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RC-10-83Scheduled Inspection Date: May 11, 2010 Inspector: Bruhn, Norman Owner: CUMING, RICHARD Job Address: 436 NE 94 Street Project: <NONE> May 10, 2010 Miami Shores, FL 33138- Contractor: LA WOODWORKS 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 For Inspections please call: (305)762 -4949 Phone Number C 1- Inspection Number: INSP- 133736 Permit Number: RC- 1 -10 -83 Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Parcel Number 1132060140340 Phone: (954)489 -9199 KITCHEN REMODEL REMOVE AND REPLACE KITCHEN CABINETS REMOVE AND RECONNECT EXISTING RANGE HOOD AT EXISTING LOCATION Passed j Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 8 of 30 Inspection Number: INSP- 141632 Permit Number: EL -1 -10 -100 Scheduled Inspection Date: April 27, 2010 Inspector: Devaney, Michael Owner: CUMING, RICHARD Job Address: 436 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: BILL DAVIS ELECTRIC INC Building Department Comments Passed m z Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments April 26, 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: Alteration Phone Number Parcel Number 1132060140340 Phone: (954)748 -8978 Page 27 of 29 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 436 94 Street Miami Shores, FL 33138- 1132060140340 Block: Lot: RICHARD CUMING Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 436 94 Street MIAMI SHORES FL 33138 -2846 RICHARD CUMING Contractor(s) LA WOODWORKS CORP Phone Cell Phone (954)489 -9199 Approved: In Review Comments: Date Approved:: In Review Date Denied: Type of Construction: REMODEL KITCHEN Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Certificate Date: Bond Retum : Occupancy: Single Family Exterior. Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Surcharge Education Surcharge Permit Fee - Additions/Alterations Radon Surcharge Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $7.80 $0.54 $2.60 $365.28 $0.54 $6.00 $50.00 ($50.00) $10.40 $393.16 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy February 05, 2010 Invoice # RC -1 -10 -36846 RC -1 -10 -36846 Check #: 10416 Total Amt Paid Amt Due $ 393.16 $ 50.00 $ 393.16 $ 393.16 $ 0.00 Expiration: 08/04/2010 ROV Valuation: Total Sq Feet: $ 12,176.00 108 Date For Inspections please call: (305)762 -4949 Available Inspections: 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. February 05, 2010 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ((-�� BUILDING Permit No. � V C ' -83 PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type (circle): Building Roofing Owner's Name (Fee Simple Titleholder) Jok i I 6 ' f y Phone # 954 714 - 2444 Owner's Address 436 NE 94th STREET City MIAMI SHORES State FLORIDA Zip 33138 Tenant/Lessee Name Phone # Job Address (where the work is being done) 436 NE 94 ST, MIAMI SHORES, FL, 33138 City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # 11- 3206 -014 -0340 Is Building Historically Designated YES NO L A WOODWORKS CORP \(, 954-089 -9199 Contractor's Company Name Phone # Contractor's Address 4555 NE 6TH AVENUE City OAKLAND PARK State FLORIDA Zip 33334 Qualifier Name STEFANIESHAWNASPINK Phone# 954489 4199 State Certificate or Registration No. CGC1516435 • Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # 1 Value of Work For this Permit 1 Type of Work: OAddition ['Alteration ONew t ® Repair/Replace 0 Demolition Describe Work: K ;Tchety Re/"lodel — ' �•en n ort a cl 2epkct k cabrner5. R ee►ave aAi lecoAAec1' /tan a #{d a .7 e x :.f1:ny to c'T,•t n . :57 3 ***************************************F ees************* * * * ** * * * * * * * * * * * * ** * * * * * * * * * * ** Square / Linear Footage Of Work: jog Fee Submittal - C 1 1 ►rl i) -- J car — CC Notary $ Trainmg/Edu tion Fee $ Technology Fee $ Scanning $ (e' Radon $ •- DPBR $ 0.S4 Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ • YI Zoning $ 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 F.i.F,CTRICAL 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 moved and a reinspecton fee will be charged. er o Agent The foregoing instrument was acknowledged before me this /it day of , , 20 � by ,gem » L ®i l l y who is personally known to me or who has produced r` taros( As