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RC-11-15291 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 163577 Permit Number: RC -8 -11 -1529 Scheduled Inspection Date: October 04, 2011 Inspector: Bruhn, Norman Owner: STOHL COOPER, ETHEL Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: PANDA KITCHEN AND BATH Permit Type: Residential Construction Inspection Type: Final Work Classification: Kitchen Cabinets QA„. Phone Number Parcel Number 1132060140855 Phone: (305)639 -6010 Building Department Comments INSTALLATION OF NEW KITCHEN CABINETS AND GRANITE COUNTER TOPS Passe / rq Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Ingrats-iscr5 QidU 'o c,L El Ir 1550 CA.• October 04, 2011 For Inspections please call: (305)762 -4949 Page 8 of 26 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 No./) l I 1°211 Master Permit No. BUILDING PERMIT APPLICATION FBC 20 AUG 1 9 2011 Permit Type: ILDING ROOFING ��vv o OWNER: Name (Fee Simple Titleholder): �'i( ,S�,12- 0/4.0L Phone#: 3a,' p�37'/ Address: �/ / i11 Grf c./ $/`• o� �D • ®1 / 0 City: Ri ( ( j of i ,e5 State: /LG Zip: .5 Tenant/Lessee Name: / Phone#: Email: (57' ` � G t rO G- 6CSb c./i f c /Greif " JOB ADDRESS: 3 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: P20A Ism •ttc¢l f97i'l Cir'rz . t O4 613)r CONTRACTOR: Company N: me: 12a' I<44 a er414'1/N Phone#: °5e — 64`(- (00/0 3Z tlw/ 7 Address: City: Mtht Qualifier Name: _ State Certification or Kegistratio #: Contact Phone#: $95 "G ('io DESIGNER: Architect/Engineer: Zip: Phone#: 30.5"- Ci'f -620117 Certificate of Competency #: e7qW eg2i�?J Email Address: aP,et"cett ►v vr 7 at.Ge ') • Phone# Value of Work for this Permit: $ 5/ 1,..Jcn-0 Square/Linear Footage of Work: Type of Work: Addition ❑Alteration _ ONew Description of Work: In9t-41 � . ElRepair/Replace ❑Demolition GAP Submittal Fee $ Permit Fee $ `7�m Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 4- /lice, pLu4 17 CCF $ CO /CC $ DBPR $ Bond Technology Fee $ TOTAL FEE NOW DUE yk.6411/1°47 " b4 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 T() 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a c ifted copy the recorded notice of contutencement trust be posted at the Job site for the first inspectio which occurs seven (7) , %'s after h uil' ' g permit is issued. In the absence of such posted notice, the inspection will not be rpproved an a reinspect' fe tvi Signatur Owner or Agent The foregoing instrument was acknowledged before me this t7 day of , 20 IL, by ' who is personally known to me or who has produced / 0 � Jlfilt t As identification andkwhAril,�!in.Aath. Sign: '_,.,� ��0 m +a Print: -7 • ` N. �b'bt' N'I wpb i' 1 •` NOTARY PUBLIC: My Commission Expires: Signature The for in day of , who is ,s :n tiil., t .,�., . to me or who has produced 3 tractor nt wa cknow edged • -. m this �( 20 6 b entification and who did take an oath. N �, TARY PUBLIC: • Sign: Print: ' (I 6 W ry AfBu 0.05 My Commission E +tx`oo .aO `oj)1 .1 ******************10*********** *****************************Nuk*d =*ek &+pr8ik+h***d'**4rt+0 iBds*****N '*+6*'hhd++h*$**** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10/07)(Revised O6 /10/2009)(Revised 3/15/09) Miami Shores Vuiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INFORMATION FOR CABINETS OR ANY INTERIOR RENOVATIONS Permit application must be accompanied by: € 2 Sets of drawings showing details of the interior remodel. (Kitchen cabinets' elevation, location and lay out). If any partition wall will be demolished, please provide drawings for before and after appearance. € Electrical service has to be upgraded in altered area as per the 2007 FBC, It requires installation of carbomonoxide detectors as well as smoke detectors. Permit has to be applied by a license electrical contractor. € If any plumbing is being done, it is required to obtain a Plumbing Permit (i.e. changing or relocating fixtures, extending pipe lines, etc) € If owner is doing the job, owner must fill and notarize Owner Builders Disclosure form (This form must be signed and notarized in the building department only). € If the job is more than $2,500.00 is it required to file a notice of commencement (paperwork may be requested in the Building Department). This must be taken to the Miami -Dade Recorders Office and then brought back to the Building Department. Revised on 11/09/2009 r NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. C/ \IHS TAX FOLIO NO. f•l— r 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. 111111111111111111111111111111111111111111111 CFN 20 1 1 80583535: OR B4: 2 ?`:10 Fs 0533; Ups) RECORDED 08/31/2011 11 :25:51 i HARVEY RUVIN r CLERK OF COURT MIAMI-DADE COIUNTYs FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of property and street/address: MEN I $ 4 E0`A}''' f terAt tofu O M? / it, %7-im to,-21 . q9 . tt ef' ri g424 w 2. Description of improvement: t gO I2r1-7-‘7. d''r 3. Owner(s) name and address: 444.,./ 0-. 5 O1- S7-0r¢'- Interest in property: /ol ap Name and address of fee simple titleholder: glide?, . 4. Contractor's name, address and phone number: 0 f 31 A /&'7? m rl-. Pt/ 5. Surety: (Payment bond required by wner from contra tor, if n ) Povipmigwar, ti190aAale4140444,4 Name, a• . res . and phone number. eilr- 7 . 3 ` 40 x 3 17'' I 'te a r Amount . <.�a;,:.,�;;� $ , 6. Lender's name and address: �B 14e' 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7.F1criLla State rtoa Name, address and phone number: ia� , , 5 /iL (2. 70pb,'. L. X 3)3 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, address and phone number: _ ‹l"v/ril � -2c k 1t 57 / 4. 1 °"f j 7 i4i 1 f/ 5-4 n / - 3 3 t7s-- • 7 ' 9. Expiration date of this Notice of Commencement: t°°4f0oD °2.- (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND PO ED ON THE JOB SITE BEFORE THE a�r> - 3,,;. : •� aU.;, ; ,••:. FORE CO ,: WORK FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT ��� jjj ��' _ _ OR Fi,DIN YO OF C99MENCEMENT. ~ Pe r — original Signatur (s • s�r) or o rer s ' A orized •fficer /Director /Partner/Ma Prepared B > ,G( 'F' � — �� Pre Print Name .i71ttt .i, 6fDt C=oop PrinfffeniN Title,)ffice .c Title /Office 6 _J STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this •. day of By ❑ Individually, or ❑ as for Personally known, orroduced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, 1 declare that I have read the foregoing and that the fac b of knowledge d b l' f C0' C 4. a�j`�01 c<' �s '.2 facts stated in it are true, to the best o my an belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director /Partner /Manager who signed above: ''' ''L ,liwc.10��,4, By By 08/31/2011 10:13 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES IJ001 /001 MobiL 7v F -X .'oS i 5-6 Tf3 8 n i iv 4.2,4fepti Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD • B. k COPY OF LOCAL BUSINESS TAX RECEIPT —L1 C C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTIONI IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. X COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT — 1 t C, C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEFT) D. X COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10850 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: PrQ>41 lex TGIF 2141-11-1 BUSINESS ADDRESS: 302-50 N -5O ) c ' CITY bo"1- j,L4 STATE PF j` ZIP CODE 531 BUSINESS PHONE: (30S) 639 -604 0 FAX NUMBER (SCA -) 633 - 1020 CELL PHONE ( ) • QUALIFIER'S NAME: Il1EQ Q �t frs QUALIFIER'S LIC NUMBER: C. CC 45-1 83 3 4- E -MAIL ADDRESS (IF APPLICABLE): ('E`i-D' ' S t, P Created on 3119109 BY MLDV I RV 3125109 MLOV • STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 DIAS, NEY PETHER PANDA KITCHEN & BATH 4751 NE 10TH AVENUE OAKLAND PARK FL 33334 : ongratulations! With this license you become one of the nearly one million Ioridians licensed by the Department of Business and Professional Regulation. 