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DS-09-1611 (2)Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 145851 Permit Number: DS -10 -09 -1611 Scheduled Inspection Date: June 14, 2010 Inspector: Bruhn, Norman Owner: LOPEZ, MAIKEL Job Address: 117 NE 103 Street Miami Shores, FL 33138- Project <NONE> Contractor: CBJ CONSTRUCTION, INC. Permit Type: Driveways /Sidewalks /Slabs Inspection Type: Final Work Classification: New Phone Number Parcel Number 1121360130810 Phone: 561 - 756 -4884 Building Department Comments circular driveway in front of property with pavers Inspector Comments Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. eetir June 11, 2010 For Inspections please call: (305)762 -4949 Page 20 of 29 Project Address Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Expiration: 05/30/2010 Applicant 117 103 Street Miami Shores, FL 33138- 1121360130810 Block: Lot: MAIKEL LOPEZ Owner Information Address Phone CeII MAIKEL LOPEZ 19891 24 Avenue AVENTURA FL 33180- Contractor(s) CBJ CONSTRUCTION, INC. Phone CeII Phone 561 - 756 -4884 Valuation: Total Sq Feet: Approved: Yes Comments: NEW CURB CUT ON NE 103RD STREET REQUIRES APPROVAL OF MIAMI -DADE COUNTY BEF( Date Approved: 11/25/2009 : Yes Date Denied: 10/1/2009 Type of Work: DRIVEWAY Bond Retum : Additional Info: PAVERS Classification: Residential Fees Due CCF Education Surcharge Permit Fee Permit Technology Fee Scanning Fee Submittal Fee Submittal Reversal Fee Technology Fee Total: Amount $4.20 $1.40 $150.00 $0.00 $3.00 $50.00 (850.00) $5.60 $164.20 Invoice# DS -10-09 -36014 DS -10-09 -36014 Total Amt Paid Amt Due $ 16420 $ 50.00 <11420 $ 164.20 $ 164.20 $ 0.00 $ 7,000.00 For Inspections please call: (305)762 -4949 Available Inspections: Inspection Type: Final Sidewalk Landscaping Foundation 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. January 15, 2010 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date January 15, 2010 1 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 noticeof 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 occur seven (7) days after the building permit is issued. In the abs nce of such posted notice, the inspection will not be approved and reinspection fee will be charged.. 1.0.r VIVA d Signature or Agent The foregoing instrumen was acknowledged before me day of C( 20 ,by moo k cope-z, , who is personally known to me or who has producedL. nu no As y , aA tion and who did take an oath. NOTARY PUB IC: Sign: Print: My Commission Expires: Signatur Contractor //- The foregoing instrument was acknowl edged before me this (O day of d1;11C1f , 20 10 , by &t Y rutii LOLuakisty who is personall as produced as identification and who did take an oath. NOTARY PUBLIC: MY COMMISSION # DD765737 EXPIRES March 05, 2012 (407)340153 FloridallofarySsrvice.com ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** **************************** ** **************:F ************t **************** APPROVED BY //19C-C9' • Plans Examiner N►/ VW/ Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked Miami Shores Village Building Department RECEIPT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 PERMIT #: DS - 10'09 - jail DATE: 12-1 Ik\ fo 9 I, 2-4-?,0 /c- COAPA7 ),( Contractor ❑ Owner ❑ Architect Picked up 2 sets of plans and ( Address: 1 t-1 I �. a calcii w cc S►6N 103 ST 'lc� From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: -e,A„. RESUBMITTED DATE: Ol L VIOI 1 O PERMIT CLERK INITIAL: 1ami Shires Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305);7563972 INSPECTION'S ' _: ® NE NUMBER: (3 762.4949 BUILDING PERMIT APPLICATION ¥'BC 20 ermit No. D -ID °" 0°1-411 Permit Type: BUILDING ROOFING Permit No. Owner's Name (Fee Simple Titleholder) MAU4G i. URGZ. Phone ,# Owner's Address i =1"`7 Ne 05 5 -T. City M I fkMt S doges State L✓ . Tenant/Lessee Name Phone # Email Irpez i 4.e i c o1a coryi Job Address (where the work is being done) 1.1 N t o City Miami Shores Villi ge County Miami -Dade Zip FOLIO / PARCEL. # ' It c3.1 3 (P - do t a Ot5i0 S - 4°i a - i 5 o Is Building Histoxieal y Designated " YES- Contractor's Company Name Contractor's Address 5i° Flood Zone City Qualifier Name State Certificate or Registration No. 