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RF-15-1809Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 COR'lD4' (Permit Issue Date: 8R/2015 Permit NO. RF-7-13-1809 Permit Type: Roof Work Classification: Gutters Permit Status: APPROVED Expiration: 02/03/2016 Project Address Parcel Number Applicant 8700 BISCAYNE Boulevard 1132060201030 MIAMI SHORES SERVICE Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell MIAMI SHORES SERVICE 9701 NW 89 Avenue MEDLEY FL 33178- A Contractor(s) Phone Cell Phone A-1 GUTTERS TECH INC (305)457-0863 of Work: Gutters onal Info: REPAIR GUTTERS 8 DOWNSOUT ification: Commercial Scanning: 3 Fees Due Amount CCF $6.00 DBPR Fee $4.14 DCA Fee $4.14 Education Surcharge $2.00 Permit Fee - Repairs $276.00 Scanning Fee $9.00 Technology, Fee $8.00 Total:' $309.28 Valuation: $ Total Scl Feet: Pay Date Pay Type Amt Paid Amt Due Invoice # RF-7-15-56398 07/20/2015 Credit Card $ 50.00 $ 259.28 08/07/2015 Credit Card $ 259.28 $ 0.00 480 Available Inspections: Inspection Type: Final Review Building Review Building cA�CF��FO C.7 X J -Ga C-7 O In consid ration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertainingPereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In acceptingU tis permit I ssume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required fd-PELECTRI L PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNER$,7%FFIDAV I ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construct& and n ermore, I authorize the above -named contractor to do the work stated. August 07, 2015 Authorized ftnature: Owner / Applicant / Contractor / Agent Date .� c.n Building Department Copy August 07, 2015 1 { \t Miami Shores Village RECEIVED n\'li0 Building Department DEC 19`Iz018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 T Tel: 305 795-2204 Fax: 305 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201: BUILDING Master Permit No. ,P—t�YYts` 1 ?Del ' PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑REN EYM ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF `)'� CANCELLATION ❑ SHOP CONTRACTOR DRAWI� JOB ADDRESS: (S CGY1�I U l V `J1 e City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: � 1 OWNER: Name (Fee Simple Titleholder): C V 1-aP�S h LAM i �'�fe t6g. S—A71 honL�ce#: 3OS- AAA.-,,- cl iriI AIIA/ vQ-1h A-V-P City: State: p: 33I� Tenant//L�/e�ss+eeyN�ame: /�,/ p /� / �/�, p1 �. /� /"� ,/�� Phone#:_ Email: /�1CII 1 ,te n \ 1 I l� 1. J \ bi l_T7- i 0 1 I , 1- 0 f f �, CONTRACTOR: Company Name: Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: _ DESIGNER: Architect/Engineer: �� Phone#: Address: City: Value of Work for this Permit: $ ua /Linear Fc Type of Work: ❑ Addition ❑ Alterati n ❑ New ❑ 01 Description of Work: I Specify color of color thru the: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $_ DBPR $ of Work: ip: Zip: it/Replace ❑ Demolition CO/CC $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ _ (Revised02/24/2014) 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. 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 ap ved and a reinspection fee will be charged. Signature Signature or AGENT The foregoing instrument -was acknowledged before me this day off � y C 2 by (1(IU A. V 1 bI l�p A -CA , who is Cersonally:k)own o me or who has produced as CONTRACTOR The foregoing instrument was acknowledged before me this day of me or who has produced 20 by , who is personally known to identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 1 Sign: Sign: Print: 1y)k13 QI I Print: Seal: Seal: �p lk% Notary Public State of Florida Estefania Ramirez My Commission GG 199994 as APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) i' We wi!I exceed your expectations RE: Miami Shores Service Station LLC 9701 NW 891" Ave Medley FL 33178 Permit NO RF-7-15-1809 To Whom it May Concern, In 2015 we signed