'ur professionals and businesses range from architects to yacht brokers, from oxers to barbeque restaurants, and they keep Florida's economy strong. very day we work to improve the way we do business in order to serve you better. or information about our services, please log onto www.myfloridalicense.com. here you can find more information about our divisions and the regulations that npact you, subscribe to department newsletters and leam more about the 'apartment's initiatives. )ur mission at the Department is: License Efficiently, Regulate Fairly. We onstantly strive to serve you better so that you can serve your customers. hank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 BATCH NUMBER =4P PANEX03 OP ID: K1 A '`� ^ CERTIFICATE OF LIABILITY INSURANCE - DATE 09107/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 561 - 964 -9190 Gateway Insurance Agency West Palm Beach Branch 561- 964 -9401 4524 Gun Club Road - A101 West Palm Beach, FL 33415 t:ONTAZ:T NAME: iico, . Ext): FAX No): EMAIL INSURERS) AFFORDING COVERAGE NAIC 6 INSURER A : Associated Industries LIABILITY COMMERCIAL GENERAL jCLAIMS-MADE INSURED Panda Kitchen & Bath Attn: Chau Cheung 3250 N.W. 77 Court Miami, FL 33122 INSURER B: INSURERC: INSURERD: INSURER E : $ INSURER F : $ S CERTIFICATE NUMBER: • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE SR WVD POLICY NUMBER POODYEYF (MMlDDIYYYYj POLICY EXP (MM1DDlYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL jCLAIMS-MADE LIABILITY OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER POUCY n JECT I I LOC PRODUCTS- COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUT1VE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y 1 N N f A AWC1007101 04/11/11 04/11/12 X WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY UMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER ANCELLATION I MIASH01 Miami Shore Village Building g g Dept. 10050 N.E. 2 AVENUE MIAMI, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE *-- 9 9 ACORD 25 (2010/05) @ 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A r�R�® /"�`` /,. CERTIFICATE OF LIABILITY INSURANCE OP ID TM DATE (MMIDDIYYYY) 09/07/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite #200 Miami Lakes FL 33016 -5869 Phone:305- 364 -7800 Fax:305- 714 -4401 —ANrnu r NAME: , Ext): FAX No): ANaTL ADDRESS: PRODUCER CUSTOMER ID #: PANDA -2 INSURER(S) AFFORDING COVERAGE NAIC# INSURED PANDA KITCHEN & BATH EXPO CENTER OF NORTH MIAMI, LLC 14768 BISCAYNE BLVD. NORTH MIAMI BEACH FL 33181 INSURER A : Burlington Insurance Company 23620 INSURER B : INSURERC: INSURER D INSURER E : $2000000 INSURER F : $ 100000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBF INSR WVD POLICY NUMBER POUCYEFF (MM/DD/YYYY) POLICYFJCP (MM/DDIYYYY) LIMITS A GENERALUABILITY X COMMERCIAL GENERAL LIABILITY OCCUR 289B005078 04/11/1104/11/12 EACH OCCURRENCE $2000000 (Ea occurrence) PMISES(Eaoccurr $ 100000 CLAIMS -MADE X MED EXP (Any one person) $ 5000 PERSONAL &ADVINJURY $ 2000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT POLICY n JET APPLIES PER: PRODUCTS - COMP /OP AGG $ 2000000 7 LOC $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ _ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXEC OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N UTIVE � I ` N / A WCsrArL- OfH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI55 Miami Shores Village Building Department 10050 NE 2nd Ave Miami Shores FL 33138 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (0) r: r ACORD 25 (2009/09) - . 1S1111_y11w •cnvv.vv. The ACORD name and logo are registered marks of ACORD 576685 -3 THIS IS NOT A BILL — DO NOT•PAY RENEWAL BUSINESS NAME/ LOCATION RECEIPT NO. 601337.'9 PANDA KITCHEN & BATH EXPO CENTER INC 3250 NW 77 CT 33122 DORAL OWNER PANDA KITCHEN &BATH EXPO CTR INC Sec. Type of Business 214 RETAIL SALES HIS 1S ONLY A LOCAL ;OWNERS TAX RECEIPT: IT MS' Not PERMIT THE (OLDER TO VIOLATE ANY kISTING REGULATORY OR ONING LAWS OF THE OUNTY_OR CITIES. NOR DOES IT EXEMPT- THE OLDER-FROM ANY OTHER ERNIT- OR "loose 'EODUiED BY LAW. THIS IS OT k CERTIFICATION OF SHE HOLDER'S oUALIFICA- IONS. FIRST - CLASS Li. &. POSTAGE PAID MIAMI, FL PERMIT. NO. 231 AYMENT RECEIVED AAMI,DADE COUNTY TAX OLLEOTOR: 07/20/2011 60050000218 000045.00 SEE OTHER SIDE EMPLOYEE /S 2 ' DO NOT FORWARD PANDA KITCHEN & BATH EXPO CENTER INC XIANG HUANG PRES 3250 NW 77 CT DORAL FL 33122 1608 576685 -3 THIS IS NOTA BILL —DO NOT PAY - RENEWAL BUSINESS NAME / LOCATION PANDA KITCHEN & BATH EXPO CENTER INC 3250 NW 77 CT 33122 DORAL OWNER PANDA KITCHEN &BBATH EXPO CTR INC Sec. Type of Business. EMPLOYEE /S 220 TANGIBLE PERSONAL PROP DLR 15 HIS IS ONLY A LOCAL NOME TAX RECEIPT. IT IDES NOT PERNIT THE OLDER TO VIOLATE ANY X18nm0 REGULATORY OR OEM LAWS OF THE DO NOT FORWARD OR CITIES. ITEE T OLDER PROM ANY OTHER ERMR OR LICENSE OT A CERTIFICATION Of PANDA: KITCHEN & BATH EXPO CENTER E HOLDER'S OUALIFIOA. INC XIANG HUANG PRES AYMENTRECEVED 3250 NW 77 CT E uNTYTAx mmicrom. DORAL FL 33122. FIRST -CLASS MS, POSTAGE . PAID MIAMI, FL PERMIT No 231 RECEIPT NO. 601336-'1 07/20/2011 60050000216 000067.50 SEE OTHER SIDE III III 11111 1111 I) 11 IT ELl I 1 III11111 ti h III'l 1111 1 11.11111119:3 11 r : wzigiRAACX1111 , 2010-2011 LOCAL IUSiNESS TX REC PT CITY OF DORAL, FLORIDA 220 DISTRIBUTOR 6300 WHOLESALE / DISTRIBUTOK 8300 Northwest 530 Street, Suite 206 Dora, Florida 33166 (KG) a.9031 rop. THE PERIOD C01,4MENCING OCTOBER 1, 2010 Empiric-3 sEPTEMBER 30, 2011 LICENSED TO iN THE I:DLO:MANG BUSINESS: Name: PANDA EXPORT INC 3250 NW 77TH CT Add(ess: DORAL, FL 33122 Condilions: ••rf.MY.Miing 2011000504 MACHINES: SEATS: STATE LIC.#: EMPLOYEES: 1 LICENSE FEE: $30.00 Chief Lic•-nsing 0* cia 3300 NW 53rd Street Suite 206, Doral, Florida www.cityofolor I.corn . 305-593-6631 Fax 305-593-6768 VAT • .:•401,141MirpENZIN-Wit,EMOWIRTIEIGIALIWIMER • ik• -Mr; ,00.41,1154414.1MWRIVAIGROTBINITOSIGN r . 