identification and whn did tab, Sig Print: D . t M t : n L My Commission Expires: II ( 5`.. / 3 AA aaaaa ***aria*** *Aaa,Aaaaaaa *Aa *A AAAabaaaaaaa**********A A************************************************* APPLICATION APPROVED BY: (Revised 07/10/07) Signature cat- Contractor The foregoing instrument was acknowledged before me this /1 day of Deer^ bee , 20 /p by .S?'1 — :4it . • e £4 1 wy •, , f�D< Y7 ( who is personally known to me or who has produced S Print: My Commission Expires: Plans Examiner Engineer Zoning NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED OM TIIE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. l + TAX FOLIO NO. 11 - 3206 - 014 - 0340 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: MIAMI SHORES SEC 2 PB 10 LOT 8 BLK 51 LOT SIZE 50.000 X 128 OR 19378 -3635 11 2000 1 OR 19378 -3635 1100 00 436 NE 94 ST, MIAMI SHORES, FL, 33138 2. Description of improvement KITCHEN REMODEL 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: LA WOODWORKS CORP 5. Surety: (Payment bond required by owner from contractor, if any) ` OF �LG�,1t9A. �l a� bibbiL Name and address: or the Amount of bond $ i HE f 6. Lender's name and address: 4555 NE 6th AVENUE, OAKLAND PARK, FLORIDA 33334 WSW 7. Persons within the state of Florida designated by Owner upon provided by Section 713.13(1)(a)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a 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 ere t date i Sig .ture of •w Print Owner's Name Sworn to and subscribed before me this 13 day of JANUARY Notary Pub!' Print Notary's Name My commission 123.01 -52 PAGE 8RS otr1,•e e .**1 4. DANIEL MEDINA MY COMMISSION # D0940165 EXPIRES November 15, 2013 (407) 398 - 0153 FiaridalloraryServicexom ,20 EilCil'_ d1Vlr: ith� 1111111111111111111111 Hill 1111111111 11111111 CFI 2010R0033419 OR Bk 27152 Ps 1891; (1RS) RECORDED 01/19/2010 11:14 :29 HARVEY RUVIHr CLERK OF COURT HIAHI —DADE COUI4TYr FLORIDA LAST PAGE �t c.taux3" Mtc� Sc-Q.� 331'8 erved as Prepared by Dm A,' Q I (1 P �; Address: f0 6r,r,S I ( Ave 9 u k f •k ri0PG `3.3 Z) 3'/ CONTRACTOR LICENSING/ REGISTRATION REQUIREMENTS FOR ALL CONTRACTORS TO REGISTER IN THE VILLAGE OF MIAMI SHORES THE FOLLOWING REQUIREMENTS ARE NEEDED: DADE COUNTY CONTRACTORS: A. Certificate of Competency B. Dade Municipal Occupancy C. Dade Occupational Occupancy D. State Registration E. Liability Insurance Certificate Workers Compensation Insurance or Exemption F. llama SivieisVettafe &day Defia4rut 10050 NE 2"d Ave Miami Shores, FI 3313 Phone 305-795-2204; Fax 305- 762 -5253 www.miamishoresvillage.com STATE CONTRACT. S: A. State License B. Occupational License C. Liability Insurance Certificate D. Workers Compensation Insurance or Exemption *AAAAA ***ALL INSURANCE CERTIFICATES MUST BE MADE OUT TO THE FOLLOWING***** * * * *** Miami Shores Village 10050 NE 2 AVE Miami Shores, FI 33138 ALL PERMIT APPLICATION REQUIRE THE QUALIFIERS NOTARIZED SIGNATURE ******** *AAAAA *** * * ******* ******** *** Business Name: I . 4 VsimdwQr kJ Corp Business Address: 4 CST ME 6 741 1 vea de / 801. tax./ P. rle, FG 3 333 If Business Telephone: (qs4) - 40f-gi44' Fax Number (T5lf) - 4r1— ac M Qualifier Name: 5 7ef a et a f y 1 a, Congratulations! With this license you become one of the nearly one million Florklians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to Improve the way we do business in order to serve you better. For information about our services, please log onto www.myforidalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Departments initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! ACS 4144600 SPINK, STEFANIE SHAWNA LA WOODWORKS CORP 4555 NE 6TH AVE OAKLAND PARK DATE BATCH NUM 11/1712008:080227027 CGC1516435 The GENERAL. CONTRACTOR Named , below.. IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2010 SPINK, STEFANIE SHAWNA LA WOODWORKS .CORP • 4555 NE 6TH AVE OAKLAND PARK STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 . CHARIM ' ie.T .:'GOVERNO,R'''• FL 33334 FL 33334 LICENSE NBR DETACH HERE STATE OF FLORIDA DISPLAY AS REQUIRED BY LAW STATE OF FLORIDA — AC?" 41 �a�(I DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGC15 11/17/08 090227027 CERTIFIED GOAL CONTRACTOR SPINK, STEFANIE SHAWNA LA WOODWORKS CORP IS