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EL-09-2098Project Address 100 99 Street Miami Shores, FL 33138 -2304 Owner Information Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Address Parcel Number 1132060132280 Block: Lot: Contractor(s) SANDERS ELECTRIC INC Phone 305 -624 -1003 CeII Phone Fees Due CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $1.20 $0.40 $180.00 $3.00 $50.00 ($50.00) $1.60 $186.20 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy January 04, 2010 at - Res Phone Type of Work: LANSCAPE LIGHT Additional Info: 10 OUTLETS AND 2 RECEPTACLE Classification: Residential Invoice # EL -12 -09 -36698 EL -12 -09 -36698 Check #: 1226 Total Amt Paid Amt Due $ 186.20 $ 50.00 $ 136,E $ 186.20 $ 186.20 $ 0.00 January 04, 2010 Date 31t017a" PROVED Expiration: 06/22/2010 Applicant STEVEN WILLIAMS CeII STEVEN WILLIAMS 100 NE 99 ST MIAMI SHORES FL 33138 -2341 (305)758 -5519 Valuation: Total Sq Feet: $ 2,000.00 0 For Inspections please call: (305)762-4949 Available Inspections: Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. 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. 1 SN EFL ERMAN D Is certified under the provisions of Chapter 10 of Miami -F County t asa °ice, t�;R C_ONT CTINQ- LLN`TH_ O Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 000017351 SANDERS ELECTRIC INC D.B.A.: 000/ QUALIFYING TR ADE(S) RADE(S Vr Or /fy...i«. / C°Y rala4ea ap r° rein MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 1 3313$ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING . - - , . • VOR TO MAIL DAYS WRITTEN NOTICE TO THE -' ' " TE H • • - J - NAMED TO THE LEFT, BUT FAILURE TO DO SO . r tt , s • - NO • : • ATION OR LIABILITY OF ANY KIND UPON THE IN -,d- r SOR "'-- SENTATIVES. AUTHORIZE) Sonia BatistalAgent �� -- - �r -4- wi.s ~um a r rwu An ..s..t s .. .ecd..,ed THE POLICES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADM INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE IDDIYY) DATE (MM W POLICY EXPIRATION DATEIMMEDD/YYYYI LIMITS A GENERAL LIABILITY 0185a00015588 09/19/2009 09/19/2010 EACH OCCURRENCE $1,000,000.00 PREMISES (Ea occurrence) S50,00).(Y) J COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $1,000.00 ❑ • CLAIMS MADE ' OCCUR v ❑ PERSONAL & ADV INJURY Si ,000,000.00 GENERAL AGGREGATE $1,000,000.00 ❑ PRODUCTS - COMP/OP AGG $1,000,000.00 GEM L. AGGREGATE LIMIT APPLIES PER: • POLICY • PROJECT • LOC ❑ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) • ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ BODILY INJURY (Per Peon) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) • ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG III EXCESS / UMBRELLA LIABILTTY EACH OCCURRENCE AGGREGATE ❑ OCCUR • CLAIMS MADE ❑ DEDUCTIBLE {] RETENTION $ WORKERS COMPENSATION AND EtMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? (Mandatory in NH) 11yes describe under SPECIAL PROVISIONS below ❑ WC STATU- ❑ OTH- TORY LIMITS ER E.L. EACH ACCIDENT EL. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LMT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ELECTRICAL WIRING-NO UNDERGROUND WIRING dek C' !2'! - PRODUCER West Coast Insurance Consultants In 707 East 9 Street - Hialeah, FL 33010 Phone (305)888 -1880 Fax (305)888-1885 INSURED SANDERS ELECTRIC, INC. 3915 NW 164 Street MIAMIMianu, FL 33054 - i (305) 624 -1003 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 POLICIES BELOW. INSURERS AFFORDING COVERAGE misuRER A.. GRANADA INSURANCE COMPANY INSURER B: INSURER C: INSURER D: INSURER E: DATE (MM/DD/YY) 09/18/09 NAIC # COVERAGES ACORD 25 (2009/01) QF CANCELLATION mil \YVJW VV,v V, \+',••v,w. - . ACORD name and logo are registered marks of ACORD 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 Permit Type: ELECTRICAL vv Owner's Name (Fee Simple Titleholder) S°- 1Jn1, 0 4 A—• Owner's Address I OD S \� City 6- -i.TA". State Tenant/Lessee Name Email St l l.L(AM& /1t� L , C_O Job Address (where the work is being done) City Miami Shores Village FOLIO / PARCEL # 113 2-0 [ 3 Z Z 0 Master Permit N1. Zip Phone e# (3 -5$ 5519 Phone # Permit No. County Miami-Dade Zip 3 3 \ 3 Cb Is Building Historically Designated YES NO Flood Zone Contractor's Company Name Sir; ( e C � Phone # O.5 (7i' " / O 3 Contractor's Address 391s Niel 1 , — �— City P-17; l - 4',�SA , State 'FL Zip 33d� tf Qualifier Name— W rt1Q D '''"9.