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PW-2-18-402, 125 NW 95 StURES L�! �LORIdp' Project Address Miami Shores Village 10050 N.E. 2nd Avenue NW Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number Applicant 125 NW 95 Street 1131010240320 MICHAEL JOHN LEWIS ALEXAN Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ... W..._ .___ - ----- MICHAEL JOHN LEWIS ALEXANDRA 125 NW 95 Street - ----- - MIAMI SHORES FL 33150- 125 NW 95 Street MIAMI SHORES FL 33150- Contractors) Phone Cell Phone MECA CONTRACTORS INC (305)542-9439 nning: 1 Fees Due Amount CCF $0.00 DBPR Fee $0.00 DCA Fee $0.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $104.00 Valuation: $ 1,000.00 Total Sq Feet: 200 Pay Date Pay Type Amt Paid Amt Due Invoice # PW-2-18-66468 02/21/2018 Credit Card $ 104.00 $ 0.00 Available Inspections: Inspection Type: Excavation Final Public Works Review Public Works 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, PLIJ.MBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: l-certify that off 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. February 21, 2018 Applicant / Contractor / Agent Buikifi4`Diepartment Copy February 21, 2018 J Miami Shores Village B 1 Q)$ Public Works Department (305)795-2210 i Public works forms are available from the building department, 10050 NE 2"d Ave., Miami Shore �-11 PUBLIC WORKS PERMIT APPLICATION Permit Type: Work in the Right -of -Way on Miami Shores Village or Miami -Dade Property Permit#: S ( V Z -" " VA{ (9 Name of Applicant (if utility see below): /q1E,1A—A1[) -fF G_(,/S do" Owner off the following described property: Legal Description: Lot Block Subdivision Folio #; d - 3/01 - O 2y ._ 03 V Address: Z Z f") INJ w-) 0 5 TN 6i_ 1 5 UTILITY NAME: Qualifier/Authorized Agent: Address: Citv: Telephone: State Certification or Registration #: Email: State: ZIP: Certificate of Competency # CONTRACTOR NAME: /1 Gft eQnl7_e19C/-04C /'/I[ Qualifier/Authorized Agent: c2jjq ", Address: l , City: M 097" l State: ZIP: Telephone: 306 - -5 Email: State Certification or Registration Certificate of Competency #: Requests permission to install (describe work, attach separate page if necessary) in the adjoining right of way: Type of Work: ❑ Paving ❑ Utility ❑ Landscape ❑ Antenna DESIGNER: Architect/Engineer: Address: City: Telephone: Registration #: State: Email: ❑ Sidewalk ❑ Electric ❑ Irrigation ❑ Other: Im Value of Work for this Permit: $ ! MO T) Square/Lineal Footage of Work: ***** Fees***** Permit Fee $ 100.00 Notary $ Training/Education $ 0.20 Technology Fee $ 0.80 Scanning $ _ Bond $ (if required) Total Fee Now Due $ Bonding Company's Name (if applicable): Bonding Company's Address: City: State: ZIP: Application is hereby made to obtain a public works permit to do the work in the right of way 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, regulation construction in this jurisdiction. I understand that separate permits must be secured for APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with applicable laws regulating construction and specifically construction in the right-of-way. "WARNING TO APPLICANT: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO THE RIGHT-OF-WAY. 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 public works permit with an estimated value exceeding $2,500, 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 the 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 public works permit is issued. In the absence of such posted notice the inspection will not be approved and a reinspection will be charged. 11-1 �7 —, Z/ SignZ�,egoilnginstrument Signature uthorized Agent Company/Utiltty A ent The was acknowledged before The foregoing instrumen was acknowledged before me this _ day of t• 201k, by m his __W day of -&LO 20�7 by hc.4.9, C07-0 LJ who Ue�C�. ,._ a T/u' who is personally known to me or who has produced is personally k�n to me or who has produced identification. as as identification. NOTARY PUBLIC: Sign: Print: lJU �Y.aM�;., f `�-Jldl�EiiiiTTNfEiilallf6E�' ' SEAL: s� �� = Notary Public - State of Florida • r • •; Commission # GG 050903 '•;?��, •••� My Comm. Expires Nov 26, 2020 +•••• Bonded through National Notary Assn. 'l, APPROVED BY: Public Works Director, or Designee 2017-04-15 STATE OF FLORIDA .:, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SOSA, CARLOS MANUEL MECA CONTRACTORS INC 5515 SW 148 COURT MIAMI MIAMI FL 33185 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myforidalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! RICK SCOTT, GOVERNOR LICENSE NUMBER (850) 487-1395 z STATE OF FLORIDA ' DEPARTMENT OF BUSINESS AND «` PROFESSIONAL REGULATION CGC 1515274 ISSUED: 06/29/2016 CERTIFIED GENERAL CONTRACTOR SOSA, CARLOS MANUEL MECA CONTRACTORS INC IS CERTIFIED under the provisions of Ch.489 FS. Expiration date AUG 31, 2018 1.1606290000809 DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 SOSA, CARLOS MANUEL MECA CONTRACTORS INC 12231 SW 118 LANE MIAMI FL 33186 ISSUED: 06/29/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1606290000809 C01274 Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 6247852 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES MECA