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RC-02-22-386Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: RC-02-22-386 Permit Type: Building (Residential) Work Classification: Alteration Permit Status: Approved issue Date:03/18/2022 Expiration:09/15/2022 Location Address Parcel Number 102 NW 101ST ST, Miami Shores, FL 33150 1131010220210 Contacts •�. L_ .......,..._..,.,_._ _.�. .. ... PASCALE GOLDENSTEIN Owner HOMEOWNER Contractor 102 NW JOIST ST, Miami Shores, FL 33150 HOMEOWNER Mobile: 6465917140 pascalegoldenstein@gmail.com Description: BATHROOM REMODELING Valuation: $ 2,000.00 Insection Reuests: Total Sq Feet: 0.00�?T' q .�....... a> 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 Building Department Copy Payments Date Paid Amt Paid Total Fees $117.10 Credit Card 03/18/2022 $67.10 Credit Card 02/14/2022 $50.00 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 DA� T: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating r n tmcti n and Honing. 0uthermore, I authorize the above named contractor to do the work stated. f Authorized ISignatu0: T Applicant / Contractor / Agent Date / / March 18, 2022 Page 2 of 2 Miami Shores Village EIVE �mQ I 3 % Is ( zz 31-7(zz BUILDING PERMIT APPLICATION 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 ❑ ELECTRIC ❑ ROOFING Master Permit No. Sub Permit No 14 2022 FBC 20 Z.-z> ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1i n 9, Vj' I'0 ( sz t City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I I - � i O % - 02-2- `2p 2 l d is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):Phone#: ���— I _� Address: 10 �.. N � to ( sr City: Newt( SymQk�s State: F� Zip:31S�c Tenant/Lessee Name: I � Phone#: Email: PASC►u:16-oc Y�s1 ^)IVia4.116l(_. e1)�`/ CONTRACTOR: Company Name: a " r to(Al N E✓Q Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration M DESIGNER: Architect/Engineer: _ of Competency M Address: City: Value of Work for this Permit: $ Zoan Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Description of Work: LArTA-Qocjik'I lt�ci'(c7Qt�Li ��' Zip: ❑ Demolition Specify color of color thru tile: Submittal Fee $ Qi Permit Fee $ t . 60 CCF $ CO/CC $ Scanning Fee $ OO Radon Fee $ DBPR $ Notary! Technology Fee $ Z • � Training/Education Fee $ u "I O Double Fee $. Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ (q-7• I 0 Bonding Company's Name (if applicable) or 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 OWNER or AGENT The foregoing instrument was acknowledged before me this day of T—f5 ZCJ f-- T-- , 20 2 Z . by r PS cP ( O 47P� C'OL DEN Sr �t r1 i? who is personally known to L �� 1�E¢ ��NSE me or who has produced as Signature CONTRACTOR The foregoing instrument was acknowledged before me this day of me or who has produced 20. by who is personally known to as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ((�� Sign: Print: sl () 4, "MF 2 Print: Seal: •im„•••. SINDIAALVAREZ Seal: "a MY COMMISSION # GG 238273 ``+°u�.g�P• P0 22 Bw&d TMu No Pubk Undeitem APPROVED BY =Z Plans Examiner Zoning Wk iP �- �1(�I zz Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE:] ADDRESS: IO2 M tI) Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that 1, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial�� 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits am contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or leas , ich violates the exemption. Initial S. I understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by my or municipal ordinance. Initial I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Ctontributions Act (FICA) and must provide workers compensation for the employee. IN�_ that my failure to follow these may subject to serious financial risk. Initial 9. 