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EL-12-50Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 169636 Permit Number: EL- 1 -12 -50 Inspection Date: February 06, 2012 Inspector: Devaney, Michael Owner: VINAGRE, JESSY Job Address: 189 NW 97 Street Miami Shores, FL 33150- Project: <NONE> Contractor: CITY LIGTHS ELECTRIC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number 305/467 -1494 Parcel Number 1131010260160 Phone: (305)495 -3697 Building Department Comments REPAIR WEATHER HEAD Passed Inspector Comments , _, Failed C,, Z c' / Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 February 06, 2012 Page 1 of 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 '' BUI DING Permit NoEL) �- °`5t PERMIT APPLICATION Master Permit No. FBC 20 RECEIVED JAN 13 201 BY: Permit Type: Electrical Phone#: - 40-� ISM OWNER: Name (Fee Simple Titleholder): Address: -46 t ( City: F c, ; rkk State: Tenant/Lessee Name: Ire e®SOL Email: 5 V :.nc� 1- �'�� : L Zip: .a) f CI Phone#: (�j o ;)5t JOB ADDRESS: k & k,_)(1%) ck -- ,---,--k- . City: Miami Shores County: Miami Dade Zip: "b' l SSO Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR Company Name: C r. L re„y�� �( 2l c� P #: 3 /4? — 3rO77 Address: /4g a �LtJ /3 City: ,We'—f3' f State: /G. Qualifier Name: oe a IQ_ State Certification or Registration #: Certificate of Competency #:0 e� ®� �� Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: T =d 13 0 �o., stir a�sa_ �.ylF,e, r Y,le 6`a°is; ?ermit: $ a e ®V Square/Linear Footage of Work: ❑New2epair/Replace Lam« tot IR E zip :3 -3 i 8e-X Phone #: TyriaUfiVolitOTElitiddresS ` ❑Alteration ❑Demolition ******** *+ x* ***+x*+x***+x ****** * * **** **** * Fees** ***************** *** ** * ********** ********* Submittal Fee $ Permit Fee $ /4 47 " CCF $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE CO /CC $ DBPR $ Bond $ 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 l?e charged. Signature Signature cyL Agent 12 Contractor The foregoing instrument was acknpfledged before me this The foregoing instrument was acknowledged befor me this t3 day of , 20 ,� by �Z S V ► A J � day of JQ.L1 v. (7 , 20 ,,,, by P C�h12 who is personally known to me or who has produced "R--'1D who is personally known to me or who has produced FCc. As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: S T Asti \\N\. ***+x*+x****.x.x*w.x** ;.., * * ** ** * - x(+ft tp i`i vi 'o * ************+ x* **+ x* *+ x********** ***ax** ** ****** ******* ****+xx: 6).-1- APPROVED BY � // Plans Examiner Zoning as 1 NOTARY P Sign: Print: •,p.+.•j' ii MARCO OMATC • Notary P • Mite 01 Florida • �, ; .1 My Comm. Et�es 28, 2015 e C EE 78980 1L4 / 1iNIWIi1 Assn. My Commission Expires: IA 3 AI Structural Review Clerk (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) • From: Ae°_ ___ CERTIFICATE OF LIABILITY INSURANCE 01/19/12 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 pollcy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to — 01/20/2012 03:57 #975 P.001/001 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 Accurate 8300 West Flagiar Suite 114 Miami, FL 33144 Phone _..