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FW-06-23-1495Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address 102 NW 105TH ST, Miami Shores, FL 33150 Contacts MENTSH PAYET LLC Owner Nicolas Camino PO BOX 310686, MIAMI , FL 332231 Business: 7867081242 bmvocamino@gmail.com Permit NO.: FW-06-23-1495 Permit Type: Fence/Wall Work Classification: Wood Fence Permit Status: Approved Issue Date:07/17/2023 Expiration:01/11/2024 Parcel Number 1121360131290 CONSTRUCTION & CONSULTING Contractor CONTRACT GILBERT DAVID MORALES 7434 SW 48 ST Suite B, Miami, FL 33155 Business: 7862365755 david@candcc.net Description: REPLACEMENT FENCE FOR WOOD 6' FENCE Valuation: $ 6,300.00 Inspection Requests: 305-762-4949 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $4.20 DBPR Fee $4.72 DCA Fee $3.15 Education Surcharge $2.10 Planning and Zoning Review Fee $70.00 Scanning Fee $9.00 Technology Fee $31.50 Wire and Wood Fence Fee $265.00 Total: $439.67 Payments Date Paid Amt Paid Total Fees $439.67 Check# 195 06/12/2023 $50.00 Credit Card 07/17/2023 $389.67 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 ELECTRIgKL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: 135rKify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a oning. Futherrmore, I authorize the above named contractor to do the work stated. Authorized July 17, 2023 Applicant / Contractor / Agent Date Page 2 of 2 K C>✓tVMD BUILDING PERMIT APPLICATION QBUILDING ❑ ELECTRIC Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax:1305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 76Z-4949 ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑ CHANGE OF CONTRACTOR JOB ADDRESS: 102 NW 105 ST Master Permit Sub Permit JUN 12 2023 BY: Qkt FBC 2026 - 74-41 FW-0l -Z3-14QS ❑ REVISION ❑ EXTENSION ❑ CANCELLATION ❑ SHOP DRAWINGS [—]RENEWAL City Miami Shores County Miami Dade Zip: Folio/Parcel#• 11-2136-013-1290 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Zone: BFE: FIFE: OWNER: Name (Fee Simple Titleholder): MENTSH PAYET LLC Phone#: 786-262-2003 PO BOX 310686 City. MIAMI Tenant/Lessee Name: Email: FL CONTRACTOR: Company Name: CONSTRUCTION & CONSULTING CONTRACTORS LLC 7434 SW 48TH ST STE B MIAMI, FL 33155 Email: DAVID@CANDCC.NET Qualifier Name: GILBERT MORALES Phone#: State Certification or Registration #: CGC061549 Certificate of Competency M DESIGNER: Architect/Engineer: Value of Work for this 33134 Square/Unear Footage of Work: 3 I S. LU 1 fi Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑ Demolition Description of work: REPLACE FENCE qip l cDRp 6' Teed 1'Ci i L�_- Specify color of color thru tile: Submittal Fee $ J CCO Permit Fee $ '7 6 s -00 CCF $ L • ZW CO/CC $ Scanning Fee $ `A - 00 _ DCA Fee $ —21- t 5 DBPR $ L{ • 7y Notary; Technology Fee $ j ( 5 _ Training/Education Fee $ Z i O Double Fee $ . Structural Reviews $ _ .... P&Z Review $ Bond $ TOTALFEENOWDUE$ _3F2.6-7 (Revi5c!04/05/2022) 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 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 on 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. AGENT