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DS-08-19-1803Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 102 NW 101ST ST, Miami Shores, FL 33150 Contacts Permit No.: DS-08-19-1803 Permit Type: Driveways/Sidewalks/Slabs Work Clossificatlon: Addition/Alteration Permit Status: Approved issue Date:10/04/2019 Expiration:04/01/2020 Parcel Number 1131010220210 Alvina Guevara Owner 102 NW 101 ST ANGEL FLORIDA BRICK INC Contractor JOSE RAU DA 17 NW 169 ST, NORTH MIAMI BEACH, FL 33169 Business: 7867159687 Description: INSTALLING 12X12 CONCRELBEREPLACED Valuation: $ 3,700.00 Ins ection Requests: DRIVEWAY AND REPLACING ASPHALT AP12X12 CONCRETE PAVERS. WALKWAY ENTRANCTotal Sq Feet: 700.00 _ WITH 12X12 PAVERS Fees Amount Application Fee - Other $50.00 CCF $2.40 Concrete/asphalt/pavers, slabs, dways, $75.00 swalks DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.80 Planning and Zoning Review Fee $35.00 Scanning Fee $9.00 Technology Fee $3.13 Total: $179.33 Payments Date Paid Amt Paid Total Fees $179.33 Check tt 1265 10/04/2019 $129.33 Cash 08/05/2019 $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 regulating c9A5truction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Signature: Owner / Applicant / Contractor / Agent October 04, 2019 Page 2 of 2 RECEIVED IvI4111 Miami Shores Village au 05 2019 5°T- Building Department BY; 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 ��'+F 1 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2014 014I /\ BUILDING Master Permit No. 7UILDIT APPLICATION sub Permit No. ING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL ❑ PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10 Z N W 10i ST City Miami Shores County: Miami Dade zip: ? 3 ! 5U Folio/Parcel#: 11- 3101 -0?2 - 0 z 1 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): At V I n/ A & U-L�1/ 14(`Zf1 Phone#: iB b T g 3 s) zpq Address: re 2 Nw 101 -V' city: 1(4wml S*a*c€3 State: T-L zip: 3 31S0 Tenant/Lessee Name: Phone#: a-b'b 'VI-3 7-17-q Email: CONTRACTOR: Company Name: 4r✓A £L -;iq&2 D/f 81C.1 G ki Phone#: dab 7:73 2 �q'7 Address: 1•a- N_W 16 7 cr City:yorz N Mr9wM f 6--A-C q State: .F 1- zip: '?316 `1 Qualifier Name: E .SQS£ A44k,- L 1 A ✓D Phone#: 446 *15' f b e?- State Certification or Registration #: o 3[?S coo 3 3 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: City: State:Zip: Value of Work for this Permit: $ 3 / :IL60 Square/Linear Footage of Work: i0U Seyu+x ber% Type of Work: ❑ Addition ❑ Alteration .❑ New •Repair/Replace VoorDemolltlon Description of Work: /n/D771 a'ryo i ZJc 17- cor^rcotc iF .Pf ews .r1'•(! 62 1 mei., ON]> 9'dPCaVA1r1 AV;" I ,?IWA-CH w IYH /CX (? CMV ezeYy ~4j. I-vAM'W" ew-mM✓Cr Tra if- rz'EAL FCFD wIT" ('zA I Z .poto-Fas . Specify color of color thru tile: An,+-„iezge, &r.2f!Z Submittal Fee $ /J C) d Permit Fee $ 1 a.J CCF $ a^^tj 0 f1 �r CO/CC $ Kl Scanning Fee $ '1. \\^� Radon Fee $ 0 • 0o , DDBPPRR $ OL.00 Notary $� Technology Fee $yA .p Training/Education Fee $ V• (Jv Double Fee $ Structural Reviews $ Bond $ Nmr ins- 35 TOTAL FEE NOW DUE$ dA Ip . K (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 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%�� rwA—tLi _ •?A �/!Y OWNER or AGENT The foregoing instrument was acknowledged before me this Signature CONTRACTOR The foregoing instrument was acknowledged before me this a�uNl�- day of *C 4 20 19 by day of '217 -20 d-i by AAA vv� GVie4o,C a`I , who is personally known to bS� OLoc 0, who is personally known to me or who has produced �-- L9 L identification and who did take an oath. NOTARY PUBLIC: Sign: Print: John Rogues r NOTARY PUBLIC as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: as Seal: ESTATE OF FLORIDA Seal: ac NOTARY PUBLIC y ' ' Comm# FF946106 c o STATE OF FLORIDA rNCE ten9 Expires 4/17/2020 ': �E 1 % Comm# FF946106 Expires 4/17/2020 ++*+++++*+++*+*++******++****+**r*+****++*+****+**++**+****++***+*w*++*+***+** +*++*+****+********++*+**+ APPROVED BY - " G Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) miamoi Shores Village Building Department SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, A"1.lIl At *- 6 0C'm``,'does hereby attest that (Property owner) The attached survey, performed by Z-AAINW—S �9 �• IAIC• (Name of surveyor's company) For address: 10 d w lot S7r, nKwna r 'N40(W5 331 SCE Performed on N LAO, (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. Further, Affiant say eth naught. Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this Z day of u*E Affiant is personally known to me, _produced as Revised on 5/22/2009/ Revised on 6/12109 Sohn *oquft NOTARY PUBLIC STATE OF FLORIDA Comm# FF946106 Expires 4117/2020 w wiB Constroction Trades ualifying Board BUSINESS CERTIFICATE OF COMPETENCY A FLORIDA BRICK INC .3.A.. f # i Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 5192299 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ANGEL FLORIDA BRICK INC RENEWAL ISEPTEMBER 30, 2020 17 NW 169 5T 5426531 N MIAMI BEACH, FL 33169 Must be displayed at place business Pursuant to County Code Chapter 8A - Art. 9 St 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED ANGEL FLORIDA BRICK INC 196 SPECIALTY BUILDING BY TA COLLECTOR CONTRACTOR 45.00 07/30/2019 Worker(s) 1 03BS00833 CREDITCARD-19-061615 This Local Business Tax Receipt only confirm payment of the Local Business Tax. The Receipt is not a license, permit or a certification of the holders 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 ea-276. MI®H= For more information, visit www m'nm'dede gnvXazenllectnr Municipal Contractor's Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL- DO NOT PAY CC NO: 03BS00833 BUSINESS NAME/LOCATION RECEIPT No. ANGEL FLORIDA BRICK INC 17 NW 169 ST 7575874 N MIAMI BEACH, FL 33169 Imc EXPIRES SEPTEMBER 30, 2020 TYPE OF BUSINESS OWNER ANGEL FLORIDA BRICK INC SPECIALTY BUILDING CONTRACTOR Restricted to City of Miami Shores N® For more information, visit 'a 'd d !1 Iledor_ Pursuant to County Code Sec 10-24 PAYMENT RECEIVED BY TAX COLLECTOR 37.50 07/30/2019 CREDITCARD-19-061615 •4`�'QRI� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYM 07/31/19 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(les) 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 CONTACT NAME: Lucia Estrella Accurate 8300 West Flagler Suite 114 PHONE : (305)226-8727 FAX No): (305)226-8767 .No' accurte.cerUficates@gmail.com INSURERS AFFORDING COVERAGE NAIC # Miami, FL 33144 INSURER A: Granada Insurance Company Phone (305) 226-8727 Fax (305) 226-8767 INSURED INSURER B : INSURER C : Angel Florida Brick Inc. INSURER D : 2325 NW 195th Street - INSURER E : Miami, FL 33056- INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S 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 ADD UBR POLICY NUMBER MMIDDYIYYYY MMIDDIYYYY LtI>dRS A GENERAL LIABILITY Q COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR ❑ ❑ GEN'L AGGREGATE LIMIT APPLIES PER: d❑ POLICY ❑ PRO ❑ LOC N N 0185FL00086280-2 08/24/2018 08/24/2019 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED PREMi E Ea occu a ce $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL & ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMPIOP AGG $ 2.000.000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AUTOLL S OWNED ❑ SCHEDULED ❑ HIRED AUTOS ❑ AUTOS -OWNED ❑ ❑ NN OMaBIINEIISINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident $ POPaaR d t AMAGE ❑ UMBRELLA LIAB [:]OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTiVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A ❑ WC STATU- ❑ OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltional Romarks Schodole, if mom space Is roquirod) 03BS00833 CERTIFICATE HOLDER Village of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 CANCELLATION SHOULD ANY OF THE ABOVE DES THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY AUTHORIZED REPRESENTATIVE Lucia Estrella BEFORE 01988-2010 ACkRb 9611PORAkTION. All rights reserved. ACORD 25 (2010105) OF The ACORD name a loco are reb'wAared marks of ACORD li* � CERTIFICATE OF LIABILITY INSURANCE DATE(UMIDDNYYY) 10/03/19 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 endorsemenL A statemad on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER Accurate 8300 West Flagler Suite 114 Miami. FL 33144 Phone 305 226-8727 Fax (305) 226-8767 CONTACT Lucia Estrella PHONE Ertl: (305)226-8727 No(305)226-8767 DD accurtecedreates@gmad.com INSURE 8 AFFORDING COVERAGE NAIC # INSURER A: Granada Insurance Company INSURED Angel Florida Brick Inc. 2325 NW 195th Street Miami, FL 33056- INSURER 8 : INSURER C - INSURER D : INSURER E - INSURER F - 9uV'r-Ka stz [:eRTIFiGATE 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. L