RC-10-1438Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 149928 Permit Number: RC -8 -10 -1438
Scheduled Inspection Date: August 24, 2010
Inspector: Bruhn, Norman
Owner: GARCIA, ERNESTO
Job Address: 1296 NE 105 Street 2
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ISMAEL DEL ROSARIO
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122320810020
Phone: (786)298 -1213
Building Department Comments
BATHROOM REMODEL
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 23, 2010
For Inspections please call: (305)762 -4949
Page 21 of 35
1
J
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
1296 NE 105 Street Number: 2
Miami Shores, FL 33138-
1122320810020
Block: Lot:
ERNESTO GARCIA
Owner Information
Address
Phone
Cell
ERNESTO GARCIA
1296 NE 105 Street
MIAMI SHORES FL 33138 -2143
Contractor(s)
ISMAEL DEL ROSARIO
Phone CeII Phone
(786)298 -1213
Valuation:
Total Sq Feet:
$ 6,000.00
150
1
Approved: In Review
Comments:
Date Approved: : In Review
Date Denied:
Type of Construction: BATHROOM REMODEL
Stories: SECOND FLOOR BATHROOMS
Front Setback:
Left Setback:
Bedrooms:
Plans Submitted: Yes
Certificate Date:
Bond Retum :
Occupancy: Single Family
Exterior:
Rear Setback:
Right Setback:
Bathrooms:
Certificate Status:
Additional Info:
Classification: Residential
Fees Due
CCF
DBPR Surcharge
Education Surcharge
Permit Fee
Radon Surcharge
Scanning Fee
Technology Fee
Work without Permit Fee
Total:
Amount
$3.60
$0.75
$1.20
$180.00
$0.75
$9.00
$4.80
$180.00
$380.10
Pay Date Pay Type
Invoice # RC -8 -10 -38657
08/18/2010 Check #: 452
08/11/2010 Check #: 450
Amt Paid Amt Due
$ 330.10 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final PE Certification
Drywall
Miscellaneous
Window Door Attachment
Tie Beam
Final
Framing
Insulation
Truss Insp
Columns
Foundation
Window and Door Buck
Fill Cells Columns
Wire Lathe
Declaration of Use
F. Termite Letter
F. Elevation Certificate
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.
August 18, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
August 18, 2010
Date
1
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST
(002-0
INSPECTION
PERMIT NO. 0.10-ittss-rAx 2— FOLIO NO. t122 3
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.
1. Legal description of property and .street/address: 1� `� N3 E
2. Description of improvement:
111111111111111111111111111111111111111111 111
CFN 2010R0560017
OR 8k 27391 Ps 4764; (1Ps)
RECORDED 08/18/2010 13:36 :41
HARVEY RUVI Id r CLERK OF COURT
MIAMI —DADE COUNTY: FLORIDA
LAST PAGE
3. Owner(s) name and address:
Interest in property: 0 (op
Name and address of fee simple titleholder:
4. Contractor's name and address:
0
12 S 2.2-0 s t F 3303
5. Surety: (Payment bond required by owner from contractor, if any) STATE OF FLORIDA, COUNTY OF DADE
!HEREBY CERTIFY that this &3 eaoy c 4 the
Name and address:
Amount of bond $
6. Lender's name and address:
7. Persons within the state of Florida designated by Owner upon whom
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 this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a
differe ,, cified)
Sign • . re o • wner
by
QS,ct� t►, Prepared.
Print Owner's Name i`-�� , "
Sworn to and subscrib e me this !-L day of A/; 20 i' ' f °
Address: /40 Q, K
c 6I1,�33I /
Notary Public
Print Notary' ' ame
My commission expires:
123.01 -52 PAGE 4 8102
iami Shores Village
Building Department •
050 N.E,2nd Avenue, Miami Shores, Florida 331381
Tel: (305) 795.2204 Fax: (305) 756.8972
CTION'S PHONE NUMBER: (305) 762.4949
BUILDIN
PERMIT A
F 2
B� O
g6£'�
'•4
Permit Type: BUILDING ROOFIN
Owner's Name (Fee Simple Titleholder) -fi'N e'
Owner's Address V2M S-
City M }tip I J�li� State
Tenant/F.essee Name
Job Address
City
FOLIO / PARCEL #
Is Building HistoricallyDesiinated
the work is being
Miami Shores Village
Flood Zon
Contractor's Company Name -
Contractor's Address
. Phone # 2d7
�n7es /e,
City 77
Qualifier Name
'State Certificate or Registration
9
Contae Phone 70' �% � :; :;.:' �•�
Aril 1 ec En U sneer s iV ame 1# applicabfie
-Valutzfr.of Work For this Permit $
- TS pe tf Work: E Addition DAlteratiitat
Describe Work: — e /L` a c/ te � ^ '� �� �
Phone #
7
k:+: ix ir:t A-:4 :F7rx• x *x k�rkki: r, ;Fx:4 -k:4 �r it :k *;k Ask :r ic*** ees1:�F�':k:l'•n:I:Y �Y 7��k �r:kki:il-'k-l; :i �F *k:r 7rk�r Jcn k:l :4 cic k;k J:kk :'.k-n -A is
Submittal Fee 5 Permit Fee $
CCF $ CO /C
Training/Education Fee
Scanning $ _ Radon $
Double Fee $ /sir?
