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EL-05-21-1165, 440 NE 92nd StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 440 NE 92ND ST, Miami Shores, FL 33138 1132060140050 Contacts GABRIELA ALMAGUER Owner GLEISY ELECTRIC INC Contractor 440 NE 92ND ST, Miami Shores, FL 33138 PEDRO JORGE CARDENTEY Home: 3057732237 mascaracan@gmail.com 8021 SW 197 TER, CUTLER BAY, FL 33189 Business: 3059702796 Ins oectron ts Description: ADD NEW OUTLETS WITH 2 NEW 20 AMP Valuation: $ 450.00 Requests: es : CIRCUITS FOR REMODEL KITCHEN CABINETS AS PER PLANS. 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 Building Department Copy Payments Date Paid Amt Paid Total Fees $110.30 Credit Card 07/29/2021 $110.30 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. AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws :onstr nd zoning. Futhermore, I authorize the above named contractor to do the work stated. c'I Z Signature: Owner / Applicant / Contractor / Agent Date July 29, 2021 Page 2 of 2 Miami Shores Village`EEI�TEI� Building Department v r, tvZi zl 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: AOL- Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 201 BUILDING Master Permit No. RC-11-20-2634 PERMIT APPLICATION Sub Permit No. F L— OS;- 0 ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 440 ne 92nd st City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 11-3206-014-0050 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee simple Titleholder): Daniel Alonso & Gabriela Herrera Phone#: 3057732237 Address: 440 ne 92 nd st city: miami shores State: fl Zip: 33138 Tenant/Lessee Name: n/a Phone#: n/a Email: mascaracan@ gmail.com / danielcalonso@ gmail.com CONTRACTOR: Company Name: C) I�.CS �/I eC/`�C ��/) C Phone#: Address: go '2— l S w t q 7 `t e, i'� C, 1,-1- 66N . H 33 ( Y.? City: r vTl e-, 0 hL State: F1 Zip: 3 3 �b �/ f Qualifier Name: rJ �� '� e�,/ Phone#: State Certification or Registration #: F(-4 boo %40I Certificate of Competency M DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $t%wU Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ElRepair/Replace ❑ Description of Work: Ai(] 4 -e u' 0 ✓�$ /Demolition � ' J'er"vde(e) [h &� e, C 001, , S. 45 p� /��•� s Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ pp TOTAL FEE NOW DUE $ ,L� 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. Signature �� ° Signature OWNER or AGENT CONTRACTOR ThMoing instrument was acknowledged before me this day of 14*%C0_ 20 21111by JULCL AZCA-750 , who is personally known to me or who has produced D z- as identification and who did take an oath. NOTARY PUBLIC: Sign: Print Seal: State of Florida -Notary Public Commission # GG 266354 ow ; My Commission Expires October 14, 2022 The foregoing instrument was acknowledged before me this �- day of ` , W L� , 20'ji by pEbRO d4R:tZ911 A -who is personally known to me or who has produced t\L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: APPROVED By Plan Examiner Structural Review (Revised02/24/2014) FLAVIA R RAMALLO State of Florida -Notary Publi Commission # GG 266354 My Commission Expires October 14, 2022 ********* _ Zoning _ Clerk Ron DtSanth, Govvernm kalsey Bcshears, SmTeury STATE OF FLORIDA 1 &VP%RTI+�ENT tJF BUSIVI"%7 0% W P�1%%&# 1QI'�^ nEt�IILATI^I~I 44 , THE ELECTRICAL I PROVISIO, CH x EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at NlyFioridaLicensexorn Do not alter this document in any form. This is your I%ense. It Is unlawful for anyone other than the licensee to use this document. Local Business Tax Receipt Miami -Dade County, State of Florida -THIS 1S NOT A BILL - 00 NOT PAY 4355095 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 4545W EXPIRE GLEISY ELECTRIC INC EPTEMBER 30, 2021 8021 SW 197TH TER CUTLER BAY, FL 33189 roust be displayed at place of business Pursuant to County Code Chapter 8A . Art, 9 & 10 e OWNER SEC. TYPE