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REV-19-975Miami Shores Village RFCEIV'=D Building Department AY 02 Z019 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 4-3 INSPECTION LINE PHONE NUMBER: (305) 762-4949 0 +-% nFBC 2201q n BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL X❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1191NE103ST 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#: Address: 8045 NW 155 ST City: MIAMI LAKES State: FL Zip: 33016 Tenant/Lessee Name: Email Phone#: CONTRACTOR: Company Name: EDWARD ROJAS PLUMBING Phone#: Y ] 2 7 Address: 880 NE 111TH ST City: BISCAYNE PARK State: FL Qualifier Name: EDWARD ROJAS Phone#: State Certification or Registration #: CFC049431 Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: p: 33161 Address: City: State: Zip: y Value of Work for this Permit: $ 5 SO Square/Linear Footage of Work: ?O � 44 Type of Work: ❑ Addition El Alteration ❑ New ® Repair/Replace ❑ Demolition Description of Work: REPLACE TOILET, SINK, FAUCET, VANITY, SHOWER PAN LINER,SHOWER VALVE AND PLUMBING FIXTURES IN MASTER AND GUEST BATHROOM.REPLACE KITCHEN SINK. REVISION: CANCEL EXISTING WATER PIPES IN GARAGE AREA. Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ DBPR $ CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 43 - " (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 fee will be charged. --Ie�Signature OWNER or AGENT The fora Qing instrument was acknowledged before me this n1n , =1 day of t(�i� I 20 19 by ►" �� P72— ,who is erso 0 me or who has produced identification and who did take an oath. NOTARY Sign:_ Print: as Signature C NTRACTOR The foregoing instrument was acknowledged before me this 10 N day of VY 1 t 120 � by E-dckuCAfd 1&-) ba who is personally known to ki me or who has produced as identification and who did take an oath. NOTARY PUBLIC: �1. Seal: tiM Seal: ;,tiP4;......,,, ANALUISAPARRILLA PublicSaw of Florida `� :< Notary Public -State of Florida gli Ondc,;Commission#GG090452n G(3 2Q2408 J-_ ^�iuunv; My Comm. Expires Apr 21, 2021022 ***** ********************��w**•to***��+adwbNxuM9No�:Mo4a�xAaxn** *********** APPROVED BY Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk 002ESO Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 5175658 [ B::IT BUSINESS NAMaPLOCATf0N RECEIPT NO. EDWARD ROJAS PLUMBING CORP RENEWAL EXPIRES 860 NE 11 iTH ST 2371250 SEPTEMBER 30, 2019 BISCAYNE PARK FL 33161 Must be disp!syed at Place of business Pursuant to County Code Chapter BA - Art. 9 & 10 OWNER SEC. TYPE Of BUSINESS EDWARD ROJAS PLUMBING CORP 196 PLUMBING CONTRACTOR PAYMENT RECEIVED CPC043431 OY TAX COLLECTOR Worker(s) i S45.00 07/12/2018 CHECK21-18-066826 TSis Local Business Tax Receipt only confirms Payo»m of the Local Business Tax The Race:pt is lot a licsnse, permit, or a cWti(icaHea of the holder s qualifications, to do business. Holder ax:st comply w,,, any pvef"entef or nonpramatsrrtal repnlatory laws and requirements which aptly to the business. The RECE.PT 1110. above must be displayed oa all comuwciai eat cles - Uiaad-Dade Code Soc fla-278. For more information, visit WWW tr'rtr'Cttb4I: [IIzr;;1H= STATE OF FLORIDA DEPARTMENT db��. OF BUSINESS AND PROFESSIONAL REGULATION CFC049431 ISSUED: 07/28l2018 PLUMBING CONTRACTOR ROJAS, EDWARDO EDWARD ROJAS PJXJ1a61 G CORP Ammmmbw--qm LICENSED UNDER CHAPTER 489, FLORIDA STATUTES EXPIRATION DATE: AUGUST 31, 2020 AC-CJKL1 CERTIFICATE OF LIABILITY INSURANCE � °"'E"YY"�' 04/10/110/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTWATE 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(,). PRODUCER Accurate 8300 West Flagler Suite 114-ADDRESS Miami. FL 33144 Phone (305) 226-8727 Fax (305) 226-8767 NANTACT NAME. Lucia Esb-aa PHONE (305)226 8727 ac No ; (305)226-8767 L accuraWcerfificates@gmad.com AFFORDING COVERAGE NAC s INSURER A: Arch Specialty Insurance Company INSURED Edward Rojas Plumbing Corp 880 NE 111 St Biscayne Park, FL 33161- INSURER B INSURER C: INSURER D : INSURER E : INSURER F - l.uvCKAULb GERTIFIGATE NUMBER: REVISION NUMRER- 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 DESCRY HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTTRR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF POLICY ExP LIMITS A GENERAL LIABR.rTM © COMMERCIAL GENERAL LIABILITY ❑ ❑ CLANSMADE 0 OCCUR ❑ N N I GGL0003446 I 08/06R018 08/106J2019 EACH OCCURRENCE s 1,000,000.00 DP E 11 E TO RENTED $ 100,000 00 MED Exp one ) s 5.000.00 PERK s ADV MURY S 1,000,000.00 ❑ GENERAL AGGREGATE s 2,000,000.00 GENL AGGREGATE LIWT APPLIES PER: 0 POLICY ❑ jECT PRO- ❑ L PRODUCTS - COMPIOP AGG S 2,000,000.00 $ AUTOMOBILE LIAMTY ❑ ANY AUTO ❑ ALL AUTOS ED ❑ AUTOS ❑ HIRED AUTOS ❑ AUTOS ED C SINGLE LIMIT s BODILY KlURY (Per pion) S BODILY INJURY (Per accident; s pR DAMAGE Per $ $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ ow U REreams $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I NER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWI�H2EXCLUDED? (Mandatary is NM El If yes. describe under DESCRIPTION OF OPERATIONS below NIA I WC $TATU- OTH- E.L. EACH ACCIDENT S EL DISEASE - EA EMPLOYE] S E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Scbedale. I mom space is mgahsd) CFC049431 l.CK 1 IrILA I t KC/LUCK CANCELLATION �CO7RD NY POLICE$BE I'ewFl 1 tT 8E Miami Shores V1Aage ATIO , DA TH CE WILL BE DELNEREDIN NCE WITH H P Y P SIONS. Building Department 10050 NE 2nd Ave AUTHORS A Miami Shores, FL 33138 305-756-8972 Lucia Estrella ®19 0 C ORATION. All rights reserved. ACORD 25 (2010/05) OF The ACOR an log re registered marks of ACORD DRIVER IICEME C' "S iF R220400-:;F-427-0 40 � *At= AS -on ME I ITT" ST e Y"f PorAt" i +Irli d 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: 7/11/2017 PERSON: EDWARDO ROJAS FEIN: 453073611 BUSINESS NAME AND ADDRESS: EDWARD ROJAS PLUMBING CORP 880 NE 111 STREET MIAMI, FL 33161 SCOPE OF BUSINESS OR TRADE: CERTIFIED PLUMBING Plumbing NOC and Drivers CONTRACTOR EXPIRATION DATE: 7/11/2019 EMAIL: RUTHLEDESMA@BELLSOUTH.NET 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