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MC-19-1978Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit No.: MC-08-"-1878 Peru Type: Me kal - Residential Work Classification: Alteration Permit Status: Approved Issue Date: 09/12/2019 1 Expiration:03/10/2020 Location Address Parcel Number 175 NW 98TH ST, Miami Shores, FL 33150 1131010240120 Contacts David Foley Owner INDIRA RAD GUTIERREZ Owner 17598 Home: 3056080714 SOFGOV LLC Contractor JOSE GOVEA 8200 SW 44 ST, MIAMI, FL 33155 Business: 7865719603 rguzmbw48@hotmail.com Description: EXHAUST FANS. HOOD. AIR DIFFUSERS. Valuation: $2,800.00 Inspection Requests: r-762-4944 Total Sq Feet: 1,896.00 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 Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 09/12/2019 $61.90 Credit Card 08/27/2019 $50.00 Amount Due: $0.00 Building Department Copy 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 re g constructiontan z 'ng. Futhermore, I authorize the above named contractor to do the work stated. Authorized Owner / Applicant / Contractor ! Agent Date September 12, 2019 Page 2 of 2 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 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING C AUG a 7 20A9 FBC 20 Master Permit No. RG 05_1 `c —106— Sub Permit No. ` �-08 ^ 1 1 ` 1 1 /j 8 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ^� �-- r ' �� % (�jQ , f CONTRACTOR DRAWINGS JOB ADDRESS: 1 '[ e N W qs+ K 5TPE I, City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: l I ^ i), V 1 2-0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: CfS Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): - ID I 1� le--,5 � Phone#: Cc 08Cq I q Address: 0-30/- le - G�� r� City: (()_ �C, cqC 4 �'� State: E' - Zip: J � 1 l Tenant/Lessee 1Na�me:e: Email: L h&' (< hone#: CONTRACTOR: Company Name: W 1 &OV 41C Phone#:�i0ro -54 1 I IUv3 Address: c0720o f)w tqq fn City: A � '(i / .,State: ��L- Zip:: �p Qualifier Name: c 05 ��� /^� l7KJ�%�� Phone#: 18630 39-7/ State Certification or Registration #: (f N G DESIGNS Address: ficate of Competency #: :�186 511%03 te:-TL Zip: 3 -61 1 Value of Work for this Permit: $ G/ `tSL.e/ - Square/Linear Footage of Work: Type of Work:: , Addition 11 ❑ Alteration ' 1C- ❑ New ❑ Repair/Replace �• ❑�Decmolition : Description of Work'.,XTI�'\W� , ROOD 2 l�(U T 44 t., `Specify co/ofiof'color thru tile: Submittal fee $y • 0 po 1 Permit Fee $ D CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ 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 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. n Signature Signature NER or AGENT `CQNTRACT The foregoing instrument was acknowledged before me this day of 4 ct 20 by jr\dfrcf Kuu �Ah-VT y-who is personally known to me or who has producecI4120 ,1 I Cuts, as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: vo('f ftf, LotrJ erb Seal: IVONNE LANDERO *" = Notary Public - State of Florida :a. Commission # GG 006859 L3 ''�rF OF FI�P �`` i*iFK 1F1F'iiF iqi� a' APPROVED BY The foregoing instrume-"t as acknowledged before me this +3�'^ day of v 20 by CjO,'F t' U, Cuff} , who is personally known to me or who has produced E[ as identification and who did take an oath. NOTARY PUBLIC: ` JAlV�9 1�', v •�.apTARy'••.ti �Z Sign: Print: �vV1= (� ;� : g 20¢3 f C,) Seal: — GG No.Q :�si`�' .PUBOC:*.Q\Q`�� OF f %% F )I Fans Examiner Zoning Structural Review Clerk (Revised02/24/2014) SofGov LLC Date: State of F 10 Y do Cad Eoun" of M tCIMl DO( .P. Before me this day personally appeared Use. M. cioven Wh o. Being duly sworn, deposes and says: That he will be the only person working on the Project locate at: Contract jnature Swan to(or irned) and subscribed before me this day -'— 20 Personally know, Or Produced Identification pro( , Type of Identification Produced J)nv ji Licenje. I Q-th �itltt�t'' 4!40s'�,, Q.,Z..... D .