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EL-18-3145Location Address Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: L-10-18-3145 Permit Type: Electrical - Residential Work Classification: Addition/Alteration Permit status: Approved issue Date: 10/17/2018 1 Expiration: 04/09/2019 Parcel Number Project 142 NE 103 ST, Miami Shores, FL 33138 1132060131750 <NONE> Contacts FERNANDO YANEZ Owner FERNANDO YANEZ Applicant 142 NE 103 ST, MIAMI SHORES, FL 33138 142 NE 103 ST, MIAMI SHORES, FL 33138 Other: 3055103348 Other: 3055103348 ARANGO ELECTRIC INCORPORATED Contractor ANGEL ARANGO Business: 7864442124 Description: ELECTRICAL WORK FOR REMODELING AND Valuation: $ 2,500.00 Inspection Re uests: 305-762-4949ADDITION Total Sq Feet: 530.00 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 10/11/2018 50.00 Credit Card 10/17/2018 61.90 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, 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 regulatingfonstr.uction and zoning. Futhermore, I authorize the above named contractor to do the work stated. re: Owner / Applicant / Contractor / Agent Date October 17, 2018 Page 2 of 2 Arango Electric Inc f$1 E 81h St. Hialeah. Fl 33010 Licensed & Insured EC13007488 Date: 10/13/18 State of Florida County of Dade Before me this day personally appeared Angel Arango who, being duly swom, deposes and says: That I will be the only person working on the project located at: 142 NE 103rd St, Miami Shores Sworn to and subscribed before me this day of 2018 By An&p i,co-ti c'1 0 J 44444JJ144,4.41414 4;7i11i41411Yii714j4J4,J11A444 j4a4744J143441474$11111744444J11i1141 11141141iIi1 111' 7; 131111 41 Personally know / Or produce Identifications Type of Identification Produced AL ,. WON GOMEZ FIGUEROA My MMISSION N IREC S Deceember1900 2020EXP Print,Ty or S p 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 Notice to Owner - Workers' Compensation Insurance Exemption Y[A.* i49 r. ':% .. ,£d. vwr+P •. 4 t .. 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 ACKNOWLED 5E THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade be- The foregoing was acknowled a before me this (1f0 day of —,201(2). By_:C who is personally known to me or has produced as identification. DANAYS DIAZ Nota `? MY COMMISSION # FF997536 EXPIRES June 01, 2020 SEAL: I C407)39"M FlarldeNote rvlce.00m Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 13y: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ill 41 FBC '20 ( BUILDING Master Permit No. _RC -G - Ie- (70a PERMIT APPLICATION Sub Permit No. _:LUQ ` 3 ( CIS BUILDING (4 ELECTRIC ROOFING REVISION EXTENSION RENEWAL PLUMBING f_ MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I LIR N to -3 S -E City: Miami Shores County: Miami Dade Zia: J3 13Qj Folio/Parcel#: W'259-012001--:51-7150 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): ]' Y1.0.y-L01.0 Yan e7 Phone#: Address: 14 Z N G • L03t City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: L E City:. Elt Qualifier Name: V Zip: 3 3 0 I, 0 one#:; State Certification or Registration #: 1: (, L -S 0 U T D,.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: E L(=_G{`C wo?s K 902)r fe yXL06eU,r L0, Specify color of color thru tile: Submittal Fee $ ' Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 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. 