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EL-19-142walill. Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date: 01/28/2019 Location Address Parcel Number 55 NE 100 ST, Miami Shores, FL 33138 1132060131420 Contacts Perm* NO.: EL -01-19-142 Permit Type: Electrical - Residential Work Classification Aiterat€on Permit Status: Approved Expiration: 07/29/2019 MICHAEL & DOROTHY ESSINGTON Owner MICHAEL & DOROTHY ESSINGTON Applicant 55 NE 100 ST, MIAMI SHORES, FL 33138 55 NE 100 ST, MIAMI SHORES, FL 33138 Home: 3052984673 Home: 3052984673 UNLIMITED ELECTRICAL TECHNOLOGIES Contractor INC OMAR VILLAR Business: 7862999500 Inspection Re Description: REMODEL EXISTING KITCHEN IN SAME LOCATION. Valuation: $ 2,500.00 quests: Inspef 2 4ction Re REMODEL EXISTING BATHROOM IN EXISTING LOCATION. Total Sq Feet: 157.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $111.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 01/28/2019 $111.90 Amount Due: $0.00 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 assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WII)HX INS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the16regoing infor atiois a urate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermo I authorize the abftp6m.ed gontractor do the work stated. Authorized Signature: Owner / Appli�.�t� Contradtor // Agent Date January 28, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION 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 ELECTRIC ❑ ROOFING AN 1 V �r tc� WI -1 FBC 201--7 r�J Master Permit No. (Y— 249 1 Sub Permit No. EU 9 —1'1(7— E] 'I'12 ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 55 (0 0 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Occupancy Type: Load: Construction Type: s the Building Historically Designated: Yes NO ✓ Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): d70 r0'� �% L S A +0 K_ Phone#: 3067 -,Q92? " L1 (a 7 S Address: 56 NO I 6D 5L Q) City: i - City: AA 1 mi JrAoytS State: F -L Zip: 331319 Tenant/Lessee Name: Email Phone#: CONTRACTOR: Company Name: C'Au wyte E I (�e— -7e4 If Phone#: (Oo --2—TI `�17Jc,3J Address: V11 V-j� ��C (.,3 City: VI -1 (V' 0 VV\ -W VL / � State: Qualifier Name: y �%� l� �LV4le- Phone#: t State Certification or Registration #: = ��� `' G Certificate of Competency #: DESIGNER: Architect/Engineer: one#: Address: I':. .+. City: State: Zip: Value of Work for this Perm_n;;y it: $ 0 o Square/Linear Footage of Work: Type of Work:''- ❑"AdditioAlteration ❑ New ❑ Repair/Replace ❑Demolition Description of Work: R2~u►ALN lbhN*?,OoIA TV 9,00 Nl 0.S '_' \ LAID r. Ai}.:., 'I , Specify color of colorahru tile: Submittal Fee $ u" ' Permit ,Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ I I I - U 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. i Signature (OER or AGENT The foregoing instrument was acknowledged before me this 1-7 1�l (— day of ll�taY'y 20 iQ - by I .�)(& FSS( Y191 br-*, who is personally known to me or who has produced j'G �'Ei �Z-[���% as Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of lam_-�� °�+�-� 20 by who is personally known to me or who has prroduced PZy E V n4Rl, s MARIA identification and who did take an oath. identification and who did t tI OTAR" , oRi iC NOTARY PUBLIC: NOTARY PUBLIC: 0,17 ,+ "IDA � Ci01�M+•+� CsC�(Ml• ' IS o UP s 1/23/ Sig n: 19 n 1 1 0� •.