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MC-11-1764Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NS P- 170240 Scheduled Inspection Date: February 27, 2012 Inspector: Perez, JanPierre Owner: INC, NICAMERICAN Job Address: 1360 NE 103 Street Miami Shores, FL 33138- Project: <NONE> Contractor: A &P AIR CONDITIONING CORP Permit Number: MC -9 -11 -1764 Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132050300070 Phone: 305 -556 -7849 Building Department Comments MECHANICAL WORK FOR INTERIOR REMODEL z7 Z Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 164842. need to see kitchen exhaust duct jpp February 24, 2012 For Inspections please call: (305)762 -4949 Page 34 of 43 G� 305- OcP- 1461. .486570 -6 BUSINESS:NAMMMOCATION :A & P: SIR COND` T: 'ONING CORP 2322 W.'78 ST . 33016. 'HIALEAH THIS: IS : NOT A BIL[. -:DO NOT PAY .` • AtENEWAI r; . . . &ECEIPi;sO:; • 5078:04-3 ...stATE8 'ex:08421 :'.c` OWNER A & P AIR CONDITIONING „CORP Sec. Type .of:Busines8:. 196 SPEC • :K IIECHAN:CAL .CONTRACTOR . THIS I8 ONLY A. LOCAL 8U8NE8S TAX RECaiT. IT DOES NOT PERMIT 1IE! HOLDER TO VIOLATE ANY E108nNG REGULATORY OR ZONING 'LAWS OP THE COUNTY OR.CIRES. NOR '!O OER. PROF! ANY OT EN ;PERAsT;` RBOI . OR LICEN N EDGY LAW. THIS 18 'NOT A CERTIICATION OP ; THEE NOt0EWS OUALIFICA- 1, FAYi ENT,:RENWIM COWRY TM 074Q51.0.11. 419Oio94Z'001 `0000045.00 SEE OTHER SIDE • 'Ffp9T -CEASE , POSTAGE: ::..MIAMI; Fi'.? "pERNOTNO.,231 • DO NOT FORWARD A & P AIR CONDITIONING CORP ADRIAN F GONZALEZ PRES 2322 W 78 ST HIALEAH FL 33016 11111111111111111;111 1111 11111 / 1;11111a1$11111111 111111111e Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 1360 NE 103 Street Miami Shores, FL 33138- 1132050300070 Block: Lot: NICAMERICAN INC 1 Owner Information Address Phone Cell NICAMERICAN INC 150 SE 2 Avenue MIAMI FL 33131- 150 SE 2 Avenue MIAMI FL 33131- Contractor(s) Phone Cell Phone A&P AIR CONDITIONING CORP 305 - 556 -7849 Tons: Additional Info: Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 1 Date Approved: : In Review Type of Work: MECHANICAL Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $6.60 $5.35 $5.35 $2.20 $356.72 $3.00 $8.80 $388.02 Pay Date Pay Type Invoice # MC-9-11-42122 10/06/2011 Check #: 102 09/26/2011 Credit Card Amt Paid Amt Due $ 338.02 $ 50.00 $ 50.00 $ 0.00 Available Inspections: 1 Inspection Type: Ventilation Final Hood Rough Duct Underground In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. October 06, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy ate October 06, 2011 1 P Miami Shores Village P'Building Department 0 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. Master Permit No. 11-1589 Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): N 1 me l �l can SAC Phone #: '��� � Address: 150 5E Z /'ht Stt 1010 _ City: %i 1 Q M► State: r L Zip: 35131 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 131.00 OE 103 6t City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 11-3205- 030-0010 Is the Building Historically Designated: Yes :Z1 NO Flood Zone: CONTRACTOR: Company Name: A 4 9 Air Cond i h Onirq Phone #04�� a 4)—'1849 Address: 2311. 1w) 98 Sf `J City: -4i%Lif State: L Zip: 33 0 l to Phone #:(305) 55(.0 —984 K • 14 Qualifier Name: Actri an r • (,"I Q - State Certification or Registration #: Certificate of Competency #: Email Address: In40 �1rCA� �J1►h0 (11 _ co Contact Phone #:(30,5)5910 -18 AEI X. d DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ /019z • 00 Si uare/Linear Footage of Work: 909 Type of Work: ❑Address Alteration (]N; _ Repair/Replace / ODemolition Description of Work: ******** **** * ** *** * ** ********* * * * *** *** Fees m****�x�xu** **a:****�x�x* * * ******* * *** Submittal Fee $ Permit Fee $_ 5671-7 �C F $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ CkZ) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature. Owner