• :. - Print Type or Stamp Name of Notary 0 T PUB:=�%o�.� Sof Gov LLC ',,0,� ;1O; 00,�• 8200 sw 44 st Miami Fl 33155 (305) 803-4634 a 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 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: 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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 T14AT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. I - 1� Signature: 3a caner State of Florida County of Miami -Dade The foregoing was acknowledge before me this 3� day of q S-% , 20 By 1i� l ra�;�;rre� who is personally known to me or has produced �Orlda 1 1 I ft r as identification. Notary: IVONNE LANDERO SEAL: . �. Notary Public - State of Florida Commission # GG 006859 1 IIIIII I� My Comm. Expires Jun 28, 2020 STATE OF FLORIDA DEPARTMENT dbpr OF BUSINESS AND PROFESSIONAL C6 REGULATION 0 0 0 �CAC1818162 ISSUED: 06/04/2018 0- �CLASS B AIR CONDITIONING CONTRACTOR QGOVEA, JOSE MIGUEL <S .2. OFGOV, LLC. ACORO® CERTIFICATE OF LIA THIS TIFICATE IS ISSUED AS A MATTER OF INFORMATION OP CERTIF TE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN BELOW. IS CERTIFICATE OF INSURANCE DOES NOT CONSTIT REPRESE ATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANTlif the certificate holder is an ADDITIONAL INSURED, tl the terms an onditions of the policy, certain policies may require al certificate hold' in lieu of such endorsement(s). PRODUCER Just Insurance Broke 1200 NW 78 Avenue Suite 105 Miami _ INSURED SOFGOV, LLC 8200 SW 44 St FL 33126 Miami' FL 33155 COVERAGES IFICATE NUMBER: OF INSURANCE LISTED BELOW INDICATED. NOTWITHSTANDING UIREMENT, TERM OR CONDITIC THIS IS TO CERTIFY THAT THE AOLICIES. CERTIFICATE MAY BE ISSUED OERTAIN, THE INSURANCE AFFO EXCLUSIONS AND CONDITIONS O LIMITS SHOWN MAY HA INSR LTR TYPE OF INSURANCE DL SUBR POLICY NUMBER A X COMMERCIAL GENERAL LI ILITY CLAIMS -MADE 17OCCUR CPS2855812 GEN'L AGGREGATE LI APPLIES PER: X POLICY CT E LOC OTHER: AUTOMOBILE BILITY ANY A ALL NED SCHEDULED A S AUTOS NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION 8/11 /2019 Photo from Indira RICK SCOTT. GOVERNOR iLDE MILLER, INTERIM - 'R TARP STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD Acemse NUMBER Nu fieu MOW 10 S lc;r%1 lrlr_u Under the provisions of Chappter Expiration date; AUG 31, 2f118 GOVEA, JOSE MIGUEL SOFGOV, LLC 8204 SW 44TH STREET MIAMI FL 3 IN ISSUED: 02/06/2017 DISPLAYAS REQUIRED BY LAW 13 „ oil ❑ o, • - t rc rr� a Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑! N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES CAI) 00 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT 1 $ Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER ,• CANCELL I N SHOULD ANY OF THEk$QVE DESCRIBED POLICIES BE CANCELLED BEFORE l THE EXPIRATION DATE"REOF, NOTICE WILL BE DELIVERED IN For Informational PyrpoSta ACCORDANCE WITH THE POLI OVISIONS. " ~ SOF Ir AUTHORIZED REPRESENTATIVE 82 0 SW 44 STREET MIAMI FL 33155 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 