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RC-18-1298C-T- — Y, a'll 0 t2.c��-tZaB -- L'FLORIDp'y Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. RC-5-18-1`298 PenPennit Type: Residential Construction ot � Work Classification: Alteration Permit Status: APPROVED Parcel Number Issue Date: 712/2018 1 Expiration: 12/29/2018 Applicant 975 NE 94 Street 1132060350020 SEVEN BALCONIES LLC Miami Shores, FL 33138- Block: Lot: Dwner Information Address SEVEN BALCONIES LLC 6815 BISCAYNE Boulevard MIAMI SHORES FL 33138- 6815 BISCAYNE Boulevard MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone CAZACA CONSTRUCTION INC (305)972-1990 Phone Cell (786)387-1483 Valuation: $ 25,000.00 Total Sq Feet: 500 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: REMODELING KITCHEN AND BATI- Occupancy: Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Certificate Status: Certificate Date: Additional Info: REMODELING KITCHEN AND BATH Bond Return : Classification: Residential Fees Due Amount Bond Type - Owners Bond $500.00 CCF $15.00 CO/CC Fee $50.00 DBPR Fee $11.25 DCA Fee $7.50 Education Surcharge $5.00 Notary Fee $5.00 P&Z Review Fee $0.00 Penalty Fee $100.00 Permit Fee $750.00 Plan Review Fee (Engineer) $90.00 Scanning Fee $18.00 Technology Fee $20.00 Work without Permit Fee $750.00 Total: $2,321.75 Pay Date Pay Type Amt Paid Amt Due Invoice # RC-5-18-67549 05/16/2018 Credit Card $ 200.00 $ 2,121.75 07/02/2018 Credit Card $ 2,121.75 $ 0.00 Bond #: 3813 AvauaDie inspections: Inspection Type: Fill Cells Columns Final PE Certification Window Door Attachment Insulation Drywall Screw Window and Door Buck Review Planning Review Mechanical Review Electrical Review Building Review Building Review Structural Review Mechanical Review Plumbing Review Plumbina 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 assumeAesponsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLIING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS and II the fo omg information is accurate and that all work will be done in compliance with all applicable laws regulating . au riz the above -named contractor to do the work stated. July 02, 2018 Owner / Applicant / Contractor / Agent July 02, 2018 1 . r `4t!OR;,' Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 LORtOQ` project Address Permit NO. RC-5►-18-1298 Permit Type: Residential Construction Pen m Worts Classification: Alteration PennitStatus: APPROVED Issue Date: 7/212018 Expiration: 12/29/2018 Parcel Number Applicant 975 NE 94 Street 1132060350020 Miami Shores, FL 33138- Block: Lot: SEVEN BALCONIES LLC Owner Information Address Phone Cell SEVEN BALCONIES LLC 6815 BISCAYNE Boulevard (786)387-1483 MIAMI SHORES FL 33138- 6815 BISCAYNE Boulevard MIAMI SHORES FL 33138- :ontractor(s) Phone Cell Phone :AZACA CONSTRUCTION INC (305)972-1990 Valuation: $ 25,000.00 Total Sq Feet: 500 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: REMODELING KITCHEN AND BATE Occupancy: Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Bedrooms: Bathrooms: Plans Submitted: Certificate Status: Certificate Date: Additional Info: REMODELING KITCHEN AND BATH Bond Return : Classification: Residential Fees Due Amount Bond Type - Owners Bond $500.00 CCF $15.00 CO/CC Fee $50.00 DBPR Fee $11.25 DCA Fee $7.50 Education Surcharge $5.00 Notary Fee $5.00 P&Z Review Fee $0.00 Penalty Fee $100.00 Permit Fee $750.00 Plan Review Fee (Engineer) $90.00 Scanning Fee $18.00 Technology Fee $20.00 Work without Permit Fee $750.00 Total: $2,321.75 h-VMIrwII III L.F 1JJQI LII11WI IL VVr.Jr Pay Date Pay Type Amt Paid Amt Due Invoice # RC-5-18-67549 05/16/2018 Credit Card $ 200.00 $ 2,121.75 07/02/2018 Credit Card $ 2,121.75 $ 0.00 Bond #: 3813 Available Inspections: Inspection Type: Fill Cells Columns Final PE Certification Window Door Attachment Framing Insulation Drywall Screw Window and Door Buck Review Planning Review Mechanical Review Electrical Review Electrical Review Electrical Review Electrical Review Building Review Building Review Structural Review Mechanical Review Plumbing Review Plumbing July 02, 2018 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 BUILDING PERMIT APPLICATION *BUILDING ❑ ELECTRIC ❑ ROOFING 1 AY 6 2 18 FBC 201 ? 104 Master Permit No.'R' 12) — 1298 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ PLUMBING ❑ MECHANICAL ❑ PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 975 N25 9* -ST. City: Miami Shores County: Miami Dade zip: Folio/Parcel#: /1-;7906 -0"— OoZ 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction :�5tYlen kolnc'4 OWNER: Name (Fee Simple Titleholder): Q C Ad Flood Zone: BFE: FFE: 1� vD --Imf /l 0 39'} /Y9 3 [ 2 2 City: C( ttit / o 0-y—Le State: T Zip: 7 31 3y O Tenant/Lessee Name: LL /y�T Phone#: NZ It - Email: Q cs O Ld S 7y C ke d CONTRACTOR: Company Name: Ir02&-fo'- �KSTrx7�/�rl 'Ah c Phone#: _ �� 97Z / V Address: S20 Mir, ors 4 L, City: Cores/ 6 a6AJ State: A'L Zip: 33I-FIZ Qualifier Name: Oarh 6rci o Phone#: -1?0✓= 97Z /9?—P State Certification or Registration #: Cf, .0 6 2 92 O Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ i Square/Linear Footage of Work: S �. Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �qe o cleh:,g 4 A�'Ie 4 e i cfyt4 o+�1i ✓n�s2S sin caJ 2 e ,.v 6gJ,4r-ot,,V Specify color of color thru tile: ($U� c2 d� �2rw, / bV! 00 U d ►-l2cf Submittal Fee $ ?� 0 Q I Permit Fee $ 03 CCF $ C_ CO/CC $ '-,G , oo Scanning Fee $ V Radon Fee $. C) DBPR $ ( ZS Notary$�ZF� Technology Fee $ 2 • p Structural Reviews $'116. 07 Training/Education Fee $ Double Fee $ ' Bond $ - Q TOTAL FEE NOW DUE $ (Revised02/24/2014) -2121----� 1:3- 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. , r "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 bt 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 appro&d and a reinspection fee will be charged. _ Si tur iQ L Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 1611 drof 20 (S , by r-Q . - ( vwho is personally known to me or who has produ Yl V QY U% CtiRM�Q as identificaronan w o did takean ath. NOTARY Print: V A Seal: �`'rP41 YANADY RI 0 COMMISSI01 I F 214031 _•, a EXPIRES: March 25, 2019 pF ;4e` Bonded Thru Notary Public Underwriters The foregoing instrument was acknowledged before me this 1 day of NUVI 20 by Carlos •1"1 .IkMIOVA 0 , who is personally known to me or who has produced :br;\K-r [ ICE LSl as who did Make an NOTARY P6BLIC: Sign:_ Print: Seal: AVADYPRIEfO MY COMMISSION # FF 214031 EXPIRES: March 25, 2019 '„p, �� .•• Bonded Thru Notary Public Underwriters APPROVED BY Plans Examiner Zoning r.. ' Structural Review (Revised02/24/2014) Clerk Property Search Application - Miami -Dade County Page 1 of 1 e') i�t;, k"" . O Summary Report Property Information Folio: 11-3206-035-0020 Property Address: 975 NE 94 ST Miami Shores, FL 33138-2916 Owner SEVEN BALCONIES LLC Mailing Address 6815 BISCAYNE BLVD #103 MIAMI SHORES, FL 33138 USA PA Primary Zone 1100 SGL FAMILY - 2301-2500 SQ Primary Land Use 0101 RESIDENTIAL - SINGLE FAMILY: 1 UNIT Beds / Baths I Half 3/2/0 Floors 1 Living Units 1 Actual Area ..... � _- ............... 