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RC-11-20-2636, 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 ;ontacts MIRYAM COLE Owner DIMANY CONTRACTOR & FLOORING Contractor 94 NE 102 ST, miami shores, FL 33138 ERNESTO SANCHEZ Other: 7865462447 miryamsvz100@gmail.com 8765 NW 168 ST, MIAMI LAKES, FL 33018 Mobile:7865142010 dimanyinc@yahoo.com i Inspection Requests: Description: INTERIOR IMPROVEMENTS: EXISTING FLOOR TO Valuation: $ 9,000.00 1 3 762 $94 BE REMOVED & REPLACED, KITCHEN APPLIANCES & FIXTURES Totals Feet: 0.00 ' TO BE REMOVED & REPLACED, MASTER BATH & 2ND? q BATHROOM TO BE REMODELED Fees Amount Application Fee - Other $150.00 CCF $5.40 DBPR Fee $4.05 DCA Fee $2.70 Education Surcharge $1.80 Permit Fee $120.00 Scanning Fee $30.00 Structural Review ($90) $90.00 Technology Fee $6.75 Total: $410.70 Payments Date Paid Amt Paid Total Fees $410.70 Credit Card 11/17/2020 $150.00 Check # 2933 01/21/2021 $260.70 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 regulatjng construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date January 21, 2021 Page 2 of 2 BUILDING PERMIT APPLICATION Miami e Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 �•, Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 uu��F,BC 20 9 �- /r ,^2 Master Permit No. 4,.--''I 4 - 20' 2(p J(p Sub Permit No. XBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [::]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1, OS N r Lo k SA. City: Miami Shores County: Miami Dade Zip: 33 i 38 Folio/Parcel#: 1 �— 3'zo (o ^ Cat; — 4k-t `I. Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Phone#: (��) y4� Address: City: P;;ir-r to -�1.4 M i State: L Zip: 33 1 Tenant/Lessee Name: M 1 R�,/r�n S V 1 (O 6M� /L3 roti'e Email: CONTRACTOR:: Company Name: yiMA" Cor\" oa,--� e-f.hov,n Phone#: (A8 J 51-f" 20 tO Address: h)llJ 168 5+ ' City: �t �►w� c �•L.,/ State: F1 Zip: 33 O 8 Qualifier Name: F1rV-1'LS4-% G ke Phone#: 1�i—zo%0 State Certification or Registration #: G(aC. lst }O to 8 I, Certificate of Competency #: r DESIGNER: Architect/Engineer: V t P. �. Phone#: `4$6) ya. C-14 ci(o Address: 1 OIo Z svi l 3 `i C�lj r-E City: P�44'* ► State: ( Zip: Value of Work for this Permit: $ g000 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Description of Work: in-�CYt, y r - 11-1 C.h k La k -• DPI Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ ❑ New Repair/Replace J Q-n-A-^4 (,' Sao y' Training/Education Fee $ A.,x4 rY 4z' CCF $ _ DBPR $ LLDemolition R � ry-oJa-►A �" �� � j CO/CC $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 't T 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. i Signature WNER or AGENT The foregoing instrument was acknowledged before me this 1(• day of 20 by c. ,_ who is personally known to me or who has produced Signatur CONTRACTOR The foregoing instrument was acknowledged before me this dD ay of �IG i .4'" � 20 by (�• f 1^ ` 2, l 0 'Sc10 d who is personally known to as me or who has produced identification and who did take an oath. 11111I1 identification and who did take an oath. as NOTARY PUBLIC: \���� �NMITGNFI( �ii� NOTARY PUON IC: tlZt O i 11,20" p��,7 Sign: = * Sign: 2 Print: E2V B K.g►t S '. o �00074604 y=. Print:- z Oq and— dd Seal: �� p 0blic un6e •' �O �� Seal: NN Notary Public State of Mich ael Ts rre HH o2s5s'3a a, n Expires 08/0212024 *****************************************r****************** ************** APPROVED BYf,�21 Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Ron DeSantis, Governor STATE OF FLORIDA Halsey Beshears, Secretary OrPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE GENERAL CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES DIMANY CONTRACTOR & FLOORING INC 8765 NW 168TH STREET MIAMI LAKES FL 33018 LICENSE NUMBER: CGC1517068 EXPIRATION DATE: AUGUST 31, 2022 Always verify licenses online at MyFloridaLicense.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. Local Busi ness Tax Fbcei pt Miami -Dade County, State of Florida -THIS IS NOT A BILL DO NOT PAY 6470975 BUSINESS NAM E/LOCATION DIMANY CONTRACTOR & FLOORING INC 8765 NW 168TH ST MIAMI LAKES, FL 33018 OWNER DINIANY CONTRACTOR & FLOORING INC Worker(s) RECEIPT NO. RENEWAL 6740113 y 1 SEC TYPE OF BUSINESS EXPIRES SEPTEMBER 30, 2020 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED 196 GENERAL BUILDING BY TAX COLLECTOR CONTRACTOR 45.00 09/06/2019 CGC1517068 0206-19-007539 This local Business Tax Pleceipt only con^rrns payment of the local Business Tax. The Receipt is not a I icense, permt, or a certi "cation of the holder's qual i "cations, to do busi ness. Holder must compl y with any governmental or nongovernmental regulatory laws and requirerrentswhich apply to the business. The FEM PT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-Z76. MIAMtMDE For more information, visit www.rriamidade.gov/taxcdlector -�..� a� oRc CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/17/20 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 endorsements . PRODUCER South Pacific Professional Ins. 500 K W. 49th Street Hialeah, FL 33012 Phone (305)825-3535 Fax (305)825-5694 CONTACT NAME: SOUTH PACIFIC PROF. INS. PHONE (305) 825-3535- aC No): (305) 825-5694 E-MADDRESS: SPPINSURANCECD_HOTMAIL.COM PRODUCER R ID INSURER(S) AFFORDING COVERAGE NAIC # INSURED DIMANY CONTRACTOR & FLOORING, INC 8765 NW 168 ST MIAMI LAKES, FL 33018 DIMANYINC@YAHOO.COM (786)514-2010 INSURER A: AIX SPECIALTY INSURANCE COMPANY INSURER B : INSURER C : INSURER D : INSURER E : 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. INS LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER MM/DD/YYYY MM/DD YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAuE TO RENTED— PREMISES Ea occurrence $ 100,000 ® COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 5,000 A ❑ ❑ CLAMS -MADE © OCCUR El N SIZGL1004A235029 05/23/2020 05/23/2021 PERSONAL PERSONAL & ADV INJURY $ 1,000,000 ❑ GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 O- ❑ LOC ❑ POLICY ❑ PRO- $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ ❑ NON -OWNED AUTOS $ ❑ $ ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ AGGREGATE $ ❑ EXCESS LIAB ❑ CLAIMS -MADE ❑ DEDUCTIBLE $ $ El RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N / A WC STATU- OTH- TRY Li E.L. EACH ACCIDENT $ (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 (Attach ACORD 101, Additional Remarks Schedule, If more space is required) PLUMBING CONTRACTOR LICENSE# CFC1429063 LICENCE # CGC1517068 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2 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. c 01988-21109 ACORD CORPORATION_ All riohts rasarvad. ACORD 25 (2009/09) OF The ACORD name and logo are registered marks of ACORD JIMMY 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 This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 5/21/2020 PERSON: ERNESTO C SANCHEZ FEIN: 900085394 BUSINESS NAME AND ADDRESS: DIMANY CONTRACTOR & FLOORING INC 8765 NW 168TH ST HIALEAH, FL 33018 SCOPE OF BUSINESS OR TRADE: EXPIRATION DATE: 5/21 /2022 EMAIL: DIMANYINC@YAHOO.COM Plumbing NOC and Drivers Swimming Pod Construction- Floor Covering Installation- Contractor -Project Manager, Not Iron or Steel -& Drivers Resilient Flooring- Carpet and Construction Executive, Laminate Flooring Construction Manager or Construction Superintendent IMPORTANT: Pursuant to subsection 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 subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 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 E01167774 QUESTIONS? (850) 413-1609 Dimany Contractor & Flooring, Inc. 8765 NW 168 St. - Miami Lakes, FL 33018 Phone: (786) 514-2010 November 17, 2020 State of ft,C, it , n n County of Hlh-"t 0,119E Before me this day personally appeared Ernesto C. Sanchez who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: 488 NE 101 Street, Miami Shores FL 33138 Cont ac Signature Sworn to (or affirmed) and subscribed before me this _17_ day of November 2020. Personally know OR Produced Identification Type of Identification Produced Print, Type or Stamp Name of Notary `\\����P�N MiTCHF���ii����/ J�E t7, ao 1Z'�o� N y • y #GG 074604 o'•�. '�9�� dyp e/ cgunder# .* p�O�� 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: 0 Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this day of 1JL) l&C- , 20'. By PA 1 �yA✓�-� (,�j !. Cis who is personally known to me or has produced as identification. \�\\\1111111111111//!!�� Notary: \��� �N ...... 44 ' \SSI0,V SEAL: a y: o J�6 ?o� '�••�,� =fir; •.• �*- 2• o �9• �°�'1p°�dedth�i��0• Q "tt STA'�o'��0�` �!!l1111111111N\