214RET RETAIL STORE .q.'"E510 11.10MAGWORDOCE11,1E141I1M1T.'41:44V.4140intaig1II0.104111V4M421. 4111140ERIMAGNIFIBATIONWPWITIF41:0=16M04-44gemmlwo.;.0.i.e..,;.544 2010-2011 LOCAL BUSNESS TAX RECUPT CITY OF DORM., FLORIDA 8300 Northwest 53rd Street, Suite 206 MACHINES: Dora!, Florida 32166 SEATS: (305) 593-6631 STATE LIC.#: EMPLOYEES: 1 LICENSE FEE: $30.00 FOR THE PERIOD COMMENCING OCTOBER 1, 2010 AND ENDING SEPTEMBER 30, 2011 LICENSED TO ENGAGE IN THE FOLLOWING BUSINESS: Business Name: DBA: 2011000505 PANDA EXPORT INC 3250 NW 77TH CT A •jd s: DORAL, FL: 33122 Conditions: Chief Li nsing S dal 8300 NW 53rd Street Suite 206, Doral, Florida ' www.cityotdoral.com . 305-593-6631 . Fax 305-593-6768 Geememon-romeme,RdoeumeNiremmmmtkomwea4!LwAnt~mftwing - ' APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION# G09000186119 fictitious Name to be Registered: PANDA KITCHEN & BATH Mailing Address of Business: 3250 NW 77 CT DORAL, FL 33122 Florida County of Principal Place of Business: MULTIPLE FEI Number: 26- 0873602 Owner(s) of Fictitious Name: PI OQIS° KITCHEN & BATH EXPO CENTER OF KENDALL, LLC 3250 NW 77 CT DORAL, FL 33122 Florida Document Number. L07000091252 FEI Number. 26- 0873602 FILED Dec 17, 2009 Secretary of State I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50, Florida Statutes, in the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath. XIANG HUANG 12/17/2009 Electronic Signature(s) Date Certificate of Status Requested ( ) Certified Copy Requested ( ) 34" 29 8" 231" 22÷" 95 8" 24" 1 ..1 25 8' 36" 33" BEP013421 SB33 24 DISH\ CEP`. BEPQ01 AUG 1 9 2011 �r� N 2G Miami Shores Village 0 c) APPROVED 0 ZONING DEPT iA BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS PG U!' D g ; F/i /, 111LeCtl- Q-19 04114 204" NO POINT ALONG COUNTER TO BE MORE THAN 2 FEET FROM REC G.EI RECEPTACLE CL UT D/W TACLE UNDER SINK. ALL FIXED APPLIANCES ON DEDICATED COS. 324" ADO SMOKE/CARBON MONOXIDE DETECTORS. ANY AND ALL CLOTH AND RUBBER ' INSULATED CONDUCTORS TO BE • • All dimensions size designations given are subject to verification on job site and adjustment to fit job conditions. 20 7..nrm, TECHNOIOa s - This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper I All I Drawing #: 1 .. •.• •• • • •••••. •••• • • • • •• •• .••••• • • • • • • • • • • •• • •••• • ... .. . ..•••• • •, 000000 .. • • 000000 • • • •••••• ••••• • • • •• ••••. • • • • ••••.• •••• • • •• • • •••••• • • • •••••• • •••.•• • • 000000 • • Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. ,�•��,Designed: TECH Loci sue/ 8/11/2011 Printed: 8/17/2011 Stuard Cooper All I Drawing #: 1 VG dr 1Ov • •... • • ...... .• .•.• 000000 • •• • • • • • ...... • • •• • • • •••• • • ..... .• ..... 000000 • • • • • • •..... • • 000000 ...... • • • • • • • • •• • .....• • Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. TECH GLGGIE3 Stuard Cooper Designed: 8/11/2011 Printed: 8/17/2011 All ( Drawing #: 1 tab bisbv 0 " Ael •••• • • •. • • • • • •• • • • •••••• • • •• • • • •••• • • • •••••• • • • •0•••• • • • • • •• • .. • ••• • •••••1 •.•. • • •••• 000000 • • •• •• • • •1•• • • • • • • • •• • • .•1•.• • • • •1010. •••••l • • •0••1 • •1010 ..•••• • • • •.•••• • • •1•••. • • Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. Q 291 Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper All I Drawing #: 1 • •Y• • • •••• •••••• • • •• •• •••••. • • • • • • • • • • • . •• • • • •••• • • • •••••. • • 000000 • • • •••••• • • .•...• .••••• • 00000 ••..•• • • • •••••• • • 000000 • • Note: This drawing is an artistic interpretation of the general appearance of the design. It is not meant to be an exact rendition. TECH 0 GIES 01 Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper 1All 'Drawing #: 1 34" WF3:153EWRI53 11F3 N- I 00 SB33 11 1 2 • • 000000 000000 000000 • •••• • • •••••• •••• • • •• • • • •• • • • •••••• • • • •••••• • • • •••••• ••••• • • • • •• ••••• • • • •••••• •••• • • • • • •••••• • •••••• • • • •••••• • • • • 000000 • All dimensions maize designations given are subject to verification on job site and adjustment to fit job conditions. ��g�w�� `' °, TECHNOLOGIES This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper El l I Drawing #: 1 •••. • • .....• • •••. . • • •. • •• • • • • ....•. •. • * *• • • • • • ..••.• • ... ••.•. . • • .• • o... 00000 • • • • •• •••••• • • • ...... •••• • • • • •+• •• ..•..• • •...•• • • • • • • • ..•.•• • 2 • • • • • All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. TECNNOl061 5 This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper El 1 Drawing #: 1 AWE PO J mkt 0 0 3 W3330 W3330 co 3 3 3 0 /, �.�.i'/.09.! 1A//. //®//,/0//.Ma f //f /s // / / / ®i /.®/ /®/ // 63401 B33 32 —" E3.3•3 • • 1.11.. • • •••• •• - •••• • • • .• •• • • 11.1.1 • • • • • • • • •• • 33" ••••• •• •••• •• • • • • •••••• • • •• • • • •••• • • • •••••• • • • •1111• • 1.1••• • • 000000 • • •1111• • • o•••o • • •1••• •/••o• • • • •••••• • • • 000000 • 16 1B All dimensions ..size designations given are subject to verification on job site and adjustment to fit job conditions. TECHNO LOGS FM This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper 1E1 1 I Drawing #: 1 All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. 1 TEC NOlOOIES This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper El 1 Drawing #: 1 WD2430R B15L BGF36R -LS •• •• • 00000 • •••• ••••. ••••• 1111. • • .. • • • . • • •• •• • 15" 501" 11 • •••• • 1111.. •••• • • • • • •• • • 000000 • • • 11 1111•• ;•• • ...•• • • •• • 1•• I .• •• 0000 • • • • 1111•. • • • •111.1 • All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. TECHNOLOGIES This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. 000000 • • 1.11•; • Designed: 8/11/2011 Printed: 8/17/2011 Stuard Cooper El 1 Drawing #: 1 National KitchAion Expe rience Professional Karam a Bath inaoaimt sbow &Immt Certified Profeedosal You are dealing with a Safe & Secure C > Professional Operation Beat Price Guarantee Best Price Guarantees you're getting the best price. If you should find a better price in any retail store front for the `same quality merchandise* within 48hrs after purchase., we will refund the difference — and give you a vacation certificate worth $260.00 "Certain Restrictions Apply. Call or visit a store for detail 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 ■ 1 6/-1 Inspection Number: INSP- 163585 Permit Number: EL -8 -11 -1530 Scheduled Inspection Date: September 26, 2011 Inspector: Devaney, Michael Owner: STOHL COOPER, ETHEL Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: AMERICAN POWER ELECTRIC CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140855 Phone: (305)216 -7491 Building Department Comments ELECTRICAL WORK FONR NEW KITCHEN REMODEL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments 7,,,,,, :H. cf,)4. r '6'/7 // September 23, 2011 For Inspections please call: (305)762 -4949 Page 22 of 41 Miami Shores Village AUG 2 6,2O11 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: Electrical Permit No. L//-/S3o Master Permit No. P.a. /5,p 9 3, ti( OWNER: Name (Fee Simple Titleholder): / 6 Siockt - - phonotaargre 8 79r Address: ‘Pc Ale al 9A 47-440- City: R414.0.1 ff (1)tonix, State: ft— Zip: 73/3e Tenant/Lessee Name: fait Phone#: Email: salc44,e. extd,t.s-gi-ttk.otr • JOB ADDRESS: TI OA TV1 City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: County: Miami Dade Zip: CONTRACTOR: Company Name:. Address: / 5 e-ofe: T 2e-e- - City: "IL/6--V7,-*//11 State: Qualifier Name: ,PQA7.e.