The foregoing instrument tas acknowledged before me this dayof20 by rsll L� S�IJ who is-pesonally kno n to me or who has produced identification and who did take an oath. NOTARY PIIRLIC 7 VYI Signature CONTRACTOR The foregoing instrument was acknowledged beforemethis I day((jj��f� '� (% OF 2023 by 6nl &f h0 rsona y n to as me or who has produced identification and who did take an NOTARY PUBLIC: s0, - }0188 m a oa Yp CB B .. � Nagr.,sn GG getn Print: Seal: as APPROVED BY LJV� 1" / Plans Examiner 1. r /Y1�77 Zoning Structural Review EiErR (Revised04/05/2022) Detail by Entity Name Page 1 of 2 Florida Department of State ? rj1 g Department of Stale / Division of Corporations / Search Records / Search by Entity Name / Detail by Entity Name Florida Limited Liability Company MENTSH PAYET, LLC Filing Information Document Number L17000154567 FEI/EIN Number 82-2440111 Date Filed 07/19/2017 Effective Date 07/14/2017 State FL Status ACTIVE Principal Address 16900 N E 19th Ave North Miami Beach, FL 33162 Changed: 03/26/2018 Mailing Address PO BOX 310686 MIAMI, FL 33231 Reaistered Anent Name & Address LI PSON, STUART A 16900 NE 19th.Ave North Miami Beach, FL 33162 Name Changed: 03/26/2018 Address Changed: 03/26/2018 Authorized Person(s) Detail Name & Address Title MGRM BRAVO, A. NICOLAS PO BOX 310686 MIAMI, FL 33231 Annual Reports Report Year Filed Date 2021 04/08/2021 2022 04/07/2022 DIVISION OF CORPORATIONS https:Hsearch.sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entit... 6/12/2023 SCALE: 1" OC 301 Miami Shores Village Building Dep> artmgnt v u w Zoning Dept.. Date n vl" Phone: (788) 3rrondo 8 --}� Building Dept. to E—mail: jokiepOrrondo®y0hoo.com S I Subject to compliance with all F er I, Phone Fax: (305) 223-6060 State and County rules and regulations. E-mail: vi2caya.13@gmail.oDm ) Ant S Permit# (-1n/ 06 -?3—I y 95 LOCATION MAP -. _.�.�:�:7s rmu wanaWAY '77, ... ". -. ..�9I.' . . .N.. . . . . lr M1SPX. FIGHT OF NT .,,l'. . ...... .. . aT. . I... .%ALT a . 0............a. Ra,Q&.. fish Cut oit C i«i K aM t«r COMMUNITY NAME AND NUMBER: I PANEL NUMBER AND SUFFIX: I FIRM PANEL EFFECTIVE DATE: VILLAGE OF MIAMI SHORES: 120652 12086 C 0302 - L 09 / 11 / 2009 COUNTY NAME: MIAMI DADE FLOOD ZONE: X BASE FLOOD ELEVATION : N/A NOT TO SCALE I (_0 P �& OF cV�2k: Th)s mLL A `' t1 L 5'llel "-tC )ZB Yec F PY 1H9 GVIIPIMMIR 11844 S.W. 203th ST. L.B. 8000 Miami, Florida 33177 13217 S. W. 46th Ln. Miami, Florida 33175 N.W. tOSth STREET Y PROPERTY ADDRESS: 102 NW 1 05 ST, MIAMI SHORES, FLORIDA. 33150 LEGAL DESCRIPTION: LOT 1 AND LOT 2. BLOCK 126, MIAMI SHORES SECTION 5 ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 1 ❑, AT PAGE 4']. or THE PUBLIC RECORDS OF MIAMI DADE COUNTY. FLORIDA. P LEGEND AND ABBREVIATIONS A=ARC DISTANCE MIL- MONUMENT LINE ELEVATION AC- AIR CONDITIONED UNIT OH= OVERHEAD UTILITIES B.C=BLOCK CORNER PCP= PERMANENT CONTROL POINT ®=WATER METER - e CB.=CATCH BASIN PCB= POINTO OF BEGINNING I/ (Cp CALCULATED P0C= POINT OF COMMENCE POWER POLE � CL CLF= CHAIN LINK FENCE IUS RpIRECORD .�.