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RC-11-20-2625, 99 NE 103rd StMiami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 99 NE 103RD ST, Miami Shores, FL 33138 1121360130990 Contacts _---- _ _.__. ...... PUJA LAKHLANI Owner Arco Construction Corporation Contractor LESTERJENSEN 1665 NE 137 TER, MIAMI, FL 33181 Business: 3058926507 arcoconstruction@aol.com Other:3058926507 g Description: STUCOO REPAIR ON THE OUTSIDE OF THE CHIMNEY. REMOVAL OF THE EXTERIOR STONE CLADDING FROM THE OUTSIDE TO FACILITATE ROOFING REPAIRS BY OTHERS THE AREA TO BE REMOVED: 12 INCHES FROM THE TOP OF THE ROOFING ALL AROUND THE CHIMNEY.AFTER THE ROOF REPAIR BY OTHERS, ARCO CONSTRUCTIION WILL PROCEED Fees Amount Application Fee - Other $50.00 CCF $1.20 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.40 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $117.10 Valuation: Inspection Requests $ 1,650.00 65-762-49+1 TotalSq Feet: 16.00 Payments Date Paid Amt Paid Total Fees $117.10 Check # 272 12/02/2020 $67.10 Check # 301 11/16/2020 $50.00 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I autl}er-2sthee above named contractor to do the work stated. Authorized Signature: Owner / Applicant / December 02, 2020 Agent Date Page 2 of 2 ?AD Miami Shores Village RECEIVED Building Department (V*, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY: ----- Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 20��' � BUILDING Master Permit No. '2ta 5 PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: "'D N - j(�� ,r City: Miami Shores �M (�(� County: Miami Dade Zip: Folio/Parcel#: I k 2.� ( _` q O Is the Building Historically Designated: Yes NO C Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):?i7;�$�,���p,��1��r�(,�e#:i7?S Address: Qq City: 8'Y`P/1 State: l_ Zip: j�41— _ Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ALw caxira c ( nM a)Q . Phone#: 5' <RD-7 Address: City: State: l Zip: I Qualifier Name: ��i� ��% dj) Phone#:�— State Certification or Registration #: cate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: _ Value of Work for this Permit: $��, ��� Square/Linear Footage of Work: 5-1 Type of Work: ❑ Addition ❑ Alteration r� ❑ New Repair/Replace ❑ Demolition Description of Work: Cji (� C45,Qr _t__) ,iV ] i- G Co 19 E I © 4— Specify color of color thru tile: Submittal Fee $�o Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ lJ (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 44wg::�-n OWNER or AGENT The foregoing instrument was acknowledged before me this day of a QV� VYl}' , 20 2 , by who is personally known to me or who has produced identification and who did take an oath. 'NOTZPUB Sign: Print: / &9.,:� Seal ************ APPROVED BY (Revised02/24/2014) Sign5ae— CO 9CT R The foregoing _\ instrument was acknowledged before me this day of `�OyeVAr , 20 Z� , by e� 7A&VlS-f- 11_, who is personally known to me or who has produced _ � L Y L-- _ as identification and who did take an oath. NOTARY PUBLIC: Sign. ,, Print: �!E�, �e nn ibn�e �ti: RAPHAELA ST. AUDE Seal: '�""�� 'F �` Notary Public - State of Florida SELENA ARANDA .4 Commission # HH 044955 My or rti,. My Comm. Expires Nov 30, 2024 f PAS COMMISSION # GG 971705 o . o EXPIRES: March 22 11 —yc 1* *** ******** em Plans Examiner Structural Review Zoning Clerk L Wi Ron DeSantis, Governor Halsey Beshears, Secretary Florida STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER JENSEN, LESTER ARCO CONSTRUCTION CORPORATION 1665 N E 137TH TERRACE f NORTH MIAMI FL 33181 LICENSE NUMBER: CGC1505163 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLice nse.com 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. Miami Shores Village Business Tax Receipt VALID 7HROUGH DATE BELOW LESTERJENSEN 1299 N.E. 104TH STREET MIAMI SHORES, FL 33138 Business 'Jame: tLeeatien ddress: Number/Crass: Issue DatE Expirar ion Date: License Ft es: 1 Commen- s: Restrictio, s: ARCO CONSTRUCTION CORPO -1299-N:.Z— 1-04TH STREET 17 / General Business 08/26/202 ) 9/30/2021 General Business Office $146.58 SUBJECT AND ISSUED ACCORDING O BUSINESS TAX RECEIPT ORDINANCE CHAPTER 14. The 2018-201 t.. fiscal year has brought atcut fay., changes th t allow for exemptions from paying a Local Business Tax in the State. Please see ee)w for the exemptions established by State la as of October 1, 2018: E -„__ _. =11i�v at! y"'I� �afy—etlti"i;tcranS3�i� • Surviving spc ises of honorably discharged veterans that hi e not remarried, -Active duty m tary service members' spouses who relocate D the county or municipality pursuant to a permanent change of station order, -Low-income i iividuals receiving public assistance, as defir d in s. 403.2554, F.S.; and -Low-income i dividuals with a household income less than ' 10 percent of the federal poverty level based on the current year's federal poverty guidelines. -If an exempt idividual owns a majority interest in a busines• with fewer than 100 employees, the business is exempt. If you fall with o any of the categories mentioned above, kind contact our Office in order to explain what is needed to obtain an Exemption Certificate from the Villa, This Business Tax Receipt does not permit the holder to ope ate in violation of any Village law, ordinance, or regulation. Any change in location or ownership mu : be approved by the Village, subject to zonin, restrictions. This Business Tax Receipt does not endorse, approve, or disapprove the holder's sk or competence or of the holder's compliance or non-compliance with other laws, regulations or standards. MU,-'JT BE POSTED CONSPICUOUSLY AT BUSINESS LOCATION Miami Shores Village" 10050 Northeast. 2nd Ave, h^lami Shores Village FL 33138 Phone: 305-762-4862 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 2758275 BUSINESS NAMEMOCATION ARCO CONSTRUCTION CORP 1299 NE 104TH ST MIAMI SHORES, FL 33138 OWNER ARCO CONSTRUCTION CORP C/O LESTER JENSEN QUALIFIER Worker(s) RECEIPT NO. RENEWAL 2889732 EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 GENERAL BUILDING BY TAX COLLECTOR . CONTRACTOR 45.00 09/14/2020 CGC1505163 0224-20-003950 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 all commercial vehicles — Miami —Dade Code Sec 8a-276. �M�+PMMrMADE For more information, visit www.miamidade govhaxcollector 11=bl AC RL® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYY1� 07/08/2020 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 Insurance Industries CONTACT NAME: Stacy Parks PNONE . (305) 891-2808 tF Not: (305) 891-6367 A D IL . stacy@insuranceindustriesinc.com 953 NE 125th St. INSURERS AFFORDING COVERAGE NAIC # INSURER A : PENN AMERICAN INSURANCE COMPANY North Miami FL 33161 INSURED INSURER B : INSURER C : ARCO CONSTRUCTION CORP INSURER D : 1665 NE 137 TERR INSURER E : INSURERF: North Miami FL 33181 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. iLT R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000000 CLAIMS -MADE rx-1 OCCUR DAMAGE TO PREMISES EaEoccurrence $ 100000 MED EXP Any one on) $ 5000 PERSONAL & ADV INJURY $ 1000000 A Y Y PAV0208087 7/12/20 7/12/21 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY ❑ JECOT X❑ LOC PRODUCTS - COMP/OP AGG $ 2000000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY F $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS* LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) RESIDENTIAL REMODELING, CARPENTRY CGC#1505163 CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33138 A Ll�� 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD e,ate W. 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: 4/2/2019 PERSON: LESTER JENSEN FEIN: 650353747 BUSINESS NAME AND ADDRESS: ARCO CONSTRUCTION CORPORATION 1665 NE 137 TERRACE MIAMI, FL 33181 SCOPE OF BUSINESS OR TRADE: Licensed General Contractor EXPIRATION DATE: 4/1/2021 EMAIL: PSINCO@AOL.COM 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 Arco Construction Corporation November 15, 2020 State of Florida County of Miami Dade Before me this day personally appeared Lester Jensen who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 99 NE 103 Street, Miami Shores, FL 33138 Sworn to (or affirmed) and subscribed before me this 16 day of November, 2020 ,by Personally know 1� Or Produced Id Type of Identification Produced Print, Type or Stamp Name of Notary SELENA ARANDA MY COMMISSION # GG 971705 ':•, o EXPIRES: March 22 2024 Bonded Thru Notary Public Undetwnters General Contractors/CGU50516311665 N.E. 137�h Terrace -IN. Miami, FL 33181 305.892-6507 Arco Construction Corporation November 15, 2020 Miami Shores Village Building Department 10050 NE 2"d Ave, Miami Shores, FL 3318 Re: Building Permit Application (Stucco repair on the outside of the chimney). Property located at 99 NE 103 Street, Miami Shores, FL 33138. Description of work: Removal of the exterior stone cladding from the outside of the chimney to facilitate roofing repaitWpthers. The.&%a to be remoded: 12 inches from the top of the roofing all around the chimney. .••... • •• . . •' After the roof MJaiAy others Arco Construction will proceed with the reapplication of the ••••.• • •• •w •• •••••• stucect.'@ ••••f• '+•••• f ••f • • • • • •••• • •••••f f • • • • • • 90 • • �,C;f�rYl( C,;1C3C('S gar°@xli4(�@ BY DATE s r,rr �!f"PT Tl IANCF WITH ALL FEDERAL ri 13111 =S AND WGUI ATInNS General Contractors/CGCI505163/1665 N.E. 137�h Terrace/N. Miami, FL 33181 305.892-6507