3,829 Sq.Ft Living Area 3,307 Sq.Ft Adjusted Area 3,533 Sq.Ft Lot Size 15,361 Sq.Ft Year Built 1950 Assessment Information Year 2017 2016 2015 Land Value $414,747 $384,025 $468,510 Building Value $253,387 $282,580 $254,748 XF Value $28,280 $0 $21,061 Market Value $696,414 $666,605 $744,319 Assessed Value $696,414 $666,605 $618,108 Benefits Information Benefit Type 2017 2016i 2015 Non -Homestead Cap Assessment Reduction $126,211 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Short Legal Description MAGEE & HAWKINS SUB PB 51-5 LOT 2 LOT SIZE 15361 SQUARE FEET OR 19992-0656 10 2001 1 COC 24174-1751 01 2006 5 Generated On : 5/16/2018 Taxable Value Information 2017' 2016' 2015 County Exemption Value $0 $0 $0 Taxable Value 1 $696,414 $666,605 $618,108 School Board Exemption Value $0 $0 $0 Taxable Value 1 $696,414 $666,605 $744,319 City Exemption Value $0 $0 $0 Taxable Value $696,414 $666,6051 $618,108 Regional Exemption Value $0 $0 $0 Taxable Value $696,414 $666,605 $618,108 Sales Information Previous OR Book - Price Qualification Description Sale Page 30938- 04/04/2018 $830,000 Qual by exam of deed 4457 28945- Corrective, tax or QCD; min 11/26/2013 $100 3359 consideration 28209 07/09/2012 $600,000 Qual by exam of deed 0536 24174- Sales which are disqualified as a result 01/01/2006 $0 3 1751 of examination of the deed The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at hftp://www.miamidade.gov/info/disclaimer.asp Version https://www.miamidade.gov/propertysearch/ 5/16/2018 Electronic Articles of Organization L18000058090 FILED 8:00 AM For March 05 2018 Florida Limited Liability Company Sec. Of State tscott Article I The name of the Limited Liability Company is: SEVEN BALCONIES, LLC Article II The street address of the principal office of the Limited Liability Company is: 6815 BISCAYNE BOULEVARD 103 #33 MIAMI, FL. US 33138 The mailing address of the Limited Liability Company is: 6815 BISCAYNE BOULEVARD 103 #33 MIAMI, FL. US 33138 Article III Other provisions, if any: TO ENGAGE IN ANY AND ALL LEGAL BUSINESS ACTIVITIES Article IV The name and Florida street address of the registered agent is: SETH Z JOSEPH 255 ALHAMBRA CIRCLE SUITE 1250 CORAL GABLES, FL. 33134 Having been named as registered agent and to accept service of process for the above stated limited liability company at the place designated in this certificate, I hereby accept the appointment as registered agent and agree to act in this capacity. I further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent. Registered Agent Signature: SETH Z. JOSEPH Article V The name and address of person(s) authorized to manage LLC: Title: MGR , ANDRES GOLDSTUCKER 1114 FERDINAND STREET CORAL GABLES, FL. 33134 US Title: MGR LISSANDRA GIANGRANDI 1114 FERDINAND STREET CORAL GABLES, FL. 33134 US Signature of member or an authorized representative Electronic Signature: SETH Z JOSEPH L18000058090 FILED 8:00 AM Sec. O0 State18 tscott I am the member or authorized representative submitting these Articles of Organization and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 1 st and May 1 st in the calendar year following formation of the LLC and every year thereafter to maintain "active" status. ~ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 ZAMBRANO, CARLOS HUMBERTO CAZACA CONSTRUCTION INC 520 MINORCAAVE CORAL GABLES FL 33134 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND y PROFESSIORAL-REGULATION CGC062920 CERTIFIERGE 19 ZAMBRANO,:CA CA2ACA;CON' IS,CERTIFIED,und DETACH HERE 8/2016 e pYtivisions­of-Ch.489.TS. . _ Li608180002394 RICK SCOTT, GOVERNOR KEN LAWSON'SECRETARY _ -__— _....— ._STATE OF-FCORIDi--" g DEPARTMENT. OF.BUSINESS AND PROFESSIONAL REGULATION i " CONSTRUCTION INDUSTRY LICENSING BOARD t ' CG6062920. ..11 F 1 I The -GENERAL CONTRACTOR' Naed'6elow.ISCERTIFIED m- . Undec.the'.provisions of:GhaPter. 489 FS. - -E)6pi�atian�''da"fe: AUG,31.,_2018 _� =" " • `ter— _ .. �,, __ - -�„`- `�,`..'``'�. ,`•. `.,'�` ``'. ...`\ `'Y ". AMBRW O„CARL°OS:HUiVIB ' -C,� ,GA.CONSTRUCTIO til 003921 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY - 4661600 BUSINESS NAME/LOCATION CAZACA CONSTRUCTION IN OPERATING IN DADE COUNTY MIAMI'FIL33999 OWNER CAZACA CONSTRUCTION IN -- Worker(s) 1 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2018 4867363 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR CGC06292( $75.'00 07/24/2017 CREDITCARD-17-049781' f` This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification 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 NO. above must be displayed on all commercial vehicles — Miami —Dade Code Sac 8a-276. For more information, visit www.miamidade.govRaxcollector A� �® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrrvyY) 04/24/2018 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. 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 have ADDITIONAL INSURED provisions or 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 Sarai Medina NAME: PHONE (305) 693-0003I FAX No): (305) 691-4381 Emmanuel Insurance & Associates, Inc. 2370 E 8TH AVE E-MAIL sarai@emmanuelinsurance.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Houston Casualty Company 42374 HIALEAH FL 33013-4236 INSURED INSURER B INSURER C : CAZACA CONSTRUCTION, INC INSURER D : CARLOS H ZAME RANG INSURER E : 520 Minorca Ave INSURER F : Coral Gables FL 33134-4226 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 ADDL SUBR POLICYNUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 CLAIMS -MADE a OCCUR DAMA O D PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 A H18AC80383-00 03/15/2018 03/15/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 X POLICY PE� LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acc dent $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALUIB OCCUR EACH OCCURRENCE $ 1,000,000.00 X AGGREGATE $ 1,000,000.00 A EXCESS LIAB CLAIMS -MADE H18AC80383-00 03/15/2018 03/15/2019 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERIEXECUTIVE PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General Contractor CGC062920. Any Changes or alterations Done to this document after being issued shall constitute it null and void. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 9 P SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue, AUTHORIZED REPRESENTATIVE Miami Shores, Florida 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD •ACC iY CERTIFICATE OF LIABILITY INSURANCE ATE D 04/24/2018 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. 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 have ADDITIONAL INSURED provisions or 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 FrankCrum Insurance Agency, Inc. 100 South Missouri Avenue Clearwater, FL 33756 CONTACT NAME: PHONE A/C, No, Ext : 800 277-1620 X 4800 FAX A/C, No): 727 797-0704 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Frank Winston Crum Insurance Company 11600 INSURED FrankCrum L/C/F Cazaca Construction, Inc. 100 South Missouri Avenue Clearwater FL 33756 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 483486 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 DL INSRD UBIR SWVD POLICY NUMBER POLICY EFF (POLICY POLICY EXP (MMIDONYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Eaoxurrence $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ P POLICY O PROJECT OLOC PRODUCTS-COMPIOP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO OWNED AUTOS SCHEDULED BODILY INJURY Per person) $ ONLY AUTOS BODILY INJURY (Per acciderd) $ PROPERTY DAMAGE Per accident $ HIREDAUTOS NON -OWNED ONLY AUTOS ONLY $ UMBRELLA LULB OCCUR EACH OCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? F__] N/A WC201800000 01/01/2018 01/01/2019 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1 000 000 (Mandatory in NN) If yes, describe under E.L. DISEASE -EA EMPLOYEE $1 000 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Effective 01/18/2016, coverage is for 100% of the employees of FrankCrum leased to Cazaca Construction, Inc. (Client) for whom the client is reporting hours to FrankCrum. Coverage is not extended to statutory employees. L.CK I trn.A I C KULUCK GANGtLLA I ION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village Building Department 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Miami ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 520 MINORU AVE CORAL UB ES R 33IN Tok (305) 9MO90 Fax: )50515899907 SEVEN BAL AddreSS: 975 NE 94 ST CRY: MIAMI SHORES Phone: State: FL Zip: 71r - I UN 52 18 CONTRACT- INVOICE 33138 REMODELING JOB (ACCORDING TO PLANS) ELECTRICAL WORK PLUMBING WORK MECHANICAL WORK FRAMING FLOORING KITCHEN BATH CABINETS STUCCO REPAIRS PAINTING GENERAL CONTRACTOR SERVICES REMODELING JOB PERMITS BY OWNER DOWN OF 20,000,00 2ND PAYMENT OF 20,000,00 WHEN ROUGH IS FINISHED 3RD PAYMENT OF 15,000,00 WHEN REMODELING IS DONE BALANCE WHEN DONE Time of Completion: 90 DAYS 896 APRIL 25 2018 Job Site: 975 NE 94 ST MIAMI SHORES FL 33138 5,000,00 5,000,00 500,00 4,500,00 10,000,00 14, 000, 00 1,500,00 4,500,00 17,000,00 Subtotal 1 62,000,00 10 %Profit Total I 6Y,o00,00 CSC 062920 Messed and Insured _ _ �17mse— ,. INSPECTION RECORD Miami Shores Village 10050 N.E 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax. (305)756-8972 Permit NO. RC-5-1 8-1298 Work Classification: Alteration Issue Date: 7/2/2018 I Expires: 1 2/29/2018 ' INSPECTION REQUESTS: (305)762-4949 or Log on at https://bldg.miamishoresvillage.comlcap REQUESTS ARE ACCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel #:1132060350020 Owner's Name: ANDRES GOLDSTUCKER Owner's Phone: (786)387-1483 1 Job Address: ' l i Total Square Feet: 500 ; ... Total Job Valuation: $ 25,000.00 Bond Number: 3813 WORK IS ALLOWED: MONDAY THROUGH FRIDAY, 800AM - 7:OOPM. Contractors o e nmary ontractor SATURDAY 8:OOAM - 6:OOPM. CAZACA CONSTRUCTION INC (30 ' 'Yes i NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. en ��p I BUILDING AND ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. 0 4t((. tyv NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION STRUCTURAL RECORD WINDOWS & DOORS INSPECTION DATE INSP Foundation Stemwall Slab Columns (1st Lift) Columns (2nd Lift) Tie Beam Truss/Rafters Roof Sheathing Bucks Interior Framing i'ELECTRICAL Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Tin Cap Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA compliance DOCUMENTS Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification STRUCTURAL COMMENTS INSPECTION DATE INSP Final Sprinkler Final nal Alarm FINAL INSPECTION DATE INSPFINAL Attachment INSPECTION DATE INSP Excavation INSPECTION DATE INSP Temporary Pale 30 Day Tempora INSPECTION DATE INSP til9 Rough Water Service 2°d Rough ,� � Top Out Fire Sprinklers Septic Tank Sewer Hook-up Roof Drains Gas LP Tank Well Lawn Sprinklers Main Drain Pool Piping Backflow Preventor Interceptor Catch Basins Condensate Drains HRS Final