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EL-19-970Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Issue Date:12/27/2019 Location Address Parcel Number 1191 NE 103RD ST, Miami Shores, FL 33138 1122320310050 Contacts Permit NO.: EL-05-19-970 Permit Type: Electrical - Residential Work Classification: Alteration Permit Status: Approved Expiration: 06/24/2020 COBIA LLC Owner MEGA POWER LLC Contractor 8045 NW 155 ST, MIAMI LAKES, FL 33016 NICOLAS LLUCH Mobile: 7869994855 3550 SW 48 CT, FT LAURDERDALE, FL 33312 Business: 9544659401 Ins ection Requests: Description: REPLACE GFCI'S IN KITCHEN TO COMPLY W / CODE Valuation: $ 1,200.00 305-762 4949 REPLACE LIGHT FIXTURES IN BATHROOMS AND KITCHEN REPLACE SWITCHES IN BATHROOMS AND KITCHEN . Total Sq Feet: 1,800.00 TO REPLACE EL-8-18-2246 Fees Amount CCF (Manual) $1.20 DBPR Fee (Manual) $2.00 DCA Fee (Manual) $2.00 Education Surcharge (Manual) $0.20 Permit Fee (Manual) $100.00 Scanning Fee (Manual) $3.00 Technology Fee (Manual) $2.50 Total: $110.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $110.90 Check # 2398 12/30/2019 $110.90 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, WINDO DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing inform n is curate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize th above med co o-do the work stated. Authorized Signature: Owner Contractor" / Agent Date December 30, 2019 Page 2 of 2 Miami Shores Village Building Department MAY 0 2MA /� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 (✓ l� Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201:' BUILDING Master Permit No. �C- �— 1 G PERMIT APPLICATION Sub Permit No. E_i� S-lq" TO ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1191 NE 103 ST City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#: 11-2232-031-0050 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): COBIA LLC Phone#: Aririracc• 8045 NW 155 ST City: MIAMI LAKES State: FL Tenant/Lessee Name: Email: CONTRACTOR: Company Name: MEGA POWER LLC Phone#: _ Aririracc. 3550 SW 48TH CT City: FT. LAUDERDALE State: FL Z Qualifier Name: NICOLAS LLUCH Phone#: _ State Certification or Registration #. EC13008454 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: _ Address: City: State Value of Work for this Permit: $ �Z� 00 Square/Linear Footage of Work: _ p: 33016 33312 Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: REPLACE CFCI'S IN KITCHEN TO COMPLY W/ CODE REPLACE LIGHT FIXTURES IN BATHROOMS pAND KITCHEN REPLACE SWITCHES IN BATHROOMS AND KITCHEN. �,Q RjCQ)� QQky I+ Q — 0 — 1,-Z?-- 2ZYb Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ ( 10 U (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 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 bf approved and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this I— day of M fN .20 19 by h0a N1A1-fiV 2 2 , who is personally known to me or who has produced as identification and who did take an oath. Signature CONTRACTOR The foregoing instrument was acknowledged before me this 90 day of by &0k ikA 1 V who is personally known me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY PLIIC: Sign: Signi(-,zet4 : p/ Print: -� lil li 2 Print: d C, Seal: aii. -P. •,. GRECIA M. BERMUDEZ Seal:yCamila llotary Public State of Florida Notary Public - State of Florida Arredondo Commission # GG 305273 My Commission GG 282408 Y P M Comm. Ex ires Mar 3, 2023 Expires 09l28/2022 ************ *****fond sugktistMenakNateA6*rt *************** * * * ************** APPROVED BY S lei I I I Plans Examiner Structural Review Zoning Clerk (Revised02/24/2014) 3550 SW 48" Ct Fort Lauderdale, FL 33312 Ph. 954-465-9401 magegroup@bellsouth.net EC 13008454 12-29-2019 State of Florida County of Browrad Before me this day personally appeared Nicolas Lluch who, being dully sworn, deposes and says: That he will be the only person working on the project located at: 4494 ut� l©3 ay st ill -am 5Ko&0 -FL 33►3r Contractor Signature Sworn to and subscribed before me this a I day of "cW4-1W - , 2019 by fV'X'0IXS LLU" It cam- qa--)4. a61� w COMMISSION /Wm EXPIRES:INguat 2, 2021 SW4W Un ►Jd q I u tJ�+dMe 3550 SW 48" CT, Fort Lauderdale, FI 33312 - Ph.:954465-9401 - Fax 954-241-5161 - megagmup@bellsouth.net Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 IV+Uuce tV Vwner — YYvrKer5 Compensation Insurance CXerriDtion 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 -tune 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 (lie 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. t Signature: _ weer State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of , 20_JCJ 14 who is personally known to me or has produced fication. JrSAL: Notary Arne Stab of Camila Arredondu My Commission GG ?5� w Expires 09r&WN2' i''� is BUILDING ° 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 AU 2 2 2018 FBC 20 Master Permit No. �R � m n35 PERMIT APPLICATION Sub Permit No. ELM- ZZ4� ❑BUILDINGELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP r� CONTRACTOR DRAWINGS JOBADDRESS: IN XX 103 Pp S7' City Miami Shores County: Miami Dade Zip: 33�3�3 Folio/Parcel#: IM — 2 2 3 Z — O 51— 0tfC Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Lggq LRtj If 0DIIA LL4f!