'Contact Phone: Phone # fiicate of Competency Architect%Engineer's Name (if applicable) Phone #_, Value of Work For this Permit $ X00'. 1 Type of Works: ❑Addition °Alteration Describe Work: Cl R.C.,U - 1\1 ewP itUtt1 t ?Av+S.- e / Linear Footage Of -Work: i "100 Repair/Replace ❑ Demolition -r pir cw * * * * * * *** *** b' Submittal Fee * * * * * * ** *** * * ** mit Fee $ CC 4 DO CateCS- Notary $ Training/Educ ation Fee $ l • Technology Fee $ (00 Scanning $ Radon $ DPBR $ Bond $ Doaible Fee $ Violation date: Structural Review. $ Total Fee Now Due $ .- •� See Reverse side --* Boring Company's Name (if applicable) Bonding Company's - Address City State dip 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 firmed to meet the standards of all laws regulating construction in this jurisdiction, . understand that a .separate permit muatbe secured for ELECTRICAL WORK, , PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and MR CONDITIONERS, ETC... that all work will be done in compliance with all OWNER'S AFFIDAVIT: I certify -t iataii the foregoing information is accurate applicable laws regulating-construction and zoning. "WARNING TO OWNER: COMMENCEMENT MAY RES IMPROVEMENTS TO YOUR PROPEI FINANCING, CONSULT WI'fl{ YOUR LENDER. RECORDING YOUR NOTICE OF COMMENCEM; RECORD A NOTICE OF PAYING TWICE FOR INTEND - TO OBTAIN ATTORNEY BEFORE Notice to Applicant: ; As a condition to the issuance of a bill permit with an estimated value exceeding- $2500, the applicant must promise in good filth that a copy of the notice,of commencement and coast tcton lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of ihe`recorded notice of commencement must be posted at the job site for the first inspection which , seven (7) days after the build ng permit is flitted. In the abseirce of such posted notice, the -" pecticn fee will be chrtrged, inspection will not be approved Signature Signature Contractor ntg instrument was acknowledged before me this by own to me or who has produced as identification and who did take an oath. NOTARY-PUBLIC: i r or A.g The foregoing instrumen was acknowfedgedfore trre day of c (, .. , 2 , by ;,t who is personally knovm to me or who has produced ilD NOTARY PUB The forego, day -who ispersvt Sign: Print: My Commission Expires: * * * * * * * * ** * * **x ** ****** *** * *** * * * *, Sign: glint: My Commission Expires: APPROVED BY. Plain *** * * * * * * * * * * * ** 1/0/767 Zoning Clerk checked (Revised 07 /10/07-XRevisers•:' BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2009 THROUGH SEPTEMBER 30, 2010 DBA: Business Name: CBJ CONSTRUCTION INC Owner Name: BARNEY H LOWENSTEIN /QUAL Business Location: 455 NE 17 AVE FT LAUDERDALE Business Phone: Rooms Seats Employees 2 Receipt #: 180 -4763 Business Type: GENERAL CONTRACTOR CONTRACTOR) Business Opened: 02/05/2002 StatelCountylCertlReg: CGC 058874 Exemption Code: NONEXEMPT Machines Professionals For Vending Business Only Number of Machines: Vending Tvae: (GENE Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: CBJ CONSTRUCTION INC P 0 BOX 7213 FORT LAUDERDALE, FL This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 33328 Receipt #013 -08- 00000852 Paid 09/24/2009 27.00 1 STATE OF FLORIDA, COUNTY OF DADE /HERESY CERTIFY tat this tip true copy of Me Mod in on I of , A.D. 20 TNESS my hand and Mal Seal. HARVEY By NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 111111111111111111111 CFN 2009- R088212° OR P.k 27111 Ps 04911 (1Ps) RECORDED 12/10/2009.11 :21:17 HARVEY- RUVIN► CLERK OF COURT MIAMI- DADE- COUNTYr- FLORIDA LAST F'AGE 1,rLegal description of property and street/address: A*11 /StAchea&` . Ste- S 'i 6 'd 1.