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RC-11-767Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 159029 Scheduled Inspection Date: October 12, 2011 Inspector: Bruhn, Norman Owner: MENNES, CHARLES Job Address: 317 NE 104 Street Miami Shores, FL Permit Number: RC -5 -11 -767 Project: <NONE> Contractor: MIAMI SKYLINE CONSTRUCTION CORP Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number 305 - 757 -7143 Parcel Number 1121360130090 Phone: (305)899 -9696 Building Department Comments BATHROOM REMODEL Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments cc- October 11, 2011 For Inspections please call: (305)762 -4949 Page 5 of 28 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 317 NE 104 Street Miami Shores, FL 1121360130090 Block: Lot: CHARLES MENNES 317 NE 104 Street Miami Shores FL 33138 -2017 Contractor(s) Phone CeII Phone MIAMI SKYLINE CONSTRUCTION COF (305)899 -9696 (305)216 -2224 Valuation: Total Sq Feet: $ 2,100.00 50 Approved: In Review Comments: Date Approved: : In Review Date Denied: Type of Construction: BATHROOM REMODEL Stories: Front Setback: Left Setback: Bedrooms: Plans Submitted: Yes Certificate Date: Bond Retum : Occupancy: Single Family Exterior: Rear Setback: Right Setback: Bathrooms: Certificate Status: Additional Info: Classification: Residential Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $2.25 $2.25 $0.60 $150.00 $9.00 $2.40 $168.30 Pay Date Pay Type Invoice # RC -5 -11 -40766 06/06/2011 Check #: 20496 $ 118.30 $ 50.00 05/03/2011 Check #: 20193 $ 50.00 $ 0.00 Amt Paid Amt Due Available Inspections: Inspection Type: Final PE Certification Shutter Final Window Door Attachment Tie Beam Slab Termite Letter Framing Insulation Drywall Screw Shutter Attachment Window and Door Buck Ceiling Grid Fill Cells Columns Declaration of Use In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. June 06, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 06, 2011 1 OP ID: J9 '`��°RO� CERTIFICATE OF LIABILITY INSURANCE DATE 0503/11 I� 05/03/11 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 poiicy(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. 954 -%%6 -2222 1201 W Cypress Creek Rd # 130 9547764446 P.O. Box 5727 Ft Lauderdale, FL 33310 -5727 Shawn A. Burton, CIC CONTACT NAME: FAX (a/co. No. Ext): (A/C, No): E-MAIL ADDRESS` CUSTOMER ID #: MIAMI37 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Miami Skyline Construction Corp. Claudio Rodriguez 609 NE 127 St Miami, FL 33161 INSURER A : FCCI Commercial Ins Co 33472 INSURER e : National Trust Insurance Co. 20141 INSURER C : FCCI Insurance Company 10178 INSURER D : 03/23/11 INSURER E : EACH OCCURRENCE INSURER F • 1,000,000 • 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM INSR SUB WVD POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR GL0011574 03/23/11 03/23/12 EACH OCCURRENCE $ 1,000,000 X DAMAGE/ ( PREMISES (EREa oNTED $ 100,000 � CLAIMS -MADE X MED EXP (Any one person) $ 5,000 X XCU Coverage PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY [J(1 JECOT- I 1 LOC $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA0018066 CA0018066 CA0018066 CA0018066 03123/11 03/23/11 03/23/11 03/23/11 03/23/12 03/23/12 03/23/12 03123/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA LIAR EXCESS LLAB X OCCUR CLAIMS -MADE UMB0012189 03/23/11 03/23/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 10,000 $ X $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Y /❑N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N / A 001 WC11 A66406 03/23/11 03/23 /12 WC STATU- OTH- X TORY LIMITS ER E L EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule if more space is required) MIAMISH Miami Shores Village Attn: Building Dept. 10050 NE 2nd Avenue Miami Shores, FL 33138 I 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 �l a'`� 4 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE" F3ATCFi NtJN1BE;R,'; 9 Obt Busines THE.:ARI. ONLY A LOCAL. • ELISINESS TAX RECEIPT. IT • DOES NOT PERMIT THE HOLDER TO VIOLATE ANY ESISTJNG NEOPLAVNYmi 017?XtrNE51 -Ege,iNoNg PritN4qc . • .. DO NOT FORWARD MIAMI SKYLINE CONST CORP CLAUDIO-S -RODRIGUEZ PRES- 705 NE 130,ST NORTH MIAMI FL 33161 56 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 SAY 0 ` all BY:o___ BUILDING Permit No. 9 "`r4"- PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING ROOFING OWNER: Name (Fee Simple Titleholder): C. \, r (, S Address: a - » k, , £- 0 21 `-. State: _ A . City: , 5 5 44.. ` -61-`"7143 Zip: t Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1\1 v ` - ® 27 S City: Miami Shores County: Miami Dade Folio/Parcel #: Zip: Is the Building Historically Designated: Yes NO Flood Zone: ts,L vv, '5 K.-1 CONTRACTOR: Company Name: C-c> �, 5 ts- L2 1i p �s: 1-- . Phone #: 3<JS.o g19,_ °/' g(o . Address: Co co -4- f ,f �� 1- 2 S t. City: N _ IA L State: T Z ( Zip: '. k C. ( . Qualifier Name: C 1 J. i D e4\ ("- ' 2 Phone #: Q 5_ 2 (b 2° Z Z 4r State Certification or Registration #: L' G C S ' -1- ertificate of Competency #: Contact Phone #: DESIGNER: Architect/Engineer: Phone #: Email Address: jj -- L Value of Work for this Permit: $ y Square/Linear Footage of Work: S 7 $ . z 7 i. Type of Work: ❑Addition ❑Alteration _New dRepair/Re e . ce ❑Demolition Descriptio i of Work: d-<::) * * * * * * ** * * * * ** * * *** ********** ** *******Fees ******* * * * ********a: ******* ** **** ** **+x ***** Submittal Fee $ D _ Permit Fee $ /.rC "`' 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. 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 ab ence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The f ' ��e �II oing instrument was acknowledged before me this day o IU S. ' , 20/0., by ho is ersona ly known to me or who has uced As identification and who did take an oath. NOTARY PUBLIC: Sign: Pn My Commissi * * * * * * * * * ** MARIA MAGALDI r. Notary Public - State of Florida `.'ate My Comm. Expires Feb 25, 2012 opltos Commission # DD 762313 Signature Contractor The fore f oing instrument was acknowledged before me this day of 2 ,20t, ,by� w o is ersona ?ly known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 1,<A4A-a Sign: ) -7 Pri.t: My * * * * * * * * * * * * * * * * * ** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) p1usj c )1!7� yea +�` • bYo ZIS'BZ gel sei X3111W0D AIN _. 11 . r. opp0I 10 ems - oll4nd tietoN u ? I011f9VIN VOIYW ••, :eo ■ ;; ;; * * * * * * * * * ** * * * * * ** Zoning Clerk Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164573 Permit Number: EL -5 -11 -769 Scheduled Inspection Date: October 05, 2011 Inspector: Devaney, Michael Owner: MENNES, CHARLES Job Address: 317 NE 104 Street Miami Shores, FL Project: <NONE> Contractor: CPS ELECTRIC, INC. Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number 305 - 757 -7143 Parcel Number 1121360130090 Phone: 305 -607 -8221 Building Department Comments REMODEL BATH 2 LIGHT FIXTURES AND 1 OUTLET 2 SWITCHES PENDING W/C 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- 159043. Add smoke / carbon monoxide detectors. October 04, 2011 For Inspections please call: (305)762-4949 Page 27 of 49 Jun 24 2011 10:20AM HP LASERJET FAX P.2 ACORD . CERTIFICATE OF LIABILITY PRODUCER MENDEZ INSURANCE & FINANCIAL SVC 508 E 49 ST HIALEAH FL 33013 305 769 4936 C.P.S.ELECTRIC,INC. P.O.BOX 669132 MIAMI,FL 33166 INSURED INSURANCE DA 6/24/2011 f 6�24�2011 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 NAICW INSURER A: ASCENDANT UNDERWRITERS INSURER B: INSURER C: INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LBAIR LTR TR ADM NM TYPEOFKNSURANCE P'OLICYNUMI3ER PDATRUTI TCA Pagi DfYYSN LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL- 34425 -1 09/23/10 • 09/23/11 • EACH OCCURRENCE $31.000.000 8 3100,000 $ $5.000 X PREMISES D (E RE ocg retme) CLAIMS MADE X OCCUR MED EXP (Anyone person) .X 500 DED PERSONAL &ACV INJURY x$1,000,000 831.000,000 8$1.000.000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JECT II LOC PRODUCTS- COMP/OP AGG 7 AUTOMOBILE LIABILITY ANYAUTO AU. OWNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED. ON- OWNEDAUTOS COMBINED SI.NGLEUMIT (Ea accident) $ BODILY INJURY (Per person) x - _ BODLY INJURY (Peraoctderej $ (P a lDAMAGE $ GARAGE LIABILITY ANYAUTO AUTO ONLY-EA ACCIDENT $ OTHERTHAN EA ACC $ AUTO ONLY: AGO $ ECCESSIUMBRELLAUABI J1Y EACH OCCURRENCE 8 10 l_ I CLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION $ _ 8 $ 8 A WORKERSCOMPENSATIONAND LI EMPLOYERS' ABILITY ANY PROPRIETORMARTNEREXMMryE 0E19CERAVEM1®ER EXCLUDED? Ifyysaaa deeoribeundsr SPEGLIALPROVISIONSbeldv WC- 602230 06/02/11 06/02/12 i X TWORILMITS rat E.L EACH ACCIDENT $$1,000,000 $ . i 1,000.000 $$1.000.000 EL DISEASE - EA EMPLOYEE EL. DISEASE - POLICY LIMIT DESCRIPTION OTHER OF OPERATIONS/ LOCATIOWRAlCiartn crrwm.. mnA.eA.,..,..e..�.,.......,,.�. _.._..._ -_._. -- .- -........... ELECTRICAL WORK CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUIDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES ,FL 33138 ACORD25(2001/08) SHOULD ANY OF THE DATE THEREOF, THE NOTICE TO THE CE IMPOSE NO 08 REPRESENTAT AUTHORIZED RE 8- RES • VE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION 1 0 INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN ATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ■ OR LIABILITY OF ANY KIND UPON INSURER, RS AGENTS OR ACO ' CQRPORATION 19188 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 317 NE 104 Street Miami Shores, FL 1121360130090 CHARLES MENNES Block: Lot: Owner Information Address Phone CeII CHARLES MENNES 317 NE 104 Street Miami Shores FL 33138 -2017 Contractor(s) CPS ELECTRIC, INC. Phone 305 - 607 -8221 Cell Phone 305 - 757 -7143 Valuation: Total Sq Feet: $ 450.00 50 1 Type of Work: 2 LIGHT FIXTURES AND 1 OUTLET Additional Info: AND 2 SWITCHES Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Invoice # 05/03/2011 06/06/2011 Pay Type EL -5-11 -40768 Check #: 20193 $ 50.00 $ 109.10 Check it 20496 $ 109.10 $ 0.00 Amt Paid Amt Due Available Inspections: 1 Inspection Type: Final Meter Box Alteration Relocation Fire Alarm Service Change Underground W. W. In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. June 06, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 06, 2011 1 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: Electrical