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MC-18-1235 (2)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 RECLI VEL MAY 0 9 7018 CD �_, W �_, FBC 20 1"c" BUILDING Master Permit No. P_ C-"I Z' 4z4 PERMIT APPLICATION Sub Permit No. Nei C. 'I2,?25 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING H MECHANICAL (PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 128 NE 94 ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-013-2980 Is the Building Historically Designated: Yes NO X Occupancy Type: residential Load: Construction Type: CBS Flood Zone: X BFE: FFE: OWNER: Name (Fee Simple Titleholder): SALVATORE INVESTMENTS INC Phone#: 305-778-5961 Address: 6130 NE 4th Ct City: Miami State: FL Zip. 33137 Tenant/Lessee Name: Phone#: Email: alsba@bellsouth.net CONTRACTOR: Company Name: DANAJO INDUSTRIAL CORP Phone#: 786-543-0200 Address: 670 NW 114TH AVE APT 103 City: MIAMI State: FL Zip: 33172 Qualifier Name: JORGE MOLINA Phone#: 786-543-0200 State Certification or Registration #: CMC1250046 Certificate of Competency M DESIGNER: Architect/Engineer: CARMEN T. DIAZ Phone#: 786-312-6060 Address: 5001 S.W. 74th CT # 100 City: MIAMI State: FL Zip: 33155 Value of Work for this Permit: $ 23,700.00 Square/Linear Footage of Work: 5,329 Type of Work: ❑ Addition ❑ Alteration Description of Work: NEW RESIDENTIAL HOME Specify color of color thru tile:, Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ 0 New ❑ Repair/Replace ❑ Demolition Technology Fee $ Training/Education Fee $ Structural Reviews $ ( 00 . <51O (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ �L Bond $ t J TOTAL FEE NOW DUE $ (-� I . I 'i Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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. 1 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 a reinspection fee will be charged. Signature Signature ' OWNER or AGENT The foregoing instrument was acknowledged before me this The foregoing i CONTRACTOR was acknowledged before me this day of NPPIL M 20 by 224- day of P'01Z%1- 20 Q by who is personally known to ---)0 0-6rS fA�D t.1 is who is personally known to me or who has produced as me or who has produced identification and who did take an oath. identification and who did take an oath. as NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: -i c� Seal: lip fin' . Commission # FF 950082 Seal: �``"' `° KARINAALEJANDRALUNA My Commission Expires _ Commission # FF 950062 January 12, 2020 .: My Commission Expires �,,,,,,,,,,.�• January 12. 2020 i. ######################################################################################################### APPROVED BY to Pans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 sation 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: State of Fl( County of The foregoing was acknowledge before me this I st By JOSE A. SBARRA day of may 20 18 who is personally known to me or has produced as identification. Notary: .�..�..�..........�.� VA L V 1\i SEAL: dnission N FF 950062 .. �Commission Expires M7anuory 12, 2020 DANAJO INDUSTRIAL CORP 670 NW 114T" Ave, # 103 Miami, FL 33172 5/1/2018 State of Florida County of Miami Dade Before me this day personally appeared Jorge Molina, who being duly sworn, deposes and says that he will be the only person working on the project located at 128 NE 94 St. Miami Shores, FL 33138 as Mechanical contractor for Salvatore Investments Inc. Sworn to me and subscribed before me this first day of May 2018 by Jorge Molina who I personally know. K 1"A A111A"11 A W"A °^= _. mmission # FF 950062 :. Commission Expires J Auary 12, 2020 Karina A. Luna RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONALCATION CONSTRUCTION INDUSTRY LICENSING BOARD CMC1250046 f' The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 MOLINA, JORGE " ` DANAJO INDUSTRIAL GRO6fKiNC 670 NW 114TH AVE _'' MIAMI FL 3317j - ISSUED: 07/2412016 DISPLAY AS REQUIRED BY LAW SEQ # L1607240002220 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6588694 SUSiNE86 NAMEILOCATION DANAJO INDUSTRIAL GROUP INC 670 NW 114 AVE 103 SWEETWATER, FL 33172 OWNER DANAJO INDUSTRIAL GROUP INC Worker(s) RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2018 6859343 Must be displayed at place of business Pursuant to County Code Chapter SA - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 GENERAL MECHANICAL ev TAX COLLECTOR CONTRACTOR 45.00 09/2912017 CMC1250046 CREDITCARD-17-065400 This Local Business yes Receipt only confirms payment of the local Business Tax. The Receipt is not a license, permit. or a cartificauoa of the holders qualifications. to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0, above must be displayed on all commercial vehicles - Miami -Code Code Sec 98-716, MIAMwnoE) For more information. visit ypgv�Lgjlmldedeg2yQ1l1LEgIlttSltlt ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 05/01/2018 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. TAIS 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 CONTACT NAME: Sunem Herrera I NC No. , (954) 725-6112 ext 151 FAX No): (954) 72"115 Advanced Professional Insurance Ser 240 Lock Road ADDRESS: Sunem@apisus.com INSURE S AFFORDING COVERAGE NAIC # INSURERA: WESCO INSURANCE COMPANY 25011 Deerfield Beach FL 33442 INSURED INSURER B : Ascendant Commercial Insurance Inc. INSURERC: Danajo Industrial Group, Inc. INSURER D : 10141 SW 38th Terrace INSURER E : INSURERF: Miami FL 33172 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 ADOLSUBR POLICY NUMBER POLICY M/ IDWYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE o OCCUR WPP1511064 11/19/2017 11/19/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE9_ PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL aADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � PECTRO- ❑ LOC J OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED X AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CA43490-1 03/10/2018 03/10/2019 COMBINED IN LE LI I Ea accident $ 50 �� BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peracadent $ 10 000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A I I I I STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Air Conditioning Installation Service and Repair License # CMC1250046 LrAIVL;tLLA I IUIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 10050 NE 2nd Avenue Miami Shores FI 33138 Cc) 19BR-2014 ACORD CORPORATION. All riahts reserved ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD T � 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: 8/31/2017 PERSON: MOLINA FEIN: 271782777 BUSINESS NAME AND ADDRESS: DANAJO INDUSTRIAL GROUP.INC 10141 SW 38TH TER MIAMI FL SCOPE OF BUSINESS OR TRADE: 33165 CERTIFIED MECHANICAL Heating, Ventilation, Air- CONTRACTO Conditioning and Refrgarabon Systems Installation, Service and Repair, Shop. Yard & Drivers EXPIRATION DATE: 8/31/2019 JORGE 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 rot recover benefits or compensation under this chapter Pursuant to Chapter 440.0502), F S , Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notce 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 firing 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