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RC-11-482Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 166989 Scheduled Inspection Date: November 29, 2011 Inspector: Bruhn, Norman Owner: JOEL I KUTTLER, MICHELE A Permit Number: RC- 3- 11-482 A IA 4_ Job Address: 1N 70A0 NDE AI 105 Street 203 Miami Shores, FL Project: <NONE> Contractor: HOME OWNER Permit Type: Residential Construction Inspection Type: Final Work Classification: Alteration Phone Number (305)984 -6507 Parcel Number 1122300500220 Building Department Comments REMODELING KITCHEN CABINETS STOP WORK ORDER ISSUED, EXPIRED LICENSE USING EXEMPTION WITH EMPLOYEES ON JOB. NB Passed Failed ?//-0.77ff Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 166814. OWNER MUST BE PRESENT. November 28, 2011 For Inspections please call: (305)762 -4949 Page 14 of 20 BY: ..o....----- 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 Q� Permit No. 19",C.) 11— LIZ Master Permit No. BUILDING PERMIT APPLICATION FBC 20 Permit Typ : BUILDING ROOFING OWNER: Name Address: ` vo City: /IL itleholder): \c c, t --- 1 3—r State: Phone #: ,3bs - , g H^ to S a Zip: .311 3 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: S/`"� City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Com an Name: Phone #: Mir P Y Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ; quareinear Footage of Work: M ']New Description of Wor , : _ Type of Work: Addition UAlteration ORepair/Replace UDemolition ***************************************Fees***************** **** x ****** * ********* Submittal Fee $ Permit Fee $ CCF $ " "'' CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ 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, BOTT 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 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 The for day of ho is Owner or Agent g ing i ;.trument was a owl ged efor a this , 20 by(;_f1 sonallyJ kno to me or who has produced ` s identification and who did take an oath. Signature Contractor The foregoing instrument was acknowledged before me this day of , 20 _, by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOT Sign: Print: My Commission Expires: ****************** *** ***** Sign: Print: My Commission Expires: **** **+ x***********+ x+ x*********** ****** *x::**** ** **** ************ ****x *** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) NAME: ECCIEVLI ° m 0 9 Zee BY: m- - - - - -- - OW ER B ADDRESS: ll Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 DER D SCLOSURE STATEN NT DATE: 9-oti 1,42,(33 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; I further understand that I 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. I 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 I, 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 2. I understand that building permits are not required to be signed by a property owner unless he or she is res isi fe for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead •f my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or licens-; u; -rs on permits and contracts. Initial 4. I understand that I may build or improve a one family or two- family residence or a farm outbuilding. I may also 'uil' r improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occb 'anc, . It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantia improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or ' antially improved it for sale or lease, which violates the exemption. Initia 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 residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and municipal ordinance. y building or county or 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 illfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Ini 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 fed: , I income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers = ±mpe ation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 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. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue rvice, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may co ^„ act the Florida Construction Industry Licensing Board at 850.487.1395 or h .: / /www.m oridalicense.com /db•r /.ro /cilb .ndex.h 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 legally and financially responsible for the proposed construction activity at the following address: Ini rty 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the informatio have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who 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 owner's 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 9 day of 143.,/ , 20 11 Produced there License or er- i • ► �il 4/110111111F who was personally known to me or who has OWNER ' 'Or1s identifi Ion. 1 LI TARY ��,,,,,,,�� CLAUDIA Y. CUBILLOS =o4""Y P °e�o� Notary Public -State of Ronda My Comm. Expires Sep 23, 2015 �, aQ Commission #r EE 128810 '% ,°r,; " Bonded Through National Notary ASSO. Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit Owner's Name (Fee Simple Title Holder): �cac -C. ��- t- t(e/ -- Phone #: 3 15 - °t $ - 66 67 Owner's Address: ■.'7 as ,42L l c).5 JA" Zo.3 City: it--•10P--+ tSt.a s State : � �- Zip Code: 33 ► s g' Job Address (Of where work is being done): City: Miami Shores State: Florida Zip Code: .Y.‘. '3 li'' /0g. s—e Z. 63 Contractor's Company Name: ! yip7 0U11c Phone #: Address: City: State: Zip Code: Qualifier's Name : Lic. Number: Architect/ Engineer of Record Name: Phone #: Address: City: State: Zip Code: Describe Work: I hereby certify that the work has been abandoned and/or the contractorlarchitect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involvement. Signet -.!r ' -- Signature The re•. i g 1st me was akno edged a ore m The foregoing instrument was aknowledged before me this day of r _ this day of , 20 by owner or Agent Contractor or Architect ersonall kn . n to : e or ho h. uce d si d entification. Nota Sign: Seal: PPV nue� % Notary `. Expires Sep 8810 rrtl� MY Commission # EE 12 Assn. b National Notary Bondded e 11 gOU9 who is personally known to me or who has produced as indentification. Notary Public: Sign: Seal: 1..4I, v. Mt s'Z c, 2. tL -ro , , t_- t "T & t.) t tJ 5 ST. Z. 15 S a 0,1 t' 51.4 0,12.15-5 ;t,.. 