a proposal with A-1 GUTTERS TECH INC to repair our gutters in our gas station canopy. The company submitted documents to obtain a permit. Unfortunately, A-1 GUTTERS TECH INC did not repair any gutters in our station. We now are attempting to submit new permits with NORTH POINTE METAL INC to replace the entire gas station canopy. We would like to cancel this permit since no repairs were ever made. This company does not exist anymore. If you have any questions, please contact me at 305-884-0008 EXT 231. Engineering Manager 9701 NW 891' Ave Medley • FL • 33178 Tel: 305-884-0008 'q//%% 665 Fax: 305-883-1927 L_`-'.J�Q.S a..�,..... YALERO ssxe*rww.� www.urbietaoil.com �� J, 1' r' n 1 k kr r r ��.—.. --- r- . __ _ .. +c -_. r t F` a /r fr rok—.�..... ...... .. ..__ _ � � _.: a �� I, 1' � `` i/ i F d rr t'. .� "t t � 1 _; �..� 1f 1� jC 1230 d apt Miami Shores Village Building Department JUL 2 V 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY= MTel: (305) 795-2204 Fax: (305) 756-8972 7E1 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No.-P - \ 9 DC PERMIT APPLICATION Sub Permit No. ❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWA ❑PLUMBING � MECHANICAL ❑PUBLIC WORKS ❑CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS: L7 7DG� 4?1:rCeY h e City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: // • jL 6) 6 - -010 `/0 30 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 114&i SN/L S � Sit T/0�� d' Phone#: 30J �Y� 6��'C'? Address: e1141 A,", i'll-1 .eve City: aeecjle`1 `4' State: fL Tenant/Lessee Name: Email: CONTRACTOR: Company Name: A — Address: 7 -ia t City: Qualifier Name:yaTz l 0/ State Certification or Registration #: DESIGNER: Architect/Engineer: Address: n 244 , Value of Work for this Permit: all Type of Work: ❑ Addition Description of Work: _a Certificate of Competency #: o q 15 d 0,6 2 -3 one#: City: StateC — Zip: Square/Linear Footage of Work: T C3 ❑ Alteration ❑ New i Y -9a1 /ic,r5 A Pl Ii Repair/Replace ❑ Demolition Specify color of color thru tile: �-1 Submittal Fee $ ��i Permit Fee $:`I 6" CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ 2— V 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. 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 a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 16 day of ;SJ I LJ 20 15 by ,io %Jl le, who is personally known to me or who has produced 1Q; as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal: COMMISSION # FF005953 - �� EXPIRES: APR. 07,2017 ... ,yrWW AARONNOTARY.com Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of. LJdll 20 /� , by UQ� 07 110L'*-n'e , who is personally known to me or who has produced A.) / 13' as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: i Seal: COMMISSION # FF005953 EXPIRES: APP, 07, 2017 www.AARONNOTARY.com ****************************** **** *********************************************************************** APPROVED BY �) Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Detail by Entity Name r Page 1 of 2 Detail by Entity Name Florida Limited Liability Company MIAMI SHORES SERVICE STATION LLC Filing Information Document Number FEI/EIN Number Date Filed State Status Principal Address 9701 NW 89TH AVENUE MEDLEY, FL 33178 Changed: 04/25/2012 Mailing Address 9701 NW 89TH AVENUE MEDLEY, FL 33178 L05000056387 N/A 06/07/2005 FL ACTIVE Registered Agent Name & Address URBIETA, IGNACIO M 9701 NW 89TH AVENUE MEDLEY, FL 33178 Name Changed: 04/30/2014 Authorized Person(s) Detail Name & Address Title MGR URBIETA MANAGEMENT INVESTMENTS, INC. 9701 NW 89TH AVENUE MEDLEY, FL 33178 Annual Reports Report Year Filed Date 2013 04/29/2013 2014 04/30/2014 2015 04/27/2015 http://search. sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entity... 