:11-2232-028-0520 Occupancy Type: RES Load: Building Department 100501N.E.2nd;Avenue MiamiSiiores; Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 Master Permit No. Sub Permit No ❑ ROOFING ❑ REVISION DPUBLIC WORKS CHANGE OF CONTRACTOR CountY: RECEIVED G 0 „2 17 FBC 20 (q Rri....5-4442.62-z)p-I901 PL 11 16 2,22.0 » -I %).5 • • EXTENSION ❑ RENEWAL CANCELLATION ❑ SHOP DRAWINGS iiiami, Dade Zip Is the Building Historically Designated: Yes Construction Type: REMODEL Flood Zone: OWNER: Name (Fee'S'vmple Titleholder):'GABRIEL'MARTIN KUSKUNOV Address:1050 NE 107ST NO X BFE: FFE: Phone#: 786-488-8315 sty:.tVIIAMI SHORES State: Tenant/Lessee Name: N/A.FL By: 33161 Email: GABRIEL@NATURALISTONE.COM ,CONTRACTOR' Company Name: A & C PORTELA PLUMBING; INC. Address: 2655 SW- 33, AVE City: MbAM6. State: FL Qualifier Name: DAVID PORTELLA State Certification or Registration #: CFC 1428617 ,DESIGNER: Anchitect/Etagineer UAN''FERNANDE;Z$ARQUIN P.E. City: DORAL Address: 2520 'NW "97TH :AVE Phone#: Phone#: 785=315;-016.4 Zip: 33133 Phone#: Certificate of Competency #: P.honet 786-336-0881 state: FL Zip: 33172 Value -°Morkfor :this ,Permit: $ 1.3 o ietrarre/Lldear::Footage of°Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: Plumbing sub permit extension 02 - 1/2 BATHROOMS, NEW UNDERGROUND„ NE LINES, HOT & COLD, WATER, TANK WATER HEATER: NEW KITCHEN, NEWLAUNDRY ❑ Demolition Specify color of color thru tile: Submittal Fee $1 2 & . 00 Scanning Fee $ - CO /�- TeclwroJogy.Fee�$ [( ` - Training Education Fee$ 2 ` eo Double Fee $ J. Structural,Reviews $ 56 -Bond $ t. T � ;DUE$ S� , �( �l�i'1-Sim- � c�x��2.': �1 , Q � DTAL:F E;NOW E (Revised02/24/2014) Permit Fee $ 44[��6, f�`�'`-'CCF $/•' Li 0� Radon Fee $ Er- 1 �DanDB$ Ip ` qe) CO/CC $ Y� Notary $ 9 `Bonding Company's Name (if applicable) Bonding Company's Address v„IA .. 1 ,Itn, City , :State - •• Ztp "Mortgage.kender's Name'(if;applicable) Mortgage -Lender's Address 1 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- per'ra►it.. and,.that. alk. wowk, wiR. be . pe foa d'to tweet. the: st orchids.. of aW laws, reg ►lot ing__ construction in this jurisdiction. Ikunderstand-that.a:separate permit must be secure.dffor' ELECTRIC, PLUMBING. SIGNS, POOLS, FURNACES, BOILERS; HEATERS TANKS, AIR•CONDITIONERS; ETC..... • OWNER'S AFFIDAVIT: l' certify that all the: foregoing, information. is ° accurate -and" that- all work witi be done in; compliance with all applicable laws regulating construction, and zoning. "WARNING:TO OWNER: YOUR FAILURE TO RECORD A NOTICE "-OF COMMENCEMENT MAY RESUiT'IN YOUR "PAYING TWICE FOR IMPROVEMENTS ;to YOUR PROPERTY..,..IF YOU INTEND TO OBTAIN `-FINANC1NG,•CONSULTWITH YOUR "LENDER ;.OR'AN ATTORNE r' BEFORE RECORDING YOUR NOTICENOTICE 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 tie posted at the job site for the first inspection, which, occurs severr (7)° days after the burtding:• permit- is issued In the absence i f such posted notice, the inspection,wrll be approved'_and%a+reinspectaon fee wiitte charged: Signature OWN R or AGENT The foregoing instrument was acknowledged before me this 0 .:day,.of - 7 i- ' , 20 / ;by 4,tY2/6Z k Va✓ ,;who i peesonally known o meorwho has produced _ as identification and who did take an oath. NOTARY PUBLIC: 1 Sign:_ Print: v7 L C- ,7U[./9 r✓C42- 1 ! ,,,, r,,, JULIAN A CARDONA sAisc•Notary Public - State of Florida Commission # FF 191910 �'o:' M Comm. Ez Tres Jan 21 2019'` < r, **** *#�[ far*** * **** *** **# ******************'******** Bonged through National NNotary*assn.Fp' l �tr./ Plans Examiner. Signature ..r The foregoing instrument was acknowledged before me this day .of , 20 / 3 by [;15Qi:/�111 /�'rl,.who is rsonally knowniJto r. J <meorwho`has produced as identification and who did take an oath. NOTARY PUBLIC: CONTRACTOR ,lam ?APPROVED 'BY Sign: Print: Seal:. ,`oPRY AUA',iJULIAN A CARDONA, , `s Notary Public - State of Florida •E Commission # FF 191910 ,,,. My Comm. Expires Jan 21, 2019 Bonded through National Notary Assn. ************* winning (Revised02/24•J2014) Structu ra l "Review 'Clerk i i i USPS TRACKING # IQ IuI i I I I I 9590 9402 2512 6306 0210 31 United States Postal Service First -Class Mail Postage & Fees Paid USPS Permit No. G110 • Sender: Please print your na vae, s adress, and ZIP+4® in this box• OBEFER CONSULTING LLC 40 NW 111TH STREET MIAMI SHORES, FL 33168 ENDER- COMPLETE THIS SECTION,, IN Complete items 1, 2, and 3. ® Print your name and address on the reverse so that we can return the card to you. ® Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: 3e5c' Nu/ 2 r r./1 . in /4 FL 3 3 / 11IIIII IIII IIIIIIIIIIIIII III 1111 II IIIII III 9590 9402 2512 6306 0210 31 '.COMPLETE THIS SECTION ON DELIVERY A. Signature X • B. ReceiGed by (Printed Name) Gig Z_ ❑ Agent ❑ Addressee C. Date of Delivery D. Is delivery address different from item 1? 0 Yes If YES, enter delivery address below: ❑ No 2. Article Number (Transfer from service label) 7016 3010 0000 7902 3892 3. Service Type ❑ Adult Signature ❑ Adult Signature Restricted Delivery ❑ Certified Mail® O Certified Mail Restricted Delivery ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery red Mail fired Mail Restricted Delivery rr $500) ❑ Priority Mail Express® ❑ Registered Mail. ❑ Registered Mail Restricted Delivery ❑ Return Receipt for Merchandise ❑ Signature ConfirmationT. ❑ Signature Confirmation Restricted Delivery PS Form 381 ' JuP )15 PSN 7530-02-000 9053 Domestic Return Receipt Nliami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138, Tel: (305)795.2204 Fax:_: (305)> 7566_8972 CHANGE OF CONTRACTOR f ARCHITECT Permit N. PL-11-15-2922 Owner's Name Fee Simple Title Holder):'GABRIEL MARTIN KUSKUNOV owner's Address: 1050 NE 107 ST Phone #: 786-4:88-8315 City: MIAMI SHORES Job Address (Of where work is being done): 1050 NE 107 ST City: Miami Shores Contractor's, Company Name: DZ,OPLUMBING CORP. Address:. 3890 NW2 TERRACE State FL Zip Code: 33161 State: Florida Zip Code: 33161 Phone:# 305-9.79-0516 City: MIAMI Qualifier`s Name : DAVID DIAZ State: FL Zlp.Code: 33126 etc. N2imber: CFC1426173. Architect) Engineer of Record Name: JUAN FERNANDEZ BARQUIN P.E Phone #: 786-336-0881 Address: 2520 NW 97TH AVE City: 130RA'L :State: 'P- DescribeWork: NEW KITCHEN, NE'W.2-112.BATH, Zip Code: 33172 1"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 es harmless of aft regal invohrement Signature, 0 era= t. The foregoing instrument s aknowtedged before me this i day of ediJy ,20P-,by 60, Vu..S i vv..., Who is personally known to me or who has produced Signature Contractor or Architect The foregoing instrument was aknowtedged before me this day of , 20 by who is personally known to me or who has produced v i 1 2613- 6s- 3 & "'D • as indentification. as,,indentificatiora. Notary Publ. Sign: Seal: JULIAN A CAROONA r Public - Stale ofi Florida 7.Commission # FF 1 My Comm. Expires Jan 21, 2019 ��- ',,4a�`� Bonded through National Notary Assn. Notary Public: Sign: Seal: Miami'Shores Village;: Building Department 10050 NM._ 2,423 Avenue'. Miami :Shores .Florida 33 13'8 Tel: (305) 795.2204 Fax: (305) 756.8972 Change of Contractor/Architect or'Engineer A change of contractor, architect or engineer must be done under a permit number. There is a $75.00 charge for a change of contractor. The owner will submit a Change of Contractor .Formcompleted. with ,notarized signatures If the signature of the previous, contractor