313 S tr Ay gcti - 46P- IE NOV9 0 9.2 n Li 1 -1E r t-� 4, fm, t~- of Ge ry T fZ A. c. 1.20 tiZ -Ft, G? 1› cvo V6 Ar)VT4 - &-ss. 11+ 1 4 a S 0;21-1 i F.16 d' 14-" 5 j CZ's G T 1 0 aJ rz F. a a L. D J e e_ -1-14 1 % c..o ri r ¢ as `fid rZ cz .y u ri ►s .1(¢. i N " ' 1? „c- D Ct. Metz Li (4 , ,i'( /4r4 3 .11 -0 10- 11-94 CLAUDIA V. CUBILLOS :749 P"°cr `- Notary Public - State of Florida 1 • _ My Comm. Expires Sep 23, 2015 • E128810 s. o v.: Commission E ", oo h National Notary Assn. '',f, o.p.•• Bow Through ®zt. e-") try _r 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 * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. 09 -22 -2011 -Lwz_ EFFECTIVE DATE: PERSON: FEIN: 09/22/2011 EXPIRATION DATE: 09/21/2013 MARTINEZ FERMIN A 201750462 BUSINESS NAME AND ADDRESS: F A M CONSTRUCTION CORP 7590 SW 82ND ST # 120 MIAMI FL 33143 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S.. sit officer of a corporatten who elects exemption from this chapter by filing a certificate al election ender 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 basrudse or (rode listed an the notice ni election to be exempt. Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt and certificates of election to be exempt shell 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 native or certificate ao longer meats the requirements of this section for issuance of a certificate. The department shall revoke n certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 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 EFFECTIVE 09/22/2011 EXPIRATION DATE: 09/21/2013 PERSON: FERMIN A MARTXNEZ FEIN: 201750482 BUSINESS NAME AND ADDRESS: F A M CONSTRUCTION CORP 7690 SW 02ND ST It IZO MIAMI, FL 33143 SCOPE OF BUSINESS OR TRADE I • CERTIFIED GENERAL CONTRACTOR IMPORTANT OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who effects exemption from this chapter by filing a certificate of election L 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 H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt. E 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? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 17'd 2L689SLS02 : 01 S826628:02 :Wald dM7 :20 TWO-EN-100 - 0 • DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTE MONROE STREET TALLARASSEE FL 32399-0703 ICARTINEZ PRAM= A FAN CONSfRUCTIgN CORP 7590 Sir 82 ST 8120 NIANI FL 33143 Congratulations! With thls license you become one of the nearly one million Floridians-licensed by the Department. of Business and Professional Regs.detiOn. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Fkvides economy strong. Every day we work to improve the way we do business in order to MVO you better. For information about our services, please log onto erww.myttarldallaense.com. There you can find more infonnation about our divisions end the regulations teat impact you subscribe to department newsletters and learn more about the Department's hridatIves. Our mission at the Department la: License Efficientty, 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 1 .• • • _ • • .• • • - cla 67. AC# e -5- -7 -14-) DETACH HERE taw 487-1395 STATE OF FLORIDA •ImPARTISsOMPSAERCREtt,-1, =Wm. NU I NIJ NIP E The MINERAL OONTRAtTOR: Wented" halo* IS .C8RTIFIEP- • ..1 . • Under .. ths ptairtailtins of Chai,tav 4497. PS. Expiration date AUG 31, 2012" 1,41ART6NZ Fink= A • . , AM ONStRtfartON CORP 739.0 SW 82 ST #120 ' • MUM FL 33143 cWXrE cRIST 2'd 22.629S/S02:01 9326622S02 • . ". • t't ••• ''` • •I• 7 • :.• .4. 's .-,•....„70... ,4,1,.. :07 •'• ,t1P • .,%V.: . ilit,. ' .:41.• - - :41 ••- i ' . • V . .-.Vi. ..v •;P''': ,..' • ' .Pt,..'. ,. '..j. • • . ......6: .4.4"!.. ' -, :WOad d07:20 TT02-6T-100 * * * * * *• * * * * * * 1 * * * * * 1 * MIAMI -DADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 10/5/2011 1300/229/001ILEV 0006 -0001 Last Seq. #:0002 WI LBT # :00 153506 -2 Local Business Tax $82.50 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT r:22111-21:13--2. LOCAL BUSINESS TAX Local Business Tax #:00153506 -2 State /CC # :C00019440 Issued to: F A M CONSTRUCTION CORP Type of Business: GENERAL BUILDING CONTRACTOR THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector E'd 2L689SL900 ;01 a it 's 1i : m s s ad m * a m a ai m m a: 10/5/2011 1300/229/001ILEV 0006 -0002 Last Seq.# :0002 WI LBT #:00 032509 -2 Local Business Tax $110.00 CK $192.50 CHANGE $0.00 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Fiagler St, - 1st Floor Miami. Florida 33130 TEMPORARY RECEIPT 2011 -2012 LOCAL BUSINESS TAX Local Business Tax# :00032509 -2 State /CC #:PE0019363 Issued to: MARTINEZ FERMIN A PE Type of Business: PROFESSIONAL THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Reoeived as Certified Above Miami -Dade County Tax Collector S m m o m m a m m = ■ m m o m m M O O 5826688502 :WOdJ d217 :80 TT08 -8T -130 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. ' q TAX FOUO NO. STATE OF FLORIDA.. COUNTY OF MIAMI -DADE: COb1`ST�t FLoplOr't tics iS a tr THE UNDERSIGNED hereby gives notice that improvemer si iii mairettialfain r =. property, and in accordance with Chapter 713, Florida Stati'viiiRarili o is provided in this Notice of Commencement. origin iff WiTh 1 1111111111111 1 11 11111.1111111111 11111 1111 1111 CFN 2011R0234-0F;4 OR 4k 27649 Ps 3925; (fps) RECORDED 04/12/2011 11 :30 :26 HARVEY RUV'IHP CLERK OF COURT MIAMI- -DAC'E COUNTY? FLORIDA LAST F'AGE %t�t�CtU`1 r cV_�n 4a0 ye I. eat N. Co -.10/0$ 1. Lena! description of property and street/ ddress: {� ®Q k) 2. Description of improvement 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, addr =s and phone number. T 1" A Space above reserved for use of recording office koS sk• 4 2 ©3 TCAN12 v.1 t = i-L 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 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., 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(1)(b), Florida 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 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 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. Signatures) of O (s) er(s)' Authorized Officer/Director /Partner /Manager �y-- By „ Prepared By 0 . f\ 1+t l �lr Print Name -'51..e1.