-",-.74),/,/ Phone#: 67/ ef; State Certification or Registration #: 6.? / ..?=7i)C")%1/ Cld Certificate of Competency #: Contact Phone#: — / Email Address. 'IR 1 - 42,1 47) DESIGNER: Architect/Engineer: Phone#: Phone#: Zip: Value of Work for this Permit: $ di:0 Square/Linear Footage of Work: Type of Work: OAddress CIAlteration New ORepair/Replace Description of Work: e,ar 0-.4-1,4-5- (14 shJLL. hi sea- 3\ li.e.A.129-oyAd to—"_ A. 3 r-St Demolition IL Ktte-ke-^- Submittal Fee s_50. II Permit Fee $ /6 26,;" CCF $ ■ fi ,' ■ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 At'FIDAVIT: 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 proved a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this 22- day of-k.)cnv CC , 20 (1 , by (1-1 , 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. Signature 2t --° Contractor The foregoing instrument was acknowledged before Zu 's day of 1;` , 20 who is p , byQ����a me or who has produced * * * * * * * * * * * * * * * * * * * ** APPROVED BY NOTARY PUBLIC: ********************************************** * * ***** * ** ************w* ******* ians Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Clerk - . TO C:',OU." OODE SEC: FXP:RF-"z' SFFT 30. PEC-11=- 3e-5942546 CC NO EC13003100 BUSEES4i6E"_OOTIO AMERICAN POWER ELECTRIC CORP 1540 E 7 CT OWNER :AMERICAN POWER ELECTRIC CORP SEE BACK OF RECEIPT FOR k LIST OF NOR-PARTICIPATING MUNICIPALITIES . Receipt holder must register in the city where work is to be dons-;. PA air RECEIVED MIAMI-DADE couim• TAX '41111123/2010 60030000219 000200.00 . . . RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD AMERICAN POWER ELECTRIC CORP YUNEXIS ROMERO PRES 1540 E 7 CT HIALEAH FL 33010 itelf2..M1-DADE COUNTY COLLECTOR -1-40 W. PLAGLER let FLOOR MIAMI, FL 33133 2010 LOCAL BUSINESS TAX RECEIPT 2011 FIRST-CLASS iVilAfiiil-DALE COUNTY - STATE CF FLORiDA J.S. POSTAGE EXPIRES SEPT. 30,2011 PAID MUST BE DISPLAYED AT PLACE OF EUSThIESS lifliAliiIi, FL PURSLIANT TO COUNT! CODE ChlAt' t i.7.1-i SA - ART. 5 Let 10 PERkrifT ND. 23: TI-liS IS NOT A BILL - DO NOT PAY --- 569762-9 RENEWAL --p-USIINIESS NAME/ LOCATION RECEIPT NO. 594254-6 - AMERICAN POWER ELECTRIC CORP CC # EC13003100 1540 E 7 CT 33010 HIALEAH vzNER AMERICAN POWER ELECTRIC CORP _Sec. Type of Business WORKER/S 12pAgECTRICAL CONTRACTOR 2 DIMNESS TAX RECEIPT. IT DO NOr PERMIT THE HOLDEF TO VIOLATE ARV EXISTING REGULATORS' OR ZONING LAWS OF THE COUNTY OR cmES. IJOR DOES IT EIEMPT THE HOLDER FROM AM' OTHER PERMIT OR LICENSE REQUIRED DV LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S OUALIFICA- TIOYIS. PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COLLECTOR: 0423/2010 60030000220 000045.00 SEE OTHER SIDE DO NOT FORWARD AMERICAN POWER ELECTRIC COi YUNEXIS ROMERO PRES 1540 E 7 CT HIALEAH FL 33010 ? sTATF:r7F''-7()RnA. DEPARTMENT CF BUSINESS AND PROFESSIONAL REGULATION ET .ECTRT. CAT , (.70=.A. Crr"r' 1"' -.1.&O NORTH MONL.:L TALLAHASSEE FL 32399-0783 LORENTE, RAMON AMERICAN POWER ELECTRIC CORP 1540 EAST 7 COURT HIALEAH FL 33010 Congratulations! With this license you become one of the Floridians licensed by the Department of Business and Our professionals and businesses range from zrchitcct For information about our services, please log onto wvvw.myfloridalicense.corra. impact you, subsuilue Lt./ u iii 11.1 xvjj u 1=411 0111.JIC tliUltJUL 111W r)p.pArtyrent'!, Our mission at the Department is: License Efficiently, Regulate Fairly. We - • • - • Thank you for doing business. in Floricte, enc.{ 2rtuins your net./ iirensel DETACH HERE STATE OF FLORIDA AC# W*7 PROFESSIONAL REGULATION EC13003100 08/13/10 108034056 - CERTIFIED 'ELECTRICAL CONTRACTOR Alk±24t,t,elkiv Z10.4V.V.RIC CORP %Inner ue provxssenS oz c1. 69 FS -Expiratiion,dittez AUG 31, 2012 1,10081301927 STATE OF FLO OD • • . DEPARTMENT puBvszawp8Aisip PROFESSIONAL REGULATION _7,1(.TORS IL:EVENS1HG BQA.RD, , : - - SW# L110081301927 -E•r!' LIC.EITSR- ATER D p. n n Pr4', n i•rne.a.%-•)", " ",•■■ • The ELECTRICAL CONTRACTOR "77 7.777:77-f: Under the provisions of..Chapter 489 FS. Expiration date: AUG 31, 2012 LORENTE, RAMON AMERICAN POWER ELECTRICCORP 1540 EAST 7TH COURT - - HIALEAH. FL 33010 CHARLIE CRIST GOVERNOR • DISPLAY AS REQUIRED BY LAW -CHkRLIE LTEM • 'I .iSECRETARY • 47'Egt,TiFkr:LisTF OF rr FA'tCQUE.E. C.„..k•NriFiCATEr. f,,'sueirt 4,4 e. - ANC CONFF1Pt' • r EriO-DEirr, A '- 0.1%011.19 ne me!!!,a:rarmrr! •Pr.P.Z rnr,tr ^PAPre, P,176 ,^^ NSUI,(ZE SERVICEE: LYZZLIZk..1i ..eortiv; 1::alas.e.alia, .iik•A!... L...%;i6Nal" TALEAE, FL 33010 a0S-216-7491 ,....o.er.t.P•fot ar-ro-.11 out,. P.M/FRAGE. a.a.ova-1.4-4W4 NArf! INSURER G: IINSURER - • . _ 1 ANY RELtuttrItti,u,...,,, ,L,,,, ,,,, --.•-.. -. • - — . NIAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICI Ut,* L. mom./ ncncir3 .. ,.....m.aci. , I la /4%.,6 I rm. 1 =raiz,. cAt..LUQIIVINI4 AMU titalraiJi i IONS OF S UGH rb -i ,Lna ;Wei*. 1 Typg OF !MCI !CMAIng - POLICY NUMBER 'Iliei'ErMA,ItOIWYi - I attailktipita- I _ LIMITS - . --7-I 7-Az. TO ritAll tu - PREMISES lEa ocrunrcm) tr,X I COMMERCIAL GENERAL LIABILITY I POLICY I I '40- 1 I LOC: ANYAUTO sm. Pa 1.q At P. A vA 601 G5MizIIAL 4, 100,ppol -1 nAn nriqi A•M EXCESSIUMBGELLA UABIUTY OCCUR 0 CLAIMSMADE DELIUCTIBLE RETENTION S EMPLOYERS' LIAbiLi lY ANY PRounsTORIPARTNecuoceCuTIVE OrgICr.rr"".777' _ !ryes. deualboullaat SPECIAL PROVISIONS below WPM:MAW JIAPAL LIMIT (Ea accident) (Perpetual) BODILY INJURY (Per eatJaard) PROPERTY DAMAGE (Peraceitleel) AUTO ONLY-EA ACC1OENT AUTDONLY: EACH OCCURRENCE AGG AGGREGATE INCSTATLI-, E.L. EACH ACCIDENT El 77-7 Ir 7".77I EL DISEASE • POLICY LIMIT oStetpIrTitly rtr rul.e. A Tlf Mr nna-rrafn tumoult FO 01011 1 FCTevot enrsF.D Ay EamoRsEmENTrvEcAL pRovisloN.s CERTIFICATE HOLDER CANCELLATION MIAMI DADE COUNTY BUILDINO CODE COMPLIANCE 16L : MIATar FL 33130 ACORD25(2001/08) SHOULD ANY OF THE AROVE DESCRIBED POLICES RE reANCELLEO FEMME THE EXPIRATION DATE 7.7 CY NOTICE 17 to rtr) SHALL MOOSE NO OEUGATioN (t u4u rY ittaa Amu units -1KE INSUNLR, ITS Ae..N.rs OR (-77 AUTItEIRIZEU Ftkertr.:,..Ntiv IA, @ACORII(CORPORATIOITTga e 08 -31 -2010 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: 08/31/2010 EXPIRATION DATE: 08/30/2012 PERSON: = PEREZ OSCAR FEIN: 752984422 BUSINESS NAME AND ADDRESS: AMERICAN POWER ELECTRIC CORP 1540 E SEVENTH COURT HIALEAH FL 33010 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED ELECTRICAL CONTRACTO IMPORTANT: 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 under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? i850i 413 -1609 -- ---- •- ••••�� nc ci crrtflnl Tn RF FXFMPT REVISED 09-06 08 -31 -2010 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: 08/31/2010 EXPIRATION DATE 08/30/2012 PERSON: LORENTE RAMON FEIN: 752984422 BUSINESS NAME AND ADDRESS: AMERICAN POWER ELECTRIC CORP 1540 E SEVENTH COURT HIALEAH FL 33010 SCOPES OF BUSINESS OR TRADE: 1— CERTIFIED ELECTRICAL CONTRACTO IMPORTANT: Pursuant to Chapter 440. 