1 agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. 1 also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations Initial 10, 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htto://www.mvfloridalicense.tom/dbor/pro/cilb/index.html Initial 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12, 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the " formation that I have provided on this disclosure. _,/ Initial 1 Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this L_day of 20 'yt -A-� ��1�tt' who was personally known tome or who has Produced there License or T(-- �E t'�tyS� as identification. :':�v'•••. SINDwALVAREZ •``'•'�;: M�YCOMMISSIONNGG238273 aTIybneOWNER NNOTA'•a. gBodwuNolakuarAdla1 Property Search Application - Miami -Dade County Page 1 of 2 OFFICE OF THE PROPERTY APPRAISER Summary Report Property Information Folio: Property Address: 11-3101-022-0210 102 NW 101 ST Miami Shores, FL 33150-1214 Owner PASCALE GOLDENSTEIN MICHAEL GOLDENSTEIN Mailing Address 102 NW 101 ST MIAMI SHORES, FL 33150 USA PA Primary Zone Primary Land Use Beds/Baths/Half 0800 SGL FAMILY - 1701-1900 SO 0101 RESIDENTIAL -SINGLE FAMILY: 1 UNIT 3/2/0 Floors 1 Living Units Actual Area 11,729 Sq.Ft Living Area I1,152 Sq.Ft Adjusted Area 1,483 Sq.Ft Lot Size 9,212.4 Sq.Ft Year Built 1940 Assessment Information Year 2021 2020 2019 Land Value $267,456 $212,889 $212,889 Building Value $111,225 $111,225 $111,225 XF Value $696 $708 $720 Market Value $379,377 $324,822 $324,834 Assessed Value $120,106 $118,448 $115,785 Benefits Information Benefit Type 2021 2020 2019 Save Our Homes Assessment $259,271 $206,374 $209,049 Cap Reduction Homestead Exemption $25,000 $25,000 $25,000 Second Exemption $25,000 $25,000 $25,000 Homestead Senior Homestead lExemption $50,0001 $50.0001 $50,000 Note: Not all benefits are applicable to all Taxable Values (i.e. County, School Board, City, Regional). Legal GOLD CREST PB 21-56 E1 /2 OF LOT 5 LOT 6 BLK 3 LOT SIZE 85.300 X 108 OR 20443-0724 05 2002 4 Generated On: 2/14/2022 Taxable Value Information County Exemption Value 2021�, 20201-- 2019 $100,000 $100,0001 $100,000 Taxable Value $20,106 $18,448 $15,785 School Board Exemption Value $25,000 $25,000 $25,000 Taxable Value $95,106 $93,448 $90,785 City Exemption Value $50,0001 $50,000 $50,000 Taxable Value $70,1061 $68,4481 $65,785 Regional Exemption Value $50,000 $50,000 $50,000 Taxable Value $70,106 $68,448 $65,785 Sales Information Previous OR Book- Price qualification Description Sale Page 32938- 12/22/2021 $628,000 qual by exam of deed 1094 20443- Sales which are disqualified as a result 05/01/2002 $0 0724 of examination of the deed 15301- 12/01/1991 $70,000 Sales which are qualified 3856 09983- 03/01/1978 $40,000 Sales which are qualified 1210 The Office of the Property Appraiser is continually editing antl uptlating the lax roll. This website may not reflect the most current information on record. The Property Appraiser https://www.miamidade.gov/Apps/PA/propertysearch/ 2/14/2022 FEB 14 2022 0 .n J niami Shores Village Building Department Zoning Dept. at Building Dept. Date Suoject to compli ce with all Federal, State and County rules and re latis. °srmit# �—� GZ 22 Tee CITY PY M 0 0 C7 Z Z PLUMBINGMANS EELECTKICA� l{EEV E` V full ? Approved —D?+e� �� �S—DATE_-__.__. ' (APPROVED Disapproved _. W WALL MOUNTED VANITY MIRROR WITH INTEGRATED LIGHT ABOVE IT v GLASS ENCLOSURE_. WITH SLIDING DOOR FLOOR TOWEL WARMER FLOOR PLAN CABINET PORCELAIN TILE FLOOR AND SHOWER PAN THERMOSTATIC SHOWER HEAD/HAND SHOWER COMBO, LINEAR DRAIN AT SHOWER PAN N0 � @ M � T � FEB 14 2022 III 102 NW 101 STREET - MIAMI BATHROOM PLANS OWNER: PASCALE GOLDENSTEIN 02.11.2022 NICHE AT SHOWER WALL EXACT LOCATION TBD- _1 ELEVATION A 2'- I ULL WALL PORCELAIN TILE AT SHOWER AND WAINSCOT TILE ' BEHIND TOILET i 102 NW 101 STREET - MIAMI BATHROOM ELEVATIONS OWNER: PASCALE GOLDENSTEIN PAINTED WALL p �C���dC� FEB 1 4 2022 D By 02.11.2022 PAINTED WALL i WAINSCOT PORCELAIN TILE- n ffly_3 {I FEB 14 ZOZZ ELEVATION B 102 NW 101 STREET - MIAMI BATHROOM ELEVATIONS OWNER: PASCALE GOLDENSTEIN 02.11.2022 MIRROR WITH I LIGHT WITH TOi ELEVATION C 102 NW 101 STREET - MIAMI BATHROOM ELEVATIONS OWNER: PASCALE GOLDENSTEIN :LAIN TILE FEB 14 2022 02.11.2022 PORCH BEDROOM BEDROOM ELECTRICAL rLViEVV �5- � xz APPROVED_iE `EX1 RG"SMOKEUETECTOR'- Q EXISTING CARBON MONOXIDE DETECTOR KITCHEN LIVING ROOM J- DINING ROOM 102 NW 101 STREET - MIAMI GENERAL FLOOR PLAN EXCLUDING GARAGE OWNER: PASCALE GOLDENSTEIN 03.11.2022 PI BATHRUOM RtCEPTACLE ON 20 AMP CKT AND G.EI PROTECTED ELECTRICAL REVIEW APPROVED�0A4�i ATE 146 CEILING LIGHT AATFP )M FAN 102 NW 101 STREET - MIAMI BATHROOM RCP OWNER: PASCALE GOLDENSTEIN 03.11,2022 MMI�IIOIAV.£V4/IY ��1 MRIMII®V'PDA IIEI.IYCEFA,IW WM GM'1®Y4LL 1I(M WM MM1N®N1AER >Q6(//ORV6W ICE � 8 K1Y �� IL :. FNYl1 u^YI11JyT �1 m I 1,6CWIA29P6fdu� OAU B6®lS �,W09fA91 D]® FLOOR PLAN ELEVATION A ELEVATION B Bathroom plumbing scope of work: Install toilet warmer / Install shower bled pan with drain, with 2% sub -slope. see section below. Install toilet 12'rough-in Install vanity with deck mounted faucet Install thermostatic shower combo with shower head d and hand shower ELEVATION C ELEVATION D .n 102 NW 101 STREET - MIAMI BATHROOM PLANS AND ELEVATIONS OWNER: PASCALE GOLDENSTEIN 03.11.2022 Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 • r a4iy'50'1&11:j Permit Type: Plumbing - Residential Work Classification: Alteration Permit Status: Applied Issue Date: I Expiration: 10/08/2022 Location Address Parcel Number 102 NW IO1ST ST, Miami Shores, FL 33150 1131010220210 •_:.. _w._ _._ .... _.ems... .�_ _ _ _:.... .: - Contacts PASCALE GOLDENSTEIN Owner Titan Plumbing Repair LLC Contractor 102 NW 101ST ST, Miami Shores, FL 33150 Aaron Gomez Mobile: 6465917140 pascalegoldenstein@gmail.com 1175 NE 109th Street, miami, FL 33161 Other: 7864879288 aaron@titanplumbingrepair.com HOMEOWNER Description: SHOWER PAN INSTALLMENT AND INSTALLING Valuation: $ 2,000.00 Inspection Requests: FIXTURES SUCH AS TOILET, VANITY, SHOWERBODY i." 305-762-4949 Total Sq Feet: 0.00 nirumn�� uuua—�:_:. Fees Amount Application Fee - Other $50.00 CCF $1.20 DEIPR 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 Payments Date Paid Amt Paid Total Fees $117.10 Check# 1632 04/11/2022 $117.10 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 authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date April 11, 2022 Page 2 of 2 BUILDING PERMIT APPLICATION ❑BUILDING LUMBING 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 ❑ ELECTRIC ❑ ROOFING RECEIVED Nil FBC 20 Master Permit No. V C dZ Z2 — J (0 Sub Permit No. PI _(Xc Z2—G )-q ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I V Z 1 V v V I O City: i Miami Shores r�County: Miami Dade Zip: ?i 1 � U Folio/Parcel#:_i I—3 O I -- 022— 02-1 V Is the Building Historically Designated: Yes V NO Occupancy Type:SJP Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name ��IVW (Fee ,Simple TitlehoIdder):Y� r-;6ni Phone#:L46 �I -+`7 I Address: I V. (*DI LS+f t i-[— City:"�m ul� s State: �IIJt I�'f\ Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: _A /�_ 't' Ili fykLn� 1/-C. �(C Phone#: �/n—�317-) O]� Address: l N � IM+t 1 SbE-ee � City: State: Eb6dlk- Zip: per/ Qualifier Name: t7N /V'11P2 Phone#: f—y�--()2 p �( State Certification or Registration #: S i� l�f z!