OWNER: Name (Fee Simple Titleholder): Address: City: /VI: 4 S Permit No. L S C 9 Master Permit Noq-G It 1 —7 Gq- a,r (mss INK e-r7 �. State: Phone #: Zip: 3 -3 / Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 1 I- E f. City: Miami Shores County: Miami Dade Zip: 3:3 I Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: CIS crezK. .1221 Phone #: 6.3"-.5S'90 Address: /boo jv-tv 2 City: rn 14144 Qualifier Name: t..4- State Certification or Registration #: Contact Phone #: 30 '5— 6 3 ( State: -- Zip: 3.3 /u- fl Alt ea-0 Phone #: 30.3- ( 1-1911 Ehecc a f/ ®2_ 0 Certificate of Competency #: 000 O (7 Z 3 3 0 Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Type of Work: ❑Address Description of Work: e, 4-5",o4e" DAlteration e Square/Linear Footage of Work: New L reRepair/Replace ❑Demolition LI(0+U fi _6 1 oi LOT * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $.D - Permit Fee $ / c ,1 Radon Fee $ Training/Education Fee $ Structural Review $ Scanning Fee $ Notary $ Double Fee $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ 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 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 Signature 22-61-1--61 Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this /8 day of , 20 , by day of `f , 201/ , by ,14,75 / / Q0 f°'? eft--6 who is personally known to me or who has produced who i . ersonally kno o me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commiss * * * * * * * * * ** MARIA MAGALDI Notary Public - State of Florida ,5 My Comm. Expires Feb 25, 2012 OF V \`` Commission # DD 762313 qJ NOTARY PUBLIC: Sign: Print:Jeci/W7 p e ka vrt t re 7_ My Commission Ex nt JEANNINE RAMIREZ r= MY COMMISSION d DD 937199 EXPIRES: December 15, 2013 Bonded Tin Notary Public Underwriters /t --e0/ Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) ALLAWSM. CERTIFICATE OF PROMMR INSURINICE & mime= 508 1 49 ST =ALM WL 33013 769 4946 a C.P.S.RLICTRIC 9.©.84Y 669132 KU= in. 33166 LIABILITY INSURANCE ! 9124(2219 THIS CERTIFICATE IS ISSUED AS A NATTER CET sprositmoN ONLY NW COWERS NO RIGHTS UPON DM C NTIIZCATE HOLDER. M1 # ;. r . TIFNCATE DOES NOT AMEND, EXTEND OR ROAM ti: MUNN COVErAMS THE MOSS OF INSURPNCE u i W K U M HAVE asem S S E D T D T E S N A N I E D M I E P A B D Y E FOR DIE MUM' PEI OD INDICATED. nwn TMO 4G me( neeismanerr, NSW OR COMMON OF NW COACT OR 01108100CA NT 'NTH RESPECT lei INNICH-TRIS i3 RTlRCA1E Wet BE WISED 011 6110.Y € ?'A!E '111E INSURANCE AFB BY THE 1 S TIESCRE3E0wRos 1S wax= TD A1.L T V TE7 MS. D CUJS D13 AND commons OF SUCH ININEDEFX REDUCEDRYPAIDCLATES. (a -32571 109/23/10 109/23/11 06/02/10 fit 06!02 /11 EAOKOCCROW - • 1,000 , 00( s 1,000.0QS IMEME.P&RJOY UMW MESCRIPTRWOFOPERWKIMMOVitERCLUSIORSA006081f9MORSEMOTTISPEC01.10fiVOONS MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E 2nd Ave Miami Florida 33138 Shores MMORMUOMWORTO 0 ISMZERMWED IiiIOWMT, TDDOSOemu UMW( OF MW WON TAE .z a, -.:, >; RVMO OOR -nesse 4011101 :4-A0,44:4141.0.14.40,1124,11'4', ' f•ftf,'"e'-',' 1 N.(,),. 3o-1,7z1699 , EtUst$,'-ftss p4Ator. i LOr.iATION _ ,„ _., _ _.,,,,, ,,,..,,,„.,, 0 - V r tLeCttc.4‘, ir4t. AS1iPEOFIEDI-It77111-ECiN , 1,, ve 1,4w a AVE obit' 'ER :C P $ ELECTRIC INC tf4'0! ',"):''''' 244:14 i--';E,.,, SACK c4;RE.i..