- kc. Lam. Print Name Title /Office g9 vy 14.1#1- STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this t 1 day of /1$ By °el ,i -r) t-1tir ❑ Individual) or. Li as for z�- g4..1, or c._ rsonally known, or produced the following type of identification:. Signature of Notary Public: :r2'0- «. Print Name: Fd frI4 (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature,(.) of • er(s) or Owner(s)'s Authorized Officer /Director /Partner /Manager By A 123.01 -52 PAGES 9/10 PEDRO I PEDRO E VALDES Notary Public - Stars of Fforkta •= My Comm. Expires Jul 13, 8012 :: Commission # DO 805261 hoAKIPMb°16fided Through Nation Nor Assn. V• w �I r v v -.s 'OP .. -vr By 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: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) Owner's Address City t State Zip Tenant/Lessee Name Phone # Email _ e Permit No. .. Master Permit No. Job Address (where the work is being done) City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Contractor's Company Name Contractor's Address City Phone # Flood Zone State Qualifier Name State Certificate or Registration No. Contact Phone�._,. k Architect /Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ©Addition Describe Work: DAlteration Phone # Certificate of Competency No. E -mail Phone # Square 1 Linear Footage Of Work: ❑New ❑ Repair /Replace ❑ Demolition C Submittal Fee $ " Permit Fee $ * * * * * ** *Fees * * * * ** 0 Notary $ Training /Education l?ee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: ctural Review. $ CCF $ CO /CC $ Technology Fee $ Bond $ Total Fee Now Due $ See Reverse side -a Bonding Company's Name (if applicabi Bonding Company's Addr City __ Mortgage Lender's Name (if applicable) Mortgage Lender's Address _ City 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 ac applicable laws regulating construction and zoning. ate and that all work will be done in compliance with all "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 Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before day of , 20 , by day of , 20 , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath, NOTARY PUBLIC: NOTARY PUBLI+ Print: d My Commission Expires: Sign. Print: My Corr 9u jet Notary Serer APPROVED In `ff Plans Examiner Engineer Clerk checked (Revised 07/10/07 )(Revised 06/10/2009} AFFIDAVIT FOR ASBESTOS SURVEY /NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Department of Environmental Resources Management Air Quality Management Division Air Facilities Section 701 N.W. 1st Court, 2nd Floor Miami, FL 33136 SECTION 1 —,,2,, p)_ a. Project Type ' D olition yation ❑ Roofing Process # Folio ' � Reno . b. Project Name 17v @ � L a � w, i '' f a� il Address ii 70 b i 6 J 7 f e L1' 2 City �..yI •a"°t- -. \ 1 a' - = Y +, �: ' 1 ' '� --(''r �_ it/d-/ a State P Zip Cod �; County /, r �� c. Project Dates (mm/dd/yy): Start t >� �: P ' ; 1' c'' _ = 1 i Finish 114'' I I � `' ' \y d. Contractor -k IA ° A Florida License # e. Contractor Address Contractor Telephone f. Give a brief description of work to be done at the above mentioned address: (include scope of work and the estimated area in squa a feet that will be impacted by the project) 1 l 0 46 -7 A r. -. ,! L1/4..,) �,. SECTION 11 I, the undersigned, hereby attest that I am aware of the following: 1. Pursuant to 40 CFR 61, subpart M, section 145(a) and 469.001 -015 Florida Statutes, a n asbestos survey at the above referenced property may be required prior to any renovation or demolition activity. 2. Pursuant to 40 CFR 61, subpart M, section 145(a) and 469.001 -015 Florida Statutes, all regulated asbestos containing materials (RACM) must be removed prior to any renovation activity that may impact the RACM at the above referenced property. 3. Pursuant to 40 CFR 61, subpart M, section 145(a) and 469.001 -015 Florida Statutes, all regulated asbestos containing materials (RACM) must be removed prior to any demolition activity that impacts the RACM at the above referenced property. 4. Pursuant to 40 CFR 61, subpart M, section 145(a) and 469.001 -015 Florida Statutes, a written notification must be submitted to DERM at least 10 working days prior to demolition or asbestos abatement activity at the above referenced property. Additionally, I am aware that the demolition of two or more single family residences, located at the same property, adjacent properties or non - adjacent properties that are being demolished for a common purpose not specifically exempted from the above regulations, is subject to the same regulations (e.g., for commercial or other non- exempt facilities). I am also aware that violations of the above - referenced regulations may result in civil or criminal prosecution or both and penalties and fines of up to $25,000 per day per violation. Name in Print' Lessee or Authorized Representative) /Title Signature(Owner, Lessee or Authorized Representative with Notarized Authorization/Letter) STATE OF FLORIDA ) COUNTY OF DADE ) ss: Address (Owner, Lessee or Authorized Rep.) V, 7 .. b°' Telephone Number The foregoing instrument was acknowledged before me this day of e ,' , 20,u by who has produced, as identification and who did (did not) take an oath. Notary Pub ' at Large_ (te �� r.? , st / /) Received by Name of DERM PersonnelSection 161.01 - 154 4/10 Dated Signature THIS IS NOT A NESHAP NOTIFICATION -A SEPARATE NOTIFICATION MUST BE. SUBMITTED FOR RENOVATION OR DEMOLITION See Reverse Side for Additional Information Effective July 1, 1994, Florida Statutes 469. 