�) 'Sig Certificate of Competency #: DESIGNER: Architect/Engineer: Address: h7� City: State:/Zip: Value of Work for this Permit: $ 2, 00 D /lam Square/Linear Footage of Work: 1 :. Type of Work: ❑ Addition LJ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: S' M)o ►ir PrnIl-U`A0I.Imer %Nri "m,��ta I I il/� f—x6 QS Specify color of color thru Submittal Fee $ Permit Fee Scanning Fee $ l�-22t Fee $ - 02 Technology Fee $_ OL • Training/Education Fee $ Structural Reviews $ CCF $ 1.210 CO/CC $ DBPR $ 2 - tN Notary $ Double Fee $ Bond $ '415� TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Compa 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 rreeiinsspection fee will be charged. Signature I A l" Signature The day OWNER or AGENT CONTRACTOR before me this 20 22 • by I "iLf11-Y OUTA't1`OTCTNwho is personally known to i me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: Seal: boa gN Notary Public State of Florida Jasmine Del Valle y� MY C0r11falaaIM HH 055457 "la add Expres 10r11=24 APPROVED BY Theforegoinginstrument was acknowledged before me this 4 M day of 40il 20 22 by EZ w a is personally known to me or who has produced-±Jj)G ()t,A1 ?-Z as identification and who did take an oath. NOTARY PUBLIC: Sign Notary Public Stale of Florida Seal: c l Jasmine Del Valle ) MY COMMISSM HH 055457 �ywd� Exprea 10/21/2024 Plans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A.COPY OF QUALIFIER'S STATE LICENCES B. 41 COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ......................................................................................... BUSINESS NAME: 11�� WM 1 PAO 06'l i BUSINESS ADDRESS: BUSINESS PHONE: a%—)'�m — I O � FAX NUMBER (_) STATE_ ZIP 331 h1 CELL PHONE (j%Q)qU:�C)7,W QUALIFIER'S NAME: kff.6d finNke Z QUALIFIER'S LIC NUMBER: � ��14zq sI Ron Desantis, Governor Halsey Beshears, Secretary d b a STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD THE PLUMBING CONTRACTOR HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES GOMEZ, TITAN PLUMBING RE 1LC 1175 NE 109TH STREET. MIAMI FL 33161 LICENSE NUMBER: CFC1429519 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. 014181 Local Business Tax Receipt Miami —Dade �CountT A y, p State NOT PAY Florida -THIS IS 7198195 BUSINESS NAMEXOCATION TITAN PLUMBING REPAIR 1175 NE 109TH ST MIAMI FL 33161 OWNER TITAN PLUMBING REPAIR C/0 AARON GOMEZ M RLLC RECEIPT NO. RENEWAL 7480618 Ors SEC. TYPE BE BUSINESS 196 PLUMBING CONTRACTOR CFC1429519 LBT EXPIRES SEPTEMBER 30, 2022 Must be displayed at place of business Pursuant to County Code Chapter SA - Art. 9 & 10 PAYMENT RECEIVED OYTA%COLLECTOR $75.00 07/15/2021 INT-21-342187 Worker(s) 1 or a certification of the holders qualifications,to do business. Haldermust comply with any governmental This Local Business Tax Receipt only confirms peymentofthe Local Business Tax. The Receipt is note license, Pannell, or nongovernmental regulatory laws and requirementswhicli apply to the business. The RECEIPT NO. above must be displayed on all commercial Vehicles - Miami -Dade Code Sec Ba-276. For more information, visit AVVVY miaMidade.govIta)(COIlector ACORO® CERTIFICATE OF LIABILITY INSURANCE `••� DATE(MMIDDNM) 04/11 /2022 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(les) 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 SEBANDA INSURANCE #29 19521 SHERIDAN ST PEMBROKE PINES FL 33332 CONTACT NAME: ELIZABETH MARTI PHONE (954) 905-6064 No): (954) 905-6023 E-MAIL ADDRESS: e.marti@sebandainsurance.