BPP-11-920Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 163587 Permit Number: BPP -5 -11 -920
Scheduled Inspection Date: September 26, 2011
Inspector: Bruhn, Norman
Owner: MONTERO, JULIAN & DEBRA
Job Address: 465 GRAND CONCOURSE
Miami Shores, FL
Project: <NONE>
Contractor: NATIONAL POOL DESIGN LLC
Permit Type: Pools/Whirlpools /Hot Tubs
Inspection Type: Final
Work Classification: Repair
Phone Number 305/685 -0412
Parcel Number 1132060170320
Phone: (305)559 -1020
Building Department Comments
PUTTING SWIM OUTS STEPS, PLASTER, TILE, COPING,
PAVERS, EXTENSION OF DECK
Passed,9 ;/ 7(r.
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- 160003. PLUMBING AND
ELECTRICAL MUST BE APPROVED. GATES MUST BE SELF CLOSING.
September 23, 2011
For Inspections please call: (305)762 -4949
Page 23 of 41
'� CERTIFICATE OF LIABILITY INSURANCE
1 DATEamaircDvvvy}
06/02/11
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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. (r SUBROGATION 15 WAIVED, Subject to
the terms and conditions of the policy, certain palicles may raqutra an endorsement. A statement an this certificate does not confer rights to the
certificate holder In lieu of such endorsemgrrt(s}.
PRODUCER
Insurance Professionals
2750 SW 87 Ave #204
•
MIMI, FL 33185
Phone (305)2640003 Fax (305)226 -7614
&N em P.Carrera '
PH Hm , ; (305) 284 -0003- 1 € . Noe: (305) 226.7614
ADDRESS, oeteriodrrora s, aaLcom
PRODUCER
INSURER(S) AFFORDING COVERAGE
NA10 #
INSURED
National Pool Design, LLC
15668 SW 10 Ln
Warn!, FL 33194
j
f`TII = Dwlacc ..p..r..,,_.__.. --
INSURER A: Scottsdale Insurance Co
A
INSURER a :
INSURER C:
CPS1295651
INSURER 0:
10/04/2010
INSURER E :
EACH OCCURRENCE
INSURER P:
1 []04000
•
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
IS TO CERTIPY THAT THE POLICIES
NOTWITHSTANDING ANY REQUIREMENT,
MAYBE ISSUED OR MAY PERTAIN
AND CONDITIONS OF SUCH
OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR�THE POLICY PERIOD
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
L
TYPE OFWSURANCE
POLI Y UMBER
to
iMMID DIYYYYI
pVIINT}DIYYYYI
LIMITS
A
GENERAL LIABILITY
® OOMM6RCIAL. GENERAL LIABILITY
❑ ❑ �AIMa stioAnE OCCUR
CPS1295651
.�
10/04/2010
10/0412011
EACH OCCURRENCE
3
1 []04000
pAMAGE a RENTED
_ PREMISES (Ea occurrence)
$
`��
MED E (P Any one person)
$
5000
■
PERSONAL & ADV INJURY $
1000000
0
GENERAL AGGREGATE $
100000D
GENI. AGGREGATE (JMRAPPLIES PER
PRODUCTS - COMPJOP AGG $
10000D0
❑ POUCY • E ■ . LOC
AUTOMOBILE UAMIUTir
COMBINGO SINGLE UMIT $
iEaaa°identl
III week TO
❑ ALL OWNED AUTOS
III
• HIRED ALTOS
BODILY INJURY (Per person) $
BODILY BODILY INJURY(Per eOrJdent) $
PROPERTY DAMAGE $
(Per accident)
111 NON-OWNED
ALTOS
$
$
• UMBRELLA LIAB ■• l oc cuR
EACH OCCURRENCE $
C1 EXCESS h.1AB 0 CLAIMS -MADE
AGGREGATE 3
d DEDUCIBLE
■ RETErmoN $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTN GUTIVE Y N
OFFICER MEMEE.4� E UDEDp
N rA
!
r1 �WC STATU- r-� 1 ER .
LJ
EL EACH ACGiDENT S
ACCIDENT
(Mandatory In NH)
Mye s, describe under
DESCRIPTION OF OPERATIONS below
E.L DISEASE - EA EMPLOYE $
E.L, DISEASE - POLICY LIMIT $
DESCRIPTION or OPERATIONS / LOCATIONS r VEHICLES (Attach ACORD lei, Additional Remarks Schedule, it more apace is required)
Pool Contractor
CERTIFICATE HOLDER __ - ---- - - - - --
City of MIAMI Shores Building & Zoning
10050 Northeast 2nd Avenue
Miami Shores, FL 33138 -2304
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BB CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTI- OR® REPRESENTATNE
Insurence
ACORD 25 (2009/09) QF
&119882009 ACORD CORi'ORA11oN. All rights reserved.
The ACORD name and logo are registered marks of ACORD
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TiME OF FIRST INSPECTION
• PERM NO. Pt1°P % RV) TAX FOLIO NO.f 3 )_O bia_o_gazt
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.
