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RC-10-417Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 10667 NE 11 Avenue Miami Shores, FL 33138 -2120 1122320280310 Block: Lot: MARIEDY MENDOZA Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.20 $0.71 $0.40 $300.00 $0.71 $9.00 $50.00 ($50.00) $1.60 $313.62 10667 NE 11 Avenue MIAMI SHORES FL 33138 -2120 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: INTERIOR Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : KITC & BATH REMODEL Occupancy: Exterior. Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential 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 Building Department Copy May 20, 2010 Pay Date Pay Type Invoice # RC -3 -10 -37291 03/15/2010 Credit Card 05/20/2010 Check #: 1463 Amt Paid Amt Due $ 50.00 $ 263.62 $ 263.62 $ 0.00 Valuation: Total Sq Feet: Available Inspections: Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use May 20, 2010 Date 1 CFN 2010R0337996 NOTICE OF COMMENCEMENT O Bk 27290 Ps 46271 (113s) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION REGORGED 0 15 :32 :0 HARVEY RUVII4e CLERK OF COURT MAUI-DACE COUNTY? FLORIDA PERMIT NO. TAX FOLIO NO.// Z8" Q / VAST PAGE STATE OF FLORIDA. COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street / address: tz 2. Description . 3. Owner(s) name and address: mprove e mP eQ ,, Interest in property: / M Name and address of fee simpl titleholder. Ai 4. Contractor's name and address: b .'' ,A.D.2 11 Wi y NESS ;;i and Cif cii s, �y� es. 3 5. Surety: (Payment bond requir Name and Address: 41 .4 Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by provided by Section 713.13(1)(a)7., Florida Name and Address: L . ; 8. In addition to himself, Owners designates the following person(s) to receive copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: Name and Address: 9. Expiration date of this Notice of Commencement the expiration date is 1 year from the date of recording unless a different date is specified) Notary Public: Print Notary's My commi .ter xpires: Signatur- of Own Print Owner's Name' 4 /I e /4e4'2.42 Swom to and subscribed before 4. MYOOMMISSION4 DD773411 * emu„ July 2, 2012 t0 ,� �` Bondedllw Nail Solo 111111111111111111111111111111111111111111111 /4' n r94 J /* /� /. 1 m 33/3 gTXaE OF �:ae lzo 1;;. dC S'( 1oN;;` by owner from cent lr$f a. r'1FY that this is � r J :opy « the nts may as Prepared by 20 a tbDo S iceOf Address: /4/0147,C "ill53' Inspection Number: INSP - 145169 Permit Number: RC- 3- 10-417 Scheduled Inspection Date: June 07, 2010 Inspector: Rodriguez, Jorge Owner: MENDOZA, MARIEDY Job Address: 10667 NE 11 Avenue Miami Shores, FL 33138 -2120 Project: <NONE> Contractor: HOME OWNER Building Department Comments REPLACE KITCHEN CABINETS, NEW SINK, TILE, DISHWASHER. Passed 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- 137981. No access NB June 04, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1122320280310 Page 16 of 24 5)0 fro W , ran (-a- BUILDING PERMIT APPLICATION FBC 20 Permit T Owner's Name (F Owner's Address BUILDING OOFING /066 7 /Pe City Pll/t1N1 ( Ac 5 State Tenant/Lessee Name Contact Phone el r/(G[ y /047,07A, 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 older) 0Y/eel Merl de Z®j Phone # � i ?; Phone # Email &J lv-ter k)e - ■ 1. 30 ® yInt420 = ce - hi Job Address (where the work is being done) 1 0(a.62 City Miami Shores Villa 1 e County Miami -Dade Zip FOLIO / PARCEL # ;2S • dt— Is Building Historically Designated YES NO Permit No. RC t O —4 Master Permit No. zip 331? .1 Contractor's Company Name C(A) 1V e& Phone # Contractor's Address 10( 06 7 46 2 /l City_td_ovvi 5442 U « State C f Zip 3 f 3 , Qualifier Name Phone # State Certificate or Registration No. Certificate of Competency No. E -mail Awy 4.14,0 r-Aio 30 , o a. co w, Architect/Engineer's Name (if applicable) Phone # Q Value of Work For this Permit $ / D Square / Linear Footage Of Work: 1,3_, Type of Work: DAddition DAlteration New epair/Replace ❑ Demolition Describe Work: 1 *C 2 / ( Cii b 0 ivei - 5 /vek0 s1 /✓k 1 7 le / /0/6s h wq,S 424- * * * * * * * * * * * * * * ***** * * * *** * * * * * *** ** * ** Fees * * * * * * * * * * * * * * * * * * * * * * * *** ** * *** * * *** * * **** XCERVEn MA 1 5 Mt BY:.... � Submittal Fee $ -1 Permit Fee $ 0-9—'°— CCF $ 1 CO /CC $ Notary $ Training/Education Fee $ 0.40 Technology Fee $ R•O Scanning $ - L •( Radon $ (� n 1 DPBR $ 011 Bond $ Double Fee $ Violation date: n ((,,,, Structural Review. $ Total Fee Now Due $ o(,0 'co cf dd�� a See Reverse side -> 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 ELECTRICAL 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 building permit is issued. In the absence of such posted notice, the inspection will not be ap, ,:ved and a reinspectidn fee will be charged. Signature Own -rorAg- .t Contractor The foregoing instrument was acknowledged before me this 5 The foregoing instrument was acknowledged before me this day of1\f-I2C14 , 20 \b, by I 4LI E.,rr i NDb , day of , 20 _, by who is personally known to me or who has produced R._ in who is personally known to me or who has produced As identification and who flitittak n oath. as identification and who did take an oath. 2:1.% ``e` 06, NOTARY PUBLIC: �� �, % ,�� NOTARY PUBLIC: ; ( mo d , 0- C y am' Sign: - o a _.� - Sign: - y o °� . °_ O Print: %., ""S � P ` ��`� My Commission Expires: ``' "runn,tt'' My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) 5 : 7�/0 Plans Examiner Zoning Engineer Clerk checked 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. M iami 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 C ( I NAME: e I drrio DATE: 05- © -10 ADDRESS: 1066 1) ,4ie. 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 I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. „ q Initial (�✓ 2. I 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. I 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 and contracts. /J Initial /' i 4. I 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 lease, which violates the exemption. d�� /l Initial Initial N ` t" 6. I 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 county or municipal ordinance. Initial A- //I 7. 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 1 1 4 8. 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 Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govem owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial IV(( 10. I 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 httoa/ www. mvfloridalicense .com/dbodoro/cilbfindex.html / 11. I 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: 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informati on that , A l have provided on this disclosure. l L" ? Initial 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 contractors 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 1 day of A1/4 , 20 l 0 By who was personally known to me or who has Produced there License or / O&i N� / / - Initial Initial Bonding Company's Name (if applicable) Bonding Company's Address too 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 ELECTRICAL 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 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 y p ‘ i a i e -* -1� a Owner or Agent Contractor The foreg ' g ' ' ' ' ent ys acknowledged before me this , The foregoing instrument was acknowledged before me thisA day of 20 0 5, by gO ( ®/�g , day of 20 by —. J /goo , who is personally known to me or who has produced who is personall v own t9 me or who has produced As identification and who did take an ,.. as identification and who did take an oath. NOTAR Sign: Print: Chc 05/13/03 My Commission Expires: *** ********* * ** ******** * ** * * * ** * ** * * * ** * * * * *** APPLICATION APPROVED