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: ASCENDANT COMMERCIAL INS INC 13683 INSURED TITAN PLUMBING REPAIR LLC 1175 NE 109TH STREET MIAMI, FL 33161 INSURER B : GRANADA INSURANCE COMPANY 10198 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. iLTR TYPE OF INSURANCE JUM SU D POLICY NUMBER MWDD EFF MMMD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 F X CLAIMS -MADE I OCCUR DAMAGE TO R-ffN-rffg- PREMISES Ea occurrence S MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A Y N 0185FLOO165539 - 0 12J06/2021 12/06/2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY JECT LOC X PRODUCTS - COMP/OP AGG S 1,000,000 FIRE DAMAGE $ 100,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea cadent $ 100,000 BODILY INJURY (Per person) $ ANY AUTO B AUTOS ONLY AUTOS OWNED X SCHEDULED Y N CA-56350-0 12/06/2021 12/06/2022 BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PIP(Per person) $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A PER OTH- STATUTE I I ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If es, describe under DSCRtPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 2007 FORD ECONOLINE 1FTSS34L77DB41255 2006 FORD F-150 1FTRF12W96NBO4270 2011 JEEP PATRIOT 1J4NT1GAOBD16874 2017 FORD T-250 1FTYR1YG9HKA98560 2017 NISSAN NV2500 S 1N6BFOKM6HN800384 FOR PLUMBING SERVICES ADDITIONAL INSURED MIAMI SHORES VILLAGE BUILDING DEPARTMENT CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2nd Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores FL 33138 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ELIZABETH MARTI ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD A� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MWDD2rn 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 CONTACT NAME: Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. PHONE Ext : 1-800-524-7024 ac No E-MAIL ADDRESS: 1 Adp Boulevard INSURERS AFFORDING COVERAGE NAIC p Roseland NJ 07068 INSURER A: Technology Insurance Company, Inc. 42376 INSURED Titan Plumbing Repair LLC INSURER B : INSURER C : INSURER D : 1175 NE 109th St INSURER E : INSURER F : Miami FL 33161 COVERAGES CERTIFICATE NUMBER: 2403891 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 LTR TYPE OF INSURANCEADDLSUBR NSA D POLICY NUMBER POLICY EFF MMIDDIYYYYI POLICY EXP (MMIDDhIrLIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) S PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY EaCOMBINED accident)GL LIMIT $ BODILY INJURY Per ( person) $ BODILY INJURY (Per accident) $ PROPERTY b7UVG-E$ Per accident S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ QED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑Y (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below N I A N TWC4035477 12/01 /2021 12/01 /2022 PER STATUTE I I ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Contractor License: CFC1429519 Job Reference: PASCALE -SHOWER PAN INSTALLMENT AND INSTALLING FIXTURES. Job Locations: 102 NW 101 STREET, Miami, FL 33161 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 FL 33138 I v I5tstl-Zu15 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Notice to Owner — Workers' Corn Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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 BECYW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. �J Signature: State County of Mibini-Dade The foregoing was acknowledgeI,Jbefore me this � day of , 20Z2 By l Uen sfia I ) o is personally known to or has produced .