05f14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 �- �wrti� •n at PVVRIIPT REVISED 09 -06 *• 4 k 35' tirr 2 L- 1 V, DADE: 305 - 542 -7228 Lur iAi N t-ILLUJ BROWARD: 786- 586 -8144 DATE OF ORDER % ._ a®- /7 ACCOUNT NAME6� MAILING ADDRESS JOB NAME JOB ADDRESS SW- / 6 ? -5 / BLDG PERMIT NO. JOB PERMIT NO. DATE JOB STARTED DATE COMPLETED DATE INSPECTION CALLED SIZE DRAIN FIELD UNIT PRICE EXTENSION NEW TANK PUMPOUT DRAIN FIELD EXTRAS 300_47- r Cf �O T T AL -1"1/7-77 DATE BILLED STUART COOPER EDIE STOHL COOPER 511 NE 94TH STREET MIAMI SHORES, FL 33138 n THE 2215 63- 1182/670 11104 t$21ii DOLLARS 2 DATE d RANA®LA. a oC North Biscayne ne FL Blvd. 81 OR 0 :0670 118 2E': 501130110611' 2 21,5 [rtLIST E/''� DISPLAYED r. IS?L LYED ,-- U :RSU ai` -T TO CCUN'.NTY....'0D= „..':7tER V/”: - ART.! &•;c .S. ?C NC 569762 -9 RENEWAL L,:us„te:,•Fi ., ,;l' E / LOC 0,-1OD! RECEPPT NO. 594254 -6 AMERICAN POWER ELECTRIC CORP CC * EC13003100 1540 E 7 CT 33010 HIALEAH OWNER AMERICAN POWER ELECTRIC CORP Sec. Tye of Business WORKER /S THIS (s c1�,�AE�'cELCTRICAL CONTRACTOR 2 BUSINESS T.::: RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EZISTI?. G REGULATORY OR ZONING LAY'S of THE DO NOT FORWARD cam:Tv CR CITIES. IIOR DOES IT E:E :PT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE. AMERICAN POWER ELECTRIC CORP REQUIRED BY LA: ::. THIS IS YUNEXIS ROMERO PRES NOT A CERTIFICATION OF THE HOLDER'S OUAUFICA- 1540 E 7 CT 1OtJB HIALEAH FL 33010 Pi;YL EHT RECEIVED LuaiiFDADE COMM' TAX COLLECTOR: 08/23/2010 60030000220 000045.00 SEE OTHER SIDE 1.11 11,11yes nilli„,,,Ilin }h I1l11ftl)l3111„ll>ag1 AMAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER gr. 1st FLOOR MIAMI, FL 33130 MUNiCIPAL= CONTRACTOR'S. 2011 FIRST-CLASS TAX RECEIPT U.S. POSTAGE MIAMI -DADE COUNTY - S T r TE OF FLORIDA PAID PURSUANT TO COUNTY CODE SEC. 10-24 MIAMI, FL "EXPIRES SEPT. 30, 2011 FERMI -la NO. 23 i RECEIPT NO. 30- 5942546 CC NO: EC13003100 BUSINESS NAVE / LOCATION AMERICAN POWER ELECTRIC CORP 1540 E 7 CT OWNER :AMERICAN • POWER ELECTRIC CORP SEE BACK OF RECEIPT FOR A LIST OF NON - PARTICIPATING MUNICIPALITIES Receipt holder must register in the city where work is to be done. eiva T RECEIVED WIAk1 -DADS COUPJTY TAX ccuF 723/2010 60030000219 000200.00 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD AMERICAN POWER ELECTRIC CORP YUNEXIS ROMERO PRES 1540 E 7 CT HIALEAH FL 33010 1i llusltiI1im„iiiin iI1it, „,1„ STATE F FLOC 9DA DEPARTMENT 0 BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSE FL 32399 -0783 LORENTE, RAMON AMERICAN POWER ELECTRIC CORP 1540 EAST 7 COURT HIALEAH FL 33010 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 log onto www.myflorklaficense.com. myfloridalcense.com. There you can find more udunnetion about our &visions 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! DETACH HERE STATE ofFL A AC# _-3 3 DEOR ; OF- BUSINESS Mgr 41X0FSSS3fl8l , REGE "iION =EC130 100 08/13/10 'L08034056 �O� C��E/�RTTIIFIIED:= ..,ELECTRICAL: CONTRACTOR L, •_Vim ,AMERI .. AN- .:POWER " .ELECTRIC' >CORP IS CERTIFIED under - the 'provisions of,ch.489 as scpiratiioa aeee AUG 31, -:20,12 L10 0 813 019 2 7 )8/13/2010 1.08034056 EC13O03 he ELECTRICAL CONTRACTOR famed below IS : CERTIFIED! ruder : the provisions of Chapel er :xpiration date: AUG 31,..:2012 tiara `LORENTE, RAMON. AMERICAN • POWER gt 7Pl+ rr TfT ALEX SINK CHIEF FINANCIAL OFFICER 08 -31 -2010 STATE OF FLORIDA 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: 08/31/2010 EXPIRATION DATE: 08/30/2012 PERSON: PEREZ FEIN: 752984422 BUSINESS NAME AND ADDRESS: AMERICAN POWER ELECTRIC CORP 1540 E SEVENTH COURT HIALEAH FL 33010 SCOPES OF BUSINESS OR TRADE 1— CERTIFIED ELECTRICAL CONTRACT(' OSCAR IMPORTANT: Pursuant to Chapter 440 . 05114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 0, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06 08/30/2011 10 :09 3055564354 ACORDTM CERTIFICATE OF PRODUCER ALL INSURANCE SERVICES, CORP. 3682 W 12th Ave Hialeah, FL 3301,2 (305) 822 -4472 INSURED ALL INSURANCE SERV LIABILITY INSURANC AMERICAN POWER ]ELECTRIC, CORP. 1540 E 7 CT HIALEAH, FL 33010 -7481 COVERAGES PAGE 01/01 OATE(MM/DDYYYY) THIS CER11FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: NATIONAT, INSURANCE COMPANY INSURER B: INSURER C; NAIC# INSURER D; INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING MAY PERTAIN REQUIREMENT. IN TERM URANCE AFFO AFFORDED BY THE CONTRACT LI DESCRIBED HEREIN I UBJ TO ALONE TERMS, EXCLUSIONS AN AND F UCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. D L C §FF , (MM/o IRSR gppL, L— TB –INSRD 1 YPP OP INS FIANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 1 CLAIMS MADE f OCCUR GENT. AGGREGATE LIMP' APPLIES PER I POLICY I I j 17 LOC AUTOMOBILE UAEILRY ANYAL)TO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON.OWNEDAUTOS GARAGE LIABILITY RANYAUTO POLICY NUMBER 021 0000887 00 09/25/10 09/25/11 LIMITS EACH OCCURRENCE $ PREMISES Foccun3nee) MED EXP (Any one person) PERSONALEADVINJURY $ GENERAL AGGREGATE $ 1.000,000 $ 100.000 3 5,000 1,000.000 1,000.000 PRODUCTS - COMP/OP AGO $ 1 000 000 COMBINED SINGLE LIMIT ME accident) BODILY INJURY (Pot person) 3 BODILY INJURY (Peraccltlnnt) $ PROPERTY DAMAGE (Percent) $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMSMADE RDEDUCTIBLE RETENTION $ WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY ANY PROPRII?TOR/PAMTLERGxE BFPtCeR,MCMDt71 EXCLWED7 SPECIALLPPROOVVIS ONS below OTHER AUTO ONLY- EA ACCIDENT $ OTHER THAN AUTOONI.Y; EAACC $ EAcM OCCURRENCE AGE $ $ AGGREGATE $ 5ESCRIPTIONOF OPERATIONS /LOCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENOORSEMENT /SPECIAL PROVISIONS :ERTIFICATE HOLDER MIAMX SHORES 10050 NE 2 AVE MIAMI SHORES, FL 33138 FAX: 305 -756 -8972 $ I COC8TA1U- LIMITI OTW. _L RYB ER E.L. EACHACCIAFNT $ _ E.L. DISEASE - EA EMPLOYE $ EL DISEASE - POLICY LIMP' $ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POucIES BE CANCELLED BEFORE Ti-I$ EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAR.3O DAYS WRITTEN NOTICE: To THE CERTIFICATE HOLDER NAMED TO THE LEPT, BUT FAILURE TO DO SO $ 1,L IMPOSE NO OBLIGATION OR LIAGIUTY OF ANT KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE-. •AUTHORIzED REP - ENT ,CORD2S(2001 /08) @ACO RPORATION 1588 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \ -A41111 Inspection Number: INSP - 164717 Permit Number: PL -8 -11 -1582 Scheduled Inspection Date: September 26, 2011 Inspector: Hernandez, Rafael Owner: STOHL COOPER, ETHEL Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: PRONTO PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060140855 Phone: (305)978 -7755 Building Department Comments NEW SINK AND DISHWASHER IN KITCHEN 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- 163828. no access 2:15 September 23, 2011 For Inspections please call: (305)762 -4949 Page 41 of 41 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Simple T holder): 1 C2e - Address: O� City: zir y State: Permit No. ro) ,777)-31 AUG 26' 2011 I ` .... ?