-oT t4- o 1I, tat cb 6L44 2. Description of improvement: (MICA. 60E4, '9'L •i1g 147b744-1-0011:44) 3. Owner(s) name and address: 'CAM Id-r,.."14 310 Interest in property: Name and address of fee simple titleholder: 55 14. hfir 4. Contractor's name and address: C. 1 Coos e. •4.0.tiA-) 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: 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 and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of thi Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is, pecif d) 402riP 11 Print Owner's Name M 1 - 1 . - - LOP i . Prepared by Al Z.41 Sig at a of er Sworn to and subscribed before me this 4k day of tVQ i Q.r , 20A. Notary Public Print Notary's Name Mt, t, t ject t,Q lD , IQ en My commission expires: Q 3‘0:6\11% 123.01 -52 PAGE 8/02 Address: St." Srt Cr,�xr fon1skao best, FL 33 1760 ADYLLANE DA:SILVA �*c MY COMMISSION # DD765737 EXPIRES March 05, 2012 407) 09'8-0103 FbddallofaryServlca� VILLAGE OF MIAMI SHORES OWNER BUILDER DISCLOSURE STATEMENT NAME: MAI1LBL- LOPE- ADDRESS: l� NE L05 5 DATE: I0li /09 NI AM( SHozV-S 331311 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 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 1 hold title to the above and I ____ planning doing • i )nstrue ion /iL 1 2. I understand that as an owner- builder I must abide by all zoning ordinances and building regulations in effect at the time of permit application Initial Initial l 3. I have an understanding of the 2004 FBC & FRC and understand that this department and its inspectors are there to help enforce and interpret the code. There is a copy of the code in this office for review. Initial 4. I understand that the building official and inspectors are not there to design, alter or give advice on how to meet code — only if the structure mee , the minimum code. Initial 13:29 JAN 06, 2010 FR: STACEY SWEENEY #56622 PAGE: 2/2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 1/6/2010 TYPE OF INSURANCE PRODUCER Affiliated Agency Ops 16 South River Street Wilkes- Barre, PA 18702 Tel: (800) 673 -2465 Fax: (570) 820 -7968 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # gmployee Leasing Solutions, Inc. Phone: (941) 746 -6567 1401 Manatee Ave W. Suite 600 Bradenton, FL 34205 1 INSURER A: EastGUARD Insurance Company 14702 INSURER B: INSURER C: INSURER D: $ INSURER E: DAMAGE TO RENTED PREMISES (Ea occurence) COVERAG 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRr TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE DATE (MM/DD/1 Y POLICY EXPIRATION DATE (IMINI/DD/YYI LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurence) $ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG POLICY I I JJEE?r 7 LOC - $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea acddent) $ SODIL $INJURY BODILY INJURY (Per acddent) $ (PPReO acddent) DAMAGE $ GARAGE L4 .BUJTY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ _ _ EY SS/UMBRELLAIII.ITY L OCCUR I I CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIE�TTQpR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes describe under SPECIAL PROVISIONS below EMWC109947 01/01/2010 01/01/2011 77�� p X I TORY LAMITS I ER E.L. EACH ACCIDENT $1 000,000 E.L. DISEASE - EA EMPLOYEE $ 1.000.0DO