B
111111111111111111111111111111111111111111111
CFN 2011RC3S9380
OR Bk 2770E Ps 28011 (ips)
RECORDED 06/02/2011 13:21:10
HARVEY RUVINv CLERK OF COURT
MIAMI -DADE COUNTY, FLORIDA
LAST PAGE
Space above reserved for use of recording office
and street/address: Per 1 S-A t z'M� +�l 4 c# ry 6 h2s'c-f S. t'',4, 3
'3
5. Surety: (Payment bond required by owner from contractqkif any)
Name, address and phone n v 1�-
Amount of bond $
7. Persons within the State of Florida designated by Own >r upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)7., Florida Statutes,
Name, address and phone number - -'
8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section
713.13(1Xb), Fonda Statutes.
Name, address and phone number:
9. Expiration date of this Notice of Commencement:
the expiration date Is 1 year from the date of recording unless a different-date is specified
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 1, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING 'MICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Off icer /Director/Partner /Manager
Prepared By
Print Name
Title/Office
Prepared By
Prlrtt Name
Title/Office !^
STATE OF FLORIDA
COUNTY'OF MIAMI -DADE [^,
The ;rgoing instrument was acknowl ed before me this . '"� day of ►"l[�. +�
By !`))a(' :1` ^‘G_ lc e• t,c-el
dividually, or Li as for
ersonally known, or ❑ produced the following type of identification:
,Signature of Notary Public:
Print Name:
(SEAL)
VERiRCATION PilRSUANT T'O SECTION 0252.5. FLORIDA STAB
Under penalties of perjury, I declare that 1 have read the foregoing and
that the facts stated in It are true, to the best of my knowledge and be
Signaturp(s) of s er(s) or Owner(s)'s Authorized Ofcer/Director/Partn
I IIEREBYCERIVY abler OP
121°1 .62 paaES me �yofme
originl filed ha this ofd on day
A.D. 20
et Seel.
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: BUILDING ROOFING
Permit No.
Master Permit No.
Ze,b o e_
OWNER: Name (Fee Simple Titleholder): - 11s,\∎(„" e ed
Address: ec,c'r4.44-
City: t� &,st <S -S State: V- VCSc1 C
� 1 Pt
Phon #: 3Q5 - 4
Zip: 73'3 2.AC
Phone#:
Tenant/Lessee Name:
Email: Pc i q e S ,Lc-On
JOB ADDRESS: L\ co
City: Komi Shores County: Miami Dade
Folio/Parcel#: \ \°-��0Ca -0 n -6 O
Is the Building Historically Designated: Yes NO
Flood Zone: Iii a
CONTRACTOR: Company Name: 1 \C.r Ci f Pcsh\ P dSiC-Y\ Phone#: S-b5
Address: al-k" S_ L>
City: R \cAM\ State: \O c-SC`C Zip: \C‘...
Qualifier Name: c\ \ -r ®( AC Phone#: 3 'czS --SSG\ °-vo)...O
State Certification or Registration #: C 5? C \ `-1 S cc i-- Certificate of Competency #:
Contact Phone#:.3c S — <.S `1 10 saaFrItail Address: - -Cedd -y & NCB., ,' t \ CS.9., ' V\ ®corn
DESIGNER: Architect/Engineer: f \ c-�® ��c--�- Z Phone#: bS- SS4 C
Value of Work for tidy Permit: $ 4 CA IC‘ s®. /r Square/Linear Footage of Worms
Type of Work: °Addition °Alteration C]New 1Repair/Replace
Description oi? Work: 5 ' m -o\A 5 1%:
\(lSO So"
()Demolition
Submittal Fee $ 50 " Permit Fee $ .G '7S% CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Trainiing/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
Bonding Company's Name (if applicable) Q e
Bonding co mpan4y's,A4C,iress
City State Zip
Mortgage Lender's Name (if applicable) L 1
Mortgage Lender's Address A) 0 "1 `' S -S
City c. \\ cLs State
Zip l 50 -- to j0
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature 10.
Owner or Agent
The foregoing instrument was acknowledged before me this R
day of R , 20 .\1_,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Signature
tract°:
The foregoing instrument was acknowledged before me this
day of 1/4.1)--A...\ , 20 AN,_, by 44yer� t�
who is personally known to me or who has produced
as identification and who did take an oath.