CERTIFIED ,endear the perovisicass of Ch. 489 ss m,r1erioa data. AUEI 31, 2010 L0 81117 000 94 • DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SE LO8il17vaos4 CHARLES W. DRAGO SECRETARY ALEX SINK STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: BUSINESS NAME LA WOODWORKS CORP 4595 NE 8TH AVE OAKLAND PARK 08122/2000 EXPIRATION DATE 08/22/2010 SPINK STEFANIE S 861086078 AND ADDRESS: FL 33334 SCOPES OF BUSINESS OR TRADE: 1- SHOWER & TUB ENCLOSURE 2- CABINET BUILDER /XMSTALLER IMPORTANT: Pursuant to Chapter 440. moo. F.S_, xo Officer of o corporation who efacts exemption from this chapter by filing a certificate of electron under this section they na1 recover benefits or compensation under this chapter_ Pursuant to Chapter 440.00(121 F.S., Certificates of election to be exempt... apply only within Ibe scope of the busihatt or trade listed on the notice el election to be exempt_ Pursuant to Chapter 440.05(131, F.S., Notices of election to be exempt aed certificates of election to be exempt shalt be subject to revocation if, of any Time after the IHro® of the native or No Issuance of the certificate, the person earned on the notice or certificate no lenger meets the requirements of this section for issuance of a certificate. The department shall revoke o certificate at shy time for fairer° of the person named oa the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 MC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE OB/2.2/2008 EXPIRATION DATE: 08/22/2010 PERSON: STEFANIE 5 SPINK FEIN: 851088078 BUSINESS NAME AND ADDRESS: LA WOODWORKS CORP 4555 NE ST-I AVE OAKLAND PARK FL 33334 SCOPE OF BUSINESS OR TRADE 1- SHOWER & TUB ENCLOSURE 2- CABINET SNIDER/INSTALLER OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 IMPORTANT O Pursuant to Chapter 440.05(14). F.S, an officer of a corporation who elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05112), FS., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed an E the notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S.. Notices of election to be exenpt and certificates of election to be exempt shall be subject to revocation if. et any time alter 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. CUT HERE 08 -22 -2008 * Carry bottom portion on the job, keep upper portion for your records. QUESTIONS? (850) 413 -1609 Jun 05 09 10:31a LA WOODWORKS STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 LA WOODWORKS CORP 4555 NE 6TH AVE FORT LAUDERDALE Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business In order to serve you better. For information about our services, please tog onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! A# 4414842 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEW L118052600779 DATE BATCH NUMBER CHARLIE CRIST GOVERNOR FL 33334 LICENSE NBR 05/26/2009 080486384 QB64165 DETACH HERE The BUSINESS ORGANIZATION Named below IS QUALIFIED Under the provisions of Chapter 489 FS_ Expiration date: AUG 31, 2011 (THIS IS NOT A LICENSE TO PERFORM WORK. THIS ALLOWS COMPANY TO DO BUSINESS ONLY IF IT HAS A QUALIFIER.) LA WOODWORKS CORP 4555 NE 6TH AVE FORT LAUDERDALE FL 33334 DISPLAY AS REQUIRED BY LAW 9544890471 p.1 (850) 487 - 1395 QB64165 s'i a rE aF FLOna Ai;# 44 DEPARTMENT OF BUSINESS MW PROFESSIONAL REGULATION 05/26/09 080486384 QUALIFIED BUSINESS ORGANIZATION LA WOODWORKS CORP (NOT A LICENSE TO PERFORM WORK. ALLOWS COMPANY TO DO BUSINESS IF IT HAS A LICENSED QUALIFIER.) IS QUALIFIED under the provlsasacts of c12.489 FS aspiration date. AUG 31, 2011 L09052600779 CHARLES W. DRAGO SECRETARY Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid $ 27.00 $ 27.00 Sep 24 09 09:40a LA WOODWORKS BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 - 954- 831 -4000 VALID OCTOBER 1, 2009 THROUGH SEPTEMBER 30, 2010 DBA Business Name: Owner Name: Business Location: Business Phone: Rooms LA WOODWORKS CORP SPINK STEPHANIE SHAWNA 4555 NE 6 AVE OAKLAND PARK 33334 (954)489 -9199 Seats Employees 5 UNITS For Vending Business Only Receipt # 180- 0008952 Business Type: GENERAL CONTRACTOR Exemption Code: Business Opened: 05/19/05 StetelCounty /Cert/Reg: CGC1516435 Machines 9544890471 NON EXEMPT Professionals Tvne: p.1 000 0000002700 0000001800008952 1001 7 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: LA WOODWORKS CORP SPINK STEPHANIE SHAWNA 4555 NE 6 AVE OAKLAND PARK FL 33334 This tax is levied for the privilege of doing business within Broward County er? and is non - regulatory in nature, You must meet all County and/or municipality c`=' planning and zoning requirements. This Business Tax Receipt must transferred when the business is sold, business name has changed or'oI. :s have moved the business location. Thls receipt does not indicate that tt7�+ee --' : business 9s legal or that it is in compliance with State Of local /ewe ,and regulations. 