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MC-18-1894Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. MC -7-18-1894 Permit Type: Mechanical - Residential P=&ft r i Worts Classification: Addition/Alteration Permit Status: APPROVED Parcel Number Issue Date: 8/6/2018 1 Expiration: 07/02/2019 Applicant 84 NW 104 Street 1121360131070 ALYKAY INVESTMENTS LLC Miami Shores, FL 33150-1238 Block: Lot: Owner Information Address ALYKAY INVESTMENTS LLC 84 NE 104 Street FL Contractor(s) Phone Cell Phone PROFESSIONAL SERVICE CORP Additional Info: DUCT REPLACEMENT AS PER PLAN Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Fees Due Amount CCF $0.60 DBPR Fee $2.25 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $158.85 Date Approved:: In Review Type of Work: Phone (305)219-8267 Valuation: $ 1,000.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -7-18-68223 08/06/2018 Credit Card $ 108.85 $ 50.00 07/13/2018 Credit Card $ 50.00 $ 0.00 Avanauie inspections: Inspection Type: Final Rough Duct Review Mechanical Underground 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, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constructjo and zoning. Futh�ermore, I authorize the above-named contractor to do the work stated. 1-1 I� 0 TL /I Auq ust 06, 2018 Authorized Signature: OvVner / Applicant / Contractor / Agent Building Department Copy August 06, 2018 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department JUL It 2018 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY: INSPECTION LINE PHONE NUMBER: (305) 762-4949 � FBC 201 Master Permit No. Sub Permit No.�� F-IBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL ❑PLUMBING r] MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: "R`I AJW /6 Y Jt City Miami Shores County: Miami Dade Zip: Folio/Parcel#: t I 2I 3 40 13 - l O i 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): A (V K ftj -rhV coa-+ Md ey4 Phone#: fO r -V W Address: 0 l� t 11 W City: rv-v%. ar^ � S N Q 4"ges State: P1 Zip: Tenant/Lessee Name: Phone#: Email: ' Q r� / CONTRACTOR: Company Name: 'e,�PL� � �-T11) i C� Glghone#: SDS Z�Z +� l7 Address: 1 V 5 T`10 N NN ' I !-\\[ C U 1 L _e :,V L �7 City: L.0A XAI) State: P L Zip: J Qualifier Name: ePhone#: ZjyS ZG1 -1 State Certification or Registration #: (1 1 (?,1 62217 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $_1h&:) • C-0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑New Repair/Replace -1Demolition Description of Work: L1 P r Q Specify color of color thru tile: (Gy Submittal Fee $ 5� Permit Fee $ Y !J ✓ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ C-7 DBPR $ 2 • v S 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 Zi 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 fe will be charged. Signature Signature OWN E r AG CONTRA R The foregoing instrument was acknowledged before me this day of 20 It by who ersonally know o me or who has produced identification and who did take an oath. NOTARY PUBLIC: SANDY ROMERO �? Notary Public -State of Florida Commission # FF 915708 My Comm. Expires Sep 19 APPROVED BY (Revised02/24/2014) as The fore oing instrument was acknowledged beforemethis 2� ' day of �WI� 20 1 ` by ()6VW0" hQl (�who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign a1,.4�r •••, '�SANDY ROMERO Notary Public - State of Florida o,• Commission # FF 915708 •''•'•'�`' oFF�•' My Comm. Ex*pire�s S 7 JqJ% Examiner Zoning Structural Review Clerk STATE OF FLORIDA p DEPARTMENT OF BUSINESS AND *Q 1 PROFESSIONAL REGULATION CMC 1250002 ISSUED: 08/28/2016 CERTIFIED MECHANICAL CONTRACTOR AGUSTIN, GEORGE MARLOM PROFESSIONAL SERVICE CORP IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31, 2018 L1608280003908 0 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CAC 1816254 