EL-16-941C Miami Shores VillageSµOREs 10050
N.E. 2nd Avenue NE DBPR
Fee Miami
Shores, FL 33138-0000 Phone:
305)795-2204 FLORIDA
0.
20 Project
Address 87
NE 92 Street Miami
Shores, FL 33138 - Owner
Information PATRICK
COWAN Permit
NO. EL -4-16-941 Permit
Type: Electrical - Residential Worts
Classification: Low Voltage Permit
Status: APPROVED Issue
Date, 4/12/2016 1 Expiration: 10/0912016 Parcel
Number 1132060130290
Block:
Lot: Phone
87
NE 92 Street MIAMI
SHORES FL 33138- Contractor(
s) Phone Cell Phone GLEZ
ELECTRICAL CORP (305)781-6179 ype
of Work: LOW VOLTAGE. WIRE CONNECTIONS. 14 S dditional
Info: lassification:
Residential canning:
1 Fees
Due Amount CCF
0.60 DBPR
Fee 2.25 DCA
Fee 2.25 Education
Surcharge 0.20 Permit
Fee -Add itions/Alterations 150.00 Scanning
Fee 3.00 Technology
Fee 0.80 Total:
159.10 PATRICK
COWAN 786)
547-3255 Valuation: $
1,000.00 Total
Sq Feet: 0 Pay
Date Pay Type Amt Paid Amt Due Invoice #
EL -4-16-59331 04/
12/2016 Check #: 2041 $ 109.10 $ 50.00 04/
08/2016 Check #: 2036 $ 50.00 $ 0.00 Available
Inspections: Inspection
Type: Review
Electrical 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
AFFID VIT: ertify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction
and z nin hermore, I authorize the above-named contractor to do the work stated. April
12, 2016 Authorized
Si§bhture: Owner / Applicant / Contractor / Agent Building
Department Copy 1
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-269735
Scheduled Inspection Date: October 26, 2016
Inspector: Devaney, Michael
Owner: COWAN, PATRICK
Job Address: 87 NE 92 Street
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: GLEZ ELECTRICAL CORP
euilaing Department comments
P,c I S- q 2-0
Permit Number: EL -4-16-941
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Low Voltage
LOW VOLTAGE. WIRE CONNECTIONS. 14 SPEAKERS, 4I
Infractio
TV 4 OUTLETS AND SOUND SYSTEM.
INSPECTOR COMMENTS
Inspector Comments
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Phone Number (786)547-3255
Parcel Number 1132060130290
False
Phone: (305)781-6179
October 25, 2016 For Inspections please call: (305)762-4949 Page 31 of 37
kAlffi 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
M
BUILDING
PERMIT APPLICATION
BUILDING , PELECTRIC ROOFING
FBC 20 0A c7--
Master Permit No. Izf-Y -/S - .7.o
Sub Permit No.LL (r -T
REVISION
PLUMBING MECHANICAL MPUBLIC WORKS [] CHANGE OF
CONTRACTOR
EXTENSION RENEWAL
CANCELLATION SHOP
DRAWINGS
JOB ADDRESS: - 1011 GV' •
City Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BF,E/: FFE:
OWNER: Name (Fee Simple Titleholder): / (li I'/f( ///1 QG"c- / G t Phone#/. ' 5- '
C17S7
Address:
City: State: Zip:
Tenant/Lessee Name:
Phone#:
Email:
CONTRACTOR: Company Name:% lr Phone#:
Address: ^ 410-' --
State: /—ice Zip: X332./
City: l/1'I6IZ!
T Phone#:
Qualifier Name:
State Certification or Registration #: e 6 d 'L 17- Certificate of Competency #:
Phone#:
DESIGNER: Architect/Engineer:
City: State: ZIP
Address:
Value of Work for this Permit: $-j 6 Square/Linear Footage of Work:
ration New F_1Repair/Replace Demolition
Type of Work: Addition Alteration
Description of Work:
Specify color of color thru tile:
6o
Submittal Fee $ Q Permit Fee $ /!%O CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ C Notary $
W
Double Fee $
Technology Fee $ D --Q-0 Training/Education Fee $ C)
Bond $
Structural Reviews $
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
Zip
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 personwhosepropertyissubjecttoattachment. Also, a certified copy of the recorded notice ofcommencement 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 ap roved and a reinspection fee will be charged.
Signature
Signatu
DWNER or AGENT
rt
TR CTOR
The for going instrument was acknowledged before me this
n
day of -20 --- by
6 24J,4 . who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: •••'s R
Seal:
OP
APPROVED BY
Revised02/24/2014)
Volar >tMyaom
O"bl. ez PFAFZC„_ m. . S'.
b%_66??