--./..p FOR _. ELECTRICAL CONTRACTOR i .....ti...ct ,r A - .EST OP 443t1'14ARTTIcIPATII'le sot fCIPALITIES $tii 0- 4c 04 u tr T FORwA141) A RILL PA'it CC':' No 00001'7233 FIIRSTCLASS —+ U.S,. POSTAGE . -Z Pi(111; MIAMI, FL W — PE$11111T NO. 231 cPtHOPERMAX1 Y Bi)SINIESS AS A C-(,)11TRA011 Ils'aktar tTlte4 retteekl ro cdy Where ,)tic itr, to:be PA*1.0 .MSAM; i.:1:',1v.ox 1,tcy if)8/2010 02' i,Cloo8o02 001 OL�O C P S ELECTRIC INC ANGEL ROMERO PRES 1600 NW 28 AVE MIAMI FL 33125 CTOB Cnnstruction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 000017233 P $ ELECTRIC INC Abhit RO ANGEL certiti under VALI of Chapter 16/liaini. -OR CONTRACTING UNTIL 0913012011 if 1 1.Tn' atm 141 tett,. 0 Ct 0 0 3t 0 Z 1,4.1 IQ 0 '.41 1...4 ac OC t,„,„ 0 423 N u .12 '^-1.11441C Ira 0 t.-4,414.iiiiiiccia&e. 14 Z Z 04.4.• 41"i" saa ulcotri z (-Ito vi.1 ?"4'34-) iv) 0 0 0 »it (/) 1.1.1 L)QU.Lfl 1-1 I-. cx0.4,-1 eX ce C+1 —I wce3u- CD Z Ot STATE OF FLORIDA 11 DEPARTMENT O BUSINESS AND PROFESSIONAL REGULATION EROO11020 07/17/10 09817235 REG ELECTRICAL CONTRACTOR ROMERO, ANC4EL C P S ELEC INC (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) 137S REOISTRRED tamitat t pt-Vii Ont% ot Ch. 48 wrc dAt., Alla 31 0 2012 1,10071,700-1;9 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 —10 Inspection Number: INSP - 159035 Scheduled Inspection Date: September 19, 2011 Inspector: Hernandez, Rafael Owner: MENNES, CHARLES Job Address: 317 NE 104 Street Permit Number: PL -5 -11 -768 Miami Shores, FL Project: <NONE> Contractor: ALL TECH PLUMBING INC Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number 305 - 757 -7143 Parcel Number 1121360130090 Phone: (305)345 -4368 Building Department Comments REMODEL EXISTING BATHROOM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 16, 2011 For Inspections please call: (305)762 -4949 Page 4 of 48 1 1 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 317 NE 104 Street Miami Shores, FL 1121360130090 Block: Lot: Owner Information CHARLES MENNES Address Phone Ceti CHARLES MENNES 317 NE 104 Street Miami Shores FL 33138 -2017 305 -757 -7143 Contractor(s) ALL TECH PLUMBING INC Phone Cell Phone (305)345 -4368 Valuation: Total Sq Feet: $ 650.00 50 1 Type of Work: REMODEL EXISTING BATHROOM Type of Piping: Additional Info: Bond Retum : Classification: Residential Scanning: 2 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $6.00 $0.80 $162.10 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -5 -11 -40767 05/03/2011 Check #: 20193 $ 50.00 $ 112.10 06/06/2011 Check #: 20496 $ 112.10 $ 0.00 Available Inspections: Inspection Type: Top Out Final Underground In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. June 06, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date June 06, 2011 1 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 No. Y 0 i 2011 JL, B��.omem FL Master Permit No. 12-C-• 1-1(63- Permit Type: PLUMBING f OWNER: Name (Fee Simple Titleholder): C 7....r ( -S Ne-"i e..- 5 Phone #: Address: 3 `i ¥ * F_ .c. c7 4 5 f' ` City: iNe(. 5 o e' P..•S State: F ( Zip: ? ( 31 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: E 1 Q City: Miami Shores 5 t County: Miami Dade Zip: k 3 cg Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ' ( -V c '.-1 I' - (r �LC�Phone #: Address: City: State: Zip: gg Qualifier Name: 1l,/ ,.� '.,7. C., i, . State Certification or Registration #: C. 7" C If 2_ 2 SC) Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Phone #:.3 Q 5 — L4 s --Li 3 , g , w Value of Work for this Permit: $, 5 a Type of Work: Address C ',.