2009 - 2010 DATE (MG4DD/YYYY) m. . CE RTIFICATE OF LIABILITY BI L ITY INSURANCE 05/01/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER Phone: (964) 946 - 0622 Fax: (954) 848 - 0823 ATLANTIC INSURANCE CENTER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE POST OFFICE BOX 2063 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR POMPANO BEACH FL 33061 - 2063 INSURED LA WOODWORKS, CORP. 4555 NE 6TH AVENUE FT LAUDERDALE, FL 33334 -2311 COVERAGES AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS , UMBRELLA LIABILITY OCCUR D CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR,PARTNERJSXECUY(VE OFRCERIMENDER EXCLUDED? R yes, desedbe under SPECIAL PROVISIONS Waive OTHER: 04GL000757860 • �u 'A tck -Ji!,w 06/01/10 01/03/10 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Eacommence) MED. EXP (Any one person) PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG. COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) OTHER THAN AUTO ONLY: EA AOC AGG EACH OCCURRENCE AGGREGATE WC SIAIU- TORY OMITS E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE- POLICY LIMIT 1,000,000 100,000 excluded 1,000,000 2,000,000 2,000,000 GEML AGGREGATE LIMIT APPLIES PER. © POLICY RO• LOC DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR CERTIFICATE HOLDER Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Attention: 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 TILE 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 — Tad Webster ACORD 25 (2001 /084 POLICY NUMBER Certificate # 15016 INSURERS AFFORDING COVERAGE INSURER A: MID- CONTINENT CASUALTY CO. INSURER B: PROGRESSIVE EXPRESS INSURER C: INSURER D INSURER E: POLICY EFFECTIVE POUCY EXPIRATI CANCELLATION LIMITS NAIC # © ACORD CORPORATION 1988 DR Si S24S7 STEF StiAWNA VOW �.,..,. STREET SEBASTIAti ONO or-Av 09-02-1952 srdt set, 54 E = 06- yx 0S42 2e1 72.704 S2 02 2 riAIVER: + "� � °'+ner24 � �` �' � �}` 3. �p.� ft: vim`` L%w' ,,t'c "ism ! .. Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 436 94 Street Miami Shores, FL 33138- 1132060140340 Block: Lot: RICHARD CUMING 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 $0.54 $0.40 $225.00 $0.54 $3.00 $50.00 ($50.00) $1.60 $232.28 Building Department Copy Parcel Number Contractor(s) BILL DAVIS ELECTRIC INC Phone Cell Phone (954)748 -8978 (954)815 -7537 Type of Work: ALL ELECTRIC PREVIOSLY DONE Additional Info: Classification: Residential Authorized Signature: Owner / Applicant / Contractor / Agent Invoice # EL -1 -10 -36863 EL -1 -10 -36863 Check #: 10359 Total Amt Paid Amt Due $ 232.28 $ 182.28 $ 232.28 $ 232.28 $ 0.00 Expiration: 08/04/2010 Applicant Valuation: Total Sq Feet: Date For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: 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. February 05, 2010 February 05, 2010 1 Owner's Address 436 NE 94th STREET Miami Shores Village Building Department Permit Type: Electrical ! / Owner's Name (Fee Simple Titleholder) . C7 / h {-0. /�� Phone # 954414 -2444 RECEIVED JAN 1 9 2010 >0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 BUILDING Permit No. EL 1 v /� - ' CDO PERMIT APPLICATION Master Permit No.•. 