CONTRACTORS INC RENEWAL SEPTEMBER 30, 2018 12231 SW 1 18 LN 6512512 Must be displayed at place of business MIAMI FL 33186 Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED MECA CONTRACTORS INC 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 1 CGC1515274 $82.50 10/09/2017 CRED ITCARD-18-001711 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 aft commercial vehicles — Miami -Dade Cade Sec Ba 27fi. For more information, visit www.miamidade.aovltaxcoflactar em ACOROF CERTIFICATE OF LIABILITY INSURANCE `„„�/ DATE(MM/DD/YYYY) 02/13/2018 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 endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Susan Camacho PHONNo,E xt : (305) 418 4701 ac No): (305) 418 4706 Just Insurance Brokers 1200 NW 78 Ave Suite 105 -MAIL scamacho@jibfi.net E-MAIL-ADDRESS:C)Ibfl.net INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Western World Miami FL 33126 INSURED INSURER B : INSURER C : Meca Contractors Inc. INSURER D : 12231 SW 118 Lane INSURER E : Miami, FL 33186 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 LTR I TYPE OF INSURANCE ADDL SUBR D POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED occurrence $ 100,000 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A NPP8368906 01/29/2018 01/29/2019 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 $ X POLICY PRO LOC AUTOMOBILE LIABILITY O BINEDISINGLE LIMIT tE,ANY BODILY INJURY (Per person) $ AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIREDAUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION OTH- WC STATU-Y LIMITS -H AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) General Contractor GEK7ltIGA I t MULUtK GANtrtLL.A I IUN Miami Shores Village BLDG Dept 10050 NE 2nd Ave Miami Shores, FL 33138 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 ACORD 25 (2010/06) 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4/6/2016 Report McAw 1 100% JEFF AiWRER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION • • CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAIN CONSTRUCTION INDUSTRY EXETMP71ON This certifies that the individual listed below has elected to be exam pt from Florida Workers' Compensation law. EFFEC71VE DATE: 6/7/2016 EXPIRATION DATE: 6/7f2018 PERSON: SOSA CARLOS M FEN: 262119789 BUSINESS NAME AND ADDRESS: MECACONTRACTORS INC 5515 SW 148 COURT MIAM FL 33185 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR nab remer OFS-F2-O WC-252 CERTIFICATE OF ELECTION TO 6E E)CEbPT REVISED 08-13 QUESTIONS? (850)413-1809 �..__.11____---u___—l_______a-- IrrrrnO_nni..1.1ZGXVW6... 1/2 You created this PDF from an application that is not licensed to print to novaPDF printer (hftp://www.novapdf.com) MECACONTRACTORS., INC. 5515 SW 148 Court Miami, FL 33185 Ph: 305-542-9437 Email: mecacontractors@gmail.com Date: Feb 10, 2018 State of Florida County of Miami Dade Before me this day appeared Carlos Sosa who being duly sworn deposes and says. That he or she will be the only person working of project located at: 125 NW 95 St Miami Shores FL 33150 Contractor Signature Sworn to (or Affirmed) and subscribed before me this 10 day of Feb, 2018 By Valentin Fernandez �'pV VALENTIN FERNANDEZ ?�' Notary Public - State of Florida •? Commission # GG 050903 '�,��,. • MY Comm. Expires Nov 28, 2020 Bonded through National Notary Assn. Personally know Or Produced Identification Type of Identification produced Print, type or Stamp Name of Notary Notice to Owner - Workers' Corn Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation Insurance Exemotion 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. l . 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 YOUCKNOWL GE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signatur • State of Florida County of Miami -Dade The foregoing was acknowledge before me this G day Re. re-0 9N , 20 1 c4 By kpt�iL .4b-AN IZ� �—TD� Avho is personally known tome or has produced 2 Notary: as identification. SEAL: ,e..y, ,r ^' ,...r c S 'r v ��aT °us. io:ary public State of Florida `n V21-22Z A4y Commission FF 15675 Expres09iO3;2018 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) &e i�tlV P 9- 646e�- 5 . hereinafter referred to as the owner of the following described property (address)- 6?5 n1 t-J %T;11 • '5 = Legal Description: Lot Block Subdivision Folio # Requests permission to install (describe work): Within the public right of way of (address) 1'7, 5 'N c,J r11' BK. 7r1851 F'a 4698 (Pss 1 j�C'e E.! 1 �1. ^{r. �.I_ 1... F, F. IN CONSIDERATION of the approval of this permit by the Viii, , the owner agrees as follows: 1. To maintain and repair, when necessary, the above -mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records-pf Dade County, Florida by the Village Manager of Miami Shores Village (or his fully auttodrjzed-re fesentative). STATE OF ROMA, C0U tr 5IHE� Mom RM ON �Y1W M .^env Signature iOwner or AgentState of Florida f}lE�iq�ll�� L� cS,RRITT#31022� County of Miami Dade ii The foregoing instrument was acknowledged before me this I day of 4'-�fZS , 201 c �, by who is personally known tome or who has produced as identification. ,,�+►++s+M1e�rlu.,. NOTARY PB Sign. - Print: o- �� .• #'FF959I �: eo end SEAL: