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DS-08-23-2121
Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 790 NE 91ST ST 1, Miami Shores, FL 33138 Contacts EROS GOMEZ Owner 790 NE 91 ST 1, MIAMI SHORES, FL 33138 erosribero2@gmaii.com Description: RE -COATING DRIVEWAY, LAYING DOWN NEW 2 " ASPHALT. PAINTING NEW LINES Fees Amount Application Fee - Other $50.00 CCF $2.40 Concrete/asphalt/pavers, slabs, dways, $150.00 swalks DBPR Fee $3.00 DCA Fee $2.00 Education Surcharge $1.20 Planning and Zoning Review Fee $70.00 Scanning Fee $9.00 Technology Fee $20.00 Total: $307.60 Permit NO.: DS-08-23-2121 Permit Type: Driveways/Walkways/Slabs Work Classification: Addition/Alteration Permit5tatus: Approved Issue Date: 01/2512024 1 Expiration:07/25/2024 Parcel Number 1132060390040 MATTHEW MARRA 2702 ALTON RD, MIAMI BEACH , FL 33141 constructionmia@gmaii.com Valuation: $ 4,000.00 Inspection Requests. 305-762-4949 Total Sq Feet: 2,363.00 Payments Date Paid Amt Paid Total Fees $307.60 Credit Card 01/25/2024 $257.60 Credit Card 08/25/2023 $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 regulatin construction and zoning. Futhermore, I authorize the above named contractor to do the work stated. r.-,.' 12, -4� O112,�12¢ Authorized Signature: Owner / Applicant / Contractor / Agent January 25, 2024 Page 2 of 2 RECEIVED Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 7S6-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ❑ ELECTRIC ❑ ROOFING AUG 2520D BY: —' FBC 202-0" Master Permit No. � , " 2-3,- 2,1 ZI Sub Permit No ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 77V lvc 4/r1 City: Miami Shores County: Miami Dade Zip: D3/3e Folio/Parcel#: i —3zO% " 639_ 0010 1 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction nnTypee/: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): C/-oJ /�.rd�a - Phone#: 7.�C4' I-T/ /1e3 / ^ n rlrirocc- IT r 7 � /C—o., rCienP U1J City: /!/,o.-Pli /'r::•••+i`, Tenant/Lessee Name: Email: rras ri6e..2 42 ° CONTRACTOR: Company Name: Address: / / 5 tV Email: (� r/rtte Qualifier Name: State Certification or -1, cbri AOL State: Fc9v-r o/,,- Zip: 3 3 /0 / LL C G ; %= 5 8'0 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Add Value of Work for this Permit: Type of Work: ❑ Addition Description of Work: I // _City: State: Zip: Square/Linear Footage of rk: Zi 5 Z 5 ❑ Alteration ❑ New ❑ Demolition 14 'L/w 4,1-7,-P, Specify color off color thru tile: Submittal Fee $ a) V -00 Permit Fee $ CCF $ L Li 0 CO/CC $ Scanning Fee $ VL 00 DCA Fee $ 00 DBPR $ 3.60 Notary $ Technology Fee $ Z�6 , bb Training/Education Fee $ i ZC' Double Fee $ Structural Reviews $ P&Z Review $ Bond $ TOTAL FEE NOW DUE $ 2-51• 42O (Revised04/05/2022) 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 pasted notice, the inspection will not be approved and a reinspection fee will be charged. Signature.n Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this W42 day of IKq O.AJ% , 20 Z3 , by .20 day of Mg4c,k , 20 _, by ieFt0 s R "Set,. who is personally known to Q aet., 111 CLryl 0- , who is personally known to me or who has produced L.. i� 162_ �.Ey. PP 3?SS- 0 me or who has produced 17 L.41 M 60,0 _ $So identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: y9s £of APPROVED BY identification and who did take an oath. NOTARY PUBLIC: e-tii'u i%!O Sign: Print: ALEXANDRINE AgI 0 •tip+ov"e'. No Public -State of Florida Seal: (a�; V;`: ALEXANDRIn30,2O23 Commission X GG.350112 Notary Public - My Comm. Commission # ExpiresJun 3 30, 2023 `-?or,ti Commission My Comm. Expires* Q'*I�*j*********** Plans Examiner #-"`Y A, DW^''o ` / `/Zoning (Revised04/05/2022) Structural Review Clerk 2023 FLORIDA PROFIT CORPORATION ANNUAL REPORT DOCUMENT# 215470 Entity Name: 790 CO-OP INC Current Principal Place of Business: 790 NE 91ST STREET APT.4 MIAMI SHORES, FL 33138 Current Mailing Address: 10178 COLLINS AVENUE APT.207 MIAMI BEACH, FL 33154 US FEI Number: 59-1671104 Name and Address of Current Registered Agent: PADULA, RICARDO 10178 COLLINS AVE APT 207 BAL HARBOUR, FL 33154 US FILED Feb 21, 2023 Secretary of State 7124681454CC RECEIVED AUG 2 5 2023 BY: Q Sr_ Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: RICARDO PADULA 02/21/2023 Electronic Signature of Registered Agent Officer/Director Detail : Title TD, TREASURER Name PADULA, RICARDO Address 10178 COLLINS AVENUE City -State -Zip: MIAMI BEACH FL 33154 Title SD, SECRETARY Name PADULA, ELOY Address 790 NE 91 ST STREET APT. 4 City -State -Zip: MIAMI SHORES FL 33138 Title PD, PRESIDENT Name RIBERO, EROS Address 790 NE 91 ST APT.1 City -State -Zip: MIAMI SHORES FL 33138 I hereby caddy that the information mift"led on this report or supplemental report is me, and accurate and met my elecumuc signature shall pave the same legal efled as ifmade under call; hat 1 em an officer or director of the co oreal in or the receiver or trustee empowered to execute this report as required by Chapter 601, Honda Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: RICARDO PADULA TD 02/21/2023 Electronic Signature of Signing Officer/Director Detail Date F2ECEIVED AUG 2 b 2t.*J BY: 9' Dear Miami Shores My name is Eros Ribero, I'm acting president of 790 Co - Op located at 790 NE 91 st Miami Shores FI 33138. We're currently fixing up the building an taking care of some violations. I'm approving the permits /��to be open. A 1 OS/2 3/23 Mission: To (rated, prorn1e & irpraethe heaM of all people in Floridattvough ink state, oau ty&arrrnaityelfons Vision: To be the Fleaft iestStailein the Nation December 14, 2023 Eros Ribero Gomez 1995 Keystone Boulevard Miami, FL 33138 RE: Modification to a Single Family Residence - No Bedroom Addition Application Document Number: AP2003928 Centrax Permit Number: 13SM-2801631 790 NE 91 Street Miami Shores, FL 33138 Dear Applicant, Ron Dwane. Governor Je.gl, A. LUdW%M16 n State Surgeon General ENT'71,RED BY: DEC 18 2023 This will acknowledge receipt of a floor plan and site plan on 10/05/2023 for the use of the existing onsite sewage treatment and disposal system located on the above referenced property. Reviewed by Ana A Flores Moreno on 12/13123. No objection to repaving parking ONLY as per your site plan. The septic system exists outside the scope of work and will not be affected. NO BEDROOM ADDITION. NO FLOW INCREASE. This office has reviewed and verified the floor plan and site plan you submitted, for the proposed remodeling addition or modification to your single-family home. Based on the information you provided, the Health Department concludes that the proposed remodeling addition or modification is not adding a bedroom and that it does not appear to cover any part of the existing system or encroach on the required setback or unobstructed area. No existing system inspection or evaluation and assessment, or modification, replacement, or upgrade authorization is required. Because an inspection or evaluation of the existing septic system was not conducted, the Department cannot attest to the existing system's current condition, size, or adequacy to serve the proposed use. You may request a voluntary inspection and assessment of your system from a licensed septic tank contractor or plumber, or a person certified under section 381.0101, Florida Statutes. If you have any questions, please call our office at (305) 623-3500. Sincerely, ana a flores moreno environmental specialist Department of Health in Dade County nar.o.pmrd..ersws N.