10
07I
The foregoing instrument was acknowledged beforeme this
Lday of 20 /0 , by
aL C 0 who is personally known to
me or who has produced as
identification and who did take an oath.
NOT
Sign
Prin
Seal
Plans Examiner
Structural Review
Zoning
Clerk
Miami shores Village
Building Department
CONTRACTORS' REGISTRATION
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
A. COPY OF QUALIFIER'S STATE LICENCES
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. (/ OPY OF LIABILITY INSURANCE*
D. ` COPY OF WORKERS COMPENSATION INSURANCE*
Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL
CONTRACTOR'S TAX RECEIPT.
D. COPY OF LIABILITY INSURACE*
E. COPY OF WORKERS COMPENSATION INSURANCE*
Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW:
Certificate Holder:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
Certificate must specify the description of operations or contractor license number.
BUSINESS NAME: (JEU 2- 4,101VIW _C,://' /
BUSINESS ADDRESS: g 3Z iy
If
yfxzet CITY .O'UM(2STATE
BUSINESS PHONE: ( 619 FAX NUMBER S
CELL PHONE (3oS1 —?B1(21?f QUALIFIER'S NAME: -.7
QUALIFIER'S LIC NUMBER: L'e /a 00 MI
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-13951940NORTHMONROESTREET
TALLAHASSEE FL 32399-0783
GONZALEZ, JANIER
GLEZ ELECTRICAL CORP
8132 NW 68TH TERRACE
TAMARAC FL 33321
Congratulations! With this license you become one of the nearlyonemllllonFloridianslicensedbytheDepartmentofBusinessandProfessionalRegulation. Our professionals and businesses rangefromarchitectstoyachtbrokers, from boxers to barbeque
restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in ordertoserveyoubetter. For Information about our services, pleaselogontowww.myfloridalicanse.com. There you can find more
information about our divisions and the regulations that impact
you, subscribe to department newsletters and learn more about
the Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate
Fairly. We constantly strive to serve you better so that you can
serve your customers. Thank you for doing business in Florida,
and congratulations on your new licensel
STATE OFfLORIDA
DEPARTMENT OF BUSINESS AND
Y
PROFESSICAXIi-REGULATION
EG13007197- hA
J9SUED:' 11/23/2015
CERTIFID ELEGTRICAL CONTRACTOR-
GONZALEZ; .IAiV'`':
GLEZ,ELECTR*CAI, CORP 71 t
J •
byµ '
a Y}'tii` e/ I '- —! '-.
r_, ` r---- _—...._._
IS GE TIFIED..under tfie provtsions'of,Ch 489 -FS
DETACH HERE
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OFA, FLO
RTRID-
DEPAMENTOF BUSINESS`AND;PROF'ESSIONAL'REGULATION`•,,
ELECTRICAL`CONTRACTORS UCENSING-BOARDti'-,
EC13007147.-.-
Chapter 489'FS:
1; 2016
R",;
Chapter 489'FS:
1; 2016
R",;
BROWARD COUNTY LOCAL BUSINESS TAXRECEIPT~ -----
115 S. AndVALID OCTOBER
110,
2015
Laude
THROUGH SEPTEMBER 302016
rdale, FL 33301-1895 — 000
Receipt#:ELECTRICAL/ALARMS/CONTFDBA: GLEZ ELECTRICAL CORP Business Type: (ELECTRICAL CONTRACTOR)
Business Name:
Owner Name' JANIER GONZALEZ Business Opened:01/08/2016
Business Location: 8132 NW 68 TERR State/County/Cert/Reg:EC13007197
TAMARAC Exemption Code:
Business Phone:
Seats Employees Machines Professionals
i Rooms
2
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
rd County and is
THIS BECOMES A TAX RECEIPT This tax is levied
non -regulatory nfnatue. you must meet all County and/or
Mortheprivilegeofdoingbusinesswithinunicipalityplanning
and zoning requirements. This Business Tax Receipt must be transferred when
WHEN VALIDATED the business is sold, business name has changed or you have moved the
itis in compliance with
receipt does not indicate that the business is legal or that
or local laws and regulat ons.