10 '93 FBC 2004 City MIAMI SHORES State FLORIDA Zi 33138 Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) 436 NE 94 ST, MIAMI SHORES, FL, 33138 City Miami Shores Vill- e County Miami -Dade Zip FOLIO / PARCEL # 11- 3206 -014-0340 X Is Building Historically Designated YES NO Contractor's Company Name BILL DAVIS ELECTRIC INC Phone # 9544484978 Contractor's Address 2709 NW 19 STREET City POMPANO BEACH State FLORIDA Zip 33069 Qualifier Name WILLIAM R DAVIS Phone # 954415 4537 State Certificate or Registration No. EC0001563 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit sil/ V V • Q1 Square / Linear Footage Of Work: I 0 Type of Work: ['Addition ❑Alteration ❑New ❑ Repair/Replace ❑ Demolition DescribeWork: Al( C(eclrec • s VP TO Cr de aft €k,'Slin, ( 0 .t (A 1...T Submittal Fee $ Permit Fee $ CCF $ Cs /CC Notary $ Training/Educa ' Fee $ 0 '40 Technology Fee $ C J Scanning $ 3'U Radon $ �'CJ DPBR $ 0 •L./ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ MCI 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 roved and a reinspection fee will be charged. Signatur r or Agent The foregoing instrument was acknowledged before me this / �( day of becehb , 20 iQ , by 7 oh 1) , (/y who is personally known to me or who has produced F : « «re NOTARY PUB ANIEL MEDINA ''~ MY COMMISSION # DD940165 1 -t ' EXPIRES Nov_ 15, 2013 Sign: Print: /7, n ti e / (Revised 02/08/06) APPLICATION APPROVED BY: Contractor The foregoing instrument was acknowledged before me this /r day ofPeCe " bee ,20(Q, litrfi4A 2 D4(43 who is personall kn o me or who has produced as identificatio and who did take an oatj, DANIEL MEDINA =•• MY COMMISSION # DD940165 EXPIRES November 15, 2013 NOTARY PUBLIC: Sign: Print: 1901 n, e My Commission Expires: �/ My Commission Expires: / /,. ( /3 � �"��� AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Plans Examiner Engineer Zoning 53 FroridaNateryService.can 1 Scheduled Inspection Date: May 07, 2010 Inspector: Hernandez, Rafael Owner: CUMING, RICHARD Job Address: 436 NE 94 Street Project: <NONE> May 06, 2010 Miami Shores, FL 33138- Contractor: GUARANTEED PLUMBING INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 RC- 1 -t0•V3 Inspection Number: INSP- 142526 Permit Number: PL- 1 -10 -86 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140340 Phone: (561)315 -3148 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments lh l s' y�� Page 11 of 11 Project Address Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795 -2204 10,552UUNE EZEMMEMNUMM , MMVA , AVMMUMsozz.Aann , .....0 , 0,...eiessoosszommdIMS:....m.szzmwaiNNSMENOMMUME":=EMEW." - 4.7 436 94 Street Miami Shores, FL 33138- 1132060140340 Block: Lot: RICHARD CUMING Address Expiration: 08/04/2010 Parcel Number Phone RICHARD CUMING 436 94 Street MIAMI SHORES FL 33138 -2846 Valuation: Total Sq Feet: $ 1,311.00 Contractor(s) Phone GUARANTEED PLUMBING INC (561)315 -3148 Cell Phone Type of Work: KIITCHEN REMODEL Type of Piping: PLUMBING Additional Info: Bond Retum : Classification: Residential 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 $0.54 $0.40 $100.00 $0.54 $3.00 $50.00 ($50.00) $1.60 $107.28 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy February 05, 2010 Invoice # PL -1 -10 -36849 PL -1 -10 -36849 Check #: 10416 Total Amt Paid Amt Due $ 107.28 $ 50.00 $ 107.28 $ 107.28 $ 0.00 Applicant February 05, 2010 Date Cell For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Top Out Re Pipe Main Drain Heater Water Service Final Water Main Lavatory 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. Futhemiore, I authorize the above -named contractor to do the work stated. 1 BUILDING PERMIT APPLICATION FBC 2004 Permit Type: Plumbing Owner's Name (Fee Simple Titleholder) J ® /1 1- 0\ y Phone # 954 714 - 2444 Owner's Address 436 NE 94th STREET City MIAMI SHORES State FLORIDA Zip 33138 Tenant/Lessee Name E -MAIL: Job Address (where the work is being done) 436 NE 94 ST, MIAMI SHORES, FL, 33138 City Miami Shores ViIb e County Miami -Dade Zip FOLIO / PARCEL # 11 - 3206 - 014 - 0340 Is Building Historically Designated YES NO Miami Shores Village Building Department >0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Contractor's Company Name GUARANTEED PLUMBING INC Contractor's Address 8291 BERMUDA SOUND WAY City BOYNTON BEACH State FLORIDA Zi 33436 Qualifier Name ELIAHU MIZRAHI Phone # 954 -489 -9199 State Certificate or Registration No. CFC041433 Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ /, 3 1/ Square / Linear Footage Of Work: ( O Type of Work: ['Addition ['Alteration ['New AI Repair/Replace . 