� . Master Permit No. '11N1 C I '— 15 Phone #: Tenant/Lessee Name: Phone#: Email: Zip: JOB ADDRESS: City: Miami Shores County: Miami Dade Folio/Parcel #: Zip: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: /2-/ 3 (/1/1t / City: G h / 1LL State: d r Qualifier Name: .., _"���; Y �1A. Al' State Certification or Registration #: i -$ 5.<6 7 c Certificate of Competency #: Contact Phone #: f/� -, Email Address: DESIGNER: Architect/Engineer: Phone #: NO Flood Zone: Phone #815 92? ,77SS� Zip: '3 Phone #: "30 Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: Address ❑Alteration New \! �` epair/Replace' Description of Work • .' h /L. iL1it' / ******* *x� b*** * * *** * * * ** *:x***x:******** Fees ***** * **** x**** ******** *** ** *** ********* * *** Submittal Fee $ Permit Fee $ /d 0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ ���•�-, I NO TOTAL FEE NOW DUE $ t %., V Div 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, BOTI .FRS, 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the • site for the first inspection which occurs seven (7) days after the building permit is issued. In the i ence of such posted n i tice, he inspection will not be approved and a reinspection fee will be charged. Signature oCi Owner or Agent The foregoing instrument was acknowledged before me this day of 20 , by r L) 1 L C t l2f7/7-- , who is personally known to me or who has produced / Signatur Contractor �% The foregoing instrument was acknowledged before me this ^' day of 4i , 20 LL, by who is personally known to me or who has produced 4e--.4 As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: \\\\\\\\11 +11uuu► ► /,� / / / /// o C--- o NOTARY PUBLIC: Sign: Print: 0111110114o. My Commission Expires: m * * * * * * * *** *may * * * * * **** * ** ** *mm ** APPROVED BY Sign: Print: My Commission Expires: ea-� r o• • • 1.44 /////11111111111 \\\\ Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) 08/25/2011 22:03 3058916367 coo P CERTIFICATE OF LIABILITY INSURANCE INSURANCE INDUSTRIES PAGE 01/01 DATE(MM/DDIYYYY) 8 26 2011 PRODUCER INSURANCE INDUSTRIES INC 953 NE 125th St N Miami, BM 33161 (305) 891 -2808 INSURED PRONTO PLUMBING, INCORPORATED 12135 NE llth Place North-Miami, F1 33161 COVERAGES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAJC# INSURER A: CH$ LSXA SURPLUS TTh$D R $RXTERS INSURER 0: US SECURITY INSURANCE IN$URSR C: INSURER 0: INSURER E: 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 CONDIT10Ns OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INER LTR AWL INSgD TYPE OF IN3URANCF POLICY NUMBER POLICY EFFECTIVE DATE( /DD /YYYY1 POpL I. 1-J(PIRA 10 DATEIMM/CO LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CL2350439C 06/28/11 06/28/12 EACH OCCURRENCE $ 100 ,I10_2 $ 50,00g $ 5,000 X UAMAdt I IiaNT' D PREMISES (Ea occuronce) t.LAIMSMADE X OCCUR MEDEXP (Arty ono !ma+) PERSONAL &ACV INJURY $ 100,000 GENERAL AGGREGATE S 200,00 0 GEN'L AGGREGATE LIMIT APPLIES PER POLICY n PRO• JeCT i--- LOC PRObUCTS- COMP/OP AGO $ 200 , 000 AUTOMOBILE LIABILITY ANYAUTO AL OWNED AUTOS SCHI RULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA- 0000113419 -00 02/12/11 02/12/12 COMBINED SINGLE LIMIT (Ee accident) $ BODILY INJURY (Per person) $ 10,000 X BOOILYINJIJRY (PareocIdrtnt) $ 20,000 _ P RROa DAMAGE $ 10,000 GARAGE LIABILITY ANYAUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY OCCUR ❑ CLAIMSMADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ —1 AGGREGATE $ $ $ WORKERS AND EMPLOYERS' ANY PROPRIETOH/PARTNFRJEXECUTIVE OFFICER/MEMBER (Mm,dntwq If Yee, d SPECIAL COMPENSATION LIABILITY Y/14 EXCLUDED? I ORY 1 i U- I IOTH E.L. EACH ACCIDENT 5 $,L, DISEASE - EA EMPLOYEE $ _j hi NN) rlbc under PROVISIONS below E,L, DISEASE - POLICY LIMit $ OTHER _ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RESIDENTIAL PLUMBING C C _. .. Miami Shores Village 10050 NE 2nd love. Miami-Shores, Fl 33138 I SHOCLD ANY OF THE ABOVE DESCRIBED PDUCIES BE CANCELLSO BEFIIE THE exPIRATION 7 0 DATE THEREOF, THE ISSUING INSURER WU,4 ENDEAVOR TO NAL DAYS WRITTEN { NOTICE TO Toni CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FARMAIt TO DO BO SNAIL IMPOSE NO OItJJGA ITY OF ANY KIND tNSURFR. ITE AGENTS OR REPR TIVES. AUTHOR ::IT ACORD25(2009 /01) 009 ACORD CO ftPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 \1 Atit19\ Inspection Number: INSP - 165058 Permit Number: MC -8 -11 -1583 I Inspection Date: October 03, 2011 Inspector: Perez, JanPierre Owner: STOHL COOPER, ETHEL Job Address: 511 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Kitchen Hood Phone Number Parcel Number 1132060140855 Building Department Comments REPLACE KITCHEN HOOD 1&f3/tj Inspector Comments Passed !/,/ /' Failed Correction Needed Ra- Inspection Fee .' No Additional Inspections can be scheduled until re- inspection fee is paid. For Inspections please call: (305)762 -4949 October 03, 2011 Page 1 of 1 Miami Shores Village �s B 7)75 uildin g Department De p ��� AUG 2 2011 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 LI 8j) Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 lay. BUILDING PERMIT APPLICATION FBC 20 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): rio S Address: �n511 /U F �`� Si; City: d� / 1 t c u c State: FG,, Tenant/Lessee Name: Email: rtl / / Permit No. Master Permit No. ex)-0/ear- Phone # 3°4 02 o (O W").:76 Zip: „_,.?./.3s). ._3 . s 3 ? Phone #: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO x Flood Zone: CONTRACTOR: Company Name: L9'-A-C Address: City: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ \� Square/Linear Footage of Work: Type of Work: °Address ❑Alteration ❑New DRepair/Replace °Demolition NDescription of Work: z,,,_. 0 Phone #: State: Zip: wwwwwwwww *******************r* ww+ xwwwwwwwwwwwww .xwww+�www�xwwwwwwwwwwwwwwww Submittal Fee $ / Permit Fee $ / V e CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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. 