E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER Client ID: #4145066 * Valid in the State of Florida * DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS p COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF: EastGUARD Insurance Company CBJ Construction Inc carries an A.M. Best Qualifiers Name: Barney Lowenstein Rating of A- (Excellent) and a financial size Flnenmtak Strength Aprox active employee count: 1 'ir-la Category of VIII A- Exnaallent nrnrlct,.w rn 1 .n. e.e■• CANCELLATION Miami Shores Village 10050 NE 2nd Avenue El Portal, FL 33138 ACORD 25 (2001/08) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTAT / 0 ACORD CORPORATION 1988 01/06/2010 13 :09 9417231440 A RA CERTIFICATE OF LIABILITY INSURANCE HERITAGE INSURANCE PAGE 02/02 DATE (MM/DD/YYYY) 1/6/2010 PRODUCER (941) 723 -1400 FAX: (941) 723 -1440 Heritage Insurance Services 1009 10th Avenue West Palmetto INSURED CPO Construction Inc 455 NE 17TH AVENUE FL 34221 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # FORT LAUDERDALE FL 33301 INSURERA:Americ n Safety Indemnity Co 25433 INSURER B: INSURER c: INSURER D: INSURER E: COVERAGES THE ANY MAY POLICIES. LTR POLICIES REQUIREMENT, PERTAIN, NERD OF INSURANCE LISTED BELOW TERM OR CONDITION THE INSURANCE AFFORDED AGGREGATE LIMITS SHOWN MAY • HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE OF ANY CONTRACT OR OTHER DOCUMENT WITH BY THE POLICES DESCRIBED HEREIN IS SUBJECT HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER �OUCY EFFECTIVE PATE (MM/DO aCal FOR THE POLICY RESPECT TO WHICH TO ALL THE TERMS, POUCY EXPIRATION DATE (MM1D0/YYYYt PERIOD INDICATED. THIS CERTIFICATE EXCLUSIONS AND CONDITIONS NOTWITHSTANDING MAY BE ISSUED OR OF SUCH rs 1,000 000 TYPE INSURANCE , LIMITS EACH OCCURRENCE A GENERAL LIABILITY COMMERCIAL GENERAL LIABLITY 156A0x81o9S -00 1/25/2009 . 1/25/2010 X PREMISES occurrence) , $ 100,000 _ r, j CLAIMS MADE X OCCUR _...�.....__ MED EXP (ArT are person) $ 5 , 000 $ 1 000 r 000 PERSONAL S ADV INJURY GENERAL AGGREGATE $ 2,000 000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000�OOO POLICY PRO- n LOC — AUTOMOBILE " " — 1.— LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS - COMBINED SINGLE LIMIT (Ea accident) $ POeDILY INJURY $ $ BODIL (Per edil )RY -- PROPERTY DAMAGE (Pet accident) $ - GA RAGE { UABILI l T ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY; AGG $ �-'11 _.. $ EXCESS _ .w 1UMBRELLALABILITY EACH OCCURRENCE $ OCCUR I I CLAIMS MADE AGGREGATE S DEDUCTIBLE RETENTION $ - $ _ _ ( 1 —•— __.....,.._ . WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (mandatory Eyes, describe SPECIAL PROVISIONS COMPENSATION LIABILITY W!, $TATU- OTH- I TORY .JLAAS I ER $ $ 8 „ rY•/� EXCLUDED? EL EACH ACCIDENT In NH) under bnlcw E.L DISEASE - EA EMPLOYE EL DISEASE POLICY LIMIT 1 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXGLU8lON$ ADOD BY ENDORSEE/ENT/ SPECIAL PROVISIONS General Contractor r!I`RTIGIfATI un1 rtes (305)756 -8972 Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 ACORD 25 (2009101) INS025 (200901) ION SHOULD ANY OP THE ABOVE DESCRRIED POLICIES S$ CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE OERTII°ICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OSUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORRED REPRESENTATIVE David Clements /LINDSA m 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 5. I understand that as an owner - builder, that any contractor disputes with sub- contractors and myself must be handled in a civil court with the advice of an attorney. The department will not mitigate any contract disputes. Initial 6. 