=LIGHT POLE _J�3'Q(J�,lJ�� ECE DME=°RAINAGEMAINT EASEMENT R. FIGHT -WAY ®= FIRE HYDRANT ENC=ENCROACHMENT TYP=TYPICAL FO=FOUND UE=UTILITY EASEMENT F FFLES FINISHED FLOOR ELEVATION WF=WOOD FENCE ®=MANHOLE IF=IRON FENCE WM=WATER METER LF.ELEV LOWEST FLOOR ELEVATION III DIAMETER (M)=MEPSERED O= CENTER LINE [AMI SHORES VILLAG PUBLIC WORKS REVIM-7j DROVED 1�DATE BM USED: MIAMI DADE Co. BM # N-567 ELEV: 10.54' =CATCH BASIN ®=SANDARVSEWER -WATER VALVE ® =TV BOX FER =FPLTRANS M =DOING POWER POLE JOB NUMBER: 23720 RESTRICTIONS. RESERVATIONS OR EASEMENTS OF RECORDS LEGAL DESCRIPTION PROVIDED BY CLIENT THE LIABILITY OF THIS SURVEY IS LIMITED TO THE COST OF THE SURVEY. UNDERGROUND ENCROACHMENTS, IF ANY ME NOT SHOWN THIS FIRM HAS NOT ATTEMPTED TO LOCATE FOCI ANESOR FOUNDATIONS ANU'OR UNDERGROUND IMPROVEMENTS OF ANY NATURE IF SHOWN BEARINGS ME REFERRED TO AN ASSUMED MERIDIAN IF SHOWN ELEVATIONS ARE REFERRED TO N G V D OF IM THE CLOSURE IN THE BOUNDARY SURVEY IS ABOVE 1. LSW THIS SURVEY IS NOT INTENDED FOR NEITHER DESIGN NOR CONSTRUCTION PURPOSES FOR THOSE PURPOSES A TOPCGRAPHIO SURVEY IS REQUIRED. FOR: DATEOFFIELDWORKJUKE 1, 2023 REVISED ON'. MENTSH PAYET LLC Ihereby oemq that The attached Skefm of Survey of the theme¢ dascnbed toopeny re to Pe too of my knowledge and Belief. awe and conea representation, of a NEW survey pedpmled under my �EIVED direction And onto meets the MbmumTetllmcalStandards asset ladh by the nmkY Board of Pmllissional Suntyom and Mappers m NOTES. A S er 5J-171150am SNITD52 F.A_C. Parsaam m Bemmn n2B2y JUN 23,2023 11 V� A ARTR° R. TOIRP.S.M.-102 ` Not veld wnlloul The symtme and the PnNnal emMsed seal of a >�cETvMJID JUN 12 2023 BY: Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 WOOD FENCE DETAIL ❑ Shadow Box ❑ Vertical Picket ❑ Board on Board At Vjo •v'zo,j 4A L ences < _ ' high posts spaced at 4' on center maximum Fences < = 5' high posts spaced at 5' on center maximum Fences < = 4' high posts spaced at 6' on center maximum Fence must not exceed 6' in height ix pickets fastened with two corrosion resistant fasteners per connection 2x4 horizontal pressure treated wood members with two corrosion resistant fasteners per connection 4x4 pressure treated posts embedded 2'Into concrete footing t 0" diameter 2'deep ALL wood must be pressure treated I All fasteners must be corrosion resistant L No less than two fasteners in any connection r�a►7 'lBBBB�I k. da STATE OF FLORIDA DEPARTMENT 1'� 1 REGULATION OF BUSINESS AND PROFESSIONAL CGCO61549 ISSUED: 08/06/2022 CERTIFIED GENERAL CONTRACTOR MORALES, VID CONSTR ON & CO L NTRACT St; LICENSED UNDER CHAPTER 489, 89, FLORIDAFLSTATUTES D IPIRATION DATE: AUGUST 31, 2024 Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 4338261 BUSIMSSUA&9F,1oCAMM flEca"Ho. CONSTRUCTION & CONSULTING CONTRACTORS IL RENEWAL C 4527512 7434 SW 48TH ST STE B MIAMI FL 331S54496 G. DAVID MORALESPP�I4 (786) a6 5755 C6t:DECO ant/CEO CTION fpcandx.nat6Is49 �U ®iyda cI S Ua IX 4) POSpRACTORS•'-' a 7434 SW 48 Str- t, Suite 0, Miami, P1.11da MIM P: C786) 236 S75S • A (786) 4093769 . www,ca clmnet � C =tE