7/ 15/2015 iaiifyinq Board OF COMPETENCY 09BS00673 INC Is certified under the provisi ons of Chapter 10 of Miami' Dade Cou tV +'INGU1 Local Business Tax. Receipt Miami —Dade County, State of f lorida , -THIS IS NOT A BILL -DO NOT PAY 718T880 BuslNEss "mwLOCAYION RECEIPT NO. EXPIRES A 1 GUTTERS TECH INC NEW BUSINESS SEPTEMBER 30, 2015 2740 E 10 AVE 7468702 Must be displayed at place of business HIALEAH. FL, 33013 'pursuant to County Code CAapter IIA`- Art: 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED A 1 GUTTERS TECH INC 196 SPECIALTY BUILDING BY TAX COLLECTOR C/O EDUARDO ALBUERNE CONTRACTOR .5,00 07/02/2015 Worker(s) 1 09BS00673 0230-15-001665 This Local awleaw Tax Mcaipi only coafirels palm al of the Local Bssiaess Tmr. Do Receipt is not a liceaw permit. or a certification of do holders galwicatiolm to do husiaess Nobler mast comply wim my wwioA"t or nagovoromenal regntawy taws and regaimmenes which apply to dw hreinew. The RECEIPT NO. abora most be displarad an all commercial vddcI s - Ming Dade Code sec Qa M ®� Formate iloraatioa rrNit Municipal Contractors Tax Receipt Miami —Dade County, State of Florida. -THIS IS NOT A BILL - DO NOT PAY CC NO: 09BS00673 13USINESS NAME/LOCATION RECEIPT NO. A 1 GUTTERS TECH INC 2740 E 10 AVE 7469292 HKEAH,FL 33013 OWNER A 1 GUTTERS TECH°1NC C/O EDUARDO ALBUERNE MC EXPIRES SEPTEMBER 30, 2015 Pursuant to County Code See 10-24 TYP, E OF BU8INESS SPECIALTY BUILDING CONTRACTOR Restricted to City of Miami Shores ® for mole information, vw PAYMENT RECEIVED BY TAX COLLECTOR 18.75 07/20/2015. 0224-15-005365 FROM:INSURANCE NETWORK CENTER TO:3057568972 07/06/2015 11:04:37 #748 P.001 /001 OP ID: LG ;......- CERTIFICATE OF LIABILITY INSURANCE F DATE(MWDDIYYYY) d7/0612015 IFI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTCATE 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 poilcy(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 endorsements . PRODUCER CONTACT Insurance Network Center NAME_ Luis De Gongora PHONE FAX 7735 NW 146 ST., SUITE 204 (a1•r N°-axe),...__.. _.-- .._.._.._.__. _ ._._.- fNC,_wo}: E-MAIL .... _ . ....... ....... ............ ..__. ...---- Miami Lakes, FL 33016 ADDRESS: LuisDe Gongora_..........................._..........---....-_._.. CUSTOMER IQ a• Al GUT-1 Al GUTTERS TECH INC - INSURED ......... __.._.._ .,,. 2740E 10 Ave INSURER A GRA_NADA HIALEAH, FL 33013 INSURER B PROGRESI vv.cnrivc� 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. -- SUi3E7 --..�_ —_. —.—r LTR TYPE OF INSURANCE ( -- POLICY NUMBER POLICY LiFF POLICY EXP_. MWDD/YVYY MM/DDIYYYY LIMITS GENERAL LIABILITY � ' I .EACH OCCURRENCE j $ 500,0 A X I COMMERCIAL GENERAL LIABILITY 0185FL00035046031291201510312912016DXIE I0"liE6iTEb" "`--- ---- - ~ - f pREM(SE ' Ea occurrence $ 100,0' CLAIMS -MADE. j.., � OCCUR - - 'r' L - ---. �--L. _ — MEQ EXP (Any one parson) I $ 5 01 i ! ..- ---' T .PERSONAL & ADV INJURY $ 500.01 ._. ._.._----.._.._.__..... ._.... ...__....._,............ _.—.......... GEN'L AGGREGATE LIMIT' APPLIES PER I AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS A X11 SCHEDULED AUTOS HIRED AUTOS i NON -OWNED AUTOS UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS DEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE f I N OFFICER/MEMBER EXCLUDED? L� I N / A (Mandatory in NH} 1f yes, describe under 1 VCry!]KAL AGUHLGATE a PRODUCTS - COMPIOP AGG $ j COMBINED SINGLE LIMIT , j (Ea aCadent) $ } BODILY INJURY (Per person) $ 12/30/2014 BODILY INJURY (Per amideni)! 