RC-12-417Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 170921
Permit Number: RC- 3- 12-417
Scheduled Inspection Date: March 28, 2012
Inspector: Rodriguez, Jorge
Owner: MONTERO, CARLOS
Job Address: 1245 NE 92 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: CONINMAQ LLC
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Kitchen Cabinets
Phone Number (786)282 -4809
Parcel Number 1132050270280
Phone: (786)285 -3073
Building Department Comments
KITCHEN REMODEL PERMIT TO LEGALIZE WORK DONE
PREVIOUSLY
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
March 27, 2012
For Inspections please call: (305)762 -4949
Page 8 of 21
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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 C/ 12--411
Master Permit No.
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): J \ e 6��. Phone #: �� 6
Address: �� c �_ C Sd
��
City: ����� � � ��� � � State:
Tenant/Lessee Name:
Email: ' a ° .C.:
JOB ADDRESS:
City: Miami Shores
Folio/Parcel #:
County:
,._
C-
Zip: �'
Phone#:
Miami Dade
Zip:
Is the Building Historically Designated: Yes
CONTRACTOR: omp Name: t
Address: 4, 1�
City: L 'U Ccu fi 6 _
Qualifier Name: ( �-' (2
State Certification or Registration #: �..�`�
C- iC5 1
Contact Phone #: Email Address: C_0(110 1 �' )CL t ` - C V CU I ' "'.-l) �,
DESIGNER: Architect/Engineer:
Zip: ? �.
L.
NO Zone:
'L bC'i
r LL(
Phone #:
State: i I
Phone #: �"
Certificate of Competency
Phone #:
'Value of Work for this Permit: $
Type of Work: ❑Addition
Description of Work ,
eY
DAlteration
Square/Linear Footage of Work:
°New DRepair/Replace
DDemolition
Submittal Fee $
Scanning Fee $
Notary $
Double Fee $
***!o a** ****** * *** **** x****** Feesxxa
xx *xxx****** * *xx**** * *** **** x **** * ***x***
Permit Fee $ /sa O a
CCF $ CO /CC $
Radon Fee $ DBPR $ Bond $
Training/Education Fee $ Technology Fee $
Structural Review $
TOTAL FEE NOW DUE $_L1' L'
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 osted notice, the
inspection will not be approved and a r'inspection fee will be charged.
Signature
The forego
day of
and who did take an oath.
Signature \*(- e-6-(
Contractor
The forego
day of
NOT
Sign:
Print:
My Commission Ex
* * * * * * * * * * * * * * * * * **
APPROVED BY
ins
ment wajacknowi - s ged be
rsona}ly
, 20
y
• -melisv
1'
own me or who has produced
and who did take an oath.
My Commissio
**************** ***** * * ********* **** * ** * ** *****
?fe(-a
Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
0.100 "' s1 Ake ''1 3 2015
G u'" PC, 2
• " � • •E VW Co rss'o N� A Notary As
• •iZ ZF o `d;;.- gore
* * * * * * * * * * * * * * * * * * * * * **
Zoning
Clerk
,44C-Cosco-,
.,Mar. 8. 2012 9:07AM THE FIRST INS. GROUP CORP Nn 2089-5A:.P.: 1 =fro
UhKI-IFIcA I k 01- LIABILITY INSURANCE : 03/08/12
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 Tilg.POVERA.gF AFFoRD_ED_DY
j INSURERS AFFORDING COVERAGE NAIC #
PRODUCER Firsi Insurance Group
10967 SW 40 St
Miami, FL 33165
Phone (305)221-7878
INSURED Coninmau LIc
18741 Royal Poinciana
Weston, FL 33326-
COVERAGES
Fax (305)554-7090
•• • •,..
I.INSURER A: UNITED SPECIALTY INSURANCE CO
; INSURER 8;
. .
INSURER F:
THE POLICIES OF INSURANCE LISTEDHAVEBiEu FOR THE PERIOD INDICATED. NOTWIThSTANDINO
• 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
•INSR; AMYL ;
LTR NERD • TYPE OF INSURANCE POLICY NUMBER I DATE (MLI/Darnj DATE.mminory_yL_I___
LIMITS
POLICY EFFECTIVE • POLICY EXPIRATION'
. ..._... . .