BY: IV o r i OTARY PUBLIC Sign: Print: My Comm ******sit**************** . * " {, ° �e" �r�a *******srt************************** Engineer Zoning ************** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * ** �>� Plans Examiner • Permit No: 10 -4(/7 Job Name , 2010 Buil ing Critique S eet a n4...4 Norman Bruhn CBO 305 - 795 -2204 M iami Shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 P A-PP r iv - TWO L Jr Ctt 4 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. IILEA Qep lace jJevJ P ZONING DEPT BLDG DEPT SUBJECT iO C STATE AND CC, i otd 2' 7" ZZMIMMI MAR 1 5 2010 J BY:—. _ ®_____ 4' 3" 10' 10' 7 ME )1 Avemva IrIcuv l Sh0reS P1 3 3I 3 £� A to pi'y° A),9eto , v 3' 2" File name:Untitled Date:212612010 Scale:Print to fit paper size Dim n:10' x 10' 10" Your note: et' A-4i tei2: 5.1i / /7", Project Address Owner Information Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Technology Fee Amount $0.60 $0.71 $0.20 $225.00 $0.71 $3.00 $0.80 Total: $231.02 Building Department Copy May 20, 2010 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Expiration: 1109 /2010 Parcel Number 10667 NE 11 Avenue Miami Shores, FL 33138 -2120 1122320280310 Block: Lot: MARIEDY MENDOZA Contractor(s) MEGA ELECTRIC INC Phone Cell Phone (305) 828 -5205 Authorized Signature: Owner / Applicant / Contractor / Agent Phone Amt Paid Amt Due Pay Date Pay Type Invoice # EL -4-10 -37685 05/20/2010 Check #: 1463 $ 231.02 $ 0.00 Applicant MARIEDY MENDOZA 10667 NE 11 Avenue MIAMI SHORES FL 33138 -2120 Valuation: Total Sq Feet: $ 1,000.00 142 Type of Work: ELECTRICAL Additional Info: KITCHEN REMODEL Classification: Residential Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Service Change W. W. Fire Alarm Underground 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, 1 authorize the above -named contractor to do the work stated. May 20, 2010 Date Cell 1 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) 1. eg� Owner's Address / C? /�� // /`T/ City 2J j L, 's State Contact Phone Type of Work: Describe Work: Contractor's Company Name Architect/Engineer's Name (if applicable) Submittal Fee $ Permit Fee $ Double Fee $ Violation date: Structural Review. $ 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 deoryt Contractor's Address /0.51 And T qi4 -rte City f //4 State Qualifier Name aIct � � - 4 -y /4 ' Notary $ Training/Education Fee $ r OV Scanning $ `00 Radon $ • l k DPBR $ 0 ° ��- O ®S - (2/9 f24 .�� --`ICf P Phone # 3 ?5 7---/Vi 9 740/e. Zip Tenant/Lessee Name Email W/C aMP/300 Xe 44,0 .(-0 j . Job Address (where the work is being done) / ,a 7 414 / Master Permit No. C_"3 /0 - L/ 1 3,`3.63 , Phone # City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Zip Phone # State Certificate or Registration No. �eaY7 Certificate of Competency No. E - mail Bye° 4t9Cp7`6'illef Phone # Value of Work For this Permit $ (00° Square / Linear Footage O ork: Addition ❑Alteration DNew Repair/Replace ❑ Demolition 17,64 eras * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** Fee * * ** * * * * ** * * * * * * * * * * * * * * * * * * * ** CCF $ Permit No. Phone # 3 en 5205 JfieVk CO /CC $ Technology Fee $ O- 1 Bond $ Total Fee Now Due O-cnp pOrIEVISt P 2 6 E\ 10 -`l 35 /3) Flood Zone See Reverse side —> 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 ELECTRICAL 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 promise in good faith that a copy of the notice of commencement and construction whose property is subject to attachment. Also, a certified copy of the recorded for the first inspection which occurs seven (7) days after the building pe inspection will not be appro nd a re- inspection fee will be charged. Signature who is personally known to me or who has produced 1 D who i As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06/10/2009) eeding $2500, the applicant must ill be delivered to the person ust be posted at the job site of such posted notice, the law brochure ice of mencement is is ed. n the ab Signature Owner or Agent l� The foregoing instrument was acknowledged before me this I S The foregoing instrument was acknowledged before me thi day off ,20 by 114 aro 4. D( m &Onht- day of . r ,20/0, by ,4 w h, e 41'4 NOTARY PUBLIC: Contractor or who has produced as identification and who did take an oath. `� \ �' Sign: — !"M Print: ..