1 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 he approved and a reinspection fee will be charged. Signature � mi�����G— Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 _, by F ___ _ , day of , 20 _, by who is personally known to me or who has �(°Rduced,,, r, who is personally known to me or who has produced As identification. `�\ !Pa di f '�' *oath. as identification and who did take an oath. ° 10629e,°`..°6- NOTARY PUBLIC: �, Islur oo <n 'i.11 r Sign: •ad�dx3.• �.a e Print: �\ 00\ My Commission Expires: NOTARY PUBLIC: Sign: Print: My Commission Expires: **17i Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Miami 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 X- NAME: I 4kQ, `S - £2 y DATE: VA /'i / ADDRESS: 51/ /(J q to S s -k4,,, a. . 3 3/ ? 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; 1 further understand that 1 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. 1 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 1, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial i;:ge-- 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 ese____ 3. I understand that, as an owner builder, I am the responsible party of record on a permit. 1 understand that 1 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. Initial s a 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. 1 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 1 have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that 1 built or substantially improved it for sale or lease, which violates the exemption. Initial 0-- 5. I understand that, as the owner - builder, I must provide direct, onsite supervision of the construction. Initial 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 1 employ have the license required by law and by county or municipal ordinance. Initial 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 �S C 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 C. 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. Initiall , Si✓ 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 http : / /www.myfloridalicense.com /dbpr /pro /cilb /ind x.html Initial 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: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. 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 contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and retumed to the local permitting agency responsible for issuing the permit. A copy of the property owners 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 40 day of , 20 /( By &WM-- ( who was personally known to me or who has Prod d there License or as identifk . igyy„,, 's 4 ������ 0 / ' %s. 421%7 .c` 1 / "Illllllll ittt�"\ r' OWNER 08/31/2011 10:13 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES !j001 /001 F&-x .bas fr6 ciY3 2 Miaryi Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 766.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD • B. X COPY OF LOCAL BUSINESS TAX RECEIPT —Lt C C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER 8 X COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT — ti, t C, C. %C , COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. X COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: Panc . COMPLETE CONTRACTOR'S INFORMATION '.L* 0 As. A>• 5 UDC BUSINESS ADDRESS: 'ZEE:0 HW 7-4.. £- CITY G"tiGC.114- STATE FL, ZIP CODE BUSINESS PHONE 095 ) 66)!D FAX NUMBER (A%_'5) CELL PHONE 1 ) • QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: ®c2I R �✓. E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV! RV 312MIM M.DV 59-‘1,1634itel) 1 Sep 24 2010 5: 50PM HP LFISERJET FAX STATE OF FLOFtlDlik • DEPARTMENT OF B SINESS AND PROF$SSIONAL REOULATXON CONSTRUCTION INbZISTRY LICENSING BOARD 1940 NORTH MONR E STREET TALLAHASSEE FL 323994783 DIAS, NEY PETHER PANDA KXT1!R & 4751 NE 10TH AVENU OAKLAND PARK FL 33334 Congratulations! With this licenseyou become one of the nearly one minion Floridians licensed by the Department of Briefness and Professional Regulation. Our professionals and businesses range toil architects to yacht brokerel from boxers to barbeque restaurants, and they keep Florida's economy strong! Every day we work to improve the way we d4, business in order to serve 4ou better. For information about our services, pleasel.t. onto www.myflorldallcen$.com. There you can find more information about , divisions and the regutattcis that impact you, subscribe to department newsletters and Item more about thb Deparbment's initiatives. Our mission at the Department is: License Erficiently, Regulate Fairly. We constantly strive to serve you better so that ou can serve your ctvetomer4. Thank you for doing business in Florida, and congratulations on your nft license' p. 1 (850) 497-1395 . . . vird pow- Miami -Dade County - Building and neighborhood Compliance Office Page 1 of 1 Home 1 product Control 1 Contractors 1 Building Officials 1 Contact us 1 Contractor License Information 09BS00193 PRODISO KITCHEN & BATH EXPO CENTER OF KENDALL LLC 12853 SW 88 ST KENDALL (305) 385 -1915 Contractor Number. Contractor name: Address: City, St, Zip: Phone: Other Phone: Fax: Email: D/B/A: Contractor Status: (305) 3850830 SEANATPANDA@GMAILCOM ACTIVE FL 33186 Class Cate o ; Cate o Description Ex • Iration Date BLDG 53 FINISH CARPENTRY 09/30/2012 CONTRACTOR INQUIR1 COMPLETE Contractor Inouh v and Comolalnt Search 1 Home Paoq 1 State License Search Menu • Boma 1 Uffino our sire 1 kouI 1 Phone Directory Privacy 1 Disclaimer E-mail your comments or questions to pI DaDentt?miamidade acv ® 2001 Miami -Dade County. Alt rights reserved. http : / /egvsys. metro- dade.com: 1608 /W WWSERV/ ggvt /BNZAW941.DIA ?CNTR =09BS00... 8/22/2011 APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION# G09000186119 Fictitious Name to be Registered: PANDA KITCHEN & BATH Mailing Address of Business: 3250 NW 77 CT DORAL, FL 33122 Florida County of Principal Place of Business: MULTIPLE FEI Number: 26- 0873602 Owner(s) of Fictitious Name: PRODISO KITCHEN & BATH EXPO CENTER OF KENDALL, LLC 3250 NW 77 CT DORAL, FL 33122 Florida Document Number. L07000091252 FEI Number. 