--rw►se. in Dade County • • , Flonda TWITTER:HealthyFLA PHONE: (305) 623-3500 FACEBOOK:FLDepartmentofHealth YOUTUBE: fldoh _� Opy u ca°ie:� REMAINDER aoP�am.:na OF LOT 4 ac 109.44'(M) 109.30'(R) QK•ma ..9. ,i4 PW 4 • � ,K"k 26.W 6.6 ,D6z a'PNIx.M yyyy )Y) J PO U4 m 6.4 II Eli ? v m 7.1' COdC '. •. LOT 3 3.5 STMRS I' 18.00 I ' I I EAST 149 FEET a O Aly OF LOT 4 O K�P I TT O Y Miami ShorE s Vi�age� uilding De rt e \ Zoning Dep. Date Building D t. Date Subject to oompliancewith all Fed ral, a State and Gounly rules and regulations. 30 6200' Permit# S 23 .DYSI � i o J SEPTIC F.IP. I HEREBY CERT4 THATTHR SURVEY WAS MADE UNDER MY RESPONSIBLE CHARGE AND TO THE BEST OF MY g OWLEDGE AND BELIEF; THIS SURVEY MEETSTHE MINIMUM TECHNI STANDARDS AS SET FORTH BY THE BOARD OF Y'/ 5789 SUREEYOR T� Cwm AVILA & ASSOCIATES SERVICES INC La eon m,y Ne e: A DM1L uAaa >b,e Tyj]ee) 317-meo E-YN: ma�OlW�yma9.cwn BY: I 1 ale a- -(`tr4vn� 3©X l 74 a�N'nw n2D A, ? 5 >r _ (Zero 4-5-PA (rod vy. MSL1R11bf COV NC{fie,®Pi„LL 4Si,T{®iaRIR�U�191RM ¢!!f ct Pa1 W eltn,nxreeuwi.0®Iof AigfMefEAVlJIOW m TF' Rli T1EA�,aSAfCOIp®YM9yp1(t ATF�De,N Of T1EA�gi1t IHLOFYSOT W WIM COIM,Y.rtOOI twamamvme .monaenv.w RIDC Puf NIBWIge me eesnmo uaa.veE oar Ar9 •�e w.e�e`ir`��.w�.�...� resew oeaoal uwmaeem;.*mx zom ae:.eew .sm man.. mcn _ mMeenn•a �aaesx Mw�ewwMm� s,. u.�w. Avuer_„P�l�eRtcww,ww,nr 1F2 YJBSL 'RYRM1OC6 li N � 91.O+L qp]l/ eASND �G PROPERTY ADDRESS; TBD NC SIf, 5,R6t. TOPOGPAPIIC SURVE MIMAI 9MOQB ROR04. 33, 30 SGNb l<2I AUG 2 0 2023 2 5x31 11) Yw"AJ M Ron DeSantis, Governor Melanie S. Griffin, Secretary Florida r STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 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 Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 7263363 RECEIPT NO. RENEWAL BUSINESS NAMEMOCATION 7550535 MATT CONSTRUCTION LLC 2702 ALTON RD MIAMI BCH, FL 33141 nrl L El I EXPIRES SEPTEMBER 30, 2024 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED MATT CONSTRUCTION LLC 196 GENERAL BUILDING BY TAX COLLECTOR C/O MATTHEW MARRA QUALIFIER CONTRACTOR 56.25 01/16/2024 Worker(s) 1 CGC1522580 INT-24-275965 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 holders 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 an all commercial vehicles — Miami —Dade Code Sec U-276. MIMI®� For more information, visit www.miamidade,govil'axcollector AC�,Rl7® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 01/15/2024 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 All Alliance Insurance I Corp CONTACT Jennifer NAME: PHONE , (407) 281-4141 aC No)* (407) 281-8385 ADDRESS: dvdcstlll@aol.com 515 N Semoran Blvd INSURERS AFFORDING COVERAGE NAIC # INSURER A: WESTERN WORLD INSURANCE GROUP Orlando FL 32807 INSURED INSURER B : INSURER C : MATT CONSTRUCTION LLC INSURER 0 : 11840 NE 19th Drive #19 INSURER E : North Miami FL 33181 INSURER F : r-nVFRAr,ES 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 MM Wvp SUER NUMBER POLIPOLICY MM DCY EFF MMIDpY� LIMITS A X COMMERCIAL GENERAL LIABILITY —1CLAIMS-MADE a OCCUR NPP8911184 08/30/2023 08/30/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO PREM SES Ea ocRENcurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 X PRODUCTS -COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea cadent $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILI Y Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) IF yes, describe under DESCRIPTION OF OPERATIONS below N ! A OTH STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ 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) License 1522580 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 2 AVE AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE -----------y-------- ISTATE OF FLORIDA ----- I— — — — — — — — — — — — —— I SERVICES I IMPORTANT OVISION FWORKE119CIOMPEN ATION CONSTRUCTION INDUSTRY EXEMPTION *I I F Pursuant to subsection 440.05(14), F.S., an officer Of a corporation who elects I CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA I O exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. WORKERS' COMPENSATION LAW I L Pursuant to subsection 440.05(12), F.S., Certificates of election to be exempt ' EFFECTIVE DATE: W M22 EXPIRATION DATE: 911=24 i D issued under Subsection (3) shall apply only W the Corporate officer named on I the notice of election to be exempt and apply only within the scope of the PERSON: MATTHEW MARRA EMAIL: GCNSTWGnpWlx@OMxA.Cg1 I business or trade listed On the notice of election to be exempt. FEN; 4717MS a H Pursuant to subsection "0.01 F.S., notices of election to be exempt and BUSINESS NAME AND ADDRESS: I E CartdlCates Of election to be exempt shall be subject to revocation it, at any I time after the filing of the notice or the issuance of the certificate, the person MATT CONSTRUCTION, LLO named on the notice Or certificate no longer meets the requirements of this PRIMERO CONSTRUCION IR E I section for issuance of a certificate. The department shall revoke a cartificate I at any time for failure of the person named on the certificate to meet the 11840 NE 19TH DR., NIB, NORTH M, AMI, FL 33191 requirements Of this section. MIAMI, FL 33191 BOOPE OF BUSINESS OR TRADE: I E01593742 I I. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850) 413.1609 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.qov 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 1;�� Address: 71t� ///I/_-- ��s< Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this ZS day of AU-5 u-�4 20 23. By E r-0 5 2' b er--U 67 QYK-&Z who is personally known tome or has produced F7L �y-e S L l L as identification. Notary: "'01111N, VivienneYao =4�PrP4°�*. Comm.:022200 SEAL: = Expires: Jan.31.2026 %L,?ornd Notary Public• State of Florida nama�� Rev12122022 Notice to Owner Page 1 of 1 MATT CONSTRUCTION, LLC GC 1522850 Date: ®o - �f Zo Z 5 State of cJ "C/6' County of %GLn7r /�ari 4 PROFESSIONALISM IS OUR GUARANTEE... 20 YEARS AND BUILDING! "A" RATING ON ANGLCOM Before me this day personally appeared Matt Marra who, being duly sworn, deposes and says: That he or she will be the only person working on the project located : 790 ne 91st Miami shores fi 33138 � N contractor Signature Sworn to (or affirmed) and subscribed before me this d i day of fsT 20D�by 0%I 0/W6X Personally know OR produced identification L51-4m600-SSO,-Fp_ ZSz - D Type of identification produced 00- L Sera e-k of Stamp Name of Notary Commission k HH 419192 �a 'Y Comm, Expires Jun 30, 2027 1 through National Notary Assn, ate__ THANK YOU FOR YOUR BUSINESS! 305.308.2821— CGC 1522580 -11940 NE 19 Dr. Suite 19, N. Miami, FL 3318 -