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: 11/2812018 EXPIRATION DATE: 11/27/2020 PERSON: MICHEL A HERIA EMAIL: SOFGOV25QGMAIL.COM FEIN: 812784566 BUSINESS NAME AND ADDRESS: SOFGOV LLC 8200 SW 44 ST MIAMI, FL 33155 SCOPE OF BUSINESS OR TRADE: Heating, ventilation, Air- Corxidwn g and Relnwabon Systems Instakatmn, service and Repair. Shy, Yard & Drivers IMPORTANT: Pursuant to Chapter 440.45(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under iNs 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 ony within the stripe of Me 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 cartiiicates of election to be exempt shall be subject to revocation it, at anytime 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 cerldicate at any firne 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 ECEIPT NO. -­----Sw"r1RES ENEW SEPTEMBER 3Q, 2 08 504074' Must be displayed at place ofb mess Pursuant to County Ce Chapter 8AArt. 10 )F BUSINESS :-CHANICAL CONTRACTOR ENT RECEIVED Y T COLLECTOR 0 $75.00 17/2017 CREDITCA 17-048113 of the Local B ess Tax. The Receipt is not a license, do busin older must comply with any governmental ,hich apply to the business. ornmercial vehicles - Miami -Dade Code Sec 8a-276. Nw.mAiAmidad"ov axcollector F= W7 111#PWIX e Local Business Tax R., ce'P Miami -Dade County, State of Florid —THIS IS NOT A BILL — DO NOT PAY I 61.`STAk'by(;W1 ' SOFGOV LLC 8200 SW 44TH S MIAMI FL, 33155 1 OWNER 50FGOV LLC C/O JOSE MIGUEL GOVEA MGR RECEI" NO. EXPIRES RENEWAL SEPTEMBER 30,2020 7504074 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPEC MECHANICAL CONTRACTOR CAC1818162 PAYMENT RECEIVED BY TAX COLLECTOR., $75.00 07/08/2019 --- - - CREDITCAIII D-1 9-051870 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 of nongovernmental regulatory laws end requirements which apply to the business. The RECEIPT NO. above must be displayed n*Uzommorcial vehicles - Miami -Dade Code Sac 8a-276. For more 8/26/2019 imagel .jpeg SOFOLLC41 �a CERTIFICATE OF LIABILITY INSURANCE THIS CERTI TE IS ISSUED AS A MATTER Of INFORMATION ONLY AND CONFERS NO ROM tom! THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMP -No, EXTEND ENS ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTnVTE A CONTRACT BETWEEN THE ISSUING INS RER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N ft twililkate hokW is an ADOMMAL INSURED, the poecy�(tea) must have AtN3 ONAL INSURED pmvisions or be It SUBROGATION IS WANED, subject to the terms and conditions of the pesky, cedain pa 1cles may require an endorsement. A stawmient on We cartMosta dose not tits to the certNkate tWdet in t,1 as *aft _r_.. n�!! aaau�c€ _ �cr Oscar HadJez I FAX t - j Insut Br W*M E 1315) 41 "701 ..41 7i)6M....... _. 1200 NW T8 Ave Suite 1I Oh ibN.rlei MNstnl, FL 33126 SOFGOY, L.LC 8200 SW Mt MI&K FL 33155 _ .. • ` " € j • • • • r ■ • 'It.. r • f • • --cut IIIItI I. tE lit AFP&S PER POMP ? i "i Lot ZTH-0.- 3NOOLE LASRM ANY AU10 ovmev AtiTi55 gsr€ir � auc€:a{q7{� 1-1 UIRIASAAUAD I OCCLA EXt LIAB CLA •N RG OPMATIOW LOCAT M / VfWLES IAAt01. "y to wftww P Air Conditioning Mecanical CERTIFICATE HOLDER CANCEi,L ATION___-__ Miami Shores Village 10050 NE 2nd Avenue, Miami Shores, FL 33138 a ►UFt i SHOULD ANY OF THE ABOVE DESCMBE D PgUM BE CANCELLED BOVAIE THE EXPIRATION GATE THEREOF, NOTICE WkL Of DELIVERED Of ACCORDANCE WITH THE POLICY PROVISIONS. https://maiI.googIe.com/mail/u/O/?tab=rm&ogbl#inbox?projector=1 1 /1