cannot be.. obtainedtheowner must send a certified letter/return., receipt notifying the previous: contractor,architect or engineer the reason for the change,: The:, owner must allow 10 business days for the contractor, architect or. engineer to,respond. A permit: application: must accompany the 'change.: of contractor' form, with the information • and signature of the new contractor. The new contractor must be registered with the Village or must submit the required documents to register with the V.iJlage. a �a. I .,Change of Contractor formcompleted, signed and 'notarized. 2. Permit application by new contractor. 3. Required fees. 4. Copy of original letter -sent via certified mail along with the returned receipt.` In addition to the requirements above the -architect or engineer "of record mustauthorized the., new:`architect or engineer :to -reproduce his documents. The authorization. must be in writing; and must be signed and sealed.. fl Miami, July 7th. 2017 D &- D 'PLUMBING CORP ! David, biaz 3890 NW 2 Terrace Miami, FL 33126 Re: Change .plumbing sub -contractor Address: -1050 NE 107 ST, Miami, FL 33161 Dear Mr. David Diaz I, Gabriel Martin Kuskunov, (Owner) of the property at 1050 NE 107 ST, am notifying you, that we are re -activating the job and decide to change the Plumbing Sub contractor, therefore your company will be no longer work as a Plumbing sub -contractor in my property. Thenew responsible for Electricalwad(wild be: Company : A & C PORTELA PLUMBING INC Qualifier : DAVID PORTELA License No.: CFC1428617 Address :2665SW 33`AVE, 'MIAMI, FL 33133 GAB EL MA TIN KUSKUNOV Owner STATE OF FLORIDACOUNTY OF DADE Sworn to and subscribed beforeme this o ?- day of `f U L' , 2014 by: [ Personally known to me; or [ ] Produced Identification 4-Signature of Notary Public (Seal) Please=hand-deliverthis ,letter to Administration. JULIAN A CARDONA Notary Public - State of Florida • Commission # FF 191910 . My Comm. Expires Jan 21, 2019 Bonded through National Notary Assn. Detail by Entity Name hap:f/ssearchsuabiz esu1t 1?... Detail by _Entity Name Florida Profit Corporation D & D PLUMBING CORP. Filing Information Document Number P04000009749 FEI/EIN Number 20-0604412 Date Filed 01/13/2004 State EL Status ACTIVE Principal Address 3890 nw 2 terrace MIAMI, FL 33126 Changed: 01/27/2014 Mailing Address 3890 nw 2 terrace MIAMI, FL 33126 Changed: 01/27/2014 RegtsteretrAgent"'N. ame-&Address DIAZ,'I?VID 3890 raw 2 terrace MIAMI, FL 33126 Address Changed: 01/27/2014 Officer/Director Detail Name & Address Title PSO DIAZ, DAVID 3890 nw 2 terrace M1AMt fPl: 33126 Title secretary diaz, angel david 3145 sw 19 st miami, FL 33145 Annual Reports Report Year Filed Date 2015 0.1/19/204 2016 03/11/2016 2017 02/09/2017 2 of 3 7/7/17, 11:52 AM AC RO® CERTIFICATE OF LIABILITY INSURANCE DATE (YSIIDOIYYYY) 07/20/2017 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(tes) 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 certlflcate holder In lieu of such endorsement(s). PRODUCER ESTHER VIDAL MUTUAL INTEREST ASSURANCE 1295 CORAL WAY SUITE 3 MIAMI, FL 33145 INSURED A & C PORTELA PLUMBING, INC 2655 SW 33RD AVENUE MIAMI, FL 33133 CON TACT ESTHER VIDAL mak305-860-2003 ADoleLess; MUTUALAS@AOLCOM INSURER(S)AFFORDING COVERAGE INSURER A: GRANADA INSURANCE CO. iJW/c, Nox 305-860-0907 NAIC 0 INSURER IS ASCENDANT UNDERWRITERS LLC INSURER c:AMTRUST NORTH AMERICA INSURER D : INSURER E : INSURER P : CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH OF INSURANCE PERTAIN, POLICIES. ADdi:"SUSIt HER WILD LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WrIICH THIS THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OP INSURANCE POUCY NUMBER POLICY EPF (MM