fiFCz C_XCELLENCE" = am ---- I I mtmrwc"m'rm°'sm"axewmoa I �tGaPecu� �uw ®avrrao:�c�Rma I sss�mzaYc ans�, FRPat4T1a1/aATE N31@] Peleeµ Ga9ar{,palµ�e � etmosn � aasa'essewa,ymaouxEsa tausrm¢YraaaccrosutmmcoxrRwcroay. iia yuesnaarlsrr�YSYae ��0—" a0 �PA0—I EXPIRES SEPTEMBER 30, 2M Must be displayed at place of business Pursuant to County Cade Chapter BA - Art 9 & 10 owula SEGTYPEBFBUSNESS CONSTRUCION&CONSULTING CONTRACIORSIL 196 GENERAL BUILDING CONTRACTOR PAY"'EUREDEaED C/OGILBEItT DAVR)MOAALB UAURER CGCO61549 BYIARCDIILCma C/OugR1 Q $75.00 07/03/2022 TNT-22-352422 Thermin local 6asinenTan Raeeiptaaly aoafimis payment of the heel 9adnseaT". The Receipt is eota jj,mca, pit. ore eeNRcatloa of ten Beldar srryelifivasns,4n do hueiossa. Holdarn,c, comply with aaq 9arsmmerttai a Doagwemnemal ta9ulalory laws and mquimaaeatswhich apply t°tla hus(ress. Tin RECE[Fr Ill ebaYe mustbedisplayedan all cemmerclal Yehkias-P:iiami-Dade Cade Szc 82-276. For move iatennatise,vieit sa'amitlad if mr CERTIFICATE OF LIABILITY INSURANCE oar a2a23 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRh1A7WELY OR NEGATIVELY AMEND, EXTEND Oft ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS I I I U I E A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the ce:6iG. holder Is an ADDITIONAL INSURED, the policypes) must have ADDITIONAL INSURED provis%ns or the endorsed. If SUBROGATION IS WANED, subject to the terms and condMons of the policy, taertain Polk ies may requim an endorsement A statement on this qeMcaft does not confer d to the certificate holder in rm of such andomM2996A PRODUCER ALL CITY INSURANCE INC. 1400 NW 107th AVE SUITE 210 DORAL FL 33172- MAIM INGRID HERRERA � PHONE(41c No _ (305)483-8431 Fa .(305}436-6797 gl:M GMAIL cQAL.LC"NS.COM .KEMPERAUTO INSURANCE 11738 RED CONSTRUCTION & CONSULTING CONTRACTORS LLC 7434 SW 48th. Street. Ste B Miami FL 33155- m1num .ROCKINGHAMCASUALTY COMPANY 42595 _ F GUVERAGES CERTIRCATE NIIMRER- DL-%nQw%U arcs as Cn. 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. aLTRm TYPE OF INSURANCEADDL SUER POLICY EFF POLICY EXP' 1lldf f 8 B X C=KMcKLGeNewl.LwBturY CLAWS -MADE OCCUR RFLG220465-00 7I24/2022 7=2023 EACHoccuRRENcE 1,000,000 DiAAAGE TO RENTED EXP arse __ _ 50,nnn 5,000 PERSON& § AOV WURY 3 1,000,000 GW'L AGGREGATE LIMIT APPLES PER. X POLICY �'� �] Loc MHER GENERAL AGOMeATE 2,000,000 - COW JOPAW 2.000,000 A E L AUTOMOBILE A.AY X ANY AUTO i� OWNED �' SCHEDULED AUTOS ONLY AUTOS WRE D NON -OWNED AUTOS ONLY AUTOS ONLY 5098200545SWO1 r2= 023 (Ea AnddanO Gi E LOrifi BODILY WXRY ()'er parson) S 300,000 S BODILY KJURY (Par aWdetM ' $ PROPERTY DAMAGE f a UMBRLLALIAB EXCESS LiAS _ OCCUR C S-AAAD MO Q=RRENCE /�GGR�ATi: WORKEFtSCONFUSATM AND EMPLOYEW LIA88" ANY PRO � E BE EXCLUDED? IF lies, deft un t N t A PER OTH- E.L. EACH El. MWASE- FA M PPLO E.L LIMrT LDESCRIt ENO CGMO 549ERALOCA11ONS Ivy d (ACORD tot. Adb%nd Rwmwft 8CJtQCbgtK awe► ba d It aso�o aRaw is roqubvm Miami Shores Village. 