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RC-11-595
REMOVE OLD KITCHEN CABINETS AND REPLACE WITH NEW CABINETS. Passed 7c_ Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 159368 Permit Number: RC -4 -11 -595 J Inspection Date: May 05, 2011 Inspector: Bruhn, Norman Owner: RODRIGUEZ, LORENZO Job Address: 9212 NE 10 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: TCT CORP Building Department Comments May 06, 2011 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060060010 Phone: (786)235 -6700 Page 1 of 1 NOTICE OF COMMENCFJVIENT A ISSIMIED ROI =ST OF RUT INSPECTODI Pfd NO. • 3 TAX Ft NO t •5 2 • C • CQLO STATE OF FLORIDA COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice Est Inthrovements vg be made to certain rea p and in accordance with Chapter 713. Florida Statutes, Rtetotiow1 Is provided In this Notice of Commencement. 3.Ormer(B) name Wares! M name, address and number: Wane sand address of simple is `y ..T► i�t S ` !��r !�� ttf for 4 - fir Under penalties of perjury, 1 declare that t have read the foregoing and that the facts stated in it are true, to the best of my knowledge end befM' $iprretUte(s)e) ��s) s Authorfa9ed Ofl�rMieotOdellAtner/Ma+ er OM* stt sb0V' J By By e _ fihwsstJP7 111111 111111111111111 11111111111111111111111 CF 2011.1R022 OR ft 27645 Ps 0351f (ipsri RECORDED 04/07/2011 I27'44 HARVEY RUVIH. CLERK OF COURT MANI -DADE COUNTY? FLORIDA LAST PAGE apageabeve for use el r.aerda+e office i P L C s 1. Legal descriptan of property ss: it 0 a MT[i (r, r — o 2. pseeripSon of hnprovement ai „z. • di A R • ate. _ -' -tram if s 5. Surety: (Payment bond required ' Nye, dress and pfd nu"ther: Mount of bond $ p be owed es Melded by 7 Persons mime and ecldrese: by O upon n To et1 7. Pet6ons the State of Florida Section 713.13(1�)(a))7...RR Statutes, ` and -- 17w, address d phon Netter: B. M additkos to�hM+s�U the *glowing Res) , 113.13M, , � -- --- Name, addIese end phone EL Expiradon date 0gds 01 C — ens iseterree WARNINOTOOWN PAYNENTS MADE tsY THE OWNER THE EXPIRATION OF THE WITICECW i YM FOR T1313. FLORIDA STATUTES, DAPROPER 61PROVEIMNIS TO 719. PART 1. SECTION P� ON Tte .108 fN'1'E �� THE EC Y p 0 TrAm NOTICE C T< H YOUR OR AN Al TO1 WORK WET INSPECTION. W Y�i INTEND TQ 08TABN t=t�• QR RECORDING YOUR Nur= OF COM=NCEMENE g�at�s) of Owned) or Own•(ffi)' Authorized ' 8 �� PreParod BY �.� ;., P oa 1 G V3 'tle1O(ffce 0 ,y rF ifN STATE OF F ORU)A _ COUNTY OF M�-OADDE Mate crte" ► nt Q • The foregoing - nt was ache BY Q h dieiduaUy. or U fags h i ® Personally turn, or C1 a of Notary Pty Thant Nam: " I - Miami Shores Village Building Department fu APR 0 5 2011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 d 1(; .. _ _ . _ s INSPECTION'S PHONE NUMBER: (30) 762.4949 BUILDING Permit No. P.0 1 PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: City: Nm i t m'L 6 ,09.9 clto R/ c State: f Zip: 3'3 o / 8 Qualifier Name: ( e co ® Te s9 Phone#: 7' - 2 2 3 a -S. V", / State Certification or Registration #: Certificate of Competency #: © `i S 0 0 6,1 Contact Phone#: 7$ ^ Z 3 ' S<</ / Email Address: c % e ,2 a & 720/44 4.ii e* `r ti-s , co DESIGNER: Architect/Engineer: A1/4 Phone#: /10�.di Value of Work for this Permit: $ g $ Q. 21 v Square/Linear Footage of Work: / / 0 r Type of Work: OAddition OAlteration ONew epair/Replace ODemolition Description of Work: e v y e a . . 7 4 _ v L d k / i t' . o,,..) c.4-,, w e t s A ail/ d OWNER: Name (Fee Simple Titleholder): Go/4947o F. /7002/ 3hone#: 7 frt m "2-4/ -h' ' / Address: 9212 A) E fO4-7 City: M/Ari / J 01■0 State: Zip: 33/7i Tenant/Lessee Name: Phone#: Email: t-0/01Z0 /2- LJ (0 604'601 7� JOB ADDRESS: 9g/ c /tit /6 4"k City: Miami Shores County: Miami Dade Zip: °' 3A Folio/Parcel #: / I oo4 001 0 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: 7 . - . C - / . "y Phone#: -7 - Z -s - Co 7 6 0 Address: /I/ o 41u 6 7 " c 7 ROOFING kept A- (.4) 7 -7 �� e.