1-0 , t it that r pe operations and maintenance plan, p ant specifications, or . ark e� a licensed as an asbestos consultant of the State of Florida. Na pin shadxa , t u c i;the State of Florida.; Deis* 'brand 701 N.W. 4st tad '. FL 331 36 7 2 Adis!#, FL 331136 N IN `VIOLATIONS OF FEDERAL NESHAP REGULATIONS, 40 CFR 61 SUB PART .M PROPER ADVANCE NOTIFICATION OF RENOVATION AND DF ITION +OPEI MAY RESULT IN SUBSTANTIAL PENALTIES AND /OR CRIMINAL CHARGES. A CITY /COUNTY DEMOLITION OR RENOVATION PERMIT DOES NOT C THIS fiS NOT A NESHAP NOTIFICATION A SEPARATE SUBMITTED FOR RENOVATION OR DEMOLITION N MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAQLER ST. 1st FLOOR MIAMI, FL 33130 2010 LOCAL BUSINESS TAX RECEIPT 2011 FIRST -CLASS MIAMI -DADS COUNTY - STATE OF FLORIDA U.S. POSTAGE 1 EXPIRES SEPT. 30, 2011 'PAID MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL PURSUANT TO COUNTY CODE (CHAPTER 8A - ART. 9 & 10 PERMIT NO. 231 THIS IS NOT A BILL — DO NOT PAY 562213 -0 RENEWAL BUSINESS NAME / LOCATION RECEIPT NO. 153506-2 F A M CONSTRUCTION CORP STATE* CGC019440 7590 SW 82 ST 120 33143 UNIN DADE COUNTY OWNER F A M CONSTRUCTION CORP Sec. Type of Business WORKER /$ ws Is o�NL�Y6A GRIERAL BUILDING CONTRACTOR 10 IUSINESS TAX RECEIPT. IT FOES NOT PERMIT THE !OLDER TO VIOLATE ANY XISTING REGULATORY OR ONING LAWS OF THE •OUNTY 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 OUALIFICA- IONS. AYMENT RECEIVED IIAMI -DADE COUNTY TAX OLLECTOR: 08/31/2010 02290015001 000075.00 SEE OTHER SIDE DO NOT FORWARD F A M CONSTRUCTION CORP FERMIN A MARTINEZ PRES 7590 SW 82 ST 120 MIAMI FL 33143 i dh"lin Iii, i/, h dhimi,Jimi,ii}Fi,i,il,id.00,t STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING .BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 MARTINEZ, FERMIN A FAM CONSTRUCTION CORP 7590 SW 82 ST #120 MIAMI FL 33143 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 Idg onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn 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 (850) 487 -1395 AC# 9IQ =3.USIN�EBS Y�g� i;FG TION 00186001 ACTOR The GENERAL CONTRACTOR below IS ,'CERTIFIED Under the provisions of ` Chap. Expiration date: AUG 31, 2012 MARTINS ,' FERMIN A FAN CQI+TSTRHCTI.ON CQ;, 7590 SW 1'2 -$T #120 MIAMI CHARLIE CRRIST IMf1T'TTSNg1q�}T . ACaRD CERT WICATE OF LIABILITY INSURANCE DATE(MMUDDITYYY) 0812312010 TIES CERTIFICATE IS ISSUED AS A MATTER OF . WORM= 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: H the certificate holder Is an ADDITIONAL MURIA the policy(lea) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, cartahi policies may require an endorsement. A statement on this certificate does not confer rights to the ceRlticate holder In 110u of such endorsement(s). 'PRODUCER A11 Dade insurance Group, Inc. PH .305 -273 -7977 l m:305 -279 -2227 8585 Sunset Drive Suite 106 Miami., FL 33143 ACT 50277@a11.state.com PRODUC CUSTOMRRI) URuREMsl APFOR05 0 INSURED F'am Construction Corp 7590 SW 82 ST APT 120 Miami, FL 33143 . INSURER A:Cypress Property .& Caa . 2ase . INSURER 8 : INSURER C : INSURER o : INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TFlis IS TO CERTIFY THAT THE DIES OF INSURANCE LISTED BELOW JEWE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT TiRACT OR OTFSER DOCUMENT 'it2SPECT TO VOUCH THIS (:ttti iHCATE 'RAY BE 'ISSUED OR MY FERMI, THE INSIIRANCE AFFORDED 8? TfIE POUOIES DESCRIBED HEREIN I8 SUB4CT TO AIL THE TEAMS, EXCLUSIONS AND CONDITIONS Of SUCH POLICIES. LETS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE iggR lobo POLICY NUMBER � tYYYY) i YI LINR8 LIR EACH OCCURRENCE 7 1 000, 000 GENERAL LIABILITY X COMMERCIAL GENERA/. UABILTTY ODOUR i. AGGREGATE LBW APPLIES PER: (° X POLICY l ! ,g131444 fl LOC AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUT08 GEL1001660 07107/2010 PREMISES 1Ea ommolcsf 9 100,000 hIEDExP ,,,e 9 5 000 07t97/3011 PERSONALS ADV I JURY s 1, 000 , 00 GENERAL AGGREGATE $ 2,000,000 PRODUCTS .CoMPIOPAGO 9 2,000,000 S COMBINED SIN@rf1 rC (Ea accident} BODtLYBUURY{Perpes . $ BODILY INJURY (Per accident) 9 PROPERTY DAMAGE (Per ems) 9 9 UMBRELLA UAL) EXCESS LIAR DEDUCTIBLE RETENTION 4 WORKERS AND EMPLOYERS' C COMPENSATION ANY PRePRNIIINPMMIETNamanedi OFFMEMMEMBER @XCAUDEm lN� 11) In 1 DESCRIPTI OF OPERATIONS be? EACH OCCURRENCE S AGGREGATE 0 Yee ti NIA $ TORYSILM 1 ER EL EACH ACCIDENT 3 EL DISEASE - EA EMPLOYEE S EL DISEASE - POLCY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES LAttech ACORD 101, AddBitmaJ Remarks Schedule More space is required} • ROUGH PEN RY CERTIFICATE MOLDER CANCELLATION Men, Shores Bung Departmere 1050 NE 2 Amnia Mont FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN A+ • .,. ,. , j-•.' THE POLICY PROVISIONS. t 1988-2005 ACORD CORPORATION. AS rights reserved. ACORD 25(2009108j The ACORD name and logo are registered marks of ACORD 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 166670 Permit Number: EL- 3- 11-483 Scheduled Inspection Date: November 16, 2011 Inspector: Devaney, Michael Owner: JOEL I KUTTLER, MICHELE A Job Address: Thrall); Street 203 Miami Shores, FL Project: <NONE> Contractor: FOSTER & SON ELECTRICAL CONTRACTORS, INC. Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number (305)984 -6507 Parcel Number 1122300500220 Phone: (305)644 -5869 Building Department Comments RELOCATE SWITCHES AND RECEPTACLES KITCHEN REMODEL Passed tx 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- 162597. See Norm before insp. Add disconnect for water heater. Rz- /11/10 November 15, 2011 For Inspections please call: (305)762.4949 Page 31 of 43 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 Permit No. Master Permit No. RECEIVED SEP 282011 SY:_e& OWNER: Name (Fee Simple Titleholder):4'4'- Address: 1'7 00 u `L t t "EL. c.S4 44F. 7s)3 City: %" kk r—,- 5--`4we4S. State: 'F L-- Tenant/Lessee Name: Email: 1C..��'� -�-- ✓•,- a.L co, Phone #: 3°S- a r`{ -`'0 7 Zip: 3.? t $3 Phone #: JOB ADDRESS: 1-7 vv City: Miami Shores County: Miami Dade Ca -S.a�, Zip: Folio/Parcel #: Is the Building Historically Designated: Ves NO ----------- Flood Zone: CONTRACTOR: Company Name: '' Il 1a, g 1 SokJ Phone #: 305- 335---3 '23 Address: 2 ( t%i.