or Agent The fi * oing * nstrument1was ackn day of 11 h , 20 11 , b 1 ed before I 1 this�_� who is . rs ally knovYlm to me or who has produced s identification and who did take an oath. NO A ' ' UBLIC: , Sign: Print: My Commission Expires: Signature Con or The foregoing instrument was acknowledged before me this I =J y of 6epiltrAbei, 20 IL, by who is personally known to me or who has produced s identification and who did take an oath. BLIC: APPROVED BY NO Sign: Print: My C * * * * * ** * * * * * * * * * ** * * * ** / Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) 1 'expires: •11r A i r ) e�•.,,, � ARIAM PAEZ Notary Public - State of Florida ,ter My Comm. Expires Aug 10, 2014 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ✓ COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. ✓ COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. ✓ COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: A a 9 W COndlii0(013 3 Corp. BUSINESS ADDRESS: 2,312, W '1 S st CITY al-el STATE fL ZIP CODE 330 t to BUSINESS PHONE: ( 305) 5a0-1849 FAX NUMBER (305) 55te -816U CELL PHONE ( ) QUALIFIER'S NAME: AdI"CV\ F • (lOn QUALIFIER'S LIC NUMBER: (1 514 -OOto - 99- 220 - 0 E -MAIL ADDRESS (IF APPLICABLE): into C� aQa►rco Or . C.OM Created on 3119109 BY MLDV 1 RV 3126109 MLDV �����Y�r A`.- -- CERTIFICATE OF LIABILITY INSURANCE 020/2011 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 poltcy(fes) 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 Ileac of such endorsement(s). PRODUCER Frank 11. Furman, Inc . 1314 East Atlantic Blvd. P. 0. Box 1927 Pompano Beach FL 33061 ACT Laura Buratt No. Ext): (954) 943-5050 1 Fw°�c. Not: (954) 942 -6310 a Laura @furmaninsurance.com it 000006891 CUSTOMER ID INSURERS). AFFORDING COVERAGE NAIC 0 INSURED A & P Air Conditioning Corp 2322 West 78th Street Hialeah FL 33016 INSURER A:First Specialty Ina Corp 34916 mum: a:Phoenix Insurance Co (tl) 25623 INSURERC: 6/23/2012 INSURER D: $ 1,000,000 INSURER E : $ 50, 000 INSURERF: CLAIMS -MADE I X COVERAGES CERTIFICATE NUMBER:11 -12 GL, Auto, Umb REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS 18 TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH TYPE OF INSURANCE OF PERTAIN, POLICIES. ADM INSR INSURANCE SWVD LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN POLICY NUMBER ISSUED TO CONTRACT THE POLICIES REDUCED BY fAtlJIrOQI THE INSURED OR OTHER DESCRIBED PAID CL.AIIMS. 1 %1 TY 1 NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS INSR A GENERAL X UABIUTY COMMERCIAL GENERAL LIABILITY I OCCUR $5M IRG15211 -1 6/23/2011 6/23/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50, 000 CLAIMS -MADE I X MED EXP (MY we P $ =MUDEn X Per Project AOG PERSONAL & ADV INJURY $ 1,000,000. X Prior written contract GENERAL AGGREGATE $ 2, 000, 000 GERM AGGREGATE APPLIES PRODUCTS :dDMPA3PAGG $ 2,000, 000 f�L1CY PRO- 8 AUTOMOH1LE UABIU1Y ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS BA3953R45A 6/23/2011 6/23/2012 C0IADINED SINGLE UNIT (Ea aociderrn) $ 1, 008 , 000 BODILY INJURY (Per person) BODILY INJURY (Peracc dent) $ PROPERTY DAMAGE (Per accident) $ X X $ $ A X UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE IRE15212 -1 6/23/2011 6/23/2012 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AW EMPLOYERS' uAalLITY ANY PROPRIETO PARTNNEERE CUTIVE Y� OFFICEFUMEMBER (Mandatory pt NH) If yy�� �sscctibe urnier DESCRIPTION OF OPERATIONS be ow NIA TORY UbiU- I I ()TH- E.L EACH AC{2DENT 6 E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION Of OPERATIONS 1 LOCATIONS f VEHICLES (Attach ACORD 101. Addlfwral Remarks Schwa, B more apace N required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Northeast 2nd Avenue Miami Shores, FL 33138 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 Frank Furman, Jr /LB ACORD 25 (2009/09) 'N8025(200909) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD /", IV I,LTM CERTIFICATE OF LIABILITY INSURANCE DATE(61MIDEVYYYT) 04/07/2011 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 Ileu of such endorsement(s). PRODUCER Insurance Office of America, Inc. 100 NE Third Avenue Suite 850 Ft. Lauderdale, FL 33301 CONTACT Bob Mihm NAME: WC, No, Erg: 954- 318 -1379 orc ,N,t:954- 318 -1383 EMAIL ADDRESS: PRODUCER CUSTOMER ID 0: INSURER(S)AFFORDINGCOVERAGE NAIL/ INSURED A & P Air Conditioning Corporation 2322 West 78th Street Hialeah, FL 33016 -5526 INSURER A: Insurance Company of the West OCCUR INSURERB: INSURERC: INSURERD: EACH OCCURRENCE INSURER E : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER F : COVERAGES CERTIFICATE NUMBER: 11 -12 WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IN R SUBR POLICY NUMBER FOLICYISFF (MMIDOIYYYY) POLICY EXP (MM/DDIYYYI) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE MED EXP (My one person) $ GENII n PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ AGGREGATE LIMIT APPLIES PER: POLICY n FjER8i n LOC PRODUCTS - COMP /OP AGG $ $ 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) $ (Pena DAMAGE $ $ $ UMBRELLALIAB EXCESSLIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS EERSCOMPENSATION RRIETOR EXCLUDED? ANNYICE P (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y/N N/A WFL 500093602 01/01/2011 01101/2012 X T RYLM S ER E.L. EACH ACCIDENT $ 1, 000, 000 CUTIVE below E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, AddElonal Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Mi ami Sho res Vi 11 age 10050 NE 2nd Avenue Mimi Shores , FL 33138 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 ... Robert Mihm/TRICIA ACORD 25 (2009109) 01999-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Miami Shores Village Building Department M@MEWY..git La NOV 1 8 2019 IN 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 B Y: Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATI ©N FBC 20 Permit No. VG (1- fl(4 - Master Permit No. Permit Type: MECHANICAL OWNER: Name (Fee Simple Titleholder): C a mti K G( J Tn C. Address: 5-0 36CG YR V1vd 43QC City: M 1QM1 State: �- Tenant/Lessee Name: Phone #: Phone #: Zip: 33 1 37 ,,, Email: JOB ADDRESS: 13(J 0 N) C_ 03 St( Q f City: Miami Shores Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: County: Miami Dade zip: 53 1 38 CONTRACTOR: Company Name: A41 P P! CO nctiitiont ( Phone #: Address: 1322. W rif3 St City: l\ oJvc, �a V r State: C Qualifier Name: 11 i .1a r\ C - Co nt,G_k-?- Phone #: State Certification or Registration #: CA C953-842:7 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Zip: 3301 l9 3 ®s n-(19 ` / 4 `i Value of Work for this Permit: $ 3, 500 Square/Linear Footage of Work: Type of Work: DAddress DAlteration ❑New epair/Replace DDemolition Description of Work: p1U ('Q► «p Pil ( some_ oq stir) du L. 4- v-\3- iwtCction oi 4 ne) extrIciuSt la its . ******* **+ a**** *•x*m*****m+x*** ****** ***** Feesm*************** ********* ** * *********a:** ** ** Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ^ m \\\11/12 C19 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature�,� — Owner or Agent 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: NOTAR Signature C .— Contract`s The foregoing instrument was acknowledged before me this act day of '01�rit, 20 11 , by who is personally known to me or who has produced as identification and who did take an oath. Sign: Sign: Print: Print: My Commission Expires: MARIAM PAEZ ar P -lic - State of Florida 110 ht,r, Alit Expires Aug 10, 2014 My Commission Expires: o I Zol4 **** ** ****xJ**** ****** * * ***s:*aJ*+x ****Jsa *** *** .11/ ******* *a: ** ***xJxJ+ xsJ*m **** *****s= xJ*+ nxJ*ox* *ss***xJ*xJxJ**+xa<aa**** APPROVED BY (� `"' " _ Pldns Examiner Zoning (Revised 07 /10/07)(Revised 06 /10/2009)(Revised 3/15/09) Structural Review Clerk