�� ®, 7 Erik -e / fin . ********* *a: *********** **** * ************F ******************** ************************ Submittal Fee $ QJ Permit Fee $ /C7 CCF $ CO /CC $ 11� Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 279-Y— r � Bonding Company's Name (if applicable) /L Bonding Company's Address City State Zip 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 FI.F,CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S Alik'DAVIT: 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 « ' os at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In /.se ce 'f s. posted notice, the inspection will not be approved and a reinspection fee will be charged 1 / Signature Signature Contractor The foregoing instrument was acknowledged before me this 30 71.1 The foregoing instrument was acknowledged before me this 3 O day of //Alan/ , 20 t 1 , by C o •a a 1+► 7� /Lo t i �r � e - � — , day of "Me-4 , 20 d / , by 1 iG® 0 Ta; vt who is personally known to me or who has produced who is peiftonally known to or who has produced As identific on • who did take an oath. as identifi - : • d w •did • . e an oath. Sign: Print DANIA PEREZ MY COMMISSION 6 DD 837616 EXPIRES: March 8, 2013 �i�p95 a.• Bonded Thru Notary Public Undenuritara NOTARY P My Commission E **************** APPROVED BY Owner or Agent (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Structural Review **iN+ k+ k* **H o******okekek *skHask*** * aN** *iN** **cN** ****W*** * **iN**** Zoning Clerk tot"( 1 IrI M iC nVLi r MIAMIS2 Village of Miami Shores 10050 NE 2 Ave. Miami Shores, FL 33138 " ^ ^""- -•••—' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED - RE / PRESENTATIVE ATIf1\I All -I..MM .os .na THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE Fore T HE rVi rtnrou 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 B TYPE OF INSURANCE ADOL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR CPP00072724 04/29/10 04/29/11 p EACH OCCURRENCE $ 1,000,000 PREMIS S (Ea o $ 300,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: — 7 POLICY n IFCT n LOC PRODUCTS - COMP /OP AGG $ C AUTOMOBILE X UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 044384587 11115/10 11/15/11 COMBINED SINGLE LIMIT (Ea acddent) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per acddent) $ $ B UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE UMB00086382 04/29/10 04/29/11 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ X DEDUCTIBLE RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR /PARTNER/EXECUTIVE Y / OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCV002958605 12/12/10 . � 12/12/11 gal. IT ER ITS ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K mom space Is required) '`t CERTIFICATE OF LIABILITY INSURANCE 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER W.F Roemer Insurance Agency William F. Dowd P.O. Box 190669 Fort Lauderdale, FL 33319 Jonathan F. Remes 954 -731 -6566 954 -731 -8438 INSURED TCT Corp dba/Tamlami Carpet & Tile Pabot Investments 11920 NW 87 Court Hialeah Gardens, FL 33018 CONTACT NAME: PHONE (A/C. No. Est): FAX No): E -MAIL ADDRESS: PRODUCER CUSTOMER ID #: TAMIA -2 INSURER(S) AFFORDING COVERAGE INSURER A: Vinings Insurance Company INSURER e : FCCI Insurance Company INSURER C: Progressive Insurance Company INSURER D : INSURER E : INSURER F : DATE (MMIDD/YYYY) 03/31/11 NAIC # 16632 10178 24252 COVERAGES ACORD 25 (2009/09) CERTIFICATE NUMBER: REVISION NUMBER: OP ID: AM The ACORD name and logo are registered marks of ACORD Scheduled Inspection Date: May 02, 2011 Inspector: Devaney, Michael Owner: RODRIGUEZ, LORENZO Job Address: 9212 NE 10 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: MESA BROTHERS INC Building Department Comments April 29, 2011 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 158711 Permit Number: EL -4 -11 -597 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060060010 Phone: (305)345 -1974 CONNECT KITCHEN SINK, FAUCETS TRASH COMPACTOR Passed Cd Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 158330. CREATED AS REINSPECTION FOR INSP- 158274. NO