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EL-18-1236 (4)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 Rik_- F- AY 0 9 2018� fmil B 201a- BUILDING Master Permit No..�' —iI% — 2L PERMIT APPLICATION Sub Permit No. �,� l r2 BUILDING Q ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL PUBLIC WORKS [] CHANGE OF CANCELLATION M SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 128 NE 94 ST City: Miami Shores County: Miami Dade Zia: 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: RQ ELECTRICAL INC Phone#: 305-790-9169 Address: 92801 NW 123 TERRACE City: HIALEAH GARDEN State: FL Zip: 33018 Qualifier Name: RODOLFO QUINTANA Phone#: 305-790-3769 State Certification or Registration #: 11 E000505 Certificate of Competency #: 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: $ 39,700.00 Square/Linear Footage of Work: 5,329 Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of Work: NEW RESIDENTIAL HOME Specify color of color thru tile: °6106 % 9t v t �f.. Submittal Fee $ Permit Fee $ 3 �' Q . ©d I CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ l' 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 approved and a reinspection fee will be charged. OWNER or The foregoing instrument was ackno ledged before me this 24 day of �- 2018 by --)fc A- �i�i/�I�-- who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print Seal: .MKARINA ALEJANDRA LUNA ?` !1 My Commission Expires 3 1.,. ito Signature CONTRACTOR The foregoing instrument was acknowledged before me this 2 � - day of I77 447- 20 1 ? by �,�J;,i&4744-j 4� who is personally known o me or who has produced as identification and who did take an oath. NOTARY P Seal: KARINA ALEJANDRA LUNA Commission # FF 950062 My Commission Expires APPROVED BY / /} I Plans 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 nsation Insurance Exemotion 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 Florida County of Miami -Dade The foregoing was acknowledge before me this 1st By JOSE A. SBARRA day of may 20 18 who is personally known to me or has produced as identification. Notary: ,,, tNX ALEj - ommission 8 FF 950062 SEAL: My Commission Expires Jonuary 12. 2020 X, RQ ELECTRICAL INC 92801 nw 123 Terrace Hialeah Gardens, FL 33018 5/1/2018 State of Florida County of Miami Dade Before me this day personally appeared Rodolfo Quintana, who being duly sworm, 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 Electrical contractor for Salvatore Investments Inc. Sworn to me and subscribed before me this first day of May 2018 by Rodolfo Quintana who I personally know. INA ALEJANDRA LUNA ommission M FF 950062 is P Commission Expires ,ldnuary 12. 2020 Karina A. Luna uc 1r %.#n ncnc RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARF1 r-CTRICA UCONTRACTORSSINESS AND � FESSIOCENS NNG BOARDAL �TION ER13014693 rnp ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 ~ (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO,CO1�T:RACTING IN ANY AREA) QUINTANA, RODOLFO R.Q ELECTRICAL, INC.., '-.I'` 9801 NW 123 TERRACE"—�- HIALEAH GARDENS. _ rEL 33018LJ a , ISSUED: 07/20/2016 DISPLAY AS REQUIRED BY LAW SEQ # L1607200001633 a 012594 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 5904735 BUSINESS NAMWLOCATION RECEIPT NO. EXPIRES RQ ELECTRICAL INC RENEWAL SEPTEMBER 30, 2018 9801 NW 123 TERR 7180599 Must be displayed at place of business HIALEAH GARDENS FL 33018 Pursuant to County Code Chapter SA - Art. 9 & 10 i OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED RQ ELECTRICAL INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR IlE000505 $45.00 07/14/2017 Worker(s) t CREDITCARD-17-047818 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 holder's gaelifications. to do business. Holder must comply with any governmental or nongevemmeatat reguls".Jaws and requirementsvAich apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sac 80-276. For more information, visit www miamidade eov/tdxcollestor QUALIFYING TRADE(S) 0001 ELECTRICAL MtAMt .7afine D. Gaston, P.E. _ � Secretary of fM Hoard -�'-- Miami- de court ret in am y rf heroin. pvw.miarrvdade.gov7ecoramy K. CTQBConstrufying Board BUSINESS CERTIFICATE OF COMPETENCY I I E000505 aINC ` D.B.A.: QUIt WARODOLFO Is certified under the provision; of Chapter 10 of Miami -Dade County M uni ci pal Contractor's Tax %Cd pt Miami -Dade County, State of Morida -THIS IS NOT A RILL -DO NOT PAY CC Nor 11 ED00505 MC BUSINESS NAM EJLOCATION RECEIPT NO. EXPIRES FUEM7F .