$ 1%J A1/4., > .1 City: ._JA.l C.. Qualifier Name: jo C k. S Q' State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: State: Zip: 33225 Phone #: 3°5 - S 1 5 .313.(. Value of Work for this Permit: $ ` Square/Linear Footage of Work: Type of Work: ❑Address UAlteration ❑New ❑Repair/Replace ❑Demolition Description of Work: `` ********* ** **** * ***** ** x **** **** ** Fees * *** **** ***** * * * * * * * * * * * * * * * * * * * * * ** **** * * ** Submittal Fee $ ,/,* Permit Fee $ 17' -4 o.a' ' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Cothpahy's Name "(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City,,:-,Q .. 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. Owner or Agent The foregoing instrument was acknowle ed b fo me this 1'6 day of /eel- , 20 /I , by �J to , 1, Signature / // The foregoing instrument was acknowledged before me this day of 5697 , 201' , by who is personally known to me or who has produced who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Exp '‘' Pu.to o • lAI'ARDL ALMA Z • * MYCOMMISSOIIDD74 EXPIRES: Jimmy 12,2012 `trf,s mop Boded Thru Buipt Mari Mho ************* * *** ****:x****4_ ********* :: x** ************* * ******:******************>«* **: x: x* **: x:x:x************:x**** 9 �/ �� Plans Examiner Sign: Print: My Commission Ex APPROVED BY 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 INSPECTION'S PHONE NUMBER: (305)_ 762.4949 BUILDING PERMIT APPLICATION FBC 20 IMV,T77)7n, e o L ii ri L BY Permit No. Master Permit No.. Permit Type: ELECTRICAL -�^ Owner's Name (Fee Simple Titleholder) V h&. k /@y-- Phone # (Yap- 26 4 - 6(1-7,7 Owner's Address / 7 -b ,C16 / 0 5- Yfr x)3 City M1 /&'/244 '-' V State T v Zip ?/3'g Tenant/Lessee Name Email jo Phone # Job Address (where the work is being done) /70-0 H- /or . r .e,1- City Miami Shores Village County Miami -Dade Zip 33 /3 8 FOLIO / PARCEL # 1/ -- a 2>0 - 0s-co- 6),01 0 Is Building Historically Designated YES NO Flood Zone Contractor's Company Name Fe:>6112I2. Sd' 10lect j2.,C ti L, Phone #(3) 3 4s ' L 3Q. Contractor's Address 2441 $ 1.1. 4 3 S't ,�' . . , City M1 DAM State Ft-0 D Zip 33 1 Z'7 Qualifier Name .3 0 12G►€ 1.... l2. Phone # (.'S) 34$ • 313 d. State Certificate or Registration No. 112. • 00 1'E4. Q,rip Contact Phone (b) 34-6. t3 t 3 4 E -mail O et✓'> C son ell € Q 01 • co, Certificate of Competency No. ct.e:i G. 00 0 24'9 Architect/Engineer's Name (if applicable) Phone # k Value of Work For this Permit $ J ®n • �'~ Square / Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration :New ❑ Repair/Replace El Demolition Describe Work: •LOCAVM' ITC-144._% ' e,ler • � r a s t. to �� x ►lei . `% La Q ic t *** * * ** * * **************************Fees******************* * * * * *** *****, * * *** * **** ** **** *** ** * * * ** * ** X fro‘-41' CCF $ CO /CC $ Submittal Fee $ Permit Fee $ l "'eV> t' Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ ‘,611 \ See Reverse side -+ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. Signature_ Signature Owner or Agent The foregoing instrument was acknowledged before me this ICA The forego mg instrument was acknowledged before me this i day of/'-t , 201 t , by , day of ►'+A 12414 , 20 1 , by who is to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: who • to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: ,� Sign: Print: /4-1/4:445 . 4/IffltiC =, — My Commission Exp. 's' %°.9% x'93 L: ALVAREZ MY COMMISSION I1 DD 7466+16 a°, •�•�o LAIAROLIg.VAR#3 * EXPIRES: .__..__..., ,,,,12 StAY c s * MY CO MISS40N #DD 746848 # m iTo EXPIRES: January 17, 2012 p'gr�� Roza °° BondedtiauB d Nam�y sera s * * * * * * * * * * * * * * * ** * * * ** ** **'414**6ACIO E S * * *** * *** * ** * * * * * * * *** *4 ::: "** * *,� x *1* *::1 ** ** j t/ APPROVED BY �+ . '% % �� ft Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) A.CC3f2o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/24/11 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 Just Insurance Brokers 1200 NW 78 Ave Suite 105 Miami, FL 33126 Phone (305) 418-4701 INSURED Foster & Sat Electrical Contractor, Inc. 2498 NW 3rd Street Miami, FL 33125- (305)345 -3453 Fax (305) 418 -4706 NAME Odalys Valcarce PHONE 305 418 - 4701 -214 (Eq/c. o. Ext1: ( ) r(, No); (305) 418 -4706 ADDRESS. odalysv @justinsurancebrokers.com PRODUCER CUSTOMER 1D #: INSURER(S) AFFORDING COVERAGE INSURERA: National Group hs. Co. NAIC # INSURER B INSURER C : INSURER D : INSURER E : INSURER F 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 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 WVD POLICY NUMBER A TYPE OF INSURANCE GENERAL LIABILITY ADDL INSR COMMERCIAL GENERAL LABILITY ❑ ❑ CLAIMS -MADE 0 OCCUR GE'tL AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ JECOT- ❑ LOC AUTOMOBILE LABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON-OWNED AUTOS ❑ UMBRELLA LAB ❑ EXCESS LIAR ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UABIL1TY ANY PROPRIER/PARTNER/EXECUrIVEI / N TO OFFICER/MEMBER EXCLUDED? l (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N 02L -0000397 -01 POLICY EFF (MM /DDfYYYY) 09/07/2010 POLICY EXpp (MM/DD/ow) 09/07/2011 EACH CCCURRENCE UMS DAMAGE I U RENTED PREMISES (Ea occurrence) $ 1,000,000 $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY GENERALAGGREGATE $ 1,000,000 $ 1,000,000 PRODUCTS - COMP /OP AGG $ 1,000,000 ❑ OCCUR t_ i CLAIMS -MADE COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) BODILY INJURY (Per accident; PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE N/A ❑ TORY LIMITS I I ERA E.L. EACH ACCDENT $ E.L. DISEASE - EA EMPLOYE DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Addtlonal Remarks Schedde, if more space Is rewired) 30 day cancellation notice Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 E.L. DISEASE - POLICY LIMIT MIAM138 U ACORD 25 (2009/09) QF CANCELLATION 