lMailing Address: Receipt $52A-15-00004241
JANIER GONZALEZ Paid 01/08/2016 27.00
1
8132 NW 68 TERR
TAMARAC, FL 33321
I
2015 .2016
JEFF ATWATER
CHIEF FINANCIAL OFFICER
P
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: 1/13/2016 EXPIRATION DATE: 1/12/2018
PERSON: GONZALEZ JANIER
FEIN: 474900965
BUSINESS NAME AND ADDRESS:
GLEZ ELECTRICAL CORP
8132 NW 68TH TERRACE
TAMARAC FL 33321
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
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 thissection 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 ofthe business or trade
listed on the notice ofelection 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 no** or certificate no longer meets the requirements ofthis
section for issuanceof a certificate. The departmentshall revokea
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609
Glez Electrical Corp
8132 NW 68T" Terrace
Tamarac, FL 33321
Phone (305)781-6179 Fax (954)722-3893
giez.electric@gmaii.com
Date:
State of dr-InZ— 6
County of — Z/ "`
Before me this day appeared who, being duly sworn, deposes and
says:
That he or she will be the only person working on the project located at e fvr- IfI "re- /
Sworn to (or affirmed) and s scribed before me this
2: day of ' , 201 by
M
Personally Known
Or Produced Identification ' S ' \+;L0 - -
Type pf Identification produced FLS- --
Print, Typ or Stamp Na a of ary
MARLENE MENDEZ
Notary Public - State of Florida
N,+ orcIF" My Comm. Expires Jul 4, 2016
o,
V09T
P ``
1-100, Commission # EE 213947
Notice to Owner - Workers' Com
Miami shores V
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation 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 usedaylabor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she willbetheonlypersonallowedtoworkonyourproject. In these circumstances, Miami Shores Village does not require verification ofworkers' 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.
IZ17Signature:
Owner
State of Florida
County ofMiami-Dade j
The foregoing was acknowledge before me this day ofT ir , 201 , 2•
By who is personally known to me or has produced
as identification.
Notary:
Notar ZUCEL FERE
SEAL: "%FOF F o MY Coam lic -State OfCorrrnriSS1oPil
E.4 & ,20 7
Apr 12 2016 11:03AM Us1 Insurance 3058280770 page 1
CERTIFICATE OF LIABILITY INSURANCE DATE40420/
617
04/04201 s
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE HOLDER THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVEORPRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certiNcate holder Is an ADDITIONAL INSURED, the pDlicylles) must be endorsed. IfSUBROGATION IS WANED, subject tothetermsandconditionsofthepolicy, cerbdn policies may require an endorsement. Astatement on this certificats does not confer rights to thecertificateholderInlieuofsuchendorsemsnt(s).
PRODUCER CONTA
US -1 Insurance PHONE 306)828-7222 Pax—Nok (305)828-07703100W76thStreetMAIL3100
Hialeah, FL 33018
ADDRES&
Phone (305)828-7222 Fax
INSURER(S)APFORDINGCOVERAGE NAW0305828-0770 INSURER A : INSURED
glee electrical Corp
8132 NW 68ttt Terrace
tamaracINYVRC RE:
FL 33321-
INsuRER FCOVERAGESCERTIFICATENUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN, 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.
TYPE OF INSURANCE POLICY M
COMM ERCIALGENERAL LIABILITY
CLAIMS -MADE OCCUR
0185f100D78134
GEML AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
OTHER
AUTOMOBILE LIABILITY
ANYAUTO
DAMNGE TO RENTED -
PMMIoccurrence)
AAUTOSNED AUTODULED
HIRED AUTOSNO11EDAUTOS
UMBRELLA LMC OCCUR
1-1 EXCESS LIAB I-1 ,,—
WORKERS COMPENSATION
ANO EMPLOYEP.& LJABWTY Y/N
A
describe under
RIPTION OF OPERATIONS bslow
01/112016 101/112017
DESCRIPTION OFOPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ifmon space Is rsgWred)
ELECTRICAL CONTRACTOR
LICENSE # EC13007097
CERTIFICATE HOLDER CANCELLATION
MIAMI SHORES VILLAJE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL,33138
ACORD 25 (2014101) QF
LIMITS
EACH o90.111RENCE 1,000,000.00
DAMNGE TO RENTED -
PMMIoccurrence) s 100,000.00
MED EXP JAny one arson s 5,000.00
PERSONAL BADVINJURY j 1,000,000.00
GENERAL AGGREGATE j 2 000,000.00
PRODUCTS-COMP/OPAGG S 0.00
OMBIN D SINGLE LIMIT
j
BODILY INJURY (Per parson) i
BODILY INJURY (Per aoddeni j
GE j
s
NCETEAREN
j
TUTE TENT
EMPLOYE s
E.L. DISEASE - POLICY LIMIT s
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHEEXPIRATIONDATETHEREOF, NOTICE WILL BE DELIVERED INACCOADNCEWITHTHEPOLICYPROVISIONS.
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