� n as identification. SEAL: V �..{'( f llNotary Public Slab of Fimcla Jasmine Del Valle Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: EL-04-22-907 Permit Type: Electrical'- Residential Work Classification: Alteration Permit Status: Approved Issue Date:04/1112022 I Expiration: 10/11/2022 Location Address Parcel Number 102 NW 1015T ST, Miami Shores, FL 33150 1131010220210 Contacts PASCALE GOLDENSTEIN Owner 102 NW 101ST ST, Miami Shores, FL 33150 Mobile: 6465917140 pascalegoldenstein@gmail.com FINETECH INC Contractor LUIS SANCHEZ 6102 SW 14 ST, FL 33144 Business: 3052673785 INFO@finetech.us Other: 3052166364 Description: ELECTRICAL FOR BATHROOM REMODELING Valuation: $ 950.00 Ins ection Requests: 305-762-4949 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 $9.00 Technology Fee $2.50 Total: $116.30 Building Department Copy Payments Date Paid Amt Paid Total Fees $116.30 Credit Card 04/11/2022 $66.30 Credit Card 04/08/2022 $50.00 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. I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws and zoning. Futhermore, I authorize the above named contractor to do the work stated. / Applicant / Contractor ! Agent April L, 2022 Page 2 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 0 ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: 102 NW 101 ST ST FBC 20 Master Permit No. RC-02-22-386 Sub Permit No. EL - Oy -22 -nl O-7 ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Pascale Goldensteln Phone#:6465917140 Address:102 NW 101 ST City: Miami Shores State: FL Zip: 33150 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Fintech, Inc Phone#: 3052166364 Address: 6102 SW 14th ST City: West Miami State: FL Zip: 33144 Qualifier Name: Luis Sanchez Phone#: 3052166364 State Certification or Registration #: EC13002008 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: A �n Value of Work for this Permit: $ / V L9 Square/Linear Footage of Work: Type of Work: ❑ Addition K Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Electrical for bathroom remodeling 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 $ (Revlsed02/24/2014) 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 , i � — W or AGEN i The foregoi instrument was acknowledged before me this day of r4,,r: . 20 Z L , by 2S cc �t �cf e l Jf.R r'w who is rsonall to me or who has produced The foregoing instrument was acknowledged before me this �— day of / Q r . . 20 t `i , by �► �!S S QK G ►'t P_ '� , wh a t C sonally know o as me or who has produced identification and who did take an oath. identification and who did take an oath. i=11 NOTARY PUBLIC: NOTARY P BLIC: n• Si n• Print: C Print: ? 0 S C. S Seal: Seal: Notary Public State of Florida A Rosa Abigail Sarria Notary Public State 7ofFlorlda My Commission Aimm Rosa Abigail Sar! FiH 220663 My Commission Exp. 2/27/2026 lil"11111IMM HH 220663 APPROVED BY l>- 2-�Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) C Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. VCOPY OF QUALIFIER'S STATE LICENCES B. V COPY OF LOCAL BUSINESS TAX RECEIPT C. V COPY OF LIABILITY INSURANCE" D. V COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) "YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ........................................................................................... BUSINESS NAME: Fine Tech Inc. BUSINESS ADDRESS: 6102 SW 14th Street CITY Miami BUSINESS PHONE: ( 305 1216-6364 FAX NUMBER () CELL PHONE( 305 ) 200-2307 QUALIFIER'S NAME: Luis Sanchez STATE FI. Zip 33144 QUALIFIER'S LIC NUMBER: EC13002008