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REV-18-3674Miami 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 ❑PLUMBING Q MECHANICAL ❑PUBLICWORKS JOB ADDRESS: 10125 BISCAYNE BLVD FBC 2014 r� Q Master Permit No. — - - 3 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11 -3205-019-0190 Is the Building Historically Designated: Yes NO Occupancy Type: Load: _ Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): BISCAYNE 10125 LLC Phone#:7863903177 Address:1680 MICHIGAN AVE SUITE 910 City: MIAMI BEACH State: FL Zip: 33139 Tenant/Lessee Name: Email: CONTRACTOR: Company Name: SUNNY HORIZON LLC Phone#: 3%62 Address: 10800 SW 84 ST City: MIAMI State: FL Zip: 33173 Qualifier Name: RODRIGUEZ ARIEL Phone#: State Certification or Registration #: CFC1429292 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ © Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 4�,o CA N + 0 0 P A / L u ^� ' ` Lw u1-1 o" I Specify color of color thru tile: Submittal Fee $ �39�Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ 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 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 _ Signature O NER GENT CONTRACT R The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _ Co day of DeCe N!4r , 20 /�? _, by _ day of l�P�Pf l�Pf 20 /X by 1210,U' ci iO PeP eO641j who is personally known to Aadrl�J� r P,L . who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: �j Sign: Print: -p e//, u&M3 Print: Z,_d( Seal: lstiet fl0pez Phnerltel Seal Y �, - W 11e� Lopez Pimenfel * _ COMMISSION /FF922657 COMMISSION OFF922657 ? EXPIRES: September 30, 2019 EXPIRES: September 3 t c 0, 2C1_ wvvw.AARoNNOTARY.COM VJWW.AARONNOTARY.COfv APPROVED BY _ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) `w Z;RICK SCOTT,• s ' . y dbpr . � c M ��X STATE OFF ORIDA DEPARTMENT OF BUSINESS.JANDzPROFESSIONAL REGULATION CONSTRUCTIC3�I,I_NDUSTRY! =1 E�ISING BOARD THEME CHAN icrALCONT��CT(-)R,H�REINIS.CERTIFIED UNDER THE �:..� _ t UTES PROVISION F0CHf I TER 89, FLt RIC A� 7Ai �o�R��GUEz; �ARi��E��: i �3 -� 90 NY HC RIZ�JN ' LL ^MI ►011 MI ;- } FL 331.77 -} ' 7 EXPIRATIt WDAI TEAtJ,GUST 31j 2020 Always verify licenses online at MyFloridaLicense.com Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business Tax Fbcei pt Miami -Dade County, State of Florida BT -THIS IS NOT A BILL - DO NOT PAY 7242869 BUSINESS NAM EILOCATION RECEIPT NO. EXPIRES SUNNY HORIZONS LLC RENEWAL SEPTEMBER 30, 2019 12660 SW 190TH ST 7529169 Must be displayed at place of business MIAMI, FL 33177 Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER . SEC. TYPE OF BUSINESS PAYM ENT RECEIVED SUNNY HORIZONS LLC ; 196 SPECIALTY BUILDING BY TAX COLLECTOR CONTRACTOR 75.00 09/04/2018 Worker(s) 1 CCC1331439 0210-18-005667 This local Business Tax Receiptordycon"mtspaynleraof the Local Business Tax. The Receipt is root a license, permit, or a cerli "cation of the holder's qt al i "cations, to do busi new Holder mat compy with any governmental or rwngovemrantal regulatory laws and requirements which apply to the business• The RECBPT NQ above mst be displayed on all = mwdel vehicles - Miarri-Dade Qxie Sec 8a-2m M®� For more information, vee isitwww mianidadov/t�ucdlector Local Busi ness Tax Pecei pt Miami -Dade County, State of Florida -THIS ISNOT ABILL - DO NOT PAY LBT 7186792 BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES SUNNY HORIZONS LLC RENEWAL 12660 SW 190TH ST 7467734 SEPTEMBER 30, 2019 MIAMI, FL 33177 Must be displayed at place of business Pursuant to County Code Chapter 8A -Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYM ENT RECEIVED SUNNY HORIZONS LLC 196 GENERAL MECHANICAL BY TAX COLLECTOR C/O ARIEL RODRIGUEZ MGR CONTRACTOR Worker(s) 1 CFC1429292/CMC125049 0210 09/04/2018 210-18-005667 This Local Business Tax Receipt only am"mus pays- At of the Local Business Tax. The Receipt is not a license, permit, or a certi "cation of the holders quell "cations, to do business. Hd der ntxsst comply with arty goverrense, l orroorrgovemmental regulatory laws and requir&Twftwwchapplytothe bsiness, The RBCEIPT NQ atone mist be displayed on all commercial vetides - Miarri-lade Code Sec Ba-276. MI®D Fbrmorei nfomtation, visit www.rri anidede goo/ts� cmllecta n ACORIXCERTIFICATE OF LIABILITY INSURANCE DATDJVYYY) 11 1/26//26/2018 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 pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 Ilea of such endorsement(s). PRODUCER First Insurance Group 10967 SW 40 St CONTACT BNI. ' ��acO (305)221-7878 ,Vc No (305)5547090 EMAIL rtodrig523@ad.com SURER(S) AFFORDING COVERAGE NAIL n Miami, FL 33165 INSURER A: EVANSTON INSURANCE COMPANY _ Phone (305)221-7878 Fax 554.7090 INSURED INSURER e: NORMANDY INSURANCE CO _ INSURER C : SUNNY HORIZONS LLC INSURER D : 10800 SW 84 St Unit F2 Miami FL 33173- INSURER E : INSURERF: 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 CLAM. LNTR TYPE OF INSURANCE DOL A BRi POLICY NUMBER MPM ICY EFF FOLIC Exp LIMITS A ❑/ COMMERCIAL GENERAL LIA81L!TY ❑ CLAIMS -MADE Ea OCCUR _ N N 3AA1613W j I 02/0812018 02118=19 EACH OCCURRENCE S 'I 000,000.00 OHMAGE TO RENTED PREMISESEa axurrence $ 1 m0 000 00 ME(Any one INJURY $ 5,000.00 D PERSONAL & ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE UMIT APPLIES PER 0 POLICY ❑ Jew ❑ LOC ❑ OTHER GENERAL AGGREGATE s 2.000,000,00 PRODUCTS . CoMPIOP AGG s 1,000,000.00 $ AUTOMOBILE LIABILITY El ANY AUTO ❑ AUTOS ON ❑ SCHEDULED HIRED ❑ NON•OWNED ❑ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB ❑ OCCUR r❑ EXCESS UAB ❑ CAMS -MADE I �BINEDtSINGLE LIMIT S BODILY (INJURY (Per person) $ B004LY INJURY (Per accident) S PROP�R�TYt AMAGE PPee S EACH OCCURRENCE $ S AGGREGATE S DED 0 RETENTION $ $ 1 WORKERS COMPENSATION AND EMPLOYERS' LABILITY Y 1 N ANY PROPRIETORtPARTNERIEXECUT OFFiCERIMEMBEREXCLUDED? Y (Mandatory In NH) If yes, describe under ' DESCRIPTION OF OPERATIONS below NIA N NHFL0083862018 I ' 102108/2018 02/08/2019 PER I-^) OTH- STATUTE 4.,a E.L. EACH ACCIDENT S 500,000.00— ' E.L. 04SEASE - EA EMPLOYE s 500,000.00 EL DSEASE - POLICY LIMIT S 500,000.00 j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addrdonal RomarKs Schedule, H more apace Is required) GENERAL CONTRACTOR LIABILITY. PLUMBING, AIR CONDITIONING, REFRIGERATION INCLUDED. f^COTIcIPATC LUNI nr_0 CANCEL -A I IUN MIAMI SHORES VILLAGE 10050 NE 2nd AVE MIAMI SHORE FL ACORD 26 (2016/03) OF 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 ,,.•- •-.,� m 79SS�L075 AL:UKU t;vKtvrwr ram. tan rryuw rcx. vcu. The ACORD name and logo are registered marks of ACORD