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EL-07-19-1630, 9923 NE 4th Avenue RdMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address M Parcel Number 923 NE 4TH AVENUE RD, Miami Shores, FL 33138 1132060171290 >ntacts rvrrrfff amcus: f4Pprvtn Expiration: 03/18/2020 BEVERLY MARKOWITZ Owner MAJESTY ELECTRIC SERVICES CORP Contractor 9923 NE 4 AVE RD, MIAMI SHORES, FL 331382439 RAFAEL GUTA Business: 7864029150 Inspection Requests: gl Description CHANGE GFI IN BATHROOM, UPGRADE THE I Valuation: $ 600.00 x �� SWITCHES, CHANGE THE FIXTURE LIGHT IN BATHROOM Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 07/16/2019 $50.00 Credit Card 08/21/2019 $60.30 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 A (DAVIT: I �cert' lFuermore, e foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatin on ruction and I authorize the above named contractor to do the work stated. / 0 Authorized Signature: Owner / Applicant / Contractor ! Agent Date October 09, 2019 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 9923 NE 4TH AVENUE RD, Miami Shores, FL 33138 1132060171290 :ontacts BEVERLY MARKOWITZ Owner GARY CONSTRUCTION LLC Contractor 9923 NE 4 AVE RD, MIAMI SHORES, FL 331382439 GADISAI AGUI 1826 RODMAN ST, HOLLYWOOD, FL 33020 Mobile: 7863128111 Inspection Requests: Description: CHANGE GFI IN BATHROOM, UPGRADE THE Valuation: $ 600.00 ^^^^ ^ 305 SWITCHES, CHANGE THE FIXTURE LIGHT IN BATHROOM Total Sq Feet: 0.00 § Fees Amount Application Fee - Other $50.00 CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $50.00 Scanning Fee $3.00 Technology Fee $2.50 Total: $110.30 Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 07/16/2019 $50.00 Credit Card 08/21/2019 $60.30 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 construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized SignaYjre: Owner Applicant / Contractor / Agent Date August 21, 2019 Page 2 of 2 RECEIVE;n Miami Shores Village J L 11 "1 Building Department BY: 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 6TIt FBC 20 \4 BUILDING Master Permit No. -LLL.' o� - 1 mot— ((o" PERMIT APPLICATION Sub Permit No. BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: M 3�L3 Folio/Parcel#: Is the Building Historically Designated: Yes NO _X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 1,1(` k L(.C'I Z-- Phone#: 0� 05— J 9,2 _ 22—CY Address: City: )��1151.1 P —State: i_ Zip: Tenant/Lessee Name: Phone#: Email: CON' Addr 5D City: // cv C J State: 1` C� Zip: ps✓ 7�� Qualifier Name: 1p,41 01IJI9— Phone#: State Certification or Registration #: Certificate of Competency #:OF DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ To 0 Ir 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ! M Repair/Replace ❑ Demolition Description of Work: Q'r) RMi G c 6- f I Yi `t ,) oc) (y) am `\ c,'dy u r A,r � ,k A i e lim V1 Y\beA Vircc, wi Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ CCF $ CO/CC $ _ DBPR $ Notary $_ Double Fee $ _ Bond $ TOTAL FEE NOW DUE $ o 3() (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. //7 r^ Signature Lkv" ' Signature s OWNor AGENT V CONTRACTOR The foregoing instrument was acknowledged before this The foregoing instrument was acknowledged before me this qme day of �L L 20 l / by day of J 0 20 lei by e Vett 2I �m y}(ZKo U, I t who is personally known to 9,64 -�- - ) C-1 u iO+ who is personally known to me or who has produced F/— 1) 0- Li C as me or who has produced + ) I Lf2,g ti- as 6230"0 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ) Sign: Sign: Print: lix _f n Print: t 1 I L I Seal: MY COMMISSION # GG 074766 Seal: *: �'",:.•�o`= EXPIRES: April 14, 2021 " Notary Public State o/ Florida %; dF F qP Bonded Thru Notary Pubk UrMWwritNs Natalie Orta r My Commission GG 324647 Expires 04/17/2023 ************************************************************* * * * ** ********************** ************* APPROVED BY � )2< / / Flans Examiner Zoning Structural Review Clerk (Revised02/24/2014) CTQB Construction Trades Quafifying Board BUSINESS CERTIFICATE OF COMPETENC` 01 E000164 MAJESTY ELECTRIC SERVICE CORP D.B.A.: GUTA' f�'AFAEL Is certifted under the provisions of Chapter 10 of Miami -Dade County Local Business Tax Fbcei pt Miami -Dade County, State of Florida - THIS IS NOT A BILL - DO NOT PAY 4470308 BUSINESS NAM E/LOCATION MAJESTY ELECTRIC SERVICE CORP 11870 HIALEAH GARDENS BLVD UNIT 129-1 HIALEAH GARDENS, FL 33018 RECEIPT NO EXPIRES RENEWAL SEPTEMBER 30, 2019 4666765 Must be displayed at place of business Pursuant to County Code Chapter BA Art. 9 & 10 OWNER SEC TYPE OF BUSINESS MAJESTY ELECTRIC SERVICE CORP 196 ELECTRICAL CONTRACTOR Worker(s) 01E000164 PAYMENT RECEIVED BY TAX COLLECTOR 45.00 09/21/2018 0204-18-001828 This Local Business Tax fbcei pt only con"m s payment d the Local Business Tax. The Race pt is not a license, permit, or a certi "cation d the holdei s quad i "cations, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The FECEI T NO. above must be displayed on all comrrercid vehicles - Miami -Dade Code Sac Ba-276. MMM A For more information, visit www r iarnidade ggyAmcdleCtor Muni ci pal Contractor's Tax %cei pt Miami -Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY CC NO: 01®00164 mc BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES MAEM8117 CSDUCE�coSEPTEMBER 30, 2019 11870 HIALEAH CaAADBd WO UNIT 7550857 129-1 HIALEAH GENE, FL 33018 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS MAESiY ELMTRIC SSMCE COMP 9.f;TR M CON?RAMR PA Y E N T RECEIVED BY TAX COLLECTOR 200.00 09/21/2018 0204-18-001828 This receipt is riot valid in the following Municipalities: Aventura, Doral, Hialeah," Biscayne, Miami Cvrdens, Miami Lakes, Palmetto Bay, Pinecrest, Sunny Isles Beach, Town of Cutler Bay. MIAM D �Sa�l�1 Forrtwmwww .olarridademoy/taxcollect RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY db ,s pr STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN HAS REGISTERED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES GUTA, RAFAEL MAJESTY ELECTRIC SERVICE CORP 11870 HIALEAH GARDENS BLVD UNIT 129-122 H IALEAH GARDENS FL 33018 4 LICENSE NUMBER: ER0015382 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com Rur a Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNM) 11....-- 07/08/19 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: H the certificate holder is an ADDITIONAL. INSURED, the poliicy(ies) must be endorsed I SUBROGATION IS WAIVED, subject to the terms and conditions of the po", car Policies may require an endorsement. A statement on this cortiRcate does not confer rights to the certificate holder in lieu of such endorsernent(s). PRODUCER CONTACT NAME. Floridian Consultants Insurance (PHONE, � (305)225-9711 FAXNo): (305)225 7477 9371 S.W. 40th St E'er FOOL-COM Miami, FL 33165 Iems)AFFORDING COVERAGE NAIC0 Phone (305)225 9711 Fax (305)225-7477 INSURER A: GRANADA INSURANCE COMPANY INSURED INSURER B MAJESTY ELECTRIC SERVICE CORP INSURER C 8752 NW 107 TERR INSLIIRER0: HIALEAH GARDENS, FL 33018- (305) 825-2680� y INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 CONTRACTOR 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 CLAIMIS. MA POLICY EFF L�1T4R TYPE OFINSLlRANCE j Tw..-- swuiry .� d %n t010ue�wv�nl LIMITS GENERAL LIABILITY W1 COMMERCIAL GENERAL LIABILITY A ❑ ❑ CLAIMS -MADE e OCCUR N El GEN'L AGGREGATE LIMIT APPLIES PER ❑� POLICY ❑ JPE Q ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ALL OWNED SCHEDULED AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ AUFIOTO'OSWNEO ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMSWADE ❑ DED ❑ RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERlEXECUTIVE OFFICERIMEMBER EXCLUDED? N i A (Mandatory in NH) "yes, describe under DESCRIPTION OF OPERATIONS bellow EACH OCCURRENCE $ 1,000,000.00 OANAGE TO RENTED PREMISES Ea occurrence $ 1 O0,000.00 UM ExP (Any one person) PERSONAL a ADV INJURY S 5,000.00 $ 1,000,000.00 0185FL00045062 04120/2019 04/20/2020 GENERAL AGGREGATE $ 2,000,000.00 PROOucTS-COMP/OPAGG $ 2,000,000.00 S COMBIN=SINGLE LIMIT BODILY INJURY (Par person) $ BODILY INJURY (Per accident) $ P 'AMAGE $ S EACH OCCURRENCE $ AGGREGATE $ $ ❑ TW«n LI MITTS D ER E.L. EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 101. Additional Ramada Schedule. N own space is nwph M ELECTRICAL WORK-WHITHIN BUILDING CERTIFICATE HOLDER Miami Shores Village Building Dept 10050 N.E 2nd Ave Miami Shores, FL 33138 ACORD 25 (2010105) QF CANCELLATION SHOULD ANY OF THE ABOVE DESCREED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD W1 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: 10/30/2017 PERSON: GUTA FEIN: 650915372 BUSINESS NAME AND ADDRESS: MAJESTY ELECTRIC SERVICE CORP. EXPIRATION DATE: 10/30/2019 RAFAEL 11870 HIALEAH GARDENS BLVD. UNI, T 129-122 HIALEAH FL 33018 GARDENS SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor 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 Ma'estY Electric Service Corp. Date: 7-05-2019 State of Florida County of Dade Before me this day personally appeared Rafael Guia who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at 9923 N.E. 4r" Agami, Fl Con Sworn to (or affirmed) and subscribed before me this_ day of onally Know N��YPubUc8f"O'Fq)r oduced Identification Natalie u /�� a ,, ► 032"Typ of Identification Produced PI I�cQoce P Mt, type or tamp Name of Notary Phone 786-402-9150 11870 Hialeah Gardens Blvd Unit 129-122 License No. CC01E000164 Hialeah Gardens FI 33018 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. 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: &4ea , Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this b day of cJy 20 a By ?�V P-7 i2 W Notary SEAL who is personally known to me or has produced > It as identification. SINDIA ALVAREZ '; MY COMMISSION # GG 238273 Bonded Thru Notary public Underwriters