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 © 1988-2009 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD f?Ab® CERTIFICATE OF LIABILITY INSURANCE OP ID JY DATE (MM/DONYYY) 09/10/10 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. A UUL INSR IMPORTANT: If the certificate holder is an ADDITIONAL MIRED, ED, the policyOes) 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). POLICY NUMBER PRODUCER BUTLER, BUCKLEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MIAMI FL 33126 Phone : 3 0 5 —2 62 —0 0 8 6 NAME: NELSON ROMERO LIMITS (AIC, No, Ext): 305- 262 -0086 (A/C, No): 305- 262 -0187 ADDRESS: NROMERO @BBDINS.COM LIABILITY PNoouctR CUSTOMER ID 4$: FOSTE -1 INSURER(S) AFFORDING COVERAGE NAIL # INSURED FOSTER & SON ELECTRICAL CONTRACTORS INC. 2498 NW 3 ST MIAMI FL 33125 INSURERA: STAR INSURANCE CO EACH OCCURRENCE $ INSURER B : $ INSURER C: MED EXP (My one person) $ INSURER D PERSONAL & ADV INJURY INSURER E • GENERAL AGGREGATE INSURER F : AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG 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, I tRM 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 A UUL INSR avek WVD POLICY NUMBER POLICatrr (MM/DDIYYYI') YC)LII.T tAr (MMIDDIYYW) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE $ DAMAGE TO rtENTtD PREMISES (Ea occurrence) $ CLAIMS -MADE MED EXP (My one person) $ GEN'L 7 PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY PR 4 LOC $ 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 LAB EXCESS LAB f OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A WC049311-2a 05/01/10 05/01/11 X WCS1Alu 01H- TORY LIMITS ER E.L. EACH ACCIDENT $ , 000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500 , 000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) *30 DAY NOTICE OF CANCELLATION EXCEPT 10 DAYS FOR NON PAYMENT OF PREMIUM r•C DTICtr'srr tint ',cm Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 ACORD 25 (2009/09) ANCELLATION MIAM138 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 e , $ • The ACORD name and logo are registered marks of ACORD i' RPORATION. All rights reserved. MIAMI -DADg Cowl TAX COLLECTOF, • 140 W . Fk«4C�LEF# S 1St.FLOOlt MIAMI, `FL.331.30 414997 -7 BUSINESS NAME / LOCATION FOSTER & SON ELECTRICAL CONTRACTORS INC 2498 NW 3 ST 33125 MIAMI OWNER FOSTER & SON ELEC CONTRACTORS IN Sec. Type of Business THIS IS a y6A F,Itf.CTRICAL CONTRACTOR BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES R EXEMPT THE HOLDER FROM ANY OTHER PERAMIT OR LICENSE NOT CERTIFICATION UA CERTIICATION OF THE HOLDER'S OUALIFICA• TlONS. LOCAL BUSINESS AX RECt IPr IAMI D iDE courm' STATE OF?FLORIDA EXPIRE$fSEPT ,30, X011 , Mtistr BE DISPLAYED AT PLACE^OF :B JSiNESS'; PURSUANT TO'.COUNTY'CODE CHAPTER=8A`.-ART :9' THIS IS NOT A BILL — DO NOT PAY PAYMENT RECEIVED MIAMI -DADS COUNTY TAX COLLECTOR: 07/16/2010 09010006001 000045.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 RENEWAL RECEIPT NO. 433378 -7 CC # 99E000259 WORKER /S 1 DO NOT FORWARD FOSTER & SON ELECTRICAL CONTRACTORS INC JORGE L FOSTER 2498 NW 3 ST MIAMI FL 33125 tl fitl 1, tlfllltllllfilt11/ 1i1l ,/1f1lIII111fiI1lfilf11l1111�1111 CTQB Construction Trades BUSINESS CERTIFICATE OF COMPETENCY MPPETET ENCY FoSTER s sON ELECTRICAL CONTRACTORS INC D.B.A.: FO TER JORGE L Is certified under the Provisions of Chapter10 of L) FOR ,CONTRACTING UNT L 09/ ede county AC# STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 FOSTER, JORGE L FOSTER & SON ELECTRICAL CONTRACTORS INC 2498 NW 3RD ST MIAMI FL 33125 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.myflorldalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and leam 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 (850) 487 -1395 ACt':tt.:1'S 1 STATE OF FLORIDA • DEPARTMENT ':OF- BPS INES'.S AND :'PROFESSIONAL REGULATION ER0015146. 0.7/17/1.0 108008268 REG: ELECTRICAL ,CONTRACTOR.:. FOSTER, JORGE:L FOSTER & SON ELECTRI.CALICONTRAC (INDIVIDUAL - .MU'S`C; MEET I L LOCAL to- __ LLICENSING REQ,DF*REMENTS 'PRIOR TO CONTRACTING' Ir':.NY AREA) HAS . REGISTERED_: under, _the provisions . of_ ch. 4.8.9t `. &xg'iration data: AUCi'' 31, 2,412 L7:oo 717OO4'�53 STATE OF FLORIDA DEPARTMENT O .BUSINESS AND PROFESSIOIITAL tPGUT,.ATION ELECTRICAL CONTRACTORS LICENSW BQ�.'�T� SKS L100717.00453 LICENSE" NBR • ATCH NUMBER .E 02,.`-4.6 QUIRE r X X X X X X X X X X X X X X X X X X X X MIAMI -DADE COUNTY TAX COLLECTOR 140 W. Flagler Street Miami, Florida 33130 Please keep your receipt for future reference. Thank you and have a nice day. 10/14/2010 1300 /228 /001SAKENI 0010 -0001 Last Seq. #:0001 WI LBT #:30 433378 -7 Local Business Tax $200.00 CK CHANGE $200.00 $0.00 MIAMI -DADE COUNTY TAX COLLECTOR LOCAL BUSINESS TAX SECTION 140 W. Flagler St. - 1st Floor Miami, Florida 33130 TEMPORARY RECEIPT 2010 -2011 MUNICIPAL CONTRACTOR TAX Local Business Tax #:30433378 -7 State /CC # :99E000259 Issued to: FOSTER 8 SON ELECTRICAL Type of Business: ELECTRICAL CONTRACTOR SEE BACK OF OFFICIAL RECEIPT FOR NONPARTICIPATING MUNICIPALITIES THIS RECEIPT IS ISSUED AS EVIDENCE OF PAYMENT FOR YOUR LOCAL BUSINESS TAX OR PERMIT. YOUR OFFICIAL RECEIPT WILL BE MAILED TO YOU WITHIN 10 DAYS FROM THE VALIDATION DATE ON THIS RECEIPT. Payment Received as Certified Above Miami -Dade County Tax Collector DAVE: f1/17/2010 LOCAL 8US[NESS TAX TIME; 14:59:44 RECEIPT INQUIRY CCOUNT� 414997-7 FOSTER SON ELECTRICAL 14OVV.PLA�L�R�T�EET i MIAMI, FLORIDA 33130 LBTR YEAR: 2011 OCLM0108 2498 NW 3 ST . . . . .. . . ... .. . ■ . . ..... ................. FCElPT� 433378-7 RENEWAL COMM-DA!E: 10/1999 ENTRY-TYPE-DTE: W 09/07/1999 STAlUS: LAST-TRANS-DATE: 10/14/2010 INSP-ID-DTE: 00/00/0000 EC TY?E ITEMS DESCRIPTION PRV-YRS: 96 ELEC 1 ELECTRICAL CONTRACTOR CURRENT: OE CLASS: PENALTY: TATE: ` CC: 99E000259 HOLD: Y DELQPEN: XEMPT-CD: VET-ID: SVC-CHG: ITV RECEIPT/ZONING PERM.IT: 11111111 MUN-CONT Y TRAN3FR: SHERIFF: OLD-APpLIC: HOLD-REC: ADJUST : EGAL: WARNING #: IN3P RCT#: EXEMPT : 'REV..Y RS: YEAR: 2010 .00 YEAR: 2009 .00 TOTAL : RANSF-FROM: TRANSF-TO: Y PAID ORIG-REC: DUE CAT/NAICS: 23821 IMPORTANT: THE INFORMATION HEREIN DOES NOT NECESSARILY CONTAIN ALL PERTINENT FACTS WITH REGARDS TO 1—MENU MWEPAWPF4E9f1m9AAVmFTWIR|*011#4FrAFIVEPEq4MTS F4=MORE REC 5=MEMINQ F6=MUNINQ F12=PRNT F13=HELP F14=PI F15=CONTR MIAMI - DADE COUNTY, FLORIDA FINANCE DEPARTMENT TAX COLLECTION ,`""".