LTR TYPE OF INSURANCE ADa UBR POLICY NUMBER POLIO FF PMG�D LMM A GENERAL LtABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE ® OCCUR ❑ ❑ GEN'L AGGREGATE LIMIT APPLIES PER: ® POLICY ❑ PR - ❑ LOC N N 0185FL00086280 - 3 08/24/2019 08/24/2020 EACH OCCURRENCE a 1.000.000.00 DAMA® PREMISES *=mencel a 100,000.00 Any at MED EXP ate person) a 5,000.00 PERSONAL 8 ADV INJURY a 1,000,000.00 GENERAL AGGREGATE s 2,000,000.00 PRODUCTS - COMPIOP AGG s 2.000.000.00 a AUTOMOWLE LIABILITY ❑ ANY AUTO AAUTLL OS ED ❑ ODSULEO ❑ HIRED AUTOS ❑ Af UTOSWNED C IEOMMgrS[NGLE LIMIT BODILY INJURY (Per person) i BODILY INJURY (Per accident S P AMAGE a a ❑ UMBRELLA LIAR ❑ OCCUR EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE a AGGREGATE a El DEO RETENTIONS S WORKERS COIrIP£NSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDI�4 (Munder yyand �fn NH) 'off �BCR[P noN OF OPERATIONS below N I A - 0 M STATUTW EL EACH ACCIDENT a EL DISEASE - EA EMPL S EL DISEASE - POLICY LIMB S DESCROMON OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remoks Ssl:sdtrts. if rwre space Is ngsrired) License # 03BS00833 GERTIFIGATE MOLDER Miami Shore Village Building Department 10060 NE 2 Ave Miami Shores Village FL 33138 Fax 305-756.8972 CANCELLATION SHOULD ANY OF THE ABA THE EXPIRATION DATE T ACCORDANCE WITH THE AUTHORIZED REPRESENTA Lucia Estrella 'IES BE CANCELLED BEFORE BE DELIVERED IN 01988.201�ACORD qORPORATION. All rights reserved. ACORD 25 (2010105) OF The ACORD name and 16go pre registered marks of ACORD we 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: 4/25/2019 PERSON: JOSE A RAUDA FEIN: 731689687 BUSINESS NAME AND ADDRESS: ANGEL FLORIDA BRICK, INC. 17NW169ST MIAMI, FL 33169 SCOPE OF BUSINESS OR TRADE: Ceramic Tile, Indoor Stcne. Marble, or Mosaic Work EXPIRATION DATE: 4/24/2021 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 Cling 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 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 Worker's' 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:%`{Q./AaAt1ft4/ Owner State of Florida County of Miami -Dade \ ,( The foregoing was acknowledge before me this SeL day of Jam-, 20 I q By N V t`\'o" G' UNr < a- who is personally known to me or has produced John Roques as identification. Otn " NOT z. , NOTARY PUBLIC t� STATE OF FLORIDA Notary: - Comm# FF946106 E 19l9 Expires 4/17/2020 SEAL: ANGEL FLORIDA BRICKS Date: 7/22/2019 State of Florida County of Miami Shores Village Before me this day personally appeareUlodeJ who, being duly sworn, deposes and says: That he or she will be the only persons working on the project located at: .�O ? n w 0. o,r0 %'5 o0 Contractor Signature Sworn to (or affirmed) and subscribed before me this Z Z day of L 20-4-4. �ptARY John Roques oR NOTARY PUBLIC o STATE OF FLORIDA ? Comm# FF946106 CE I Expires 4/17/2o2p Personally know Or produced identification Type of identification produced V/- -t> L p name of notary CGC # 03BS00833 This property descri7in , The East 11 of Lot 5 Lot 6; Block 3,GOLD CREST,according to the Plathereof, as recorded1 A �C z'3/g9 Plat Book 21, LIB L of h� P ol�IL 1-t44��c1 Dam pp'' LIC�5 Lav rR��-{►FI(E�W\� f Note: tU�pexps,Qu �l�bcr�c'Hs" and srta"_ Fc �7 Qi uti3 V�f1'�J r not located. NO OBJECTION FLOOD ZONE: x Florida Health Miami -Dade County Certified To: consumers Title Age1P•,T.D&&,V\j4U ggig���dn Sergio M. and Alvina H. and F,yjjjtgag its successors and/or assignsn,,,. oignature 1 ' 00 AP � m fi1 2 /9• 1J5� �+ I I I _�1 _ � cc. � m /7.�7• � Q - m 29 0.20 e,1. a✓P�/eoo' Uri/rfy � PROPERTY OF: Guevara, Sergio M. and Alvina H. Not valid unless embossed SURVEY with. Stirveyor`s Teal. I.hereby certify that the survey repre. sented hereon meets the minimum technical standards set forth by the Board of Land Surveyors pursuant to Section 472027, Fla. Statutes. There are on the,Mat, other than as slo. // P J..l ` 13At 85•� a a..�� w S 7� 4v,�/'- , l� i 50 5 r11�' \ w Z o , AT. :, q�v�tgVNk f.41Wh [' 4� tt lu�.K7 j00 \Ij l,l 02 N.W. 101st Street, L A N-N E-5 and CA R C I A, INC. ENGINEERS - LAND SURVEYORS - LAND PLANNERS Office address: 359 Alcazar Avenue, Coral Gables, Florida 33134 Mailing address: P.O. Box 561131, Miami, Florida 33156 Reg. Land' urveyor No. ` Vf� DATE SCALE DRAWN BY I DRWG. NO :.ICE 4t(.eor=Sf4E5 //—/6-9/ 1 ///=2F%' 1 60*ra zJ 1q1-11.1 a .....: .. . . ..