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EL-11-20-2637, 488 NE 101st StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 488 NE 101ST ST, Miami Shores, FL 33138 1132060170440 Contacts MIRYAM COLE Owner SOLIS ELECTRICAL INC Contractor 94 NE 102 ST, miami shores, FL 33138 IHOSVANY MORALES Other: 7865462447 miryamsvz100@gmail.com 2319 W 60 ST D-211, HIALEAH, FL 33016 Business: 7863564964 hirosquimolina@gmail.com Inspection Requests: Description: KITCHEN, MASTER BATH AND BATH # 2 TO BE Valuation: $ 2,100.00 3 r REMODELED ' Total Sq Feet: 0.00€ .j 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 $30.00 Technology Fee $2.50 Total: $138.90 Building Department Copy Payments Date Paid Amt Paid Total Fees $138.90 Check # 2933 01/21/2021 $138.90 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. 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. n ---' 1 re: Owner / Applicant / Contractor / Agent Date January 21, 2021 Page 2 of 2 Miami Shores Village RECEIVED Building Department NOV17Z 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 �pFBC 20 A �' BUILDING Master Permit No. Y`l — \`' (P3(P PERMIT APPLICATION Sub Permit No.Ek-'11-20- Zt03`1- ❑BUILDING Q ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 488 NE 101 Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-3206-017-0440 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Miryam Cole Phone#:786-546-2474 Address: 488 NE 101 Street City: Miami Shores State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: LL II CONTRACTOR: Company Name: lid F It pAyy' Ca.r � 10121 Phone#: Address: .231 9 wtb f (to $0 Z/Aj i � d- 2- City: State: FL Zip: 33 0/ Qualifier Name:',/1'-'%uSVanV lC�/� Phone#: a9 -�'��- YZ%t-� State Certification or Registration #: EC 1,300 90GS Certificate of Competency #: DESIGNER: Architect/Engineer: Edge Engineering Phone#: 305-988-7657 Address:10912 SW 134 Ct. city: Miami State: FL Zip: 33186 Value of Work for this Permit: $ 2_1 / 00 . Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Kitchen, Master Bath and Bath #2 to be remodeled Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ 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. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this _ day of QQVE; i 20 by I (ZYllM who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: MITCHEZ�����i� Sign: _ Print: IFV#4 is �* • G074W a .m: •o Seal:ypr y ubd� ��de`.•��o��@ I c, • S T Signature .0, /, CONTRACTOR The foregoing instrument was acknowledged before me this C' day of A10ye xl � e r 20 a d by ✓a,4 y1-1y-r�eS , who is personally known to me or who has produced 7- L as identification and who did take an oath. NOTARY PUBLIC: Sign: hl1 rt�ti APPROVED B Plans Examiner Zoning Structural Review (Revised02/24/2014) Notice to Owner — Workers' Com Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 nsation 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. I . 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: C'1� A Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this �_ day of ND20. By jM. I P4A/A 00" who is personally known to me or has produced as identification. MITCHELC Nota/ �� ' I •' 9 /�i rY: � ASS ON �c • 0 i 41) SEAL: = m: =* � �� •fir Z = ���• rdyp nded�`0' O� 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: 7/24/2019 PERSON: HIROSQUI MOLINA SOLIS BUSINESS NAME AND ADDRESS: SOLIS ELECTRICAL INC 2319 W 60 STREET, UNIT D-211 HIALEAH, FL 33016 SCOPE OF BUSINESS OR TRADE: Electrical Wiring Within Electric Light or Power Line Buildings and Drivers Construction & Drivers EXPIRATION DATE: 7/23/2021 EMAIL: INFO@FLORIDALICENSESANDCORPORATIONS.0 OM 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-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 E01023385 QUESTIONS? (850) 413-1609 A400RD' CERTIFICATE OF LIABILITY INSURANCE kk.� DATE(IYa11DD/YYYY) F11/16/2020 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER Florida Bankers Insurance CONTACT NAME: MARTA ALONSO PEE (305) 266-6493 ac No): (305) 262-0679 ADDRESS: marta@floridabankersinsurance.com 6874 SW 8 St INSURERIS) AFFORDING COVERAGE NAIC S INSURER A: CAPACITY INSURANCE COMPANY Miami FL 33144 INSURED INSURER B : INSURER C : SOLIS ELECTRICAL INC INSURER D : 2319 WEST 60 ST INSURER E : INSURER F : HIALEAH FL 33016 COVFRAGFS 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 TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER M POLICY EPF MPOLIDY EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR N N CLM01015898A 08/07/2020 08/07/2021 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED- PREMISES Ea occurrence)$ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL BADVINJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: X a LOC POLICY ❑ jE OTHER: GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS -COMP/OP AGG $ 2,000,OUO.OU $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY CEaOMBINED SINGLE LIMIT accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 1 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ELECTRICAL CONTRACTOR LICENSE EC13009065 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES, FL 33138 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Local Business Tax Receipt Miami -Dade County, Star of Hodda IS "OTdl SU-OD "OT PAY SOUS ELECTRICAL INC 2319W WTHSTUNNTD-211 HW-EAH, FL 33016 Me _ wb ker(S) WX RENEWAL 9S EXPIRES SEPTEMBER 30, 2021 Itti m be Aspiwied at place of baekow PUMUNd w COOMY Corte Cbapw8A—AwL9&1O �� �f'�ieta�l �711it��at ps�.ara �� m�s,taH6Rat�� w bmMd s teals � 91yel�:a�aea�t�d�e�mrn�wstetad�a— t�ssi.