ISSUED: 08/28/2016 CERTIFIED AIR COND CONTR AGUSTIN, GEORGE MARLOM PROFESSIONAL SERVICE CORP IS CERTIFIED under the provisions of Ch.489 FS. Expiration date . AUG 31, 201.8 L1608280001907 4b esm instkute�~ Program EPA Approved I DecetnKn 28, 1993 CERTIFICATE NO. 0384211211100 NAIME: GEORGE M. AGUSTIN has been certnied as a d UNIVERSAL technician as required by 40CFR part 82 subpart F 003316 Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILJL - DO NOT PAY 6496558 BUSINESS NAME/LOCATION RECEIPT NO. PROFESSIONAL SERVICE CORP RENEWAL 18500 NW 62 AVE 302 6766555 I MIAMI FL 33015 LBT EXPIRES - ' SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 -11 N __;�OWNER � � T C. TYPEr F BUSINESS I PROFESSIONAL SERVICE CORP 196 GENERAL MECHANICAL CONTRACTOtAYMENT RECEIVED Y TAX COLLECTOR i r i lCMC1250002✓g75.00 08/15/201.7,,, Worker(5) 1 ` 1 f I I FPPU04-17=013648 'This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, t permit, or a certification of the holders qualifications, to do business. Holder must complywith any governmental or nongovernmental regulatory, laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. For ore information, visit www. miamidalde.00v/taxcollector 003317 Local Business Tax Receipt Miami -Dade County, State of Florida r,. -THIS IS NOT A BILL - DO NOT PAY 6496566 BUSINESS NAME/LOCATION PROFESSIONAL SERVICE CORP 18500 NW 62 AVE 302 MIAMI FL 33015 OWNER PROFESSIONAL SERVICE CORP Workers) 1 RECEIPT NO. - EXPIRES + RENEWAL SEPTEMBER 30, 2018 6766563 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR PAYMENT RECEIVED CAC1816254 BY TAX COLLECTOR 05:00 08/15/2617, . FPPU04-17= 013648 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 requirementswhich apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. ' d t For more information, visit www.miamidade.govRaxcollector ACOR[JDATE �� CERTIFICATE OF LIABILITY INSURANCE pNMII)WA- ) 0714112018 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: N the certificate holder is an ADDITIONAL INSURED, the pol(cypes) must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and condltlons 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). guar+T Ample Insurance Company P.O. Box 929 Oakland, FL 34760 MI AM,�CTJULIO JIMENEZ NE 305 264-9900 N • (305) 264-5382 EAIL AD RE imenez@ampleins.com INSURER AFFORDING COVERAGE MAIC IN RER A : CYPRESS INSURANCE COMPANY INSURED PROFESSIONAL SERVICES CORP 18500 NW 62 AVE 302 HIALEAH, FL 33015 INSURER 8: INSURER C : INSURER D 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 ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. LTR TYPE OF INSURANCE TH PI TION DATE THEREOF, NOTICE WILL BE DELIVERED IN A R A CE WITH THE POLICY PROVISIONS. vim POLICYNUMBER Fimumpin EXP" LIMITS A GEMALLIABUJW X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y GFL-1020592-05 11109/2017 11109/2018 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO REN i tv PREMISES Ift occurrence) S 100,000.00 MED EXP lArV onePerson) S 51000.00 PERSOW1L&ADYIN.wRY s 1,000,000.00 GENERAL AGGREGATE S 2,000,o0O.00 GEN1 AGGREGATE LIMIT APPLIES PER: POLICY �-IcCT LOC PRODUCTS - COMPIOP AGG S 11000,000.00 s -LIMIT AUTOMOBILE LIAaILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE BODILY "RY(Pot parsolr) S _ BODILY INJURY (Per =Word) S PROPERTY DAMAGE $ S UMBRELLA UAB EXCESS LIAR OCCUR CL41MS-MADE EACH OCCURRENCE S AGGREGATE $ DED I I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS' LIABILRY""--^- ANY PROPRIETOAIPARTNER0MCUTWE Y❑ OFFICERMEMBER EXCUIOEb7 (Mandstay k1 NII) I desalbe under DESCRIMON OF OPERATIONS below MIA WC' E L EACH ACCIDENT S E.L DISEASE - EA EMPLOYE S C.L. DISEASE - POLICY LIMIT $ DESCFNPn ON OF OPERATIONS I LOCATIONS I VEHICLE$ (Aeach ACORD 101. Additional Remarks Schedule. N more apace Is