> UAlteration D 'ption of Work: e- t Square/Linear Footage of Work: UNew aRepair/Re lace sep ODemolition —5 f -c t- _ (–) ( -t ' — `-t 3) 4s4D \J c ******** * **** * ** * **** ** ** * **** ***** ** ** Fees************* * ************ * ***** * ** **** *** ** Submittal Fee $ .0.13" --° Permit Fee $ 6 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. 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, BOTT.RRS, 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. Owner or Agent The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Signature Con day of ,20_,by who is personally known to me or who has produced As identification and who did take an oath. day of Yl , 20, by /449-140 who is personally known to me or who has produced as identification and who did take an oath. NOT -• IC: NOTARY PUBLIC: Sign: Print: My Com es: Notary Public - State of Florida My Comm. Expires Feb 25, 2012 'o;;OF gov Commission # DD 762313 * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Sign: DO 1A .� N # DD770824 EXPIRES March 20, 2 2 Fk vidallotaryService.00m ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Zoning Clerk APR-15-2011 00:47AM FROM- Fax Too kisi vi Cein !a5J95j2 8q3-2 . T-013 P.001/006 F-046 ALLTECH PLUMBING INC. 252D SW 22 sr, Suite 2-403 !team'. R. 33145 (305) 345-4368 (4110,1•61•13•7 Fn.= Al fer a(1)04-q 0 Urgent 0 For Review [7:1 Please Comment D Please Reply 0 Please Recycle • COMMOrstIM rk4 Con44- arfle-N- *(1,12--e- le4-7•A.-1 APR -15 -2011 06:47AM FROM- T -013 P.002/005 F -046 DEPARTIINNT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (830) 487• - 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 CIFUENTES ALFONSO ALLTECH PLUMBING INC 2520 SW 22 ST, SUITE2-408 MIAMI 3145 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 they way we do business in order to serve you better. For information about our servlces, please log onto www.myfioridallcense.com. There you can find more information about our divisions end the regulations that Impact you, subscribe to department newsletters and learn more about the Department's Initiatives. Our mission at me Department is: License Efficiently. Regulate Fairly. We Thank you for dot to serve you i bettor and cong serve ins your y license! DETACH HERE -•:' wtir;+1',:..:: r�r: e'F?] `•t`'La. y' • ..^t': J.:tJ� 7 i�.'•pih_ stekV DATE , BATCH NUMBER 0.803.G9 �•Q �1 ;the` F,ra'CI]S= zsrratx ITA4er-p nv ^-*Act.as :.©t^�, iratio ,•' -- fir_.•: • ExP a.:.i�•te:. AUG A;U,t� 31•�::`2Q;3„2: �;:`•x.�. r ,, . l� ;,..,:.�.��....�:.�- ��_�+•.: • Tr =1-`; _._((--•t}. :T:. 't ^r . r ?I ..: • :v. _.� -"_e jt t.+ py -ST '.' r .- •t•'��. °_••••• '.^..li!,.:fir... ....ice .. iJ..:ii _••, _: 41. • tr• =' • C� ?1.SI. •. 2 A I• •mo:t .. a i • L •= • - i• •_ ^ ._ ' ¢ •_ ; ,, .N ••• � : - 4 r • �• •_• •..I..� r`a • ' • ms ' := i 1 : r . , " „Al* * Nt.,- •-:1 - ∎L - «•• +S '"4• I.- :474 :'t, 'a tf r 0�.`...'`a.Z: t'- . '� :i ,'y�J F _ ' a ` G c- 1 - • ! : � . _ - l a i� L� ! :j _ 7 + • :J..: t,• = t '.:•r.: "7'4 f‘'. ::„.`• `• ."Y� '&':•0•77 ..:41P H: • • 115y4 <•: `' • � a trU - t11.1. i1; SiTI3It2 i '% '-.L • _T•• L CIE am__7. .i• . • •_..M1 I ,. _•.._ . � _. • a ' � _ . • � -_ - S- } � •'t . T - � .�.. ., t . ... .. • . .� . . .: . .t,.,_e� , . =- • . ` .'