^~". uuv�xun'man�m�� /,�x�u��c�//��n DIVISION ��^��^~^�^��~�� 140 W. FLAGLER STREET MIAMI, FLORIDA 33130 . 00 45.00 .00 . 00 . 00 .00 . 00 .00 .00 45.00 45.00 .00 DATE: i1/17/2010 LOCAL BUSINESS TAX LEITR YEAR: 2011 OCLM0107 TIME: :;4:59:46 ACCOUNT INQUIRY 1CCOUNT : 414997-7 COMM-DATE: 10/1999 ENTRY-TYPE-DTE: W / U S l N E S S : DELETE-ST: INSP-ID-DTE: !OAF.: FOSTER & SON ELECTRICAL CONTRACTORS INC 1DDR; 2498 NW 3 ST SUITE: 33125 NUN: 01 ZONE: 06 PHONE: ( 305 ) 644-5869 :ORP / OWNER (MAILING): !AME: FOSTER & SON ELEC CONTRACTORS INC C/O: JORGE L FOSTER 'DDR: 2498 NW 3 ST CITY : MIAMI STATE: FL IP: 33125 HOME OFFICE: N THER INFORMATION: P-FOLIC: 00 000000 S3N/EIN: E 65 0906808 BADCHK: E-FOLIO: 01 4103 033 2110 FlCTNM: LAST-TRAN3-DTE: 10/13/2004 0q/07/1999 '^^^^^ ` ^^` ^^^^'~^' `^^^^^`^^^^^^^^^^^ LET RCPT SEC TYPE AMOUNT-DUE D/R PD LEGAL INSP -ID INSP-DATE HOLD-RCPT 433378-7 196 ELEC .00 0 IMPORTANT: THE INFORMATION HEREIN DOES NOT NECESSARtLY CONTAIN ALL PERTINENT FACTS WITH REGARDS TO REAL ESTATE CLOSINOS AND OTHER SIMILAR AcmnMsS. 1=NENL/ CLEAR=PREVSCR F4=MOREREC ENTER=REC F12=PRTAPPL F13=PTX F14=PI PG 1 Please note that this Business Tax Receipt expires on September 30th of the effective year listed herein. Ensuring renewal by October 1st is the responsibility of the business entity. For further information you may call: (305) 416 -1570 or (305) 416 -1918. Favor de tomar nota que este Recibibo de Impuesto para Negocio se vence el 30 de Septiembre de ano indicado. Asegurar la renovacion para el 1 ro de Octubre es la responsabilidad del negocio. Para mas informacion puede Ilamar al: (305) 416 -1570 o (305) 416 -1918. Souple pran not ke Resi Enpo pou Biznis-sa ap exspire 30 Septan -m ane sa men -m nan lis Ia. Se responsablite dirijan Biznis sa pou li renouvle -I Pwemie Oktob kap vini. Si ou bezwen plis enfomasiyon sou zafe sa , pa bliye rele nan (305) 416 -1570 ou byen (305) 416 -1918. tz Q POST THIS DOCUMENT IN A CONSPICUOUS PLACE. NOT TRANSFERRABLE OR VALID AT ANOTHER ADDRESS UNLESS APPROVED BY THE FINANCE DEPARTMENT, CITY OF MIAMI 444 S.W.2 AVE 6Th FLOOR, MIAMI, FL 33130, PHONE (305)416 -1918. EFFECTIVE YEAR OCT. 1, 2010 THRU SEP. 30, 2011 RECEIPT FOR JORGE L FOSTER ISSUED FEB 04, 2011 TOTAL FEE PAID ACCOUNT NUMBER RECEIPT NUMBER NAME OP'BUSINESS LOCATION 307985 - 00743067 195299 -0002 JORGE L FOSTER 2498 NW 3 ST $131.00 IS HEREBY IN COMPLIANCE TO ENGAGE IN OR MANAGE THE OPERATION OF: ADMINISTRATIVE OFFICE DIANA M. GOMEZ Finance Director THIS IS NOT A BILL DO NOT PAY This issuance of a business tax receipt does not permit the holder to violate any zoning laws of the City nor does it exempt the holder from any license or permits that may be required by law. This document does not constitute a certification that the holder Is qualified to engage In the business, profession or occupation specified herein. The document indicates payment of the business tax receipt only. 2011 1 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL �� Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 157393 Permit Number: PL- 3- 11-484 Scheduled Inspection Date: November 14, 2011 Inspector: Hernandez, Rafael Owner: JOEL I KUTTLER, MICHELE A Job Address: 1700 NE 105 Street 203 Miami Shores, FL Project: <NONE> Contractor: EDDY MARTINEZ PLUMBING SERVICE Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)984 -6507 Parcel Number 1122300500220 Phone: 305 - 883 -8486 Building Department Comments KITCHEN REMODEL AND WATER HEATER Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments SEE NORM before inspection. November 10, 2011 For Inspections please call: (305)762 -4949 Page 6 of 34 Apr 18 11 04:27p Xpert Plumbing, Inc. 3052583679 p.1 03 -11 -2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WQRKERS' COMPENSATION . * * CERTIFICATE OF ELLCTIDN TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * CONS"T"RUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE; PERSON: FEIN: 03/11/2011 MARTINEZ 650333023 BUSINESS NAME AND ADDRESS: EDDY MARTINEZ PLUMBING SERVICES INC 11250 SW 175 STREET Nib FL • 33157 SCOPES OF BUSINESS OR TRADE: 1- CERTIFIED PLUMBING CONTRACTOR EXPIRATION DATE: 03110/2013 EDDY A IhIPORTAMT: Forwent to Chapter 440 06114). F.S., ae oilier of a carper tiba Wet sleets esewptioe Item Ilia ceome, ly Mae • certlltcale et etectfoa sneer we e seated may net recover beeerits or taapassonae eater tble ceepter. Person; Is (Raptor f40.tiVID F.S, CesGlicette at elsdim to tie elnerpf apply o* t1"' the scope of the business or erode listed w et• sauce at electron ro he ettenot, rarsquq to Ropier +40.05(13i, F.S.. Ratites e!•elenhan to bit exx,wi n1 oNlilIealet Or !Ierttan to be 'motet seep he noted to teaoest3ea II, at sa,y ttata eller IN' flung et Me mice or Our issasece rar One sar11ticele. Be perean doused er tee Donee or taRitieate fe teagor aaa t tla r19u110e09119 of eh atatioe for rostrum of t cortllleste. The feprrtarsnt shah reoabe a aartrnwta et may moo for tonere et the partite aaunad ar the certititata to Aoeal I1e rrtttllrpaeem et tare eetsioh. OWC -252 CERTIFICATE OF ELECTION TO BE dDEMPT REVISED 01 -11 • PLEASE CUT OUT THE CARO BELOW STATE OF FLORIDA DEPARTMENT OF FINtNC1At.SERVICEu3 . DMSION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE E IDERIPT FROM FLORIDA WRS'COMPENSATION LAW flUEST10N4 {560} 413 -116tie AND RETAIN FOR FUTURE REFERENCE EFFECTIVE: 03/11/2011 EXPIRATION DATE: 03/10/2013 PERSON EDDY A MARTINEZ FEIN: 030833023 BUSINESS NAME AND ADDRESS: EDDY ttARTIt6Z PLUffl)%G SQt:VIGES is 11230 SW 170 Fiber: M►AMI, FL 39151 SCOPE OF BUSINESS OR TRADE: CERTIFIED PLUMBING CONTRACTOP IMPORTANT lR Pursuert to Chapter 440.05E14). F.S., an officer of a