� 1 �1 �i Print: lV0 °�: Notar Public -State of Florida nt: l QLO.,l es N Commission # GG 006859 6ZOZ/£Z/l BeJ. „ t Seal: My Comm. Expires Jun 28, 2021 al: O�'Sfi, •iYi. APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 7360 West 20th Ave. • Sude # 135 Hialeah, FL 33016 Phone: 786-838-9192 ballester0120@gmail.com ❑ INVOICE T1 ESTIMATE ' (Expires In 30 da" WORK ORDER NO. MATERIAL. AMOUNT P O DATE -OF ORDER_ x , O KEN 8Y E R # _ [� DAYWORK ❑' CONTRACT 0 EXTRA JOB NAME I nom, JOB LOCATION S /�! UOJOB PHONE BTAKIFINUS • DATF CI BR WPB TECHNICIAN MATERIAL. AMOUNT DESCRIPTION OF. Rk' S; FPRE w, • �•��'"" ;,� - 'OTHER CHARGES '` , '''' , PERMIT FEES pW FUEL ;SURCHARGE •TOTAL OTHER TECH *". "HAS: RATE AMOUNT .t TOTAL LABOR TOTAL BMATEFOALS DATE COMPLETED TOTAL MATEUU.B TOTAL O' THER SUM-CONiRACT � ��LUMP PAYMENT: CHECK CHECK J1 CASH >p IS� �x -CREDIT CARD -TYPE ilEXP. DATE �llfh Wu a, –Pnc�s. qu-tWbVUr rnled icafTectrtoiogies sTraA be based in accordance vvia Nat10_(kll PfIce Service or any'equivatent service. It Unlimited E� Techrx ogles delivers arry materials to you in cornec5on with this invoice prior to services, you shall become fully respanslbie—or the safekeeping oT'stich rriaTe-=I!CAW Unkruted Ekchical Technologies liabriity, with respell m the materials shall cease Yoush iufl payment to UnBmted Electrical Tet3inorogies for arty and all vkxk perf xrned, rirakmiels Piovided, and other ers) to you_ You shall be fully costs and fees as appfi able Per ` 0rr�the i tkne that Unrunited Electical Technologies completes fire above desrn'bedsyice( fiable for arty -and all costs anin d arrmd by Un . -td Technologies aS a result of any non-payrr ent on this lnvoice, not i to aP,!rty /s tees and costs, ..t cast% arbdra5 and nic�dM60M riri& result in �°p payment to Unlimited Electric ai'Techrmbgies. may result in a Gen oil your properfy per Florida G ym Statutes Chapter 7,13. A6 gven on are ' fit . /S• APPROVED BY: : '"'DATE� / � • I HEREBY AY OF THE ABOVE OESWISM WORK RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY 61 w- J 0 2 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES VILLAR, OMAR UNLIMITED ELECTRICAL TECHNOLOGIES INC. 11575 CITY HALL PROMENADE BLDG 4-141 MIRAMAR FL 33025 LICENSE NUMBER: EC0002054 EXPIRATION DATE: AUGUST 31, 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 Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 4227641 BUSINESS NAME/LOCATION UNLIMITED ELECTRICAL TECH INC 8804 SW 130TH CT MIAMI, FL 33186 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2019 4414934 Must be displayed at place of business Pursuant to County Code Chapter SA — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED UNLIMITED ELECTRICAL TECH INC 196 ELECTRICAL BY TAX COLLECTOR OMAR VILLAR PRES CONTRACTOR 75.00 09!1412018 Worker(s) 1 EC0002054 0229-18-007252 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is cot a license, permit or a certification of the holders qualaicatiorm to do business. Holder most comply with any governmemal or nongovernmental regulatory laws and requirements which apply to the business The RECEIPT N0. above must be displayed on all commercial vehicles- Nion"ade Coda Sao Be -M. MD For more iofonmitioa, visit ACORV CERTIFICATE OF LIABILITY INSURANCE • . `,,,�' DATE (MM/DD/YYYY) 01/1812019 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(les) 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 NAME: Adnana L Clavijo Mauri IPA NE . (305) 220-7447 ac No): (305) 220-4821 Excellence Insurance, LLC. DBA A&A Underwriters. ADDRESS: certificates@aaunderwriters.Com 3801 SW 107th Ave INSURERS AFFORDING COVERAGE NAIC S EACH OCCURRENCE $ 2,000,000 INSURERA: Hiscox Insurance Company Inc. 10200 Miami FL 33165 INSURED INSURER B: INSURERC: UNLIMITED ELECTRICAL TECHNOLOGIES INC. INSURER D: 