1 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 rein1pection fee will be charged. The foregoing instrument was alnowledged before me this Qday of 0 6C1 .20 1Pj by A6 5 o 10 (c 1-7> l DU, who is personally known to me or who has produced X J e'. -T Q-CC-ri!:,eas identification and who did take an oath. NOTARY PUBLIC: Sign: Print - Signature Signature `- CONTRACTOR The foregoing instrument was acknowledged before me this day of 20'a by w rf`1_ (/%Or % . who is personally known to me or who has produced % i U'a.Sc • as identification and who did take an oath. NOTARY PUBLIC: Print: Seal: IVON GOMEZ FIGUEROA Seal: MY COMMISSION # GG056090 EXPIRES December 19, 2020 APPROVED BY Revised02/24/2014) Plans Examiner Structural Review IVON GOMEZ FIGUEROA EXPIRES Zoning Clerk i P RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY a bpr i. WE 1 iSTATEOFFLORIDASTATEi DEPARTMENT OF BUSINESS, -AND -,PROFESSIONAL REGULATION I rv ELECTRICAL.CONT RA .OR LICENSING BOARD THE ELECTRICAL CONTRACTOIZ UNDER THEHEREIN'ISTIFIED PROVISIONS,F— FL(ORI_©A'"STA UTES1-CHAPT,ERR4$9; ffJ_0-5EARANG;OV-- ' II CEL j ARANGO ELFCTRIC`INCORP0RATED 58'1?EAST 8THtS7 HALEAH '.FL 33010: LICENSE=NU MBERs EC130 77488 EXPIRATfONDAT E- 4AUUST 31, 2020 Always verify licenses online at MyFloridaLicense.com i II Do not alter this document in any form. This is your license. Itis unlawful for anyone other than the licensee to use this document. i Local Busi ness Tax FLcei pt M,ami--Dade County, State of Florida rH191S NOTA BILL 00 NOT PAY 7198104 GUSIN!'86 NAM CA OCA rION ARANGO ELECTRIC INCORPORATED 581 E 8TH ST HIALEAH, FL 33010 LLW_ Ln_ _.. ftUG.1lJT NO EXPIRES RENEWAL SEPTEMBER 30, 2019 7480518 Must 3e displayed x plscv of businoss Pursuant to County Coda Cnoptat SA Art 0 & 10 UWNart 58C Typti OF BU-JiNP56 PAYMENTNLCEIVEO ARANCO ELECTRIC 198 ELECTRICAL 9Y TAX COLI FCPOn INCORPORATED CONTRACTOR x5.00 10/bV2018 roma($) aanNrf1 EC13007488 0200.19-000005WOrktlr(s) _ 1 TN s local f usi nsss Tax Rxd pt Orly ton"mu poyment of tho Locd 9uN near Tax T w Pace) pt is not a i iconae, ports t, or a curb "cation of Ltio ho cws quat i ~cations, to do business. Holder must comply with arty 0ovormental ornonyovcrrunontai ro0ulatorytowsandroquim, ntawNch apply to" busimss Tho REMPT NO oboes Rst bo dlsOnyod On Ml cotmcla v*Ncies Kam- Dodo Oxo Sac 0.•270 MIAMI FOr more intor Alonvisit vkww(n0W0.09MCQlloctq e A o® CERTIFICATE OF LIABILITY INSURANCE DATE (MMDD/YYYY) 10/09/2018 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 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: Maria Almolda Blanco Insurance Assoc., Inc. PAHic°NN Ext): (305) 888-0524 ac No ; (305) 883-6218 ADDRESS: maria@blancoinsurance.com1462E4Ave INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: GRANADA INSURANCE COMPANYHialeah, FL 33010 INSURED INSURER B : INSURER C : ARANGO ELECTRIC INCORPORATED INSURER D: 581 E 8 STREET INSURER E: INSURER F: H IALEAH FL 33010 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. INSRLTR TYPE OF INSURANCE ADDLSUBRPOLICY IVSD WVD POLICY NUMBER EFF MM DDIIYYYY POLICY EXP MM DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000.00 CLAIMS -MADE Fx_1 OCCUR DAMAGE TO RENTED— PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 500,000.00A0185FL00069329-2 04/09/2018 04/09/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000.00 X POLICY JE0 LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION10 AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If as, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) LICENCE #EC13007488 L;tK I IrIGA 1 t MULUtK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE WEST SHORES FL 33138 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD a wit 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: 9/13/2018 PERSON: ANGEL ARANGO FEIN: 473665924 BUSINESS NAME AND ADDRESS: ARANGO ELECTRIC INCORPORATED 581 E 8ST HIALEAH, FL 33010 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor EXPIRATION DATE: 9/12/2020 EMAIL: ARANGOELECTRICINC2015@GMAIL.COM 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 facture of the person named on the certificate to meet Die requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609