DPBR 5
Violation date:
Technology F
Bond $
Structural Review. $ Total Fee Now Due $
See Reverse s
Bonding Company's Name (if applicable)
Bonding Company's Address
City
state:
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
city:
State
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 aper-mit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction, I under'standthat a separate permit moat be seo ed:for.ELECTRICALWORK; PLUMBING SIGNS,
WELLS, POOLS, FtJRNACES, BOILERS; I EATERS, TANKS and AIR GQNtITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all foregoing information is aocrirate and that all work will be done in compliance with all
applicable taus regulating construction and inning,
`WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE :OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWIelt FOR
IMPROVEMENTS 'TO YOUR PROPERTY. IF YOU .:INTEND TO OBTAIN
F NANCI G, 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 $2500, the applicant must
promise in good faith that a copy of the notice :of commencement and construction lien law brochure will be delivered to the person
whose prIver ty i bject to attachment; Also, a certified copy of the recorded notice of cornmencement must be posted at the job site
for the Atki`tn$p Lion which occurs seven (7) days after the. building permit is issued. In the absence of cuch posted notice, the
inspection will not be approted and a reinspection fee will be charged.
Signature
Owner or Agent
Theforegoin, instrument was acknowledged before
day of c 15 20 L(2, by L� 1.F( 7'p.
who is personally known to me or who has produced _ n
p y p rn
t= r/ • As identification and who did t
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
I *, *.** r*kkl,** *** *n*
APPROVED BY
bz
Signature
ntractor.
The foregoing instrument ova acknowledged before
day of AL y' us T 20/0, by -LS oreee.
who is personally known to rite or who has produced
v "l t . - rt., • I as identification and who did tak
z
o vino r
w.�:."" m NOTARY
1)efe..AnteL-'
/ Lo/ 0
Siggn :.
Print; /MOS.-ha-el ;4-
My Commission Expires. See j„ / O Cl 0/ 0
** ***** **:te********* *;' *- k- k-,k ikkh **** xkA• .'r;****ti:4irir*;k:l*ic***k**
Plans Examiner
Engineer:
(Kevised 07 :10;071(Revised 0010:2) ))
Zoning
Clerk checked
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: C
PERMIT # r /O-/43,y
ADDRESS: 1.3e toc t\m-wq
FOLIO NUMBER: FLOOD ZONE:
BASE FLOOD ELEVATION: FREEBOARD: EAST OF FL.CCCL:
COST OF PAST IMPROVEMENTS (12 MONTHS):
COST OF PROPOSED IMPROVEMENTS: 1--006
(ATTACH COPY OF.CONTRACT)
TOTAL CUMULATIVE COST OF IMPROVEMENTS (past and proposed):
VALUE OF PRINCIPAL STRUCTURE (attach appraisal):
OWNERS SIGNATURE:
PLANREVIEWER:
PLAN REVIEWER SIGNATURE: DATE:
DATE:
Created on June 2009
FROM :
FAX NO : Jan. 10 1998 06:04AM P2
STATE OF FLORIDA
DEPARTMENT OFINESS AND PROFESSIONAL RIAATXON
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399.0783
DEL ROSARIO, ISMAEL
INDIVIDUAL
25220 SW 197 AVENUE
HOMESTEAD FL 33031
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.mytoridallcense.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!
tom; r *,.
DETACH HERE
(850) 4871395
lfir`{�T �y7 t''� • '1 -`
FROM :
FAX NO. : Jan. 10 1998 06:05AM P3
SEE OTHER SIDE
DO NOT FORWARD
DEL ROSARIO ISMAEL
25220 SW 197 AVE
MIAMI FL 33031
�u tfrf1#11 {1:11111111,11;110111 1111)1111M}M h IN
svS •ayl� �� s?
��$��Je��, 3� W,GO53(a( F�L n9��3y
3oS (o °I e
e3g°r te
STATE OF FLORIDA AC# 4183851
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
ER13014164 12/16/08 08701.84b4
REG ELECTRICAL CONTRACTOR
DURAN, YASSER
YD TECH INC'
(INDIVIDUAL MUST MEET ALL LOCAL
TO CONTRACTIN I G IN ANYS PRIOR
AREA)
HAS REGISTERED under the Provisions of Ch.489
sxpiratioa date: AUG 31, 2010 L08121600188
ALEX SINK
CT C B
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
08E000799
YD TECH INC
D.B.A.:
DU N '7 ' ER
i
i Is certified under the provisions of Chapter 10 of Miami -Dade County
VALID FOR CONTRACTING UNTJL09 /30/2011 "
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.
01 -20 -2009
EFFECTIVE DATE: 01/08/2009 EXPIRATION DATE: 01/08/2011
PERSON: DURAN PASSER
FEIN: 263330448
BUSINESS NAME AND ADDRESS:
YD TECH INC
15765 NW 52 AVE #203
HIALEAH FL 33014
SCOPES OF BUSINESS OR TRADE:
1- REGISTERED ELECTRICAL CONTRACT
*
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 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
arced on the certificate to meet the requirements of this section.