11575 City Hall Promenade INSURER E: Building 4 Apt # 264 INSURER F: Miramar, FL 33025 CnVFRAnll CFRTIFICATF NIIMRFR- 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 SUER POLICY NUMBER LICY EFF /DD//YYYY) MM POLICY EXP IMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR <' UDC -2400201 -CGL -18 10/30/2018 10/30/2019 EACH OCCURRENCE $ 2,000,000 IMAGE TO E PREM SES Eaoccu encs $ 100,000 MED EXP (Any one person) $ 5,000 &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JE 0 [_-]LOC OTHER: -PERSONAL GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY(P.r.. J L I COMBaaccINED INGLE LIMIT $ EdentS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per acc dent $ UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE F_ OFFICER/MEMBER EXCLUDE[ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below A NIA STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License # EC0002054 CFRTIFICATF HOI_rfFR CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 <' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD JEFF ATWATER 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: 3/19/2017 PERSON: VILLAR FEIN: 650873004 BUSINESS NAME AND ADDRESS: EXPIRATION DATE: 3/19/2019 OMAR UNLIMITED ELECTRICAL TECHNOLOGIES, INC 11575 CITY HALL PROMENADE #264, HOLLYWOOD FL 33025 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 firing a certificate of election under this section may not 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 -DWG -262 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 62 e: Proof of Coverage Page 1 of 1 WC Mobile App WC home Search Our Data CFO home Employer Detail Page This database was last updated Friday, January 25, 2019 12:09 .AM. Carrier Location Information IReturn to Search Page Employer Information Employer Name Employer Type NAICS Code IUNLIMITED ELECTRICAL TECHNOLOGIES (CORPORATION IN/A INC Coverage History No Coverage History Exemption Listings Exemption Holder Name - Click on the name(s) below to view more detailed information DAVID B AYERS OMAR VILLAR Owner Election Listings No Owner Election of Coverage Listings Employer Name History Employer Name Name Type Change Date UNLIMITED ELECTRICAL TECHNOLOGIES INC Legal lCurrent UNLIMITED ELECTRICAL TECHNOLOGIES, INC. Also Known As N/A Return to Search Page https:Happs8.fldfs.com/proofofcoverage/EmployerDetail.aspx?EmpID=000065791 1/25/2019 Proof of Coverage Page 1 of 1 WC Mobile App WC home Search Our Data CFO llome Exemption Detail Page This database was last updated Friday, January 25, 2019 12:09 AM. IReturn to Previous Page Exemption Details Name Title I Effective Date 'Termination Date Exemption Type 'Business Activities I Employer Name I UNLIMITED Click Here to View 1 DAVID B AYERS VP Jun 27 2018 Jun 26 2020 ELECTRICAL Construction ACGvities Listed on ;TECHNOLOGIES Exemption INC Click Here to View UNLIMITED DAVID B AYERS VP Dec 23 2015 Dec 22 2017 Construction i Activities Listed on ELECTRICAL i ?TECHNOLOGIES I Exemption INC `Termination may be through the revocation of the exemption, or expiration of the exemption. "The exemption only applies to the business activities listed on the exemption. Return to Search Page https:Happs8.fldfs.com/proofofcoverage/ExemptionDetail.aspx?pr_person_id=X00128485 1/25/2019 Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation 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 ) I . By N �-LSS 1 "AZ`�' who is personally known to me or has produced .......ac identification_ �w -• 6� SEAL: •; M,(VCU A �l�Ct9� "J �L .K got��ec� • � a /���i tint'• :°:::%°� c'�Q.;o`