• . - • • •••• ••• •• •
GENERAL, LiAssay
EACH OCCURRENCE ._ :. _ _1,000,000
. R COMMERCIAL GENERAL LIABILITY i NS1211636 01/30/12 TIATA-a*TORENTED-*---- - - 6.
01/31/13 2RE_Imisgsig_a_racs..yrencE9... ..:.: _ . ... .5....!909:.
MED EXP (Any one person) ! •5000
• :A i n
• 00 CLAIMS MADE 0 OCCUR
0
•
. GEM_ AGGREGATE UMIT APPLIES PER:
0 POLICY PROJECT 0 LOC :
AUTOMOBILE LIABILITY
; 0 ANY AUTO
•
. ALL OWNED AUTOS
•
B . n SCHEDULED AUTOS
. ,
C] HIRED AUTOS
•
0 NON OWNED AUTOS
GARAGE LIABILITY
•
C ; 0 ANY AUTO
•-•-•-••••,. ..... ••-• ^ •• ..•.•
EXCESS/UMBRELLA LIABILITY
0 OCCUR CLAIMS MADE
D
DEDUCTIBLE
• RETENTION $
WORKERS dOi/IPENSiTIOVAD
EMPLOYERS' LIABILITY
E I ANY PROPRIETOR / PARTNER / EXECurivE ,•
OFFICER MEMBER EXCLUDED? .
If yes, describe under
• •
. . !.§P.gP110- .
OTHER
F
• DESCRIPTION OF
GENERAL CONTRACTOR LIABILITY
FLOORING AND PAINTING
• ••• ..•••_. • HOLDER
MIAMI SHORES VILLAGE BUILDING DEPT
10050 NORTHEAST 2ND AVENUE
MIAMI SHORES, FL 33138
Adokbii iitibirttird0.
PERSONAL & ADV INJURY.
GENERAL AGGREGATE
I PRODUCTS COMP/OP AGG
• 1,000,000.
.1,000,000.
1 000 000.
COMBINED SINGLE LIMIT •
(Ea accident)._
BODILY INJURY
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Par accident)
AUTO ONLY - EA ACCIDENT
OTHER THAN „gA6.9.9...: • .
Aq4
1 EACH OCCURRENCE
AGGREGATE
. . . .
•
.ER
E.L. EACH ACCIDENT * • •
E.L, DISEASE - EA EMPLOYEE:
E.L. DISEASE - POLICY LIMIT
BY ENDORSEMENT / SPECIAL PROVISIffla FIRST-INSURANCE GROUP
CORP
10967 Bird Rd
MIamI, FL 33105
305.221,7870
CANCELLATION
1•, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING IN R WILL E DEAVOR TO !VIAL '
• AT HO ER NAMED TO
PION OR LIA TY
TATIVES.
30 DAYS WRITTEN NOTICE TO THE C
THE COT, BUT FAILURE TO DO SO SHALL IMP
OF ANY KIND UPON THE INSURER, ITS AGENT
AUTHORIZED REPRESENTATIVE
02 -14 -2012
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.
EFFECTIVE DATE:
PERSON:
FEIN:
02/14/2012 EXPIRATION DATE: 02/13/2014
GUTIERREZ ANA
651013600
BUSINESS NAME AND ADDRESS:
CONINMAQ LLC
18741 ROYAL POINCIANA DR
WESTON FL 33328
SCOPES OF BUSINESS OR TRADE:
1- GENERAL CONTRACTOR
IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of
election 10 be exempt shall be subject to revocation 11, a1 any time alter 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.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
QUESTIONS? (850) 413 -1609
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: 02/14/2012 EXPIRATION DATE: 02/13/2014
PERSON: ANA GUTIERREZ
FEIN: 851013600
BUSINESS NAME AND ADDRESS:
CONINMAQ LLC
16741 ROYAL POINCIANA DR
WESTON, FL 33326
SCOPE OF BUSINESS OR TRADE:
1- GENERAL CONTRACTOR
IMPORTANT
0 Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D 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
Rthe notice of election to be exempt.