26- 0873602 FILED Dec 17, 2009 Secretary of State I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50, Florida Statutes, in the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath. XIANG HUANG 12/17/2009 Electronic Signature(s) Date Certificate of Status Requested ( ) Certified Copy Requested ( ) CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 09BS001 93 PRODISO KITCHEN & BATH EXPO CENTER OF KENDAL HUANG XIANG Is certified under the provisions of Chapter 10 of Miami -Dade County VALID FOR CONTRACTING UNTIL09 /30/2012 AE.Coiro® CERTIFICATE OF LIABILITY INSURANCE OP ID TM DATE(MMIDD/YYYY) 09/02/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER: THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite #200 Miami Lakes FL 33016 -5869 Phone:305 -364 -7800 Fax:305- 714 -4401 UN LNANA w La "c°N`o, E t): I (Fa, No): ADDRESS: CUSSTOMERm#: PANDA -2 INSURER(S)AFFORDINGCOVERAGE NAIL* INSURED PANDA KITCHEN & BATH EXPO OF NORTH MIAMI, LLC NORTH BMII BEACH Ft 33181 INSURER A: Burlington Insurance Company 23620 INSURER B : 289B005078 INSURER c 04/11/12 INSURER D : $ 2000000 INSURER E : PRREMISF-S(Eaocarmence) INSURER F : CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �s TYPE OF INSURANCE AUDL INSR WSW iNVO POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL — LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR 289B005078 04/11/11 04/11/12 EACH OCCURRENCE $ 2000000 X PRREMISF-S(Eaocarmence) $100000 CLAIMS -MADE X MED EXP (Any one person) $ 5000 PERSONAL &ADVINJURY $ 2000000 GENERAL AGGREGATE $ 2000000 GEN1. —1 AGGREGATE UMIT APPLIES PER: POLICY n JECT fl we PRODUCTS - COMP/OP AGG $ 2000000 $ AUTOMOBILE — LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ — BODILY INJURY (Per accident) $ — PROPERTY DAMAGE (Per accident) $ — $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ — AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXEC OFFICER/MEMBER EXCLUDED? (Mandatory in NH) II yes describe under DESCRIPTION OF OPERATIONS Y / N N / A IT WC LIMITS S I I OETR E.L EACH ACCIDENT $ UTN$---1 E.L DISEASE - EA EMPLOYEE $ below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Addfdonal Remarks Schedule, K more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave Miami Shores FL 33138 ACORD 25 (2009109) MIAMI55 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE oir © 1988-2009 ACOR ' CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PANEX03 OP ID: K1 A °- CERTIFICATE OF LIABILITY INSURANCE 1 DATE 08/31/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 561- 964 -9190 Gateway Insurance Agency West Palm Beach Branch 561- 964 -9401 4524 Gun Club Road - A101ss: West Palm Beach, FL 33415 CONTACT PHOP a �, I FAX No): (MNNIUDDSYYYI INSURER(S) AFFORDING COVERAGE NAIC $ INSURERA:Associated Industries LIABILITY COMMERCIAL GENERAL uRED Panda Kitchen & Bath Attn: Chau Cheung 3250 N.W. 77 Court Miami, FL 33122 INSURER B: OCCUR INsuRERC: INSURER D : INSURER E : EACH OCCURRENCE INSURER F : CER THIS INDICATED. CERTIFICATE EXCLUSIONS Mk IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERT. E INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM DCDEIYYYY (MNNIUDDSYYYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL UABIUTY OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1 CLAIMS-MADE MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE UMIT APPLIES PER nLOC PRODUCTS- COMP /OP AGG $ 7POUCYngip& $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — OWNED COMBINED SINGLE LIMIT accident) $ — BODILY INJURY (Per person) $ _ SOIEDUI.ED AUTOS BODILY INJURY (Per accident) $ _ NON PROPERTY DAMAGE (Per accident) $ _AUTOS $ UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 I RETENT ON $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY A* ER EXCLUDED? TN PROPRIETOR/PARTNER/EXECUTIVE Ya (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A AWC1007101 04/11/11 04/11/12 X 1 WCY TAMTU- I IOER- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space Is required) CERTIFICATE HOLDER CANCELLATION MIASH01 MIAMI SHORES VILLAGE 10050 N.E. 2 AVENUE MIAMI, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 9424) ACORD 25 (2010105) O 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are, registered marks of ACORD Miami -Dade County - Building and neighborhood Compliance Office miamidade.cov V Page 1 of 1 Home 1 Product Control 1 Contractors' Building Officials 1 Contact u4 Contractor License Information 09BS00193 PRODISOKITCHEN & BATH EXPO CENTER OF KENIDALLLLC 12853 SW 88 ST KENDALL (305) 385 -1915 Contractor Number: Contractor name: Address: City, St, Zip: Phone: Other Phone: Fax: Email: D/B /A: Contractor Statue: (305) 385 -0830 SEANATPANDA@GMAILCOM ACTIVE FL 33188 FINISH CARPENTRY 09/30/2012 "CONTRACTOR INOUIRR COMPLETE Contractor Inautry and Comolaint Search 1 Nome Pace 1 State Dense Search Menu • lime 1 Ustno Our Site I Al= I Phone Directory 1 Ed200I I ! E -mail your comments or questions to BWGDeotCa?miamldeda acv St 2001 Miami -Dade County. All rights reserved. http: / /egvsys. metro- dade.com:1608/W W WSBRV/ ggvt /BNZAW941.DIA ?CNTR= O9BSOO... 8/22/2011 APPLICATION FOR REGISTRATION OF FICTITIOUS NAME REGISTRATION# G09000186119 Fictitious Name to be Registered: PANDA KITCHEN & BATH Mailing Address of Business: 3250 NW 77 CT DORAL, FL 33122 Florida County of Principal Place of Business: MULTIPLE FEI Number: 26- 0873602 Owner(s) of Fictitious Name: k_PROD[SO KITCHEN& BATH EXPO CENTER OF KENDALL,_LLC 3250-NW-77-CT = - DORAL, FL 33122 Florida Document Number. L07000091252 FEI Number. 26- 0873602 FILED Dec 17, 2009 Secretary of State I the undersigned, being an owner in the above fictitious name, certify that the information indicated on this form is true and accurate. I further certify that the fictitious name to be registered has been advertised at least once in a newspaper as defined in Chapter 50, Florida Statutes, In the county where the principal place of business is located. I understand that the electronic signature below shall have the same legal effect as if made under oath. XIANG HUANG 12/17/2009 Electronic Signature(s) Date Certificate of Status Requested ( ) Certified Copy Requested ( ) 576685 -3 BUSINESS NAME / LOCATION PANDA KITCHEN & BATH EXPO CENTER INC 3250 NW 77 CT 33122 DORAL OWNER PANDA KITCHEN &BATH EXPO CTR INC Sec. Type of Business 214 RETAIL SALES HIS IS ONLY A LOCAL IUSINESS TAX RECEIPT. IT TOES NOT PERMIT THE (OLDER TO VIOLATE ANY XISTING REGULATORY OR ONING LAWS OF THE AUNTY OR CITIES. NOR DOES IT EXEMPT THE (OLDER FROM ANY OTHER ERMIT OR LICENSE :EOUIRED BY LAW. THIS IS IOT A CERTIFICATION OF HE HOLDER'S OUAUFICA- IONS. THIS IS NOT A BILL - GO NOT PAY RENEWAL RECEIPT NO. 601337-9 AYMENT RECEIVED IIAMLDADE COUNTY TAX OU.ECTOR: 07/20/2011 60050000218 000045.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE I PAID MIAMI, FL PERMIT NO. 231 EMPLOYEE /S 2 - DO NOT FORWARD PANDA KITCHEN & BATH EXPO CENTER INC XIANG HUANG PRES 3250 NW 77 CT DORAL FL 33122 1608 576685 -3 BUSINESS NAME / LOCATION PANDA KITCHEN & BATH EXPO CENTER INC 3250 NW 77 CT 33122 DORAL OWNER PANDA KITCHEN &BATH EXPO CTR INC Sec. Type of Business EMPLOYEE /S 220 TANGIBLE PERSONAL PROP DLR 15 HIS IS ONLY A LOCAL •USINESS TAX RECEIPT. IT 'OES NOT PERMIT THE OLDER TO VIOLATE ANY XISTING REGULATORY OR ONING LAWS OF THE DO NOT FORWARD O OR PT. E OES IT EXEMPT TH FT THE OLDER FROM ANY OTHER ERMIT OR UCENSE EOIXRED BY LAW. I OT A CERTIFICATION OF PANDA KITCHEN & BATH EXPO CENTER OIL HOLDER'S OUAUFICA- INC XIANG HUANG PRES THIS IS NOT A BILL - 00 NOT PA" RENEWAL FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT NO; 601336 -1 AYMENTRECEIVED 3250 NW 77 CT UUIFDADECOUNry TAX DORAL FL 33122 O MI -DADE 07/20/2011 60050000216 000067.50 SEE OTHER SIDE IIIIIIIIIIIIIIIIIIlIIIIII lI IIIlII,Illh,111IJII,I.IIIIIM