(306)226-8727_. iiisuReo City Lights Electric Inc 14026 SW '13 Street DATE (MM/DD/YYYY) C ACT -- - -.... _- — •- .... __ _ Lucia Estrella • PHONE 305 226 -872A 1La Ext)L ( )_..- 7- ._.. —_. ADDRkSS: luclae$trelibeilsouth.net . INSURER(S) AFFORDING COVERAGE NAiC D .x(305)226-876 7 INSURER A : American Builders Insurance Company I_wsuRER g :, INSURER C : Miami, FL 33184- (305) 496 -3198 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 CONDfTIONS OF SUCH POLICIES. LIMITS_ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL••SUBR: — LT Gl:1RAL TENABILITY INSURANCE INSR vvva� POLICY NUMBE(2 I PpY E__,�FPDXP • LIMITS INSURER o 1 INSURER E_, INSURER F • i © COMMERCIAL GENERAL LIABILITY ❑ 0 CLAIMS -MADE ® OCCUR Ia _..._..._. ... -- i — . — , ! GENE AGGREGATE LIMIT APPLIES PER `__:_a POLICY -_.. Q. LOC AUTOMOBILE LIABILITY i 0 ANY AUTO ❑ AUTOS OWNED ❑ AUTOS i ❑ HIRED AUTOS ❑ ANO NEO -_t ❑ _ ID ! El UMBRELLA LIAR Ei OCCUR j ' ❑ EXCESS LIAR ❑ GAO -MADE . — _:_1:1, -,DED ❑ RETENTION$ I WORKERS COMPENSATION ... ' i i AND EMPLOYERS' LIABILITY Y / N • ; ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? - !NIA i (Mandatory In NH) ; hIfyea describe under L— , DESCRIPTION OF OPERATIONS bolo!!! . ... ,_-- ( 030711000004608 ;01/03/2012:01/03 /2013 i I 1- ti- 1 EEAq�fJ� OCCURRENT DAFdAOE TO REN1 D PREMISES. gasaunence) L INED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGO ! omeiNgo SINGLE LIMIT $ 1,000,000.00 $ 100,000.00 $._5,000:00 _ $ .1,000,000_00 ! $ 2,000,000.00 $ 2,000,000.00 ~ --i BODILY INJURY (Per person) $ BODILY INJURY (Per accident). $ • PROPERTY ?AMA_ GE .$ —1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is reguked) CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 350- 756 -8972 ACORD 25 (2010/05) QF CANCELLATION EACH OCCURRENCE ; $ AGGREGATE �._— _..___ WC sre OTH - .TORY LlMrrrrS E.L. EACH ACCIDENT , $ L EL DISEASE - EA EMPLOYEE $ _ TEL. DISEASE _POLICE' LN1T! $ __ 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. Ili AUTHORIZED REPRESENTATIVE �! Lucia Estrella I'1 © 1988-2010 AC • - D CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �� s ALEX SINK STATE OF FLORIDA CHEF OFFICER DEPARTNENT OF FINANCiAL SERVICES DIVISION OF WORICEIW COMPENSATE .:a: so uc ? FROM MEM WIMMIlif MOIMMOSATION LAW * p - ses.sa nINS 08 -24 -2010 liaArt i 1 DAXISIRY EXENIS TION This =stifles that the inratithsd fisted halos his eiected to he exert from Fhsida Wanka EFFECTIVE DATE .06124/2011 EXPIRATION DATE 08/23/2012 Pmt CAMERA JORGE FEffit 203310924' BUSINESS NANE AND CITY LIGIWS OLEC1'RYC INC 14020 S1 13 ST RIM FL 33104 OF MOMS 06 TRADE 1- LLECIRICA1. CONTRACTOR � :. InnTANTs Psrsmat to Chapter 440 . ONK F.S., es alba e a mapenthes aae. elesot sampan tram ads by flito a earthiest. et elegies ear ties saaHaa en y at ram besefits rife tater itas td Ptemm4 to lid MOM F.B., Cognizable of eteeam to be tempi— sob asty teeth tie sap of the babas ar bade listed es the awe e1 election te be e:®pt .Psrsm to tapas 440.0504 F.O. Mtn of althea to be etaapt the ittankeso of deities to be exempt shell be salsa 2* revamalos 0. et sy *ke after Ib Ming ca the a iko or the Isestmat at tire athitheme. the ems armed se aat ethics sr retaliate es beget meets the reqehaaease at this sodas tor issue= of a anthem. Ike datetmest staff reaeke it mistakes et asy time br base at the psrsos sated es tie ewe as meet He storminess e1 this scion Q055i1093? 