10050 N.E. 2nd Avenue. Miami Shares M1 U-1-I Vw SHOULD ANY OF THE ABOVE DESCRIBED POLtC" BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VWTH THE POLICY PROVM10M FL 33138- 1 AMCIVED �A.nyE waP ivy -raul5 AWK0 CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and forgo are registered marks of ACORD Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.gov 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 industrywho 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. L � # %W �+)� h� �N �ty�< Y� , �P I Your contractor: 1n A'0 ( is requestinga 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' compensatioXinsurance coverage from the contractor's company for day labor, part- time employees or subc, BY SIGNING BELOW YOU Signature: State of Florida County of Miami` -Dade THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Address: I 2 N ",3 IDS Si The forego' w a e or m this ti g� day of t� u 20 Not ry �pphc Scale d Floe p Ca no By q¢M�a 25 who is personally known to me or has produced p� P ExPues 0529(20 STs4n} w� as identification. �1 Notary: SEAL: Rev12122022 Notice to Owner Page 1 of 1 Miami Shores Village - BUILDING DEPARTMENT 10050 NE 2 Ave Miami Shores, FL 33138 305-795-2204 www.msvfl.Qov BusinessName: C'> Address: Phone: ( in6-) 23 6 ' 1 -+SS E-mail: Qualifier Name: Contractor Registration Form "NC C-. 4 M Qualifier Lic Number: JUN 2 i_ 2Q23 BY: �ti F I- 33j S� Contractor may register license and insurance information with the Village on an annual basis. The initial fee will be $50 with an annual update fee of $30. Contractors that elect not to maintain their information on file will need to provide their information with each permit applied for. Please confirm if you would like to register your Contractor for a fee of $50. A FLORIDA STATE CERTIFIED CONTRACTOR: A. ! Copy of Local Business Tax Receipt B. ! Copy of Qualifier State Licenses C. i Copy of Liability Insurance* D. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 6th edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice to Owner form and Contractor Affidavit) A MIAMI DADE COUNTY CONTRACTOR: A. Copy of Certificate of Competency of Qualifier B. Copy of Local Business Tax Receipt C. Copy of State Registered Contractor Licenses or Miami Dade County Municipal Contractor's Tax Receipt. D. Copy of Liability Insurance* E. Copy of Workers Compensation Insurance* Provide proof that the contractor has secure compensation for its employees as required under section 105.3.5 of the 6`h edition to the 2017 F.B.C. (Workers Compensation FEIN EXEMPTION must have Notice of 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. rW-66-2.3-44g5' CONSTRUCTION & CONSULTING CONTRACTORS, LLC. June 12", 2023 State of Florida County of Miami -Dade VtEEE1VF;D JUN 2 i ZOZ3 BY: Before me this day personally appeared Gilbert David Morales who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 102 NW 105 St Miami Shores, FL 33150 44q Gilbert David Morales Lic# CGC061549 Or Produced Type of Identific 7434 SW 48 Street Suite B Miami, FL 33155 P: (786) 236-5755 LIC# CGC061549 david@candcc.net www.candcc.net �4c State d Fbrda 0, N tolebs Bran GG 987rsm7 5 Name of Notary