+ �po. • /, • ••• ........ ©[ #i� 1 110 e EXPIRES: OCT.13 , WWW.AARONNOTARY.Com '/ TAT \ Marisol Cruz My Commission Expires: 4\74:t /t,'CO Miss oN # DD7 1792 P ip . ° 2011 e y, -•... Plans Examiner Zoning Engineer Clerk checked ITEM BATH TUB UNIT FEE ITEM SWITCH CUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DIAL _ SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN SERVICE SIZE IN AMPS 1 ®'`C' DUCT WORK FLOOR DRAIN SERVICE. REPAIR /METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RANGE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE (ROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0— 1 H' STEAM BOILERS SHOWER MOTORS OVER 1— 3 HP HOT WATER BOILERS SINK, POT /3 COMP. MOTORS OVER 3— 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS OVER 5— 8 HP TRANSPORTING ASSEMBLIES SINK, SLOP MOTORS OVER 8— 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10— 25 HP FIRE SPRINKLER SYSTEMS URINAL MOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- A/C WINDOW RE I NSPECT I ON WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFERS HEATER —NEW INST. GENERATORS TRANSFORMERS HEATER — REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER —WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMdERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFORMERS UTILITY —SEWER SIGN TIME CLOCK UTILITY —WATER FIXTIRES SEPTIC TANK ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, Q' TILE/RES. VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPIK ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATIONEOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, TEE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL THE POLICIES OF INSURANCE LISTED 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 UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I R LT R LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMMID IYIYYY) ( POUCY (MMIDD DATE j LIMITS A GENERAL LIABILITY CPS0995827 06/11/2009 EACH OCCURRENCE 1,000,000 06/11/2010 GE TO RENTED PREM PREMISES (Ea occurrence) 100,000 V COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) 5,000 ❑ ❑ CLAIMS MADE J OCCUR v ❑ PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 ❑ PRODUCTS - COMP /OP AGG 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: V POUCY ❑ PROJECT ❑ LOC B ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS 05351579-0 03/25/2009 03/25/2010 COMBINED SINGLE UMIT (Ea accident) 1,000,000 BODILY INJURY (Per person) V SCHEDULED AUTOS V HIRED AUTOS BODILY INJURY (Per accident) V NON OWNED AUTOS ❑ PROPERTY DAMAGE (Per accident) ❑ ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG C EXCESS / UMBRELLA LIABILITY EBUO26045296 09123 /2009 09/23/2010 EACH OCCURRENCE 1,000,000 AGGREGATE 1,000,000 V OCCUR ❑ CLAIMS MADE V ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under SPECIAL PROVISIONS below ❑ WC STATU- ❑ OTH- TORY UMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POUCY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ELECTRICAL WORK WITH BUILDINGS 30 DAYS NOTICE OF CANCELLATION EXCEPT 10 DAYS FOR -NON PAYMENT OF PREMIUM CITY OF MIAMI SHORE 10050 NE 2 AVE MIAMI SHORES ,FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 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 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE FELIPE GOMEZ PRODUCER Floridian Consultants Insurance 9371 S.W. 40th St. Miami, FL 33165 Phone (305)225 -9711 Fax (305)225 -7477 INSURED MEGA ELECTRIC