0 Demolition Describe Work: ]2e /IA Ove c1. d eCotihPCT St /t' f t WK Sti a% ex:.J toCw7,•on P�� J a 1 4. Na r cu c ( s �5 / e cal Q,i— s76, , (c7 on as *t *aaasaaa*****xaaa * ***** *****aaw **********aawwar **** **** ****aaawawwaaa *waa Submittal Fee $ Permit Fee $ /64 ° 67 Fee . CCF $ CO /CC Notary $ Training/Education Fee $ + '1 Technology Fee $ 00 Scanning $ 3 e 00 Radon $ 0 ' DPBR $ 0 '5" Bond $ Phone # Permit No. VL 1 C Master Permit No. 9-C. 1 () D 2) Phone # 561 - 315 -3148 Zoning $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ • See Reverse side -- Bonding Company's Name (if applicable) Bonding Company § 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 comm ement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. 1 1 e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature (Revised 02108/06) o or Agent Contractor The foregoing instrument w acknowledged before me this /L( The foregoing instrument was acknowledged before me this / , day of ,/Ve/4b ,. /0 , by o L. 11y , day of ec'eA.4er /0, by (1. 't 4" f1 who is personally known to me or who has produced who is 12raualixeewn to me or who has produced L C - Aside__'_ a.., .,� ... . NOTARY PUBuceliii, DANIEL MEDINA MY COMMISSION # 00940165 „ _ S November 15, 2013 Sign: t. FlorldallotwyService.corn Print: IJRn, e My Commission Expires: APPLICATION APPROVED BY: _ 7 Signature as identification and who did take an oath NOTARY PUB L>4'"• ( DANIEL MEDINA -•• •'= MY COMMISSION # 00940165 S November 15, 2013 ,. ► ' '� Sign: / rt ,• �� .corn Print: D.► /tie ( c h e S My Commission Expires: (1 - /S' — 3 t t t t t t t t t t t t t t t t t t t t t t t t tt tttm t t ***fait tt ***********10 *A ttt t to t t ***AI go*** iitttt *la tttt t* d ttt t t t t t t *A* t t t t t t t t t t t tt Plans Examiner J/ Engineer �/ Zoning 10050 NE 2"d Ave Miami Shores, FI 3313 Phone 305- 795 -2204; Fax 305 -762 -5253 www.miamishoresvillage.com CONTRACTOR LICENSING/ REGISTRATION REQUIREMENTS FOR ALL CONTRACTORS TO REGISTER IN THE VILLAGE OF MIAMI SHORES THE FOLLOWING REQUIREMENTS ARE NEEDED: DADE COUNTY CONTRACTORS: A. Certificate of Competency B. Dade Municipal Occupancy C. Dade Occupational Occupancy D. State Registration E. Liability Insurance Certificate F. Workers Compensation Insurance or Exemption STATE CONTRACTORS: A. Y State License B. Occupational License C. Liability Insurance Certificate D. Workers Compensation Insurance or Exemption * *** AAAAA *ALL INSURANCE CERTIFICATES MUST BE MADE OUT TO THE FOLLOWING ***** * * * *** Miami Shores Village 10050 NE 2 AVE Miami Shores, FI 33138 ALL PERMIT APPLICATION REQUIRE THE QUALIFIERS NOTARIZED SIGNATURE ***** *it ** *** ** ***Iri. A A A A k* * * ***Ir** ****iris** **tk ** Business Name: Guapahiee I flfu,M b: A 5 :Cm C. Business Address: BZ 1/ & r e c, d ti $m U b O It" y Business Telephone: (SG/) 2 — 310 Qualifier Name: 61: w 4u "'L r 4 he Fax Number: 6. ) S 3 3 STATE OF IDA DEPARTMENT OF FINANCIAL SERVICES • DIVISION OF WORKERS" COMPENSATION . . * EEKTIFICATE O fECTION TO BE EXEMPT MOM FLOIIDA WORKERS' CENWENEATION LAW c CONSTRUCTION INDUSTRY' EXEEMPTION This ctrtifies that the.•irxiilridtml listed below has elected b he exempt from Florida Warlcers Sum ion laatrlo. EXPIRATION DATE 02 /2712DtO EFFECTIVE DATE . 02/2812008 PERSON: . RAIZEWII FEIN 6927+95121 BUSINESS NAM Al11CJf Ad d : ' TIED' PLUMBING INC 8221 BERMUDA SOUND NAY BOYNTON BEACH FL 33 SCOPES OF BUSINESS Oft_ TRAD 1- CIDITIFIRO P6 MUl6 isowrmicitat tlaSitrAB& - r P440R au "Venta e • 65044 r.6., as d ew figcr of • pmradm vLo' etsae aawoP!7n� •TLis' � I T iy Mae. • mfdll eat electfafa•�et Ala sectiesr mar a t resew** kc•dxn of •mpoea lanai= Ws Owen.- Peso is limper oon_o3i12. ES. Cenilitathe of elecitu• to' for inept— apply .ply .amen lie - mmps d, r!o bei•nsa.n. - bias G•oA re .the aattae al eledfaa co be exeaet. to -amour 44llfSil F.$. Rakes 4 alaetils te he td ®l8 the collhmin of gleam to be amt Shads ha. a�hk 1 to teemed= L itt lazy, t 'liter Ile dote el the abrhe or tot Inane et en cedirtesk. 'Wa Posse 'ENO ®1rc'eattG ar castiligw to huger pleats the rotaite undo el Utis Settet lm fpm .tiro daptifoott soar revoke a renak= m 'mqt 11 be h?Twv. nt vas' Pam.' • (l IE5IDIS? 41 01 443 -1109 WIC -292. cerrocAn #1E' Et[C'n0N 7o -ff1 F.Rt:MP1' Rkimmo 00- 06. .... 