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RF-20-184Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 i�i�fn�n ut� Issue Date: 02/18/2020 Location Address Parcel Number 9811 NE 4TH AVENUE RD, Miami Shores, FL 33138 1132060170220 Contacts Permit NO.: RF-01-20-184 Permit Type! Roof Work Classification: Gutters Permit Status: Approved Expiration: 08/ 17/2020 Kenneth Kotalik Owner 98114 CAG SOLUTIONS CORP Contractor CARLOS GARCIA 1145 NE 4 AVE, HIALEAH, FL 33010 Business: 3052242127 CAGCORP2018@GMAIL.COM Description: RAIN GUTTERS Valuation: $ 1,505Inspection Requests: 305-762-4949 TotalSq Feet: 231.00 Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $3.75 DCA Fee $2.50 Education Surcharge $0.40 Roofing Fee $50.00 Scanning Fee $9.00 Technology Fee $6.25 Total: $123.10 Building Department Copy Payments Date Paid Amt Paid Total Fees $123.10 Credit Card 01/27/2020 $50.00 Credit Card 02/18/2020 $73.10 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. Authorized Signature: Owner / Applicant / Contractor / Agent Date February 18, 2020 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village ENTERED Building Department JAN 2 7 2020 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 W „ ' FBrc Za�- Master Permit No. R r " C) I - zo + 184 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Q, �t JOB ADDRESS: g V I 1 N o 4 \r �`1- City: Miami Shores County: Miami Dade zip: o 33 UE) Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): v .x �I "`�' 1 Cl 1y Phone#: �lq �[ (0 �—f /U 3� Address: x — Fef 1 I I v c Ave — City:)( H � G 5A i lnnre S State: zip: y 33 Tenant/Lessee Name: Email CONTRACTOR: Company Name: 0 CA Address: 1 4 S Wg�+ ��(I City: 1611-e Qualifier Name: S 'k(Y1S (`6 SOS- 2.29-212'- 35010 hone#: State Certification or Registration #: X `O 00 I UO O Certificate of Competency #: DESIGNER: Architect/Engineer: Address: Phone#: State: Zip: Value of Work for this Permit: $x_ I '�3Q Square/Linear Footage of Work: k 231 Type of Work: ❑ Addition ❑ Alteration EANew ❑ Repair/Replace ❑ Demolition Description of Work: )� C-7r�- Specify color of color thru tile:. Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ Permit Fee $ CCF $ Radon Fee $ DBPR $ Training/Education Fee $ t CO/cc $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 3') O (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. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this 2 ) 5� day of 341) U A 20 Z D , by Ike r,neiiilh I(Dgj�-I i yL who is personally known to me or who has produced identification and who did take an oath. NOTJPIC:,Sign: Print Seal: APPROVED BY (Revised02/24/2014) �yd) Notary Public State of Florida Dayana Perez My Commission GG 139415 Expires 08/29/2021 fila v Signature CONTRACTOR The foregoing instrument was acknowledged beforemethis 21 dayoftGnUCAN ,20 20 by (\CJY\OS 6 who is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: <►. t MELISSA ALFONs0 MY COMMISSION # GG 356206 EXPIRES: July 17, 2023 Plans Examiner Structural Review as Zoning Clerk PCTqConstruction Trades uaiifying Board BUSINESS CERTIFICATE OF COMPETENCI 16BS00160 CAG SOLUTIONS CORP D.B.A.: BEOVIDES CARLOS A Is certified under the provisions of Chapter 10 of Miami -Dade County QUALIFYING TRADE(S) 0078 PAINTING 0049 SHEET METAL GUTTER DOWNSPO M®� Jaime D. Gascon. P.E. _w .u_l,( Secretary of the Board r N..ww,miamidade.gov/economy Miami -Dade County retains all property rights herein. Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7294752 BUSINESS NAME/LOCATION CAG SOLUTIONS CORP 1145 W 28TH ST HIALEAH, FL 33010 OWNER CAG SOLUTIONS CORP C/O CARLOS ALBERTO GARCIA RFnVIIIFR 01 IAI IFIFR Worker(s) 1 RECEIPT NO. NEW BUSINESS 7584315 LBT EXPIRES SEPTEMBER 30, 2020 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY BUILDING PAYMENT RECEIVED BY TAX COLLECTOR CONTRACTOR 45.00 01/22/2020 16BS00160 0229-20-062883 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, 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 88-276. a% For more information, visit www.miamidade gov/taxcollector Municipal Contractor's Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: 16BS00160 MC BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES CAG SOLUTIONS CORP SEPTEMBER 30 2020 1 145 W 28TH ST 7584318 � HIALEAH, iR 33010 Pursuant to County Code Sec10-24 OWNER TYPE OF BUSINESS CAG SOLUTIONS CORP SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR C/O CARLOS ALBERTO GARCIA BEOVIDES QUALIFIER200.00 O1/22/2020 0229-20-002883 This receipt is not valid in the following Municipalities: Aventurs, Doral, Hialeah, Key Biscayne, Miami Gardens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny Isles Beach, Town of Cutler Bay. M®CI For more information, visit www.miamidade.govhaxcollector of � JIMMY PATRONIS CHIEF FINANCIAL 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: 1/21/2020 PERSON: CARLOS A GARCIA BEOVIDES FEIN: 832589001 BUSINESS NAME AND ADDRESS: CAG SOLUTIONS CORP 1145 WEST 28 STREET APT 4 HIALEAH, FL 33010 SCOPE OF BUSINESS OR TRADE: Sheet Metal Work - Installation & Drivers EXPIRATION DATE: 1 /20/2022 EMAIL: YGARCIA@MARLESINSURANCEBROKERS.NET IMPORTANT: Pursuant to subsection 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 subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 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 E01104726 QUESTIONS? (850) 413-1609 Company Letter Head Date STATE OF FLORIDA COUNTY OF VAi Q m, d.Ud-e Before me this day personally appered Wo m Q� (�_ I G who, being duly swron deposes and says: That he or she will be the only person working on the project located at: 91b11 N e 4 -P�e M16rr ~l snf is 21, 33 )35 Contrator Signture .ih �} Sworn to (or affirmed) and suscribed before me this day of VQnQ 01 20_2-1 by 4221. MELISSA ALFONSO *� *e My COMMISSION 0 00 350206 EXPIRES: Ady 17, 2023 '+$F ^:• Bonded Thru Notmy PuM UMerW Im. Notary Public, State of Florida at Large and Witness Personally know Or Produced Identification Type of identification Produced ) I - 21is60 IfHv�ianz (Printed Name of Notary Public) (SEAL) 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' Comoensation Insurance Exemation 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 ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Z2�� Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this Z,5_ day of , 2020. By K.-vi ltf V_ of a I l k who is personally known to me or has produced as identification. oa0v •Wk Notary Public State of Florida Notary: Dayana Perez My Commission GG 139415 Expires08/29/2021 SEAL: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/18/2020 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER CONTACT NAME: Adrian Nodal PHOIAIC.NENo, (305) 826-4411 alc No): (305) 826-4334 Rapid Insurance Underwriters E-rapidinsurance@Bellsouth.net SS: PMAIL ADidinsurance Bellsouth.net 11300 NW 87th Ct. #150 INSURERS AFFORDING COVERAGE NAIC # INSURER A : GRANADA Hialeah Gardens FL 33018 INSURED INSURER B : INSURER C : CAG Solution Corp INSURER D : 1145 W 28th St INSURER E Hialeah, FL 33010 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. INSR TYPE OF INSURANCE ADDL SUER. LTR POLICY NUMBER POLICY EFF POLICY EXP i LIMITS MMIDDIYYYY MM/DD/YYYY GENERAL LIABILITY �(((�X I EACH OCCURRENCE S 1,000,000.00 jI��CO����MMERCIAL CLAINIS-MADE J\ OCCUR DAMAGE TO RENTED PREMISES IEa occurrence) I S 100.000.00 MED EXP (Any one person) S 5,000.00 0185FLOO119343-1 01/04/2020 01/04/2021 PERSONAL & ADV INJURY S 1,000,000.00 GENERAL AGGREGATE S 2,000,000.00 A AGGREGATE LIMIT APPLIES PER: �'EE_NIL /� POLICY PRO - Ix, JECT LOC I PRODUCTS - COMP/OPAGG S 2,000,000.00 OTHER: I I IS AUTOMOBILE LIABILITY I C0M 3INED SINGLE LIMIT S iEa accidenq BODILY INJURY (Per person) S ANY AUTO I OWNED r—� SCHEDULED I I I AUTOS ONLY AUTOS I BODILY INJURY (Per accident). S �� HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accdent S S UMBRELLA LIAB HOCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Contractor License #: 16BS00160 Subject to Policy terms and Conditions Miami Shore Village 10050 NE 2nd Avenue Miami, FL 33138 LANULLLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CAG SOLUTION CORP Seamless Rain Gutters, Shutters, Accordion -Panels, Aluminum Roofing, Regular- Insulation. Painting. Pressure Cleaning. All types of fences All types of welding works g6, Ph:305.224.2127 Ph:786.262.0407 g.a a6, !agsolutionscorp@gmaii.com .'www.cagsolutionsfi.com 1i ald r%W r iC 2 a F- w o 2 r— I , w f z ? I I� z Q m I-- i ( C) m 9 Painting 0 Exterior O Interior Gutters Colors /42 lelorcshutters Downspout Colors _��� O Accordion Facia O Panels Screen Enclosed Color Fence Measurements: Linear Feel: 2 �t3 Total Downspout: Total Feet: �I• 2— Check No: Received by: Date: 1-3 . . •••• ••••• ...... . ••••• 06 e. • • • • •••••• ••• • O •••• •• • •• ••• •• • •• ••••• • • • • • • • • •• • •••••••• • • • • • • •• • •• • •••• • • • •••• /3 10 .` " % fQ _ IV.jik L 4!-'-i if — Pressure Washing " Aluminum Roofing Downspout size Gutter Size Olnsulation 04 x 5 0 5' K ORegular X x 4 6' K Color 02 x 3 O 'K Door O Conductor O Custom make Materials: Aluminum O Copper O Galvanized O PVC Signature Costumers Address: 1K State: t "�`'� Zip Code: �� `3 B Signature _ Sale Rep: CANCELLATION POLICY If the job is cancelled we retain the 25% of the actual deposit. Hea O Half round C"hTotal• -S� Anchor s) I I 1a5t 0 Spikes crew Hangers O Aluminum Screen O Painting • Total price would be charge after Tax: 90 days of proposal date. Customers Total' agree to pay additional charge determined by the contrasctor, or Amount Paid: expenses for any overdrawn or Amount Due: returned check Note: No alteration or additional work shall be performed unless agree to by "CAG Solution Corp." before hand in writing. Guarantee: 1 year guarantee on labor, 20 years on materials by factory. Guarantee on labor includes liquid corners and downs pout repair. This does not include damage caused by hurricanes. We are not responsible for damages on any roofs. ALL CREDIT CARDS 3% 1147 W. 28 St. visa AMIX Hialeah, FL 33010