INC 16252 NW 79 Ave Miami Lakes, FL 33016- 1(305)828 -5205 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 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: SCOTTSDALE INSURANCE COMP INSURER B: PROGRESSIVE INSURANCE COMP INSURER C: COMMERCE & INDUSTRY INSURANCE CO INSURER D: INSURER E: DATE (MMIDDIYY) 04/26/10 NAIC # COVERAGES ACORD 25 (2009101) CIF NCELLATION 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD1 INSRD TYPE OF INSURANCE POUCY NUMBER DA. JC ACTIVE (M DIYY) POUCY EXPIRATION DATE (MM/DD/YY) LIMITS NAIC # INJURED MEGA ELECTRIC INC. 16252 N.W. 79TH AVE MIAMI LAKES GENERAL UABILITY COMMERCIAL GENERAL LUIBIUTY INSURERABUSINESS FIRST INS CO / / / / / / / / / / / / / / / / EACH OCCURRENCE $ P SES Ea OCCUrTenCe) $ INSURER E: 1 CLAIMS MADE OCCUR MED EXP (Any one Person) $ PERSONAL & ADV INJURY $ GENERALAGGREGATE $ GENT_ AGGREGATE OMIT APPUES PER: POUCY n JE&& n LOC PRODUCTS - COMP /OP AGG $ n AUTOMOBILE LIABILITY ANY AUTO ALL OVIINED AUTOS SCHEDULED AUTOS HIRED AUTOS NON - WNED AUTOS / / / / / / / / / / / / / / / / COMBINED SINGLE OMIT (Ea accident) $ — BODILY INJURY (Per won) $ — — BODILY INJURY (Pe accident) $ — PROPERTY DAMAGE (Per acciden) $ GARAGEUABILITY ANY AUTO / / / / AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS!UMBRELLA UABIUTY [Ti CLAIMS MADE DEDUCTIBLE RETENTION $ / / / / / / / / EACH OCCURRENCE $ n OCCUR AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE ., OFFICER/MEMBEREXCLUDED? Ryes, describe under SPECIAL PROVISIONS below 521 - 01440 12/07/2009 / / 12/07/2010 / / X ITORYLIA4ITSI 19A EL EACH ACCIDENT $ 1,000,000 EL DISEASE -EA EMPLOYEE $ 1,000,000 E.L DISEASE - POUCY UMIT $ 1,000,000 OTHER / / / / / / / / / / / / DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES1EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1) 12/08/2009 PRODUCER (305) 824 -3464 JACKSON AGENCY INC 2075 W 76TH ST P.O. BOX 160340 HIALE_AH, FL 33016 -0006 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 NAIC # INJURED MEGA ELECTRIC INC. 16252 N.W. 79TH AVE MIAMI LAKES FL 33016- INSURERABUSINESS FIRST INS CO INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES CERTIFICATE HOLDER ( ) - ACORD 25 (2001/08) INS025 (0108).05 CITY OF MIAMI SHORES 10050 N.E. 2ND AVE MIAMI SHORES FL 33138- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INJURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE N • CATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ENTATIVES. AUTHORIZED REP TIVE ELECTRONIC LASER FORMS, INC. - (800)327 -0545 RPORATION 1988 Page 1 of 2 L E TNIUMESR, MIAMI -DADE COUNTY 2009 TAX COLLECTOR 140 W. FLAGLER ST. let FLOOR MIAMI, FL 33130 529532 -4 BU$ S N WC ' Eic /Mod 16252 NW 79 AVE 33016 MIAMI LAKES o MESA ELECTRIC INC sec i r irereiTICALcoNTRACTO THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CRIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER MART OR LICENSE REQUIRED BY LAW. MS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED ItMD -DADE COUNTY TAX amjw 4 08/19/2009 02280065001 000045.00 SEE OTHER SIDE MUST BE. PURSUANT°TO' THIS IS.IVIT:A.R O`NOT PAY RENEWAL STAT algal 728 WORKER /S 6 DO NOT FORWARD MEGA ELECTRIC INC ARISTIDES REYES GAVILAN PRES 16252 NW 79 AVE MIAMI LAKES FL 33016 50 IIIIIN IN IIiiuIII Il,i /;IIIi,Ililill,i.i 553266 CLASS pSTAGE 11 OVAA.. r 1VO1211O313 1.000 (S)3ava1 ONUdllVflb i VALID FOR CONTRACTING UNTIL 09130/2011 M BUSINESS CERTIFICATE OF COMPETENCY 95E0 Under X Inspection Number: INSP - 141545 Permit Number: EL -4 -10 -708 Scheduled Inspection Date: June 02, 2010 Inspector: Devaney, Michael Owner: MENDOZA, MARIEDY Job Address: 10667 NE 11 Avenue Project: <NONE> Miami Shores, FL 33138 -2120 Contractor: MEGA ELECTRIC INC Building Department Comments June 01, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1122320280310 Phone: (305) 828 -5205 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments fc Page 7 of 18