�� F _ ••:tl `;.r• +'. ?IZTV1E :47 n'.'xfl11 - G: j t4 -'FL: 33145: �= , , _ • rszAirr o ,•c'4 . •'V: ": _ t• ti.. r , • t,T._r=: .Y. + • � _ . ._• tst i= • MIAMf- -DADE COUNTY • TAX COLLECTOR • 140 W.'FLAGLER ST. "'1st FLOOR F 'MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT 2011 • . FIRST -CLASS • MIAMI.DADE COUNTY - STATE OF FLORIDA • • U.S. POSTAGE EXPIRES SEPT. 30, 2011 PAID MUST RE DISPLAYED AT PLACE OF BUSINESS _; . MAUI, FL PURSUANT TO COUNTY CODE CHAPTER SA -ART. 9 &;1O PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY 595754 -4 RENEWAL BUSINESS NAME 1 LOCATION RECEIPT HO. 621406-0 ALL TECH PLUMBING INC _. STATE# CFC1427250 2580 SW 29 AVE 33133 MIAMI OWNER • ALL TECH PLUMBING INC Sea Type of Realness ma es J r6A [MBINO CONTRACTOR TARES TAR RECEIPT. IT IOU NOT mum SHE CABER TO VIOLATE ANT XISTINQ BEIULWTORT OR MONO LAWS OP TRe xtuNiv BEE IT E T uTHE EIIWIT OR "Uc t s UE1 CGN T a OTUFOAF TITITENT RECEIVE Y 1Ax TILLF -CTDR: 09/30/2010 09011311001 000045.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD ALL TECH PLUMBING INC ALFONSO CIFUENTES PRES 2580 SW 29 AVE MIAMI FL 33133 11ah.11..1111Wh11' I 11Telleleah[1aeNsa ' I APR -15 -2011 06 :48AM FROM- APR -15 -2011 06:48AM FROM- T -013 P.005/005 F -046 CERTIFICATE OF LIABILITY INSURANCE natd 04/14/11 I—THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANA CONFERS NO RIGHTS UPON TIME CERTIFICATE HOLDER, THI: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CER17FncATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE MOLDER. IMPORTANT: It tha cattiest* holder Is as ADDITIONAL MUM, the poflcy(tes) must be endorSeil n EUBROGA'ICN IS WAIVED. sullied to the terms and condITlens or the policy. certain Fancies may require an endorsatnerd. A 3teminent on this aeittllcate does not carder rights to the ...licate herder in Oen of auen endorse rltts). PkooucgR Egulna & Associates 7229 Canal Way WWI. FL 33155 Phan* (305) 2E6 -1700 . iNSURu.o Allteeh Plumbing, Ina 2520 SW 22nd Straet. Suite 2408 MFemi, FL 33148. (30S) 345.431$ ax (30$) 267.1197 'N- 3052891700 -rate �..." —ADDRESS: St1LiDIrFRJQr enema •1 wayaqta COV@RAGF?S t> g1 r CEIt FICATE NUMBER: REVISION NUMBER/ INAT THE DOI.IGtES OF RANCE LISTED BELOW HAW BEEN ISSUED YD THE INSURSO A3CtVE POR THE POLICY PERIOD INDICATED. NQTWITI4STANDING ANY REQU }REIYENY, TERM CR CQNOfrION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTsPiCA TE MAY BE t5..'"VEG QR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUSJECT TO ALL THE TERMS. PAGLIJSIONS ANC CONDITIONS OF SUCH POLICIES_ WA TS SHOWN Awe HAvE BEEN REDucE° ay FAO C LAtms, bodes AFRL]ntenO DDVERAae GRANADA INSURANCE COMPANY TYPE OF INSURANCE OCNERAL LIABILITY 0 0 Dukusrmse OCCUR G CENt AGORE4A1B LNAITAPPI.CS fit: 0 POLICY [_.,I .0 co: AVTDMOAILE LIA04Lr?Y 0 AN. AUTO C7 ALL OWNED AUTOS scsouita Atom �- WRCAALIYOS 0 NoN•OPPIEDAVMS L tMIeRELIAt lA5 OCCtiJii t r� � exCes$ LIAp DoE C �� I DEDUCTIBLE . em.NTION s WORKETIS eoMPER ATION AND EMPLOYERS' LIATTLITY OFFICETBMENTER ANY PROPRIETO}rrPARTNBRA C TKO INAndziOXY NH/ DESCR Wt11Q�if ORD RATIONS below MIA AO Numeirx _tMM iYY UNITS 0185FL00022304 10122/2010 1022/2011 DESCRIP?' N OFOPERATIUNS, LaG►11DNS, VEidCLES (Ae•,d1 ACONO TOT, Aeamonat Runorlts *Wok main space Is maw/64 PLUMING sERV10Es �4'ER'flFICATE HOLDER MIAMI SHORE VILLAGE 10080 NE 2 AVE MtAMI,FL. 38138 ACORD 25 (20031D9) QF CANCELLATION Pak acctirsimee &C04%vtAMonoemRunl L PERsawALt:FDV 41URY ,S CEACRALAOGRECATE PRDtlucT8,CAM DFAt:{f y OambeCia SevGLENA}If $ a gnDLYI (PirPOAOM1) S BODILY INJURY IPer aueidon S PareeefdeMt S CACH OCCURRENCE' AGGRgc AYC WO A ry D FL EACN ACCOSVT a EL. DasawaR qA ENNA TE s