(.1bEge Phone # State Certificate or Registration No.tC,. 1)CD Certificate of Competency No. P Y Contact Phone 305 lot 4 --1 ®®) E -mail 3os 113 -- Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ['Addition ❑Alteration [Sw ❑ Repair/Replace --� � ❑Demolition Describe Work: e L)C.. `- 0hi'Dc_c_vm r!~- Li OLYrL ) 0 .stab C...- tEe Iprr a 00 c C . � mittal Fee $ ® 00 Permit Fee $ / bee 40 CCF $ 1- 2 J CO /CC $ Pi Notary $ Training/Education Fee $ 0 -40 Technology Fee $ ) J Scanning $ 6'00 Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total: Fee Now Due $ ) 3p • 2.0 See Reverse side -a 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. Signa , � Signature Owner oorr Agent � d s �y Contractor C ^� l e r binirms eht vb�fi' actcnov dged before me this g Th f or go ng insim�nt` as ac c�'now edged�iefore me this day 666:216fe 20t(, byg{ N&$ Wt U.t pr+-` , day o 20() , by Awl S who is personally known to me or who has produced l 1 who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: `��- ,. — _ Sign: Print: Print: . My Commission Expires: NOTARY PUBLIC: My Commission Expires: *************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner APPROVED B (Revised 07 /10 /07)(Revised 06/10/2009) Zoning Engineer Clerk checked ALEX SINK STATE OF FLORIDA C.HIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO IN EXEMPT FROM FLORIDA WORRIES' CORWINSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This codifies that the MMus( listed below has elected to be exempt from Florkla Welfare Compensation law. EFFECTIVE DATE 08105/2008 EXPIRATION DATE: 08/05/2010 POISON: SANDERS HERMAN D FEB* 650009893 BUSINESS NAME AND ADDRESS SAM3ERS ELECTRIC INC 3915 N W 164TH ST MIAMI GARDENS SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL CONTRACTOR IMPMITANT: Palma to Chapter 440. 05(14), F.S., an oMaa of a corporal= who elects eltellWROD from this chapter by filing a coalfields of election under this section may eat tecover benefits or compensialoo seder this chapter. Persasol to ampler 4411.0502/. CoMilconle of election to be eliantt— eppty indY within the scope of the business or trade listed en the =dee of election to be exempt. Pursuant m Chapter 440.05(14 F.S.„ Notices of electism to he exempt and certificates of election to be exempt shell be subject to revocation if. et any time sitar the filing of the notice ar the issuance of the codifies% the person mooed en the notice or certificate au Weer meets the requirements of Ms section for Issuance of a swath:ate. The department .shati revoke. certificate et any time far failure of the person named en the =IMMO to meet the requirements of Ms section. O.UESTIONS7 DM/ 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 FL 33084 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF R-ORIDA DEPARTMENT OF FDIANCIAL SiERVICES- DAMON OF =MOMS' COMPENSATION C0NSTRUCTIIN4 DMISTRY CERTIFICATE OF ELBCTUNI TO BE ESISEPT FROM FLORIDA WORKERS' CINSPENSATION LAW EH:Emma 08/05/2008 EXPIRATION DATE: 08/05/2010 PERSOAk MIRAN D SAPNIERS FBI* 650009883 BUSINESS NAME AND ADDRESS: SANDERS ELECTRIC 3915 N W 1647H ST MIA WN GAMES, FL 33054-6216 SCOPE OF BUSINESS OR TRADE 1- ELECTRICAL CONIRACTOR IMPORTANT 0 F Pursuant to chow 440.05114i F.S., an officer of a corporation who , elects exisoption from this chapter by filing a certificate of election 1 - under this section may not recover benefits or compensation under this D chapter. H Pursuant to Chapter 440.05(12i, F.S. Certificates of election to be ▪ exempt.. apply only within the scope of the business ar trade listed on e The notice of election to be exempt.. E Penman to Meter 440.1151131 F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time alter the filing of the notice or the issuance of the certificate, the parson yarned an the notice ar certificate no longer meets the requirements of this section for imam of a certificate. The department siell revoke a certificate at any time for failure of the person maned an the certificate 10 mgt the requirements of this section. 111113110LS? (850) 413-1609 * Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 CUT HERE 08-05-2008 DO NOT FORWARD SANDERS ELECTRIC INC HERMAN D SANDERS PRES 3915 NW 164 ST MIAMI FL 33054 11 11I ,1,1111i,st.l,ll,L.IIN+IIlEIII 11I11+u,ll hld11P, J1