APPROVED BY Plans Examiner
Structural Review
(Revised 07 /10/07)(Revised 06110/2009)(Revised 3115/09)
NOTARY PUBLIC:
Sign:
Print:
My Commiss
Zoning
Clerk
1
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit NO. RC -5 -11 -920
Issue Date: Not Issued
Expires:Not Issued
Folio Number:1132060170320
Owner's Name: JULIAN & DEBRA MONTERO
Job Address: 465 GRAND CONCOURSE
Miami Shores, FL
Owner's Phone: 305/685 -0412
Total Square Feet: 1950
Total Job Valuation: $ 9,850.00
Contractor(s)
NATIONAL POOL DESIGN LLC
Phone Primary Contractor
(305)559 -1020 Yes
Planning and Zoning Criteria and Comments
Approved: Yes Date Approved: 5/20/2011: Yes
Comments:
Rick Scott
Govemor
H. Frank Farmer, Jr., M.D., Ph.D.
State Surgeon General
May 18, 2011
(Pool Depot)
465 Grand Concourse
Miami, FL 33138
RE: Contingency Letter
Application Document No: API035945
Centrax Permit Number: 13 -SC- 1350278
OSTDS Number:
465 Grand Concourse
Miami, FL 33138
Lot:24 -25 Block: 87 Subdivision: Miami Shores Sec 4
Dear Applicant:
This will acknowledge receipt of an application dated 05/13/2011 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
Proposed pool & deck at the back yard.
There is not increase in sewage flow, change sewage characteristic, or compromise the
integrity or function of the system.
From a review of your completed application, it has been determined your existing system is
adequate for the proposed use,
If you have any questions on this matter, please call our office at (305) 623 -3500.
Enclosures
cc:
Miami -Dade County Health Department
1725 NW 167 St, Opa Locka, FL 33056
Phone: (305) 623 -3500 . Fax: (305) 623 -3645 . http: / /www.MyFloridaEH.com
JUN -2 -2011 01:11P FROM:
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 ha exempt from Florida Workers' Compensation law.
TO:3057568972 P.3
10- 08-2010
EFFECTIVE DATE:
PERSON:
FEIN:
05/17/2010
RODRIGUEZ
281806357
BUSINESS NAME AND ADDRESS:
NATIONAL POOL DESIGN LLC
2423 SW 147 AVE
APT 212
MIAMI PL 33186
SCOPES OF BUSINESS OR TRADE:
1- CERTIFIED POOL CONTRACTOR
EXPIRATION DATE: 05/16/2012
ALFREDO
IMPORTANT: Pareeael la Chapter 440 , 06114). F.S., au niflcer al a corperatlon wile elects exemption Ins this chapter by /Wet a certificate of election coder this
enceee may set recover benefits or compeeastias under WIe calmest. Penman l Chapter 440.06(12) F.S.. Certificates of election to be sxampt... apply only within the
scope of the business or trada fisted en the wake of election to be exempt. Per1e018 to Chapter 440.06413), F.s., Nantes al eIetecn et be exempt led connate* 01
election to be exempt Ow be sableel to revecstloa 11, al art time alter the illtog el the wiles et the faeeance al the coificate, the person named on the 00010 el
certificate so (eager moats the requirements of lhts mike for fasuaace of cortlfeale. The dependent doll revoke a certificate 11 ooy Ilene for idlers of the person
named en the 100111eMe to meet the regoltestemo of this seetlee.
QUESTIONS? (850) 413 -1809
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OP FINANCIAL SERVICES
DIVISION OP WORKERS COMPENSATION
CONSTRUCTION
CERTIFICATE ELECTION B BXCE jPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 05/17/2010 EXPIRATION DATE:
PERSON ALFREDO RODRIGUEZ
FEIN 281808357
BUSINESS NAME AND ADDRESS:
NATIONAL POOL DEMON LLC
2423 SW 147 AVE
APT Z12
IRANK. FL 33185
SCOPE OF BUSINESS OR TRADE
1- CERTIFIED POOL CONTRACTOR
OS/ 10/2012
IMPORTANT
"Pursuant to Chapter 440.05(14). F.S., an officer of a corporation wile
elects exemption from this chapter by filing a certificate of election
I- under this section Ditty not recover boneflts or compensation under this
O chapter.
Pursuant to Chester 440.05(12), F.S., Certificates of election to be
fl exempt... apply only within the scope of the business or trade listed an
the notice of election to be exempt.
E 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
tl, at any time after the filing of the notice or the Issuance of the
certificate, the parson 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 -1809
CUT HERE
Carry bottom portion on the Job, keep upper portion for your records.
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -08
JUN -2 -2011 01:10P FROM:
TO:3057568972 P.2
STATi OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION' INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTS MONROE STREET
TALLAHASSEE FL 32399 -0783
RODRIGUEZ ALFREDO
NATXONAL POOL DESIGN LLC
15665 SW 10TE LANE FL 33194
With this &tense you became one deer nearly are rot
Roamed by the Deparbnent of Business and Praha Regulation.
l to berbegue and from o yacht brokers. from
t keep Florida's Fforide'e economy strong.
Every day we work to improve We way vat do business in order to serve you baker
For infomwtion about our services, please tog onto wvw►.myforidaitcsnsa sore.
There you can find more information about ow divisions maths regulations that
i you. , a deparbrmard nawebltero and leant more about the
Department's
Our mission at the Department ls: License Effidently, Remote Faddy. we
combs* strive Th you doling Fioddda and you can your new unennel
°Acei49 54
frrtf
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