El. DISEASE • POLICY UM1Y S SHOULD ANY OF The Asa DESCRIBED POLicIES OE CANCELLED BEFc THE DCPIRATION °AYE w R OF, NOTICE WILL OE DEL{UERED tN ACCORDANCE WITH POLICY PR0VISI°N5. s IONCR® MAR 19884008 ACORD CORPORATION, AU rights re The ACORD tame and Ingo are registered marks of I APR -15 -2011 06 :47AM FROM- T -013 P.003/005 F -046 01 -10 -2011 JEFF ATWATER 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 a CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 01/10/2011 EXPIRATION DATE 01/09/2013 PERSON: CIFUENTES FEIN: 205828405 BUSINESS NAME AND ADDRESS: ALLTECH PLUMBING INC 2520 SW 22ST SUITE 2 -408 MIAMI F!. 33145 ALFONSO SCOPES OF BUSINESS OR TRADE: 1- PLUMBING CONTRACTOR 2- MAINTENANCE 3- SACKFLOV SERVICES IMPORTANT PurShcmr to Chsplar 440. 051141, F.S.. to officer of a cotporalien Win *leers exemption from Ibis chaplet by Iiliog a certificate of election ander 1 section may not recover benefits or eempeassties Nader this chapter- Pursuant to Chapter 440.05U2}, F.S., f anifieetes of Gledhill to be sxemPL.• apply aaiy WOhl scope al the business at trade listed as the attics of *lactic* to be exempt Pursuant to Chapter 440.U51I3J, F.S.. Notices of efoulee to be exempt and genitive election to be exempt shall be tabled to rereanna it, it any time liter the Mime of the nuke ST the lame= of the eettilieete, the parson vaned on the oar certificate no Longer meats the requirements of this sachet for issosoce of a certificate. The diamagnet shill resale a certificate at any time tar lame* of the named on tba certificate to meet the requirements el Nis tedium QUESTIONS? OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL. SERVICES DIVISION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECT1Ve 01/10/2011 EXPIRATION DATE: 01/08/2013 PERSON: ALFONSO CIFUENTES FE111b 205828405 BUSINESS NAME AND ADDRESS: ALLTECH PLUMBING INC 2520 SW 22ST SUITE 2-408 MIAMI, FL 22145 SCOPE OF BUSINESS OR TRADE; t- PLUMBING CONTRACTOR 2- MAINTENANCE 3- eACCFLOW SERVICES IMPORTANT F Pursuant to Chapter 440.05110F.S., an officer of a corpor 0 elects exemption front 'this chapter by filing a certificate o I- under this Section may not recover benefits ar compensate' D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election H exempt.. apply only within the scope of the business or tri the notice of election to be exempt E Pursuant to Chapter 440.051131, F.S., Notices of election to and certificates of election to be exempt shall be subject 1 if at any time after the filing of the notice or the issuenc certificate, the person named on the notice or certificate m the requiremenLS of this section for issuance of a certifies department shall revoke a certificate at any time for failure person named on the certificate to meet the requirements section. QUESTIONS? (85 CUT HERE • Carry bottom portion on the job, keep upper portion for your records. DWC -2E2 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 SCOP lir (737713 f1AY 0 3 2011 BY: ......... fix =yes... - OF WORK: Iii '1 L COPY (0) RPLA1 I X16-FINS PL,,MlINS & 1 LEGT{zIGAL FIXT,,iz s (2) RFDPI TILE WEIR< (3) PRIMER & PAI \T BAT _M Miami Shores Village BLDG DEPT SUBJECT TO COMPLIANCE WITH ALL FEDFFRAL STATE AND COUNTY FIULFS AND Fir rUI ATIONS ' ;jz J/ "Y //— s '7VG ADD SMOKE/CARBON MONOXIDE DETECTORS ANY AND ALL CLOTH AND RUBBER INSULATED CONDUCTORS TO BE REPLACED. BATHROOM RECEPTACLE ON 20 AMP CKT AND R.F I PROTECTED