required) A/C INSTALLATION SERVICE & REPAIRS LICENSE NO. CAC 1816254 r-CDTiCMATC 11111 RCD f_AklMi" THIIN ACORD 25 (2010/05)1 -Lulu AI:VHU 4VnrLFrW 11vn. OMI 1401144 FUM19 VUW- The ACORD name and logo are reg to Na of ACORD SH A OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE TH PI TION DATE THEREOF, NOTICE WILL BE DELIVERED IN A R A CE WITH THE POLICY PROVISIONS. BUILDING DEPT. I 10050 NE 2ND AVE Au ESE MIAMI SHORES VILLAGE FL 33138 1 7r I ACORD 25 (2010/05)1 -Lulu AI:VHU 4VnrLFrW 11vn. OMI 1401144 FUM19 VUW- The ACORD name and logo are reg to Na of ACORD of � � S 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: 10/6/2017 PERSON: AGUSTIN FEIN: 320216188 BUSINESS NAME AND ADDRESS: PROFESSIONAL SERVICE CORP 18500 NW 62 AVE SUITE 302 , HIALEAH FL SCOPE OF BUSINESS OR TRADE: 33015 Welding or Cutting NOC and Boiler Installation or Repair ❑ Drivers Steam EXPIRATION DATE: 10/6/2019 GEORGE X Sheet Metal Work - Installation & Heating, Ventilation, Air - Drivers Conditioning and Refrigeration Systems Installation, Service and Repair, Shop, Yard & Drivers 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 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-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 COMPANY LETTER HEAD Date: State of County of Before me this day personally appeared deposes and says: That he or she will be the only person worki ectWted at: Contractor Signature Sworn to (or affi by day of Personally know OR Produced Identification Type of Identification Produced duly sworn, 20 Print, Type or Stamp Name of Notary Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 imotice to VWner — VVorKelrs- toompensatlon Insurance tXemotlon 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 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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: Own State of Florida County of Miami -Dade The foregoing was acknowledge before me this 9 day of , 20/f By & ua (G.V � �L who is personally known to me or has produced as identification. SANDY ROMERO Notary Public - State of Florida Commission # FF 915708 My Comm. Exoires Sea 7, 2019 `I'( dfl°SSi J16?t 536rvl C- e ��' �gsoo pi (0 -Z eqve30Z h FL 3 3 0 /� COMPANY LETTER HEAD 3o j- 2 '9 -2 41S6 �f Date: ') Ut � - 1 201 ? State of V W k0L Countyof �lamf'G� Before me this day personally appeared AWS-lywho, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 0 P �4 i ami Sbu(es, A 3315i) Contractor Sworn to (or affimed) and subscribed before me this by C ' day of &I I a . 20 , Personally know ✓ OR Produced Identification Type Of Identification Produced SANOY ROMERO Notary Public - State of Florida Commission #t FF 915708 NY Comm. Expires Sep 7. 2019 Print, Type or Stamp Name of Notary 2018 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L08000117271 Entity Name: ALYKAY INVESTMENTS LLC Current Principal Place of Business: 9017 BISCAYNE BLVD MIAMI SHORES, FL 33138 Current Mailing Address: 9017 BISCAYNE BLVD MIAMI SHORES, FL 33138 US FEI Number: 26-4240491 Name and Address of Current Registered Agent: HERNANDEZ, REINALDO D 9017 BISCAYNE BLVD MIAMI SHORES, FL 33138 US FILED Jan 17, 2018 Secretary of State CC9806820705 Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: REINALDO D. HERNANDEZ 01/17/2018 Electronic Signature of Registered Agent Authorized Person(s) Detail Title MGR Name HERNANDEZ, ALINA M Address 9017 BISCAYNE BLVD City -State -Zip: MIAMI SHORES FL 33138 Title MGR Name HERNANDEZ, REINALDO D Address 9017 BISCAYNE BLVD City -State -Zip: MIAMI SHORES FL 33138 Date I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes, and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: REINALDO D. HERNANDEZ MEMBER 01/17/2018 Electronic Signature of Signing Authorized Person(s) Detail Date