ONE HOME Add combo. smoke / carbon monoxide detectors outside office & bedrooms. Add smoke or combo. detectors inside bedrooms & office. Page 15 of 27 4 BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 CONTRACTOR: Company Name:�� Address: /6 - / , tee . City: XI/Cr ,- State: iffpolmwm? ll APR 0 5 2011 b BY: Permit No. 1 '51 Master Permit No. 1 5 13 — Permit Type: Electrical /� OWNER: Name (Fee Simple Titleholder): 10/101 0 ) A000/r1 Phone#: 7kb - 2 / - 616/ Address: 9 7i Z /6/ /o/ c� City: /4I W ii j b 5 State: Pi' Zip: 33 /3 P Tenant/Lessee Name: `�,, / Phone#: Email: te `1A 't0 �g ® L' �1te ? ,/t/ JOB ADDRESS: 7' / 2 — City: Miami i Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: Phone#: 36 d 61 ' ;21T4I 9 Zip:2 Qualifier Name: K'4 s / _ Phone#: 3-e-- C, <, 2 eV Y State Certification or Registration #: s (? - c e 6 d sP7c) Certificate of Competency #: e Contact Phone#: ° S 4-- lx ? 7 Email Address: DESIGNER: Architect/Engineer: Phone#: Type of Work: ❑Address Description of Work: f Value of Work for this Permit: G" 6 $ " Square/Linear Footage of Work: �L 'ration ❑New ❑Repair/Replace ❑Demolition * ************************ ************** F ** ****** ***** * *** **+x** **** * *** **** * * ** Submittal Fee $ SQ • 1"'" Permit Fee $ /S oP a d CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ . D • Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 Fi FCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 budding permit is issued ° In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. SignatureX Signature Owner or Agent Contractor The foregoing instrument was acknowledged before a• e this The foregoing instrument was acknowledged before me this 3 as �� day of 20 ±L, by L ov-e, K �� 4# ' - , day of iNtit '�( , 20 / , by ? 1 - 114 e=s A who is personally known to me or who has produced who is personally known to me or who has produced As identification , :, o did take an oath. as identification and who did take an oath. DANIA PEREZ I* { ;- :. MY COMMISSION it DO 837616 W. `': EXPIRES: March 8.2013 '1 ` Bonded Thru Notary Public tinderv/titers NOTARY f IC: Sign Print: My Commission Expires: Ned * * ** * *** * ** * * ** ** *s• * * * *** APPROVED BY Structural Review (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) ?" "/ Plans Examiner r ire IY COMMINION 0 It 827818 EXPIRED March 3 : 013 Sdf dad?hru Notary P:iii .:::iderwrilel8 NOTARY ' c IC: Sign:ll Print: My Co ** ** * ** ***** * **** k**** d< ***** **d<Hr*Rrd<*** ** ** da rkNr * * ** *** Zoning Clerk INSURED RO CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BROWN & BROWN -HBA DIVISION 2500 NW 79TH AVE, SUITE 101 MIAMI FL 33122 Mesa Brothers Inc. 5215 S.W. 103Rd Avenue (Rear) Miami FL 33165 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. INSR A GENERAL LIABILITY X TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY J CLAIMS -MADE X OCCUR 1 GEN'L AGGREGATE LIMIT APPLIES PER: X j POLICY r JECT r LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB EXCESS LIAB DEDUCTIBLE CERTIFICATE HOLDER OCCUR CLAIMS -MADE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN ADDL INSR NIA Miami Shores Village 1050 Ne 2Nd Ave Miami Shores FL 33138 suave WVD GL0003191 POLICY NUMBER INSURER B : INSURER C: INSURER D : INSURER E : INSURER F : (MMIIDD 12/18/10 - POLiCYEXP -- (MMIDDIYYYY) 12/18/11 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES Attach ACORD 101, Additional Remarks Schedule; if more space is required) CANCELLATION AUTHORIZED REPRESENTATIVE OP ID JG (.UNIA(.1 NAME: PHONE I FA No): (NC, No, Ext): E -MAIL ADDRESS: PRODUCER CUSTOMER ID #: MESAB -1 INSURER(S) AFFORDING COVERAGE INSURER A : *FCCI Insurance Company* LIMITS EACH OCCURRENCE $1,000,000 UAMAGETO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG I $ 2,000,000 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE WC STATU- OTH- ITORY LIMIT ! ER I E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DATE (MMIDDIYYYY) 12/14/10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NAIC 10178 .