12130/2015 $ I PROPERTY DAMAGE t (PER ACCIDENT) $ 1 i ! i $ j EACH OCGURRENCE $ AGGREGATE .... $ �._.... $ OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) INSTALLATION E L. EACH ACCIDENT' ! S E L. DISEASE - EA EMPLOYEE $ 500 1 1 VILLAG4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES E CANCELLED BEFORE VILLAGE OF MIAMI SHORES THE EXPIRATION DATE THEREOF, NOTICE W BE DELIVERED IN FAX (305)-756-8972 ACCORDANCE WITH THE POLICY PROVISIO 10050 NE 2ND AVE MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE Luis De Gongora ACORD 25 2009/d9 (D 1988-2009 ACORD CORPO TION. Ail rights reserved. ( ) The ACORD name and logo are registered marks of ACORD II JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION e e 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: 7/10/2015 EXPIRATION DATE: 7/9/2017 PERSON: ALBUERNE EDUARDO FEIN: 204997312 BUSINESS NAME AND ADDRESS: Al GUTTERS TECH INC 2740 EAST 10 AVE HIALEAH FL 33010 SCOPES OF BUSINESS OR TRADE: SHEET METAL WORK - INSTALLATIO Pursuant to Chapter 440.05(14), F.S., an officer of a c«p«atlon who etscts exemption hom Use chapM by !ding s c Ncsts of IW—under this secfion may not recover benedb «olnpeiroNon under tlde aiwtar Purwwg to Chapter 440 W12). F.S.. CeNficates a deCtim to be exempt... apply «dy *ftn the scope,uf tM bonne" «trade filled an the mtica a ebctlon b be exempt Pureu14 b Ctulpoer 440.05(19). F.S.. Notices or aecdon to be xemq end ceibficetes a ebcbn b be exempt Mad be subjeab ravocerm It, at sry 6me aher ill ng a the notice «ill issuance a the ceNflcate, the parmn named on the nafioe «cerdFcste no longer meets the reawernerds d this aec5on br issuance of a cerOr .tide. The depeNnont shell revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 06-13 QUESTIONS? (650)413-1609 A-1 GUTTERS TECH INC. 2740 EAST IOT" AVE HIALEAH, FL 33013 (305) 30S-S19-2114 July 17, 2015 State of Florida County of Miami Dade Before me this day personally appeared Eduardo Albuerne who, being duly sworn, deposes and says: That he will be the only person working on the project located at 8700 Biscayne Blvd. Sworn to (or affirmed) and subscribed before me this 17th day of July 2015, by Eduardo Albuerne. Personally know_X_ J - /,/ P, Erika Guido ,,Wit" eycgiY PGd%,, Erika Guido a COMMISSION # FF005953 -•... c EXPIRES: APR. 07 2017 °�, www.AARONNOTARY.com 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 nsation 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 / day of 20 X. By c; a /�.y��ji 4 who is personally knuwn to me or has produced as identification. Notary: / " Erika Guido �p ki PV¢`'/''. SEAL: =?' r%COMMIW0N#FF005953 EXPIRES: APR. 07, 2017 µ/yyW.AARONNOTARY.com A-1 Gutters Tech, Inca Tel: 305-512-5158 • Cell: 305-319-2114 • •r . 1h40 WEE Name . • :..... ••r••• .... •• •• •Pv&@ss• ••.. .faro. see .fit'" • i• • ...r•' f ,fUL 0 2015 J� ate: - lo� LIC# 09BS00673 ORK TO BE PERFORMED AT. Address: S �� City, State I 71 r�ir�■ ®■r�w■�� . WHITE . CREAM IVORY 13 BROWN L GRAY C3 D. GRAY10 I��iiiirr.r~�� ■ ■ RED Iff ISO ■ H' ■ . . rim INS 01=110MEM, MINES MINIMS us S. ■ f �I 0BROPMe 0GRAVees 1 ! ■ r L. GRAY'■ D. GRAt, 4�� ■ • r ` r .+ ■ RE c MIEN 0, MORE 133X4 DCONDUCTOR 0 0 OTHER MONO TOTAL FOOTAGE 'Y ii L L— I TOTAL DOWNSPOUT SALES REP -j ra S YEAR GUARANTEE ON LABOR 120 YEAR GUARANTEE ON MATERIAL EXCEPt Damage resulthg from accident, misuse, abuse. neglect, or from other than normal and ordinary use of the product. TOTAL $ 10 0 . f.. t.:l ❑ CASH ❑ ALUMINUM DEPOSIT $ ) + ' ❑ CHECK ❑ COPPER . ❑ GALVANIZED BALANCES _ i' °. ❑ CREW CARD ❑ STAINLESS STEEL Crew Chief: Installer: ❑ 1 /4 ❑ 1 /2 ❑ 3/4 ❑ Completed TERMS OF PA)&fiNl - Paymentjp fuhpye upon completion. Contracts which state a draw cut off date and payment release date are the only exceptions and must be sigredrbyTepresentQtvas of both parties SMANAE CHARGE: finasce chow in am8unt of the lesser of 1.5% per month (18% per annum). or the maximum showed by Maw, will be added to all • in•bice4fhat arew9Qeiaye� dugeacf therttHh of the fottowing month. We are not responsible for damage to roof thes sMrgba or faeda boards. 'fA�a9 wto mof tiles tdtingMs �st+ah be perfom-d unless agreed to by l Gutters Tech, 1'n%! beforehand. in wring. we are not responsible .t1QRIZEO •St6'!V!►T{�RE: • DATE CLIENT SIGNATURE • • •• •• • • •••••• 0 •••••• •