1 understand that if I compensate any person or company for work performed they are required to have a business license in the county. If for any reason they do not posses a business license I will be responsible and liable for any wrong doing from this unlicensed company or person. 7. I understand that if any person gets injured on my construction project—they are entitled to workmen's compensation. And if they do not posses a workmen's policy I could be held liable for all doctor and related cost which could include loss of wages during recovery from injury. Initial 1 / /,/A. 8. I understand that under state and local laws I can not do any ectrical, Plumbing, Heating, Air & Roof work on my property with out first obtaining the proper permits by licensed contractors. Was acknowledged before me this T day of 4.2 4 , 20 0 By nla \ who was personally known to me or who has Fq191_- Produced there License or as identification. NOTARY Miami Shores Village 10050 Northeast Second Avenue Miami Shores, Florida 33138 -2382 Telephone: (305) 795 -2207 Fax: (305) 756 -8972 www.miami shoresvillage,com COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, M Pr i , hereinafter referred to as the Owner of the following (owner) described property: 111 ki r= > 1 03. Legal description/folio#: 11- 2-1 3 (' + 01 7- — 0 10 Lot 11 w VZ L.-©T' 13 Block 1 Z-Z_ Tax Folio #: 11- 13(Q- 17-) —©csi U Requestss/permission to install: t9/ Asphalt, concrete, brick pavers ❑ Landscaping ❑ Other Within the public road right of way of 111 N.) ►��- Subdivision 1 C ST • (address) IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1. To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, AND DELIVERED in the presence of: SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this . 1-i day of all1 4 /L_ � i 11. p� "4'1V�4� Barbara M. Gonzalez ..• P, Commission #DD483646 : OCT. i19, 2009 Miami Shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: '6:7 7 /6/1 DATE: 8 - 7dy I, M Pr % I(.- L L-OP� Contractor 'Owner Architect Picked up 2 sets of plans and (other) le•t... Address: 41.414 From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continu- permitting process. Acknowledged by: i A4lifLeAl PERMIT CLEARK INITIAL: r RESUBMITTED DATE: C L� SUBMITTED DATE. r V PERMIT CLEARK INITIAL: 11\.1.) Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Issue Date: Not Issued Permit NO. DS -10 -09 -1611 Not Expires: Folio Number:1121360130810 Owner's Name: DENNYS GONZALEZ Owner's Phone: Job Address: 117 103 Street Total Square Feet: 1100 Miami Shores, FL 33138 - Total Job Valuation: $ 7,000.00 ..............E <E <.......... Contractor(s) Phone Primary Contractor ..........._.....>:...,,,.,,.. any... z,,......<.✓. ��..,. ...,......::4••.t:�..... ✓...... .... .. . ?:vii;. :'r..:••....... ........ .•. ... < }•. Planning and Zoning Criteria and Comments Approved: No Date Denied: 10/1/2009 Comments: NEW CURB CUT ON NE 103RD STREET REQUIRES APPROVAL OF MIAMI -DADE COUNTY BEFORE LANS MAY BE REVIEWED BY MIAMI SHORES. DRIVEWAY CAN NOT EXCEED 12 FEET IN WIDTH INCLUDING AT CONNECTION WITH EXISTING DRIVEWAY AND SIDEWALK CAN NOT EXCEED 3 FEET IN WIDTH Permit No: 09- /e // Job Name: /ar5 , 2009 Miami Shores Viiiage Building Department Building Critique Sheet GC7ilr :r �,�4ilo��z% i� 4 ce h•cC� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Aiier Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 PIann a d ono • er a Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit NO. DS -10 -09 -1611 Issue Date: Not Issued Expires: Folio Number:1121360130810 Owner's Name: MAIKEL LOPEZ Job Address: 117 103 Street Miami Shores, FL 33138- Owner's Phone: Total Square Feet: Total Job Valuation: 1100 $ 7,000.00 Contractor(s) Phone Primary Contractor Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 