E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt
and certificates of election to be exempt shall be subject to revocation
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
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
GUTIERREZ, ANA BEATRIZ
CONINMAQ LLC
16741 ROYAL POINCIANA DRIVE
FORT LAUDERDALE FL 33326 -1542
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.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
STATE &F FLORIDA AC# 514 7 5 4 3
DEPARTMENT OF BUSINESS AND
PROFESSIONAL:.; EEGULATION
CGC151471.60' O o;,T
CERTIFIED rz `
GUTIERRE
CONINMAQ 1
107012601
ute
IS CERTIFIED under the" 'Provisions of ch.489 s3
s+ipiracicn daces AUG 31., 2012 L10b83103623
CTOR
AC# 5147543
STATE OF FLORIDA-
DEPARTMENT OF BUSINESS .AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SE(Loos31os62a
LICENSE NBR
The GENERAL CONTRACTOR
Named below IS CERTIFIED i !
Under the provisions of Chaptel`
Expiration date: AUG 31, 2012 .:
GUTIERREZ, ANA BEATRIZ
CONINMAQ LLC
16741 ROYAL POINCIANA DRIVE t�
FORT LAUDERDALE FL 33326=25 Wa
CHARLIE CRIST
GOVERNOR
�xxe :+aa
DISPLAY AS REQUIRED BY LAW
CHARLIE 'LIEM
SECRETARY
MIAMI-DADE COUNTY
TAX COLLECTOR
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
617746 -3
BUSINESS NAME / LOCATION
CONINMAQ LLC
DOING BUS IN DADE CO
2011 LOCAL BUSINESS TAX RECEIPT 2012
MIAMI -DADE COUNTY - STATE OF FLORIDA
EXPIRES SEPT. 30, 2012
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY, CODE CHAPTER 8A - ART. 9 & 10
•
THIS IS NOT A BILL - DO NOT PAY RENEWAL
RECEIPrNO. 644187-7
STATEt CGC1514716
OWNER
CONINMAQ LLC
Sec. Type of Business
196 GENERAL BUILDING CONTRACTOR
THIS IS ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY OR CRIES. NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR LICENSE
REQUIRED BY LAW. THIS IS
NOT A CERTIFICATION OF
THE HOLDER'S QUALIFICA-
TIONS.
PAYMENT RECEIVED
MIAMI-DADE COUNTY TAX
COLLECTOR:
09/30/2011
02280030001
000075.00
SEE OTHER SIDE
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
WORKER /S
2
DO NOT FORWARD
CONINMAQ LLC
CLARA GUTIERREZ
16741 ROYAL POINCIANA DR
WESTON FL 33326
I1i)h 1th 111111I�$1111ir1IiHI lIIlIIIlliIilrill)rfll1J� bll
CUMULATIVE SUBSTANTIAL IMPROVEMENT
VERIFICATION WORK SHEET
In accordance with FEMA regulation and Miami Shores Village Flood Damage Prevention Ordinance the costs of all
improvements must be monitored. The costs of any improvements in the past 12 months and the costs of any proposed
improvements must be shown on the worksheet. The cost of improvements must include demolition, raw and finished
materials (include those donated), labor (including volunteer and self- performed), construction supervision and
management, and overhead and profit. A list of items the costs of which are to be included as well as those excluded is
attached for your reference. (A Copy of the Contract must be attached)
PROPERTY OWNER:
PERMIT #
ADDRESS: \ - -3 k.
FOLIO NUMBER: FLOOD ZONE:
BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL:
COST OF PAST IMPROVEMENTS (12 MONTHS):
COST OF PROPOSED IMPROVEMENTS:
(ATTACH COPY OF CONTRACT)
5-666
3.f0 0
TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed):
VALUE OF PRINCIPAL STRUCTLJRE (attach appraisal):
•
OWNERS SIGNATURE: r . ` "' z °� DATE:
PLANREVIEWER:
//
PLAN REVIEWER SIGNATURE:
Created on June 2009
Axod /fi'l�/ /OOH/