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ELC-11-20-2546Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 790 NE 91ST ST 4, Miami Shores, FL 33138 1132060390040 Contacts RICARDO PADULA Owner APR ELECTRIC CORP Contractor 790 91st 4, Miami Shores, FL 33138 ALEX DE LA PAZ Business: 3058965144 padulabox@icloud.com Business: 3053183692 Description: ELECTRICAL FOR A/C. REMOVE AND REPLACE Valuation: $ 2,400.00 Inspection Requests: ` CABINETS AND COUNTER TOPS, BATHROOM RENOVATION '305 762.4949 LTotalSq Feet: 720.00 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 $3.00 Technology Fee $2.50 Total: $111.90 Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 02/09/2021 $111.90 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. OW14ER i AFFI AVI I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulal�ng+go+t�icti¢ ,d zgning/ Futhermore, I authorize the above named contractor to do the work stated. Applicant / Contractor / Agent Date February 09, 2021 Page 2 of 2 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Parcel Number 790 NE 91ST ST 4, Miami Shores, FL 33138 1132060390040 Contacts Permit No.: ELC-11 20-2546 PerfnitType'i Electrical - Commercial Work Gf s ttt n: Alteration Permit Status: Approved Expiration: 08/09/2021 RICARDO PADULA Owner APR ELECTRIC CORP Contractor 790 91st 4, Miami Shores, FL 33138 ALEX DE LA PAZ Business: 3058965144 padulabox@icloud.com Business: 3053183692 Inspection Requests: I Description: ELECTRICAL FOR A/C. REMOVE AND REPLACE Valuation: $ 2,400.00 305 762 4949-771 CABINETS AND COUNTER TOPS, BATHROOM RENOVATION: Total Scl Feet: 720.00 I. 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 $3.00 Technology Fee $2.50 Total: $111.90 Applicant Copy Payments Date Paid Amt Paid Total Fees $111.90 Credit Card 02/09/2021 $111.90 Amount Due: $0.00 For Inspections, Call (305) 762-4949 or Log on at https://bldg.miamishoresvillage.com/cap/. Requests must be received by 3pm for following day inspections. NOTICE: In addition to the requirements of this permit, there may be AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER additional restrictions applicable to this property that maybe found in the GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, public records of this county. STATE AGENCIES, OR FEDERAL AGENCIES. February 09, 2021 Page 1 of 2 Miami 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 BUILDING PERMIT APPLICATION ❑BUILDING *ELECTRIC ❑ ROOFING RECF��T�� BY FBC 20 ( /�� Master Permit No. Sub Permit No-;Ei 120' �2E ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF JOB ADDRESS: 77—(�) O CN CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS M City: Miami Shores County: Miami Dade Zip: (� Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): kzzC� `l _� Mv LAPhone#: 5C� `G96 ' �f 4� / Address: b ( ?s Co U� (J City: LLP� State: Tenant/LessQee�JName: Email: 1 r PLA ip: CONTRACTOR: Company Nam`e:, A r'=-'l 1 —t �`v� Phone#: —Yos Address: City: State: Zip: Qualifier Name: ��—X 1 � Z— Phone#: State Certification or Registration #:tl�2 1 Certificate of Competency #: p / DESIGNER: Architect/Engineer: if, A UO j _� . r-12F Phone#: -3 2 I / 9 ,5` Address: 3 3 City: 01,40 1 f 00 (""5Ate: F1 Zip: 3313 Value of Work for this Permit: $ � Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 1 ! I . :: "': `) (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 s ven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b nd ai pecti will be charged. n Signature ./ Signature ! OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged befor me this day of 4— ( 20 by who i personally known o me or who has produced identification and who did take an oath. NOTARY PUBLIC: 1r�,pYPV//� DENA CRUZ Sig B4� Notary Public -State of Florida mission # UG 305462 Print: ';ForvZ My Commission Expires Seal: as The foregoing instrument was acknowledged before me this day of D en ' 6�) 'r , 20 10 by ji l(4 y'I L who is personally known to r me or who has produced 1" L- h ' as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: 4�: ;pW GRISELL FERNANDEZ Notary Public . State of Florida Commission # GG 227482 My Comm. Expires Jun 11, 2022 APPROVED Btu .Z`ZJ/f � � Plans Examiner Structural Review ******** Zoning Clerk (Revi sed02/24/2014) TkNT ( tq C, ("tDC Ron DeSantis, Governor Halsey 134eshears, Secretary STATE OF FLORIDA db'pr ,DEPARTMENT Or BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ELECTRICAL CONTRACTOR HEREIN HAS REGISTERED UNDER THE PROVISIONS OF CHAPTER 489, FLORIIDA STATUTES (INDIVIDUAL MUST MEET ALL LOCAL LICENSING X'EQUIREMENTS PRIOR TO CONTRACTING IN ANY ARE91 APR ELECTRIC CORP 8183 NW 8TH ST SUITE C-4 A! MIAMI FL 33126 LICE 4st NUMBER: ER13014093 EXPIRATION DATE: AUGUST 31,2022 Always verify licenses online at MyFloridaLicense.com X.r. , I OR ff] % Do not alter this document in any form. 1 011 This is your license. It is unlawful for anyone other than the licensee to use this document. Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT ABILL - DO NOT PAY 6317176 RECEIPT NO. RENEWAL BUSINESS NAME/LOCATION 6583570 APR ELECTRIC CORP 8183 NW 8TH ST C-4 MIAMI, FL 33126 * p SEC. TYPE OF BUSINESS OWNER 196 ELECTRICAL PR ELECTRIC CORP EXPIRES SEPTEMBER 30, 2021 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR A CONTRACTOR 76.00 09I0912020 1 08EO00914 0206-20-006685 Worker��}�� This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is nogovernmental Th comply y permit, or a certification of the haa,d� �� equi etments wh ch apply toNhe business. or nongovernmental regulatory I The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba-276. For more information, visit tAf A, - mi�mjdade govttaol ector t++tiA►M Aco!2o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F10/14/2020 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 endorsement(s). PRODUCER Safe Insurance Group 7901 NW 2nd St. Miami, FL 33126 CONTACT Soraya Hernandez PHONE FAX N Ext : (305)264-8964 A/C No): (305)267-1576 E-MAIL E-MAIL ADDRESS: sorayafssafeinsgroup.com INSURERS AFFORDING COVERAGE NAIC /f License #: A161532 INSURER A: NAUTILUS INSURANCE COMPANY INSURED INSURER B : Progressive Insurance Company 10193 INSURERC: APR Electric Corp 511 SW 64 CT INSURER D: Miami, FL 33144 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 00000902-6712899 REVISION NUMBER: 65 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. INSRPOLICY LTR TYPE OF INSURANCE INSD WVD SUER POLICY NUMBER EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY NN1173039 09/09/2020 09/09/2021 EACH OCCURRENCE $ 11000000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L X POLICY JE� LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 04334206-7 09/02/2020 09/02/2021 CD Ea aociden SINGLE LIMIT $ BODILY INJURY (Per person) $ 10,000 ANY AUTO OWNED AUTOS ONLY X AUTOSULED BODILY INJURY (Per accident) $ 20,000 PROPERTY r acc dentDAMAGE $ 1 O 000 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) 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 if more space is required) SUBJECT TO POLICY FORM,CONDITIONS,ENDORSEMENTS,LIMITATIONS AND EXCLUSIONS. ELECTRICTRICAL SUB -CONTRACTOR ER13014093 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 Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE s SDH 00- 988-2015 RD C ORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are re "red marks of ACORD PrKted by SDH on October 14, 2020 at 11:05AM 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 Wow has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 9/7/2020 PERSON: ALEX DE LA PAZ FEIN: 262663989 BUSINESS NAME AND ADDRESS: APR ELECTRIC CORP 8183 NW 8 ST APT C4 MIAMI, FL 33126 SCOPE OF BUSINESS OR TRADE: Electrical Wiring Within Buildings and Drivers EXPIRATION DATE: 917/2022 EMAIL: APRELECTRIC@YAHOO.COM 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 440.05t12). 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(l 3) F. S., notices of election to be exempt and certificates of election to be exempt shall be subject to revocation it, at any time after the filing of the notice or the issuance of the certrificate, 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 E01209793 QUESTIONS? (850) 413-1609 APR ELECTRIC CORP 8183 NW 8T" ST STE C-4 MIAM1, FL 33126 305-318-3692 Date: 10/15/2020 State of FLORIDA County of MIAMI DADE Before me this day personally appeared �who, being duly sworn deposes and says: That he or she will be the only person working on the project located at: ?90NE o11T UNIT 4 Contract r Sign e Sworn to (or affirmed) and subscribed before me this 15 day of OCTOBER . 20 20, by Personally know L—''" OR Produced Identification Type of I DENA CRUZ Notary Public -state of Florida _• Commission N GG 305462 %yrEof tt�PA'� My Commission Expires April 07, 2023 Type or Stamp Name of Notary 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: 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 YOU ACK`NO�LEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: — �r /7 — 'CT Owner State of Florida Countv of Miami -Dade The foregoing was acknowledge before me this Z_ day of ®(7'r ,?0 Z,). By who is pe Halt r wn to me or has p roduced as identificatio �;S;Jp;;.,, DENA CRUZ =o ��c Notary Public -State of Florida *= Commission it GG 305462 ry: tee;? My Commission Expires °;,`,V°,` April 07, 2023 SEAL: