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EL-19-2016Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 1296 NE 99TH ST, Miami Shores, FL 33138 rnntacts W -.0 hu iu Issue Date: 09/09/2019 Parcel Number 1132050090140 Permit NO.: EL-08-19-2016 Permit Type: Electrical - Residential Work Classification: Pool Permit Status: Approved Expiration: 03/09/2020 FELIPE VISSER Owner 1296 NE 99 ST Business: 3057937279 INFO@VCLOSETS.COM TESLA ENGINEERING INC Contractor JOSEPH T PADRON 10811 SW 33 ST, MIAMI, FL 33165 Business: 3052520076 Inspection Requests_:_ Description: NEW ELECTRICAL FOR SWIMMING POOL Valuation: $ 3,000.00 Inspec i n Re Total Sq Feet: 400.00 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 09/09/2019 $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, 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent Date September 09, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village REC1:nVz1D Building Department AU 29 ^019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 Master Permit No.��"�— Sub Permit No. (�( I ❑BUILDING M ELECTRIC ❑ ROOFING ❑PLUMBING MECHANICAL [:]PUBLICWORKS JOB ADDRESS: I Z ILIp N e qq v-�- ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑ CHANGE OF ❑ CANCELLATION SHOP CONTRACTOR DRAWINGS Folio/Parcel#: 11- 32,05 - cD-T— QIL10 Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: _ OWI Add m FFE: City: M l ltul Sfh✓S State: FL Zip: 3,51,3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: 119 1 Q_ &V' City: (5os zsz 0CQ tv L Zip: 33111 Qualifier Name: UL)4:! Ijki- _j"4&2r I Nnone;t: State Certification or Registration #: E% 3 W431 I Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: l City: State: Zip: Value of Work for this Permit: $_ 31DD©. oo Square/Linear Footage of Work: "L �Sq Type of Work: ❑ Addition N Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Permit Fee $ CCF $_ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $, _ CO/CC $ _ Notary $. Double Fee $ _ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ I I1 . E7 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. r(, Signature r y OWNER or AGENT The foregoing instrument was acknowledged before me this day of U/ 20 �� by who is persnnallyknown to me or who has produced as identification and who did take an oath. NOTARY P Signature Q.�. , CONTRACTOR The foregoing instrument was acknowledged before me this 1�— day of 20� by �y �.Q�_ who is person_ ally known to me or who has produced as identification and who did take an oath. NOTARY ;n: Sign fi n : Print: LANAEJAMES Seal: t�Y.Py•. LAN,4EJAMES "� MY COMMISSION # GG 178019 AIYCOMMISSION # GO 178019 `-". EXPIRES: ! rch 2, 2022 EXPIRES �22 P 1a '•,f Bonded Th . M (� ,2� '•� 60F M1O•� Bonded TNu Notary Pub#C Uader: ft0, S APPROVED B / Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESSrANWP.ROFESSIONAL REGULATION ELECTRICAL�O,IT�tACTORS:LICNSING BOARD THE ELECTRICAL C,ONTRgCTO ,HEREIN 1-9 CERTIFIED UNDER THE PROVI ,O'NS,a0FyCHAPT, Ek489- FLORIDA"STATUTES PADRON`�JC-SEPH, T "' {:. TESLA ENGINE�RIN��,INC- . + • 1{001 i •SWt 33 ST i MIAMI PL. 3?165. =f ' of L f r LICNSE,NUINBER- EC13004311 EXPIRATIONV^DATE;;^:AUyGUST 319 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. Fl rida 018946 ;Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT ABILL -DO NOT PAY 6577820 BUSINESS NAME&OCATION TESLA ENGINEERING INC 17910 SW 137TH CT MIAMI FL 33177 OWNER TESLA ENGINEERING INC C/O JOSEPH PADRON PRES Worker(s) 2 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2019 6848460 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 S �.4 PAYMENT RECEIVED BY TAX COLLECTOR $75.00 07/09/2018 C RE DITCARD-18-051094 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license;- ry' r' permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276.{! } For more information, visit www.miamidade.go„yAoxcollector 4 , SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13004311 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/19 F7, PRODUCER South Florida Casualty, Inc. 415 North 4th Street Lantana, FL 33462 561-533-6144 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICII L-L-RELOW INSURERS AFFORDING COVERAGE NAIC INSURED Tesla Engineering Inc. 17910 SW 137th Court Miami, FL 33177 305-205-9668 INSURERA INSURER H Progressive (CA) 24260 INSURER C: INSURER D: nr%VFRAnFC 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTA INSRDI POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000.0 11111010M$ COMMERCIAL GENERAL LIABILITY CLAIMSMADE GDOCCUR MED EXP A one $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A CS17007648-02 11/6/18 11/6/19 GENERAL AGGREGATE $ 2.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY MX PRO - AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Eaacd $ 1dent) /000 / 000 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ B HIREDAUTOS NON-OWNEDAUTOS 07553969-1 04/23/19 04/23/20 PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHAN ACC $ ANYAUTO $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ _ AGGREGATE $ OCCUR ❑ CLAIMSMADE DEDUCTIBLE $ WORKERS COMPENSATION I WC STATU- OTH- FR AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? U E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If ,describe Under OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Electrical Contractor-EC1300`131) CFRTIFICATF HOI nFR CANCFI t AMN MiamiSHOULD Shores Village ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Build Building Department 10050 NE 2 Avenue NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Miami Shores, FL 33138 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON INSURER, ITS AGENTS OR NTATrVFSL AUTHORIZED REPRESENTATI ACORD 25 (2009✓01) 01988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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: 1/11/2018 PERSON: PADRON FEIN: 270752542 BUSINESS NAME AND ADDRESS: TESLA ENGINEERING INC 17910 SW 137 CT MIAMI FL SCOPE OF BUSINESS OR TRADE: 33177 Licensed Electrical Contractor Electrical Wiring Within Buildings and Drivers EXPIRATION DATE: 1 /11 /2020 JOSEPH 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 sectlon'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 shag be subject to revocation If, at any time after the filing of the notice or the Issuance of fhe 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 111 July 8, 2019 State of Florida County of Miami Dade Before me this day personally appearek" Pal e p(1 who, being duly sworn, deposes and says: That he/ she will be the only person working on the project located at: 33 Co ctor gnature Jo eph Padron Tesla Engineering Inc. Sworn to (or affirmed) and subscribed before me this __g_ day of 2019. Personally known Or Produced Identification Type of Identification Produced or Stamp Name of Notary ►"Y'. LANAE JAMES MY COMMISSION # GG 178019 EXPIRES; March 2, 2022 Thor Notary Pubk underwriters 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 txemption 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: l . 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 .0 Signature: (ay( �• Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this I day of 20_ff. By ge V IJ who is personally known to me or has produced t / / as identification. Notary: SEAL: `''` LANAE W COMMISSK EXPIRES: March 2,