&WC SEPTEMBER 30, 2018 9801 NW 123 THFR 7513734 H EM C#iDENa FL 33018 .0 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS PAYM ENT RECEIVED RQELE RCALINC 9104CALCONTR417TOR BY TAX COLLECTOR C/O FM0U`QUINTANAQUAUFIER 200.00 08/0112017 0202-17-004763 This receipt is not W id In the tdlowing Muridpel Itlex AVenttra, Doral, Fideah, Kay Biscayne. ,�� Mlard O rdens, Mimi takes, Palmedo Bay, Plnecrest, Suriny Isles Beach, Tow n d Cutler Bay. MIA-61ok ] For More irftrrzrtion,ASit WWW.rtiaMdB. dapoM1Tdil ectorr 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: 11/30/2017 EXPIRATION DATE: 11/30/2019 PERSON: QUINTANA RODOLFO FEIN: 4531137567 i BUSINESS NAME AND ADDRESS: RQ ELECTRICAL INC 9801 NW 123 TERRACE HIALEAH FL 33018 GARDENS SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor 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 riot 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 shall be subject to revocation if, at any time after the filing 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 ACCOR, CERTIFICATE OF LIABILITY INSURANCE I DATE `oBYYY) THIS'GERTIFICA7E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RK3HTS UPON THE GERTIFICA7E 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 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 i certificate holder In lieu of such endorsement(s), PRODUCER CONTACT 1- NAME: Honest Trust insurance i AI _ —- Y PHONE EtctL' _ _�305) 951-1544 —_.. ._. L Jai. Nek _._. (305) 675-8112 428 East 49st lEiDORESs: scabezas@�bellsouth.net Hialeah, FL 33013 INSURER(S) AFFORDING COVERAGE }. _ NAIC0 Phone (305) 951-15" Fax (305) 675-8112 INSURER A: Granada insurance INSURED INSURER ---------- .__._._._.-- R 0 Electrical Inc. 9801 NW 123 Terrace Hialeah, FL 33018 INSURER E ___._. ___.._- ___INSURER F : COVERAGES_— _ CERTIFICATE NUMBER: _ _ _REVISION NUMBER:- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD I 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, EX.CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAI_D_CLAIMS. ___.. -.. _._ _.�_._ . _ _ _ INSR TADOL'SUBR_ _ POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS LTR _—_.____�INSRIWYi1: POLICY NUMBER IMMIDDIYYYYJ 114 IRDIYY]y_ i GENERAL LIABILITY I r EACHOCCURRENCE E 5 1,000,000.00 _ ® DAt�AE fo'RENTEtS COMMERCIAL GENERAL LIABILITY$ 100,000.00 } PREMISES (Ea rlccu7enf�J a (❑ a CLAIMS -MADE ❑ OCCUR 10185FL0030912 MED EXP (My one Person _ $ 5,000.00 A h i 10/31 /2018 — I ❑ N N 10/31 /2017 _ } i PERSONAL S ADV INJURY - $ 1,000,000.00 ' i GENERAL AGGREGATE E $ 2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER. j PRODUCTS - COMPIOP AGG S 2,000,O00.00 $ ❑POLICY ❑ PRO-- ❑ LOC _ _ } g } AUTOMOBILE LIABILITY — } COM61NcD SINGLE LIMIT ❑ ANY AUTO } _ I BODILY INJURY (Per person) 1 $ ❑ALL OWNED SCHEDULED ` BODILY INJURY (Per accldenq S — AUTOS ❑ AUTOS ® HIRED AUTOS I❑I AUTOS NON-OWNFI) I j�PROT'>€ gAMAGE' �'-•- - i $ ❑ UMBRELLA LIAS ❑OCCUR +ir EACH OCCURRENCE IS_— ❑ EXCESO LIAR AGGREGATE S ,[ J DED El RETENTrON S.. ._.. _ —_ r _ _ _ 4 — ___ WORKERS COMPENSATION I WC STATU OTH-' AND EMPLOYERS' LIABILITY Y I N r ; I _TQRY_LINITS___❑_ER......._........__.._._ ._._ ANY PROPRIETORIPARTNERIEXECUTIVE i E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? } N /A ( - i 1 (Mandatory In NH) C n j E L DISEASE • EA EMPLOYE S I M yas. describe under I DESCRIPTION OF OPERATIONS Bebw E L DISEASE -POLICY LIMB S I ;I r � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) ELECTRICAL CONTRACTOR License # 11 E000505 I CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I 10050 N.E. 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FI. 33138 AUTHO Y—D REPRESENTATIVE —— — i -- - — - O 1808-2010 ACO*1are ATION. All rights reserved. ACORD 2ti (2010/Oti) OF The ACORD name aegistered marks of ACORD