OF BUSINESS GLEIGY ELECTRIC INC 196 ELECTRICAL PAYMENT Y TAX OR C/O P'EDRO JORGE CARDENTEY CONTRACTOR 45-00 0910312020 Worker(s) 3 ECO002401 CREDITCARD•20-072296 This local Business Tax Receipt only codraw payment o1 the Local Business flax. The Receipt is not a license, permit, or a certification of the holder's *aliBcations, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the busioess. The RECU T NO. above must be displayed on all commercial vehicles -(Miami-Dade Code Soc On-2M. MIAM For more, information, visit Excallfiefor 03 is ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDD/YYYY) �� 03/08/2021 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 ONE C SANDRA PEREZ PHONE 305 552-5250- ac Noll:305 552-5292 JVS Insurance Agency R'ESS: SANDRA JVSINS.COM 9600 SW 8th St. INSURERS AFFORDING COVERAGE NAIC # Miami, FL 33174 INSURER A: GRANADA INSURANCE INSURED INSURER B : INSURER C : GLEISY ELECTRIC INC. INSURER D : 8021 SW 197 TERR INSURER E : INSURER F : CUTLER BAY FL 33189 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 L R TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TO RENT - PREMISES Me oocuMrrancel$ 100,000.00 MED EXP (Any one son $ 5,000.00 PERSONAL a ADV INJURY $ 1,000,000.00 A 0185FL00055969 01 /20/2021 01 /20/2022 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000.00 X POLICY JFCT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me accident BODILY INJURY (Per person) _ $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ NON -OWNED HIRED AUTOS HAUTOS UMBRELLA LIAS OCCUR EACH OCCURRENCE $ AGGREGATE _ $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) B yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required) ELECTRICAL CONTRACTOR LICENSE # EC0002401 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE AUTHORIZED REPRESENTATIVE 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 ACORD 25 (2010105) 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JfWY 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 Ths certifies that the individual listed below has elected to be exempt from Flonda Workers' Cbfnpensation law, EFFECTIVE DATE: 3/1312021 PERSON: PEDRO J CARDENTEY FEIN: 650705979 BUSINESS NAME AND ADDRESS: GLEISY ELECTRIC INC. 8021 SW 197 TERRACE MLAML FL 33189 SCOPE OF BUSINESS OR TRADE: E iecwxjw W" Wamn Boodings and D-ows EXPIRATION DATE: 3113/2023 EMAIL: GLEISYELECTRIC(-4YAHOO,COM WK)RTANT: Pursuant to subsection 440,054141, F S., an ofteg of a coqwalior who e6eds exenVocin from this chapter by likV a cettibcate of ekKtOrz UrKIW is section may not rep oirw beneitits or co" saran under Ows dliaoev Ptrruardlcsubsection &QOr-4i2).FS.Certficalosofokctonsoboexempt mvied wder subsection (3) shag apply only to the corporate cifter r4whed an VW notice of eiecbcyn to be exewro and appty only' wleftn Vv scope of It* Wsawss or ode Irsted on It* notice of exact in to be exerr". Pirwary Io subsection 440 O5(13), VS . m6ws of ek*cbon to be exempt and cart;fKjiles or e4rton 10 be *#iro shag be subpart to revocation 4. at any fivro after Ow " of the niolice or the issuance at the cettlx-atw the person named on the rK*ce or cortific al# ; WorWr meets V* rogweOwnts of this section for iswanoe of a cart kate The depaiulwit steal revoke a certftale at arry tm* Ior fatit" of the person w*d or ft cerWate to trieel the reqweiriwts of Ifts section, FS-F2-OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08- 13 EO 1303416 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 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 THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENT . Signature: Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this � day of 20 Z l By AN IE�— i�c1- kJ l� Sb who is personally known to me or has produced VZas identification. Notary: SEAL: SINDIA ALVAREZ zl; X PIR 4 MY COMMISSION # GG 2=73 fit` 654, BMW Tfn Notary Public Ur4WV ten