'PLEAS. .cUT OUT -THE 'CARD :BELO.W AN RETAIN. •FOR. FUTtiRE• REFERENCE ammor FLORIDA PEpARTJe iT 1F RbamarzaLsottorss iON f WORKBIO COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE QFl ITORE E FROM PLEBoun WONORS COMPEINSATIONLaw 1FF Ci NG 02/28 /2ooa exPIRMTON DATE: 0/3/27 /2010 PEPCSOrt RLif r- MI RAtm .. nEr* . 93279S121 @, mesesS iapo4E AND ADDt . GUAKAKTEED PWimrhti >jZ91 BERJHWA 50U912 WAY B17[1tCt3M OWN. Et. 33438 IMPORTANT T • Pflrsuitt .>1a Cbap ' 44110'Nf4) FA: au 'al film et ® t. , diets exfsr�fien from this.. by Bing a mtifisate of aim Heller a1Ci -steam' may. mt. recover vicar fits - w setwo an • ender • �tls Purs+asat to Ebopecr 44eJD6f1Z. F S.. ti of eler 6e H ex y oni Wi bt the . oCerf the ficeteg. businriss e t.Ods to "Gall sa E the . notice - of - elao40e to lea exempt. • • g Persteirt to 'Chapter 4401. 113}; F.S., : Notiees 'of . election- to be .exempt • . _ mid certificates of.eleetiem m- -tie oiffInft, shaft lie .sehfect Iq' reveeatitn if. at any tam after the filing ..of• the notice or the Issuance of the • . col tif'trate, the perm toned. ee *0 - net a or eerdfieetei ne kmger .mer>4e th regalrunonts of this section for issuance • of e eerdfieafe Th 1 • department- oh revoke a eert'ifiaate "at am tine .far - fair e of iha mind 0i' 1he --cartilldate te. ewe* am renuiraanfoti c f. this • Ql►ES 1ONS1 issel 41$ - laN tengraiaajarrensl With this Iicensa you become one &the twat') arts ration Roridieris licensed by the Depedinent of Business M P1 Regulegnn. Our professionals and messes range.frorrk architects to watt hitikarg. from boxers fo barliegtle itetaurenfe, mid they keep Render. eery Every dhy we work to enpinve #ITe way, weals bu$duees Oiler to Serve you bane For informalinn about ram sue, pleaseion onto VArninwftoritlailleense.com. There You c er f hind more inftinmetion abutour divisions aftEitharectitotiofis hot impactyrou. subsarbe hs denatImerit nensletters and learn more about the - Decertmant's inibatvea. Our mts$io i ethos Deterrent is= !Jeanie Efficiently; Regulate Fairly. We • constantly strive to Serwy0U better So that you can =VC your c gommeIe. Theft you fer doing business in Florida and essattfuletionsmri yorr new license! 1:ACS STATE OF FLORIDA imiamTim OF DITEMIESS 1471p PROFSSOTO.NAL REO1714TION CAS l 1cUGrIQNN INi us x :. LNSIAIG BOARD' 1940 1RTE MONROR . TAIL BASES FL 32399-0783 (850) . 487-1395 GUARANTEED PLUMBING INC MIZRAHI ELIAHU 8291 BERMUDA SOUND WAY BOYNTON BEACH FL 33436 -1727 Dear Business Owner This is your new local business tax receipt. Please keep the upper portion for your records and detach the bottom of this form. Verify the Information and display it conspicuously at your place of business, open to the view of the public_ This receipt is in addition to and not in lieu of any license required by law or municipal ordinance and is subject to regulations of zo n1n g,lieaitii, and any ofhe-r IbwiikauT�ioi - (Count Ordinance Number - 72-7). Receipts may be transferred to a new owner when Evidence of a sale is provided; the original receipt is surrendered and a transfer fee is paid. Receipts may be transferred to a new losaztion when proof of zoning approval is provided; the original receipt is surrendered and a transfer fee is paid. Business name changes require a new receipt. This receipt expires on September 30, 2010. Renewal notices are mailed at the end of June. If you do not receive the notice by the end of July, please let us know. I hope you have a successful year. Tax Collector 2008 -17943 as DETACH AND DISPLAY BOTTOM PORTION, AND KEEP UPPER PORTION FOR YOUR RECORDS iOQ STATE OF FLORIDA PALM BEACH COUNTY LOCAL BUSINESS TAX RECEIPT EXPIRES: SEPTEMBER - 30 - 2010 GUARANTEED PLUMBING INC HIZRAHI ELIAIR) This receipt Is hereby valid fat the above addles for the period beginning on the first day of October and ending an the tidrtieth day of SepteMber to ravage in the business, profession or occupation at PLUMBItN8 CONTRACTOR CFC041433 I •d Ali Anne M. Gannon, Tax Collector P.O. Box 3715 west Palm Beau, FL 33402-3715 WWW.TAXCOLLECTORPBC.COM TaI:(551) 355 -2272 8960•09CI9S LOCATED AT 8291 BERMUDA SOUND WAY BOYNTON BEACH FL 33436-1727 Account Number 2008 -17943 IHEINZIW i1HuI13 OC -032 . CtASSIFICATiON CNTY 27.50 TOTAL THIS 15 NOT A BILL.