corporation who elects exempnlon iron this chapter by filing a certificate of election L under this action mey rat recover bowling or compensation under this D chanter. H Pursuant to Chapter 440.051121 F.S. . Certificates of election In be Rexempt.. apply Only within the scope 0 the business or trade listed on the notice of election to be exempt E Persgant to Clavier 440.05(13), F.S., Notices 0 election to by exempt we certificates of election to bus esen t shall be sebiect le revetxliian if. et any time after the filing 0 the notice. or the ;Sewn of the ceflificatz. the person named on the novice or certificate no longer meets the requireinenis of this section for Ssuance of a certificate. The department shall revoke a certificate m tiny time for failure of the parson named an the certificate to meet the requirements 0 this section. OUESTtOIJST (>I50) 413 -1Cp9 1 CUT HERE e Curry bottom portion on the job, keep upper portion for your records. DWC. 252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 Apr 18 1 1 12:55p a� ; • r U 1 I Xpert Plumbing, Inc. 3052583679 p.1 0 4arm 1F1[`bfTlG OF LIABILITY ITV 111u1Lr lfal ti�ru+ u • cv�� DM= jeleVODNY) utRT PRODUCER Amos Insurance Group 6726 N.W. 28th Street, Suite #11 Donal. FL 33172 Phone (305)592 -7700 Fax (305)503 -B785 INSURED Eddy Martinez Plumbing Service* In 11250 SW 176 stmt MIAMI, FL 33167- 1 (305) 256 -9093 COVERAGES T141S cERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS P1O RIGHTS UPONN THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER T4E COVERWEAFFoRDED BY THE POLICIES W INSURERS AFFORDING COVERAGE NAIC 4 INSURER A: Notional Group Insurance INSURERS: AIBURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. Try OR CONDmON OF ANY CONTRACT oR OCHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE mums Dl?SCRIaED HEREIN IS SUBJECT TO ALL THE TERMS, ExCLU ®IONS AND CDNDRI0N8 OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tlaR Lne ADD1. (NERD TYPE OF INSURANCE POLICY NUMBER PA er IV P i O331. O E&RT0N DATRWM V GENERAL LIA88.rry ® COMMERCIAL GENERAL LIABILITY ❑ ❑❑ CLAHASMADE ® OCCUR GEN'L AGGREGATE UMIT APPLIES PER: ❑ POD' ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ ❑ SCHEDULED AUTOS ❑ MIRED AUTOS ❑ NON OWNED AUTOS ❑0 GARAGE LIABILITY ❑ ❑ ANY AUTO EXCESS 1 UMBRELLA LIABILITY ❑ OCCUR 0 CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR 1 PARTNER, EXECUTIVE YAK OFFICER / MEMBER EXCLUDED? 11 o , dabbe weer . SPEEQIAL PROVISIONS brlow OTHER 02L000109700 02105/2011 02/05/2012 LIMBS EACH OCCURRENCE 1,000,000 100.000 5,000 1.000,000 1,000,000 PRODUCTS.CCMPIOPA o 1.000,000 R IS66 f u z HIED EXP (Any one ;mewl PERSONAL & AOV INJURY GENERAL AGGREGATE COMBINED SINGLE Llh9T (Es Radiant BODILY INJURY (Per oomon) BODILY INJURY (Peraccldeng PROPERTY DAMAGE (Per accMent, AUTO ONLY• EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGO EACH OCCURRENCE AGGREGATE 6,L. EACH ACCIDENT E.L. DISEASE- EA EMPLOYEE. E.L. DISEASE - POLICY LIWI1T DESCRIPTION nr OPERATIONS 1 LOCATIONS r VEHICLE$1 EXCLUSIONBADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS PLUMBER CERTIFICATE HOLDER Miami Shores Village Hall 10050 Northeast 2nd Avenue Miami Shores. Florida 33138 Phone: 305- 795 -2207 Rim 305 -7S -8977 ACORD 26 (2001U01) OF CANCELLATION BIioUI.D ANY Or THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP1RATI0N DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL SO DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 'THE LEFT, BUT FAILURE TO DO 60IHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON MB INSURER, ITS AGENTS OR REPRESENTATIVES. AUThURLED REPREBENTATIYE Pr1d�0.,..E'M� VSg6?V�C. V 1908 -2008 ACORD CORPORATION. All rights . The ACORD name and logo are t�uslalerod marks of ACORD D 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. Ft,(1 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) CrDe.Q., (i # ] Owner's Address 70D /C(-- City Ja-/1/1;1 S2Ver State Tenant/Lessee Name Email Master Permit No. Phone# 3Dr_ !e / -6ro Zip 33 / 3 8 Phone # j//m&' @,rn#4/. oryi Job Address (where the work is being done) City Miami Shores Village /7DV ?W /Dr L&) e4- dt 2-D3 County Miami -Dade Zip 3 3/3 n FOLIO / PARCEL # A3 a - O O)-a, V Is Building Historically Designated YES NO Flood Zone Contractor's Company Name 1C(Ck MCr-h Ile 2_ PCt'mbt n rill Phone # 1-(0 25-) _ 3? 1 1t) Contractor's Address ) 1 2.j 0 SLO 15 City (Y ( (Th j State Qualifier Name E6t d tyAct Q�- State Certificate or Registration No. CRc_O rl 09 I Contact Phone 75-4)) ) to Zip 33t n Phone # X8(0) 2 1-3R ) 6 Architect /Engineer's Name (if applicable) Value of Work For this Permit $ Type of Work: ❑Addiiion E -mail Certificate of Competency No. NIA- Phone # Square / Linear Footage Of Work: ['Alteration ❑New. Describe Work: sztr...) ❑ Repair /Replace ❑ Demolition l- 10afer ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ if9e Notary $ Training /Education Fee $ Scanning $ Radon $ CCF $ CO /CC $ DPBR $ Double Fee $ Violation date: Structural Review. $ Technology Fee $ Bond $ Total Fee Now Due $ z3-(GO See Reverse side Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the fret 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 Owner or Agent Contractor The foregoing instrument was acknowledged before me this L 1 The foregoing instrument was acknowledged before me this 15 day of P\M4 , 201 , by J -0^- , day of who is wn to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: onall Sign: /Gc._ i 't'&. — LA-"A'1/0 ! W. Print: My Commission Expires: 201 1 , by •Leiti i1-11(tirke o me or who has produced as identification and who did take an oath. My Comm �Pev ru�� ABO L. ALVAREZ ,pire.OURDES SUAREZ �� y +• o MY COMMISSION M DD 746646 ': "_ MY COMMISSION # DD964055 EXPIRES: January 17, 201 "2 '• r" EXPIRES April 30, 2014 *************************4 *�eR9 I�W1d449@ i� * * * ** * ** * * * * * * * * ** i?,.i4- 6v61:r * ** rysehadoidn * * * *4 APPROVED BY l Plans. Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Zoning Clerk checked