11/25/2009 : Yes Comments: NEW CURB CUT ON NE 103RD STREET REQUIRES APPROVAL OF MIAMI -DADE COUNTY BEFORE LANS MAY BE REVIEWED BY MIAMI SHORES. DRIVEWAY CAN NOT EXCEED 12 FEET IN WIDTH INCLUDING AT CONNECTION WITH EXISTING DRIVEWAY AND SIDEWALK CAN NOT EXCEED 3 FEET IN WIDTH 11/25/09 MIAMI DADE APPROVED CURB CUT Charlie Crist Governor NOV IMCMUViTI ig 2 5 2009 L BY: Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General October 21, 2009 (All Pro) 117 NE 103 St Miami, FL 33138 RE: Contingency Letter Application Document No: AP939803 Centrax Permit Number. 13- SC- 1006474 OSTDS Number: 117 NE 103 St Miami, FL 33138 Lot: 18 Block: 122 Subdivision: Miami Shores Dear Applicant: This will acknowledge receipt of an application dated 10/20/2009 for a permit to u onsite sewage treatment and disposal system located on the above reference There is no increase in sewage flow, no change in characteristics compromis function of the system. From a review of your completed application, it has been determined that yo adequate for the proposed use.. This permit is granted for construction of a driveway that will have no impa area. • • • • If you have any questions on this matter, please call our office at (786) 315 -2444. Enclosures cc: Sincerely, • •. • • • • • • • • 00000 • • • • • • • er, E ERM T # APPROVED pecialist II • Miami Shores Village ZONING DEPT BLDG DEPTd DATE SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS Miami -Dade County Health Department 11805 SW 26 St, Miami, FL 33175 Phone: (786) 315 -2444 Fax: (786) 315 -2090 SKETCH OF SINIVEY r = 2049' riPinlifgELIIM ( loaf 14 1 • • • • • • • .. ,AL8..,,p,e D COUNTY 11 MR "fey itaw o o 1 -r:e.t;" WA C r .s a..:�•�v <.. • •• ••• .. • .. • • ... .. • ••. • 0.0 ... • ... • 000 • • 0• ... • •••• o m ; • aQ''4 • A^ � A L a-a • • • • •. • •. • a MIAMPDADE ritett COUNTY miamidade.gov Permit#: Date of Issue: Date of Expiration: Extended To: PW#: Work Order #: Permit Status: Description of PUBLIC WORKS DEPARTMENT 2010001004 11/20/2009 11/20/2010 Open Work: sfr Comments and Conditions: BARNEY LOWENSTEIN PO BOX 7213 FORT LA17DERDALE/FL/33338 Qualifier #CGC 058874 JOSE LUIS RODRIGUEZ 954-782-4600 117 NE 103RD ST TYPE OF WORK cess No. UNIT AkW QUANTITY COST SIDEWALKS LF 10 $160.00 CONCRETE APPROACH ONLY APR 11 . $100.00 NON-REFUNDABLE FEE FOR PLANS AND SPECIFICATIONS EA • a • • • :"4" $30.00 *4100 •• • ,T@TAL. $290Npo ••• • .2ratLTAIWNZI40....1 7,112,202SMS.,E0- ...gmawmamearatrzeirent.k....NA BARNEY LOWENSTEIN a,LNIVOSMEONNWSW7' •0100 *0 Acknowledges the sum of $290.00 . dollars in payment of this permit, and it isflupeersto:dstid • • • •••• • agreed that all work to be done hereunder will be in accordance with the requirem17::t this, ofro . •• 000 • • 00 • o• The work herein described and permitted is to be commenced and completed within ti/tie department. reference time frame. • • .....441,•: • ••• :i • • • • 24 hour notification shall be made to Miami Dade County Public Works Department, phoNa,305-3,3h2135 when • work for which this permit is granted is ready for construction. This permit is isAleesubjeptote actuVecedlc being done by a contractor properly certified by the CONSTRUCTION TRADES QUALIFYING BOARD. I-noecetpting this permit, the permitee agrees to hold thereof harmless from payment of any compensation or damages, resulting from his exercise of the privileges granted under this permit. Construction must be in accordance with the approved plan, and/or to recorded portions of the Public Works Manual. All required Traffic Control devices must be installed prior to placement of asphalt surface. Inspection can be requested online at www.miamidade.gov/pubworka/ Inspection Date Passed Failed Comments pertb_permit THIS PERMIT MUST BE KEPT ON THE JOB SITE Issued by: LUGO, MIGUEL A Contractor Copy THE PERMITTEE and /or HIS CONTRACTOR SHALL: 1. Prevent the creation of any obstructions or conditions that may become dangerous to the traveling public, and provide, where necessary, adequate signs, barricades; .warning lights, flashing arrows boards, flagmen and /or other necessary precautions for the prevention :of-aecideht-snrinjuries to persons -or property result- ing from his exercise -of the privileges granted under this permit: 2. Notify the local police department if lane of travel will be blocked more that two hours. (Section 336.048, Florida Statutes 1986) 3. Repair promptly any damage or injury to roads, driveways or other paved surfaces caused by his exercise of the privileges granted under this permit. Restoration shall be equal to or better than the condition existing at the time of damage or injury. 4. Move or remove, at the expense of the Permittee and/or owner, any utility as may be required for public convenience whenever specified by Miami -Dade County in the event of any future widening, repairs, instal- lation, construction, or reconstruction by or for Miami -Dade County of any road, bridge, canal, culvert, traffic signal, street light, water, sewer, storm drainage system or any other County facility within the public right- of-way in which the Permittee and/or Owner has constructed said utility. • • ••..•• .. • • • 5. I>zgba+ll i�emporai asphalt patches prior to opening area to any traffic. • $. Pnov de;not 1GsS•th'an 48 hours notification to all owner, of existing facilities in the proposed area of work. • • :• • IN•ADDITIO ;iig Permitted and/or his contractor, alpng with owner of the utility must cooperate • etiernine thc.exact location (field exposure as warranted) of the respective utility facilities, by what- •• ever cleans.av�rltib '* • 11•• • • • • • ••••• 3. Obf tm r ecess rp eAement where required right = of- way has not been dedicated. • • • • • •••• 8. All permit fees include the costs of inspections and any applicable engineering and material testing procedures. However, the costs of additional testing, due to the failure of the Permittee and/or his contractor in achieving the County's specification requirements, will be the sole responsibility of the Permittee and/or his contractor. 9. The maximum allowable time for right - of-way restoration for permits issued to private companies shall be 45 days from the date construction commences, in accordance with Miami -Dade County Ordinance No. 03 -89. 10. Comply with current FDOT Roadway and Traffic Design Standards, Index No. 304 and No. 515 for ADA compliance. Use "safety yellow" as the contrast color for the truncated domes detectable surface area. ;ter I SKETCH OF SURVEY SCALE r- 20,00' ` & . IEMK .r . 6.42 w #41.4,1 0M, . tip wz o,Os N Ott "14.6 ftaf4a 0144.. •••• • • •••• •••••• • • •• •• OOOOOO • • • • • • ••• •••1..• • • 4141. •• • • 00. 00 • • • • • • • ••• • 4100 • • • • •00� •• • • • • •• • • • • • •• • iP /0540'MesO eta t. D Aso x :y 4 S 4: • F Qn (pip DRIVSWA 6 THICK DRIVEWAY H SHALL HICK TO THE NATIONAL FLOOD 11 E SUBJECT PROPERTY FALLS iN PL000 ZOHEI " • ./Z0402 0093 0J" P4 4 ire 8 LOCATION MAP (N.T.S.) µf . I04- 7 12 10 8 7 b 15 1 9 to 21 22 23 — N£ • 103° PROPERTY ADDRESS: 117 NE 103 Street Miami Shores, Florida 33138. • • LEGAL DESCRIPTION: Lot 17 and the West '/2 of Lot 18, Block 122, of `MiAMLSHORES SECTION 5", according to the plat thereof; as recorded in Plat Book 15, at Page 4t,�g% he blip :. Records of Miami -Dade County, Florida. • FOR: MAIKEL LOPEZ & DAVID VALDES. CERTIFY TO: MAIKEL LOPEZ & DAVID VALDES. SOVEREIGN 'M LE & TRUST COMPANY. • OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY. . • REGIONS BANK D/B /A, REGIONS MORTGAGE, its successors na/or assigns, as their interest may appear. SURVEYOR'S NOTES: •••• • • •••• 0••000 • • •• • •• 0000•• • • • 1) 7hle away twee conducted tar the purpose of e BotndwySurvey* only end 18 not intended to delineate the mgriaexyr julodbbn d am/federal, state. runt ar local sway. board. ocnrrre stop mother etty. 2) The aawnerayebtainedby measurements andadrx4ationsanelesurvey, meetsandereeeetmth eMinimumTeotnlos! Standards mequlen18u)m fora Cuban area (1 toot In 7. 800 feel) as specmed h Chapter 81017.6. Florida Administrative code. 6 hie Survey does not rated or delernire ovintesFds• MUMS deecrtpBOn subject to any dsdteelorts. Wnnetior18. reaskaorm reservations oreasement& of record. 6) Esmrrianon& theAbetraddTd teanthairs fobemadeto dsterniner8OOrdedi S8UTIOrda ,taryeffacer*theproperly,eeerdhd Public Records not performed by this ribs 6) tie effort Mt* made bytds cake a beets any underground ul iseex8eretruc lmreewithaorabndtngt hesubject Property 8) Ills away hes been prepared for the ahokaive use of the entitles named hereon only and the aeretioatione hereon do not eh0emd 10 tiny unnamed patties. 8) This sunny was prepared fora Mortgage Trar18eato1 only. Not to be teed for design andorpohmurman plapoems wt18utthe consent d his Gbe. 100) UMW tallies Within Utility Easements not noted es violations. 11) Dui eaeys or portions thereof wimp Roadways not doted as vitiations o enooechmeruan. 12) Foundations situ foams underneath tiegramds rfacethatmayonaeebayordtheboundary1118 •&thebasindescribed parcel are no'ehown. 13) Al Soh Pipes or Reber found end drown en the sketch of surrey trews no caps unless otherwise stated. 14) Fence ownership determine by visual rneera only Of artM legal orehashis not demnrined 16) No swatch of records wee made bythis flan beside** record piaL therefore we do not impact mom responfiblay forany Easement, Dedicates or Limitation for ninth htormatoh was not 4mdehed. 18) carded the appropriate authorities prior to any deals" wok on the lhereon•deeofoed Parcel for 9r/dhg and 2oning irtonm6on. 17) Rnteseiohal Lad Surveyor end Mapperh responsible chew Aplomb ORO LS 4572. State of Reads. 18) This survey Is not vend va hoo to suture and the Maki sad of a Florida Licensed lend Gun/Byer and Mapper. hereby magyto the above tamed tan miler swoons that the 81aesh of Roney& to described proper* la hue and =recta) the best dnyloawtsrge end belief.• srecet lyaua:bedandplatedunder mydrectio abetted meets the MrinrnTechnical Standards set h Chepllr 611017 -8. Florida A47 coda. pursuant to 8adlon 472.027 Ronda Matinee. • •• • • 0 • • .• • ••• • • • •• • • •••• • • •••. • •• • • • ••0•• • • • • ••••• f • • ••••• ••••• • •• • • 00000 • • imegagto - PFiEPAREt3 BY C ' ; 43P "nuNT aR OUi': ° Mwo sum - Ln®r l:t1d144.G () i F.I.P. F050 tp1•�•• P.' F� ' FLIMILA CERIIFICA E. U .141116ZA1I0, j- tBr4507. FORM 411" mum OR0.L mac • • 9350 S w. 22rd 1ERRA'Y' F.N d D NNAL AP0 .. . t-B.S. ANDC MAR STUCCO a/t GTO1 BASIN iIYP) T1PICAL LME 110 0 DIT UNE e PROPERTY UNE CLEAR 8nc. ENCROACH ca.! CHAIN MK FENCE tf.F.' *WO CO/C. CONCRETE C.P. CONCRETE POLE *AA Wen T METER *P. WOOD POLE t.P. LtcNT PRE P.C.P. MANOR CONTROL pl. PPOOOR MTIRSEC11N P.c. POINT OF CDOIENCE Pa POINT OF TANSY us. anon' EASELIENt 0.11.6 YANZTEtuiNCEE EASEMANT DATE. I JOB 1611 FA 1 SKETCH MADER I . FE + PCih DRAWN BY. [[ memo 08.28 169 - /7 9 88 l /6593 1q/6 1 t■lL. MIAMI. FLORIDA 33165 (305) 220-0073 , 6Y R000100:00•Z ;-L$.`4312 01:wRd AR00 l+R11 ` LS 5629 • PROFES t 4Zt. (4145- s1RVEVOR & MAPPEML.. STATE OF FLORIDA.