413-1109 DWC -252 CERTIFICATE OF MI'0S TO BE WORT 199-08 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OFPLORIDA MOON OP WORKERS' COMPENSATena CONSMCI7101 =BMW CER9FICATB OF EBBC112110 BE mown FROW FLORIDA meow COUPENSAVON LAW EFFECTIVE 08/24/2010 @S+ZRATION DATE: 06/23/2012 Pot MIME CAEBIEiA Rat 203310024 BUSINESS NAB AM ADS: CRY uoms aECrtmc c 14028 SW 13 ST tnAK R. 33184 SCOPE OF BUSINESS OR TRADE 1- asmterm. CONTRACTOR IMPORTANT' P to C 440.05(1+ FS, an officer of a who D elects exemptiau from this dopier by thing a mwtificate of election L t Ibis sect* may met rte or URder this D t Parsea<tt to Minder 44013(1* F.S, Certificates of election to he apply only within the scope of the Maims or trade loot the imam of eta to be exempt. Pwoias t to Meier 440.115i13). F.S. Notices of election to be exempt and certificates af Weed= to is exempt shall be subject to revocation if, at any the after the filing ef the notice or the ef the the person named em the entice ar certificate no tenser MO the remdreetents of this std far issuance of a Certificate. The thmartment shy revoke a certificate at any timme far failure af the person named on the certificate to meet the requirements of this H E R E QUESTIONS? 01514 413 -WEI09 cur HEM • Cary bottom portion on the job, keep ewer won for yaw ice, OWC-252 I03 TI ATE OF Warn 3D BE EX 'T IEW39 09 -08 :11Ati _R ''y: LICENSE:: 08/20/2.010 1.08040883 •_. ae ELECTRICAL COa�'c Named be1ew HAS REGISTL I 'Under the provisions �t1 Expiration date: AUG 31, (INDIVIDUAL- MUST MEET.: =LOS -' REQUIREMENTS PRIOR TO CON—TWA', CABRERA, JORGE _ :A ., CITY .'LIGETS;ELECTRZ IN 14028' S!WW =13 STREET, MIAMI FL 3318 TAX COLT ECTOORU 144 W. RUI.OLER ST 1stRC/0R MIAMI, FL 33130 585890 -8 BUSINESS NAME I LOt:ATION CITY LIGHTS ELECTRIC INC 14026 SW' 13 ST 33184 UNIN DADE COUNTY OWNER CITY LIGHTS ELECTRIC INC Sec. Type of Business 2011 LOCAL BUSINESS TAX RECEIPT 2012 COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 3012 MUST BE DISPLAYED AT PLACE OP_ESS . PURSUAh1TTO COUNTY CODE CHAPTER 8A' MIT. R. 10 THIS IS NOT A BILL — DO NOT PAY RENEWAL � ' g35 611029 -0 CC 41- FIRST -CLAI U.S. POSTA PAID PERIM*N Ft. „� is f aECTRICAL CONTRACTOR WORKER /S. rex rr 1 DOES NOT PERMIT THE HOLDER 70 MATE ARV I MEMO REGULATORY OR ZONING LAZO imam NOR me S DOES Cr HitatPT ROWER FROM ARV 011011 PERMIT OR LICENSE REWIRED SY LAW. MS'S ROT CERTIRCATION OF lee maims GUALFICA- t TIMM PAYuEHT 07/05/2011 09010194001 000075.110 DO NOT FORWARD CITY LIGHTS ELECTRIC INC JORGE CABRERA PRES 14026 SW 13 ST MIAMI FL 33184 ' 111111111111111111111. 111111111 1i1l /I /IIIIIIII ilitlllliliki7 SEE OTHER SIDE �T Board BUSINESS CERTIFICATE OF COMPETENCY • 06E _ 9' C97Y LiGHTS ELECTRIC INC D.B.A.: 111 RERA JORGE Is astifled under thepro of Ct er 10 of Courtly_ FOR CONTRACTtN . L0 30f ij 3