- Phone#: Address:. :Di City: N I Ar11 State: FL, Zip: 330 ((12 _ Tenant/Lessee Name: Phone#: Email:/y CONTRACTOR: Company Name: Jr y�� L�7� li nj �G�fi'Tlu� [ �7�T Phone#: ?C7 6.35:5--m 7' Address: /1631 AI V) 3tl p L City: 4,2 (C;A ,/ State: 4^ zip: 33 Qualifier Name: Name: ,'W—/ iA✓/0 1qCas-7-4 Phone#: State Certification or Registration #: Certificate of Competency #: /D �ff add V d DESIGNER: Architect/Engineer: Phone#: Add Value of Work for this Permit: Tvoe of Work: ❑ Addition ❑ Alteration City: State: _AZip: ,� Square/Linear Foo age of Work: 20 C) 29 0 ❑ New epair/Replace ElDemolition Specify color of color thru tile: Submittal Fee $ �°0 01 Permit Fee $ � � CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ DBPR $ Notary $ Double Fee $ Bond $ 11 TOTAL FEE NOW DUE $ ! � . �3 (Re%ised02/24/2014) 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 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. Signature _ OWNER or AGENT The foregoing instrument was acknowledged before me this day of :Jy V 20 t O , by who is personally known to me or who has produced �t7�Sf 1 41 I 6&A identification and who did take an oath. Signature K CONTRACTOR The foregoing instrument was acknowledged before me this day of 1-4 �A 20 %% by USi�PJr1r�J who is personally known to Mg or who has produced identification and who did take an oath. as NOTARY PUBLI NOTARY PUBLIC: Sign: Sign: Print: Print: Seal:'�� e t1111a Arredondo C Seal: ,Omp, ' Notary a is fate o lorida Isis M Paez My Commission GG 195698 rr 163102 Expltea 04100022 4:xNi: .: SEP 24, 2018 OF Gf@� THRU APPROVED BY,�* Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ACCM& �,,. 1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/31/18 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 Southern Star Insurance Agency, Inc 8338 SW 8th Street CONTACT NAME, PAIICNE EM . (305) 262-2740 ac No): (305) 262-2647 E-MAIL southernstarinsurance@gmail.com INSURERS AFFORDING COVERAGE NAIC # Miami, FL 33144 INSURER A : GRANADA INSURANCE CO Phone (305) 262-2740 Fax (305) 262-2647 INSURED INSURER B : INSURER C EVOLUTION ELECTRICAL CONTRACTOR, INC INSURERD: 11631 NW 58TH PL HIALEAH, FL 33012 305-978-8537 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 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. ILTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM/DD�Y MMLDD/YYYY EXP LIMITS q GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE❑ OCCUR El N N 0185FL00072497-3 07/30/2018 07/30/2019 EACH OCCURRENCE $ 1,000,000.00 DAMAGE(RENTED PREMISESS Ea occurrence) $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL 8 ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: © POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OW NED SCHEDULED ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ AUTOS NON -OWNED ❑ ❑ COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Perr acccidenDAMAGE $ $ ❑ UMBRELLAUTAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WCT STATU- ❑ ER ❑ RY DMITS E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space is required) ELICTRICAL CONTRACTOR LIC.#10E000610 CFRTIFICATE HOLDER CANCELLATION 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. Hall Budding & Zoning 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 ROBERTO OJEDA @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF The ACORD name and logo are registered marks of ACORD CL10'TUOENT■I,, 1N LICENSED & INSURED JANUARY 22 2015 STATE OF FLORIDA COUNTY OF MIAMI DADE City of Hialeah 11631 NW 58 PL, FI 33012 Ph: 786-351-5784 Fax: 305-982-8911 Email: evolutionelectricalco@yahol BEFORE ME THIS DAY PERSONALLY APPEA D JOS=MALDONAD�0)1-10 ,BEING DULY SWORN DEPOSES AND SAYS: THAT HE WILL BE THE ONLY PERSON WORKING ON THE PROYECT LOCATED AT 1191 NE 103 STREET MIAMI SHORES FL 33138 SINCERELY EVOLUTION ELECTRICAL CONTRACTORS ANTONIO ACOSTA SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE MI THIS 19 DAY OF AUGUST,2018 PERSONALLY KNOW OR PRODUCED IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED PRINT, TYPE OR STAMP NAME OF NOTARY Abtary Public State of Florida Isis M Paez My Commission GG 195696 Expires 04/06/2022