- DO NOT PAY !'AID. PBC TAX COLLECTOR 27.50 BTR 049 01662272 07/17/2009 27.50 BGZ =GO GO CO 400 INSR LTR ADD L NSRL TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IRD MIDDARI DATE fSIMIDOMYI UMfr A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY I CLAMS MADE a OCCUR PD Ded:1,000 CPP00078843 01115110 01,15/11 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED PREMISES (Fa ocalrrencaM - $100,000 MED EXP (Any one Pin) 85,000 X PERSONAL &AOV INJURY 81,000,000 82,000,000 $2,000,000 GENERAL AGGREGATE GEN'L ACE RECATE LQAIT APPLIES PER: POLICY rail 5087- n LOC PRODUCTS - COMP/OP AGG — 7 A AUTOMOBILE LIABILITY ANY Au ro ALL OWNED ALTOS SCHEDULED AUTOS HIRED AUTOS NON- OWHEDAUTOS CA00100083 01115/10 01115/11 (Ea COMBINED SINGLE LIMIT Si 000 000 X BOOLYINJURY (P ) S _ X GODLY INJURY (Peraccidesy S X PROPERTY DAMAGE (Peracddent) S GARAGE LIABILITY ANY AUTO AUTO ONLY - EAACCIDENT S OTHER THAN EA ACC S AUTO ONLY: MSG $ EXCESSIUMBRELLA LIABILITY . .. EACH OCCURRENCE S 7 OCCUR I CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION 5 S $ _— $ A WORILERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETDRtPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Ifyes, descr und SPECI PR OVJSIONS below 001 WC09A60139 07/12/09 07/12110 X I T "cs i MIUTEI 1 1 °FRR E.L. EACH ACCIDENT 51,000,000 $1,000,000 51,000,000 E.L. DISEASE - EA EMPLOYEE E.L D LSEASE - POUCY LIMIT OTHER DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS PRODUCER Richard T. Thorogood Bateman, Gordon & Sands, Inc. P.O. Box 1270 Pompano Beach, FL 33061 INSURED Bill Davis Electric, Inc. PO Box 16575 Plantation, FL 33318 B ACORU,a CERTIFICATE OF LIABILITY INSURANCE 1 INSURERS AFFORDING COVERAGE INSURER A: FCCI insurance Company INSURERS.. INSURER C: INSURER D: INSURER E: COVERAGES 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 DESCRIBSD HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CERTIFICATE HOLDER Miami Shores Village Building Department 10060 N.E.2nd Avenue, Miami Shores, Florida 33138 Client#: 36198 ILDA 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. CANCELLATION • • 10 Days for Non - Payment SHOULD ANY OP 'THE ABOVE DESMD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NOOBUGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITSAGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE A TE (M WDDIYYYY) /15/2010 NAIC # 10178 • • •• • • • • ':•• • 0 • • • • • • • • • • • • • • • • • • • • • • • ••• • • • • • • • • • • • • • 001 • • • • •• • • 4T/writ' 6,,K; RIFIENNIEM filmon -41 =1..E1 © id '''''s .S.,11111 AM11111111111111 -MEMEL_ .11 ;71 , -1111111F111111111 UNE OF SECOND STORY ABOVE LIVING ROOM KITCHEN DINING ROOM 41friSaffig"7"Sirs4;4:Mrfategv BEDROOM 4 AXI*77, 4PV;46 1ST. A/C 4, wsp.pmew.wpow , 1WA'?e'Reff „g,v,,e0p*..mitetolg& 31; EXIST. COVERED TERRACE ' Aili!MIN ) IcaMKT 41??4:,',-, ..p.......mi • - l r • . • . • : . . 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CONCRETE BEAM ABOVE ■••••■ 11... • II .■•■•■■■■• V*. ERMIT #: ' C ►O — R3 Miami Shores Village APPROVED BY DATE drg „:37,:ied Z 0 DEPT 4Bf: DEPT ei J,--)-4-ield SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS IA- /® A5 /i47-2i4 •••• • •• • • •••. • • • • : .•••• • • • • •• •• •••• • • •. • • •• •••. • • • ••• • • • • • •• • • • • • • • • • • • •••• • • • • • O . • • • • • • •oTh-T—r ►QED p JAti 1 9 2010 • • • • • • • -- kt-/ L eh C c b n [T 2epttkc tie "t Coil •••• • • • • • • •••• .. il Z9 •••• •• •• • • • • • • • • ••- • • • • • • • • • • •••• • • • • • • • •• • • • • • • - • • MECHAA 'CAL'" - l6Qtgl1' _al) Ec aco M'tect (Ivan 8 Qxr to Rh.o.1 CGC15 'f * 1 17Z 6 U le 4U NE 7q I1' IEL MEDINA • �, • - MY COMMISSION # DD940165 EXPIRES November 15, 2013 6407) 398-0153 FlwidaaotaryServcs.wm 0) sec ove • . . I p [ c•-1 ; o r\ •••• • • • . . • • •••• • .. end EZCCOV1neC, •• •• • • c PC 5 n� wE f1 4 n d (5 tar je (oc : ©^ s. n l < 0 , teN d D4 5c1 vi4 st (,- R-eCotine 1< &rt ex,s7;n 6 ANIEL MEDINA COMMISSION # DD940165 EXPIRES November 15, 2013 � ( 407) 398.0163 F D tdaNWmy8ervloe.cn 4 i/ Pre7 / - z'X.S'6J f!� • • •. • • • • • • • •• • • • •••• • • • • ••. • E f ecC y3` aE 9y DANIEL MEDINA a MY COMMISSION # DD940165 EXPIRES November 15, 2013 mot 3984153 dar -cam • • •••• 1$:;3Z 9 Si IL • i••• • • • • • • _ ' ,e �1r` •• • • • •••• , 0 1 -w "967/:t/r" A-1 Afr o- 1 o rij ' 2 �'l /z /li C f 6