--- Cil 9 ACORD CO P ATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 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 POUCIES. AGGREGATE OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AMYL TYPE OF INSURANCE POLICY NUMBER POLICY DATE ffMMDD� POLICY TTE tt11M/DDIYYYYI S ITS LTR VSRD GENERAL LABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ $ DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP My one person) $ $ CLAIMS MADE I OCCUR PERSONAL & ADV INJURY GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ GENT. AGGREGATE UMIT APPLIES PER OUCY JEC 1--- LOC AUTOMOBILE UABILnY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS - COMBINED SINGLE OMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABIUTY ANY AUTO AUTO ONLY - EA ACCIDENT $ EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR I CLAIMS MADE $ DEDUCTIBLE $ $ RETENTION $ A WORKERS AND ANY OFFICEWMEMBER (Mandatory If yes, SPECIAL EMPLOYERS' PROPRIETOR describe COMPENSATION Y t N WCPE0000005601 10/29/2010 10/29/2011 WC ST IMIT O R TORY LIMITS ER E.L EACH ACCIDENT $ 1.000,000 1.000,000 /PARTNER/EXECUTIVE II EXCLUDED? E.L DISEASE - EA EMPLOYEE $ In NH) under PROVISIONS below EL DISEASE - POLICY OMIT $ 1,000,000 OTHER DESCRIPTION Coverage Location OF OPERATIONS/ LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS provided for all leased employees but not subcontractors of: Mesa Brothers Inc Effective: 1/1/2011 ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER Sunz Insurance Company PO Box 1777 St Petersburg, FL 33731 wnnw.ins4biz.com 727 -497 -1247 727 - 497 -1280 INSURED Employee Staff, LLC 5543 Edmondson Pike, Suite 190 Nashville TN 37211 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER a SUNZ Insurance Company INSURER B: INSURER C: INSURER 0: INSURER E DATE (M611DDIYYYY) 1/5/2011 NAIL # 34762 COVERAGES CERTIFICATE HOLDER CANCELLATION 5362 City of Miami Shores 10050 NE 2nd Ave. Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCB:S BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Glen J Distefano ACORD 25 (2009/01) CERT NO.: 9236133 Denise C1u££ 1/5/2011 7.49 :16 AM Page 1 of 1 © 1988-2009 ACORD CORPORATION. All rights reserved. Scheduled Inspection Date: April 25, 2011 Inspector: Hernandez, Rafael Owner: RODRIGUEZ, LORENZO Job Address: 9212 NE 10 Avenue Project: <NONE> April 22, 2011 Miami Shores, FL 33138- Contractor: DIAL PLUMBING CORP Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Phone Number Inspection Number: INSP - 157964 Permit Number: PL -4 -11 -596 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Parcel Number 1132060060010 Phone: (305)221 -8569 CONNECT KITCHEN SINK, FAUCETS AND TRASH COMPACTOR Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 13 of 26 Miami Shores Village Building Department l jii L , ,,J. j i i� � APR 0 5 2011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. 1 ( -S9 to PERMIT APPLICATION Master Permit No. / t — S95 FBC 20 Permit Type: PLUMBING / OWNER: Name (Fee Simple Titleholder): /t/fJ ?ov F %2D ihf 1/ Phone#: 7 r/ 24/- 6 Address: 9 j I Z E /DM/ City: D/�, j State: Ft Zip: 33/3g Tenant/Lessee Name: Phone#: Email: 149404 /100 64.1( . P.I JOB ADDRESS: t 7f 2- Ad e / 0 Ali City: Miami Shores County: Miami Dade Zip: 3 W3 Folio/Parcel #: it — 3 — 00 — ®c3 / Is the Building Historically Designated: Yes NO r Flood Zone: CONTRACTOR: Company Name: J l A L- p 4, , r' j Phone#: Ise - 0 ( z - 67 2- Address: 9 9 KD s W z s City: 111 / 4 - 7 --'r-v - I State: , Zip: S 3 / 1 Qualifier Name: f/t4 A/ K f 0 iv 7 - e — 0 Phone#: -' — 4 I Z - — 6 7 2- D State Certification or Registration #: Certificate of Competency #: 00 0 0 / 41 I 9 ® Contact Phone#: — 5f6 — 4 12 4 6 -7242 Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $� 7 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: A l Ai k / 7-e 4 A s Al k / �/ ' r M 11 C.