DD/YYYY) POLICY EXP II111/DWYYYY1 UNITS A OENERAL UABIUTY COMMERCIAL GENERAL LUBILITY OCCUR 0185FL00006034-9 1 /20/2017 1/20/2018 EACH OCCURRENCE 1$ 1,000,000 X PREMISES (Ea oENTEcc srencel 1 $ 50,000 CLAIMS -MADE X MED EXP (Any one parson) j S 5,000 X 131 $500. DED. PERSONAL & ADV INJURY $ 1,000,000 X GEN'LAGGREGA PD$500 DED GENERAL AGGREGATE I S 2,000,000 PRODUCTS-COMP/OPAGG:S 2,000,000 ATTELIIMITAPPL�IESPER: —1 POLICY 1 IJECOT IT LOC S t. B AUTOMOsILEUAaILITY ANY AUTO SCHEDULED AUTOS NON -OWNED AUTOS ` CA-33189-5 7/03/2017 07/13/2018 {(Eaa" derrcSINGLE LIMIT ; s 100,000 BODILY INJURY (Per person) S 100,000 ALL OWNED AUTOS Lyle_ BODILY INJURY (Per accident) S 300.000 _ HIRED AUTOS PROPERTY DAMAGE I $ 100,000 (PeracddeM) UMBRELLAS/AS CLAIMS -MADE EACH OCCURRENCE S EXCESS LIAO I 1OCCUR AGGREGATE S DEO RETENTIONS S r.0 WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory 1n NE) I(pes, desvibe under DESCRIPTION OF OPERATIONS Y / N N!A AWC1074417 `01/13/201701/13/2018 • X TORYSLANN'S: ER - EL EACH ACCIDENT $ 1,000,00() EL DISEASE - EA EMPLOYEE S 1,000,000 beam E.L. DISEASE - POLICY UNIT S 1,000,000 I I DESCRPTION OP OPERAT1ONE I LOCATl0N81 VEHICLES (*Men PLUMBING CONTRACTOR. DAVID PORTELA Eason woos is req,irad) ACORD 101, Adettenal Ramada SehadiM, LIC. CFC1428617 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 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 ESTHER VIDAL ACORD 25 (2010/051 ®1988-2010 ACORD CORPORATION. All rights resented. The ACORD name and Ioao are reaistered marks of ACORD Local. Business Tax Receipt Miami -Dade County, State of Florida I'f4 vat 4 St/ -DO NOT tAV 5719928 OUSINFSS NAME/LOCATION A C POPI rut PLUMBING INC 2655 511/33 AVE AIWA Ft 33133 0%ViNISIR A C POR MLA KIWIS:NC INK OAVID PORiEtA $09AUl1ER 1:Porker (14 2 "MCC:PT 1410. RENEWAL 5455522 EXPIRES SEPTEMBER 30, 2017 ssc r VP€.O ausintss 1% Pi. 0.7.1i3J1g; N'M CI TA CFC anriti (044"w.: riut rom$3:va =tour:wit SO tAkisei tOdii Ctrapts, SAL '4. *AsteENT CLIVED Si' TAX C04.4.t C700 SZS 00 07n5/2016 CAI DO CAM--16 -04 ihs i... orri itoi***** i******4*****coltistmet woo**1ieke totisHileguern 4* is* Retaut Is ma* isimoK sasoiLis • cesi14-4414,4110 Wit' istuStionivez.to St tssiotts. II essit timosar•oiSh roe, gewmwometti 40 410.4ntrASm1llstl ttlitstery Hist ***..****mmet,,,mott *******Feb*Seome=. Its &MS'S F10 above- moil t ISsrsval 4mAattstesteioShrelichos Otis444:46111r Sec a41.4;s„ hur woe ist-mSersts,-erst iorsocgsgottS005 potkeviOrmi, „. . _ RaCK SCOTT. GOVERNOR LIteNS€ MUSSER• -C:4222517 KEN LAI/ SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS -AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY. LICENSING BOARD The'PLUMBING CONTRACTOR "NaiTteil belowIS,CERTIFIED Under tt',e divisions of Chapter a84 FS. Expfra,londate., AUG 31.. 2018 FOR`CEt rDAVID :. A8C PORTELA PiUMBINGrt 2655 SW 33 AVE -� t WWI ,=El 33133 zg ISSUED G&/22,?0 6 DISPLAY AS REQUIRED SY LAW SEC) x 1.:6221XVItt. JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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,Fiorida Workers' Compensation law. EFFECTIVE DATE: 3/22/2014 PERSON: DIAZ FEIN: 200604412 BUSINESS NAME AND ADDRESS: D & D PLUMBING CORP EXPIRATION DATE: 3/21/2016 DAVID 3145 SW 19 STREET MIAMI. FL 33145 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter440.05(14), F.S., an officer. of a corporation who elects exemption from this chapter by fling 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 shalt be subject to revocation it, at any time after the filing of the notice or the issuance of the certificate, the person named en the notice or certificate no longer meats 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 07-12 QUESTIONS? (850)413-1609