- •— *** ***** ** ******* *****m****************F ******** ******* *** **+x*********** *** ****** * ** Submittal Fee $ SO Permit Fee $ / CCF $ CO /CC $ Scanning Fee $ � "1 � Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 5"3" • Bonding Company's Name (if applicable) Bonding Company's Address City State Zip 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 FT .F,CTRICAL WORK, PLUMBING, SIGNS, WFT T S, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 t ce of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature X Owner or Agent The foregoing instrument was acknowledged befo e me this ' day of 20 , by ,A' #i 2f� �e' day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced As identifici and who did take an oath. as identification and who did take an oath. NOT ' P ; LIC: NOTARY ' C • S'.!1 Sign. �. tom. orb, Print: My Commissioi My Commis Print: APPROVED BY P AR • DANIA PEREZ � r,;, : h MY COMMISSION 9 DD 837616 Bonded UmN r yP U nderwriters Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Signature Con The foregoing instrument was acknowledged before me this Zoning Clerk INSR LTR TYPE OF INSURANCE • GENERAL LIABILITY ❑ COMMERCIAL GENERAL LIABILITY El ❑ CLAIMS -MADE 0 OCCUR •N'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ JECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON -OWNED AUTOS ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS UAB ❑ CLAIMS -MADE ❑ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is require!) PLUMBING CONTRACTOR CERTIFICATE HOLDER ACORD 25 (2009/091 QF ADD SUBR IKSIL WVD NIA POUCY NUMBER GFL1007254 -02 VILLAGE OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES FL 33138 'f O-LICY EFF (PAMIDDIYYYY) 07/25/2010 CANCELLATION POLICY EXP (MMIDDIYYYY) 07/25/201 AUTHORIZED REPRESENTATIVE icy:„.? e IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen , s PRODUCER Pat Del Vecchio Insurance Agency 263 N.E. 8th St. Homestead, FL 33030 Phone (305)246 -9500 INSURED DIAL PLUMBING CORP 9940SW. 22;.ST. MIAMI FL 33165 305221 -8569 CERTIFICATE OF LIABILITY INSURANCE Fax (305)246 -9502 PHONE LAIC. No. Ext): (305) -,�,��y INSURERS) AFFORDING COVERAGE INSURER A : CYPRESS PROPERTY & CASUALTY INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : M/ DATE (MDDIYYYY) 07/28/10 C ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS TIFICATE 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. CONTACT N ANGUL O FAX . No): ADDRESS PRODUCE CUSTOMER ID 0: NAIC A 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 S,WBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) EACH OCCURRENCE AGGREGATE UMITS $ $ $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ ❑ TORY I IMIITS ❑ ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE POLICY LIMIT $ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. $ 1,000,000 ;008 5,000 1,000,000 1, ()00,000 ,000 ©198:- 009 ACORD CORPORATION. All rights reserved Tha ACORr) name and Innn ara raniatarad marks of ACARr i STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW di NSTRUCTION INDUSTRY EXEMPTION is certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. ALEX SINK CHIEF FINANCIAL OFFICER • EFFECTIVE DATE: 10/28/2009 EXPIRATION DATE: 10/28/2011 / PERSON: FONTEBOA FRANCISCO A FEIN: 592248413 BUSINESS NAME AND ADDRESS: DIAL PLUMBING CORP 9940 SW 22ND ST MIAMI FL 33165 SCOPES OF BUSINESS- OR TRADE: 1- REGISTERED PLUMBING CONTRACTOR 10- 28-2009 IMPORTANT: Pursuant to Chapter 440 . 05(141, 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 Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 13 1C 1 113.n - CT TO CQMI'3IANCE ITH ALL FEDERAL S 'Alf ANf) CQI JN TY RULES AND REGULATION . _ Q aYI9 tt990q¢g99 ago eoe , !I G ►2- i1 OuynF,L tones hzo F 400,'-t (,v ' Z q?-12- ,a= IO th) �- 33 r3 MI r S�o�s, ,-(• gRVMW3 Aki APR 052011 1 to' // //444,01/1 0 '4-L 4,N 01 t !4i, wldi o ,K -S. 1, sv A.pl ho Atickh S r 1 k Ate .+ D drkp fC, e Iep fern1c ou4 -1-eh cITY COPY e_ L(✓ ADD SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM G.F.I PROTECTED RECEPTACLE. PUT D/W RECEPTACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED CKTS.