OWC'52 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
QUESTIONS? (850) 413 -1609
FROM :
A, ' D
PRODUCER
FAX NO. :
Jan. 11 1998 04:42AM P1
CERTIFICATE OF LIABILITY INSURANCE
Carrunurtity Insurance Group
MOO S.W. 2884I3 Saw®t. Ste 305
Homestead, FI 33033
Ismael Dia ROSatto
2522D SW 197 Ave
Homestead, FI 33034
COVERAGES
S
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DATE (RmiTiorfYYY:
B8110/2010
ONLY AND CONFERS NO RCS UPON THE CE T?FrCATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSTSRTERS WORDING COVERA.GE ! NA1C
p tsseR Alacideet# froststence Campers/
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aV URER
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NQ1 T 4STANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT T OR WISER DOCUMENT VON RESPECT TO 4it;`ItCH THIS calo KATE MAY
SE ISSUED Ott MAY PERTAIN, ma tN$LURANCE AFFORDED EY T14E POLICIES DESORIEED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND
CON� O $uc POLimtES. AGGREGATE LIMITS SHO't41N MAY RAVE SEEN REDUCED �SY PAM %Mid -S-
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Miami Sham's Wage • 8t1Id#f1E Ceparboont
10050 N.E. 2nd Avenue
Miami Shores. FI 33136
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Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 149952 Permit Number: EL -8 -10 -1439
Scheduled Inspection Date: August 19, 2010
Inspector: Devaney, Michael
Owner: GARCIA, ERNESTO
Job Address: 1296 NE 105 Street 2
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ISMAEL DEL ROSARIO
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122320810020
Phone: (786)298 -1213
Building Department Comments
PLACE FIXTURES, SWITCHES AND RECEPTACLES IN 2
BATHROOM REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
August 18, 2010
For Inspections please call: (305)762 -4949
Page 24 of 36
1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
1296 NE 105 Street Number: 2
Miami Shores, FL 33138-
1122320810020
Block: Lot:
ERNESTO GARCIA
Owner Information
Address
Phone
Cell
at
ERNESTO GARCIA
1296 NE 105 Street
MIAMI SHORES FL 33138 -2143
Contractor(s)
ISMAEL DEL ROSARIO
Phone CeII Phone
(786)298 -1213
YD TECH INC
(305)525 -2355
Valuation:
Total Sq Feet:
$ 1,000.00
150
1
Type of Work: BATHROOM REMODEL
Additional Info: ELECTRICAL
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Surcharge
Education Surcharge
Permit Fee - Additions/Alterations
Radon Surcharge
Scanning Fee
Technology Fee
Work without Permit Fee
Total:
Amount
$0.60
$0.75
$0.20
$150.00
$0.75
$3.00
$0.80
$150.00
$306.10
Pay Date Pay Type
Invoice # EL -8-10 -38658
08/18/2010 Check #: 451
08/11/2010 Check #: 450
Amt Paid Amt Due
$ 256.10 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
W. W.
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.
August 18, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
August 18, 2010
Date
Miami Shores Village pEoznnED
Building Department 111 auc 1 1 n» !J
BY:
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. 10 —.14N
Master Permit No. 0 J 143E
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) 6t'-TY j51 0 670ArCIA Phone #
Owner's Mg Address &) aE 1 SST
9{4.14:i City State e.,
Tenant/Lessee Name
Email
Zip
Job Address (where the work is being done
City Miami Shores Village
FOLIO / PARCEL #
Phone #
7e6 343y0?
County Miami -Dade Zip 3 ( 36
Is Building Historically Designated YES
Contractor's Company Name y
Contractor's Address
City / t ` State
Qualifier Name YA.59
State Certificate or Registration No. 08 E000 47,6!
Contact Phone g GAS *4. ,,,SS' -mail
NO �f
�W 5r
Phone #
Flood Zone
-c7=5 �35'S
m« . Zip 9-t;
Architct/Engineer's Name (if applicable)
Phone# 73e) s 5&6 SG
lcate of Competency No. 054-000 wq
to
ateari mai o CIYV\..
Phone #
a)uof Work For this Permit $ 600
Work: ['Addition Q to
liesce Work:
Linear Footage Of Work:
Repair/Replace ❑ Demolition
i
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees**** 1.******* * * * * * * * * * * * * * * * ** * * * * * * * * * * ** **
Submittal Fee $ Permit Fee $- ® / S' CCF $ CO /CC $
Notary $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date:
Structural Review. $
Training/Education Fee $
Technology Fee $
Bond $
Total Fee Now Due $ •t O
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap r• ed and a re- inspection fee will be charged.
Si
Owner or Agent
The foregoing instrument was acknowledged before ml
day of /ii/( -t/S , 20 /O by el2.NG74.WD
who is personally known to me or who has produced k , a. y
P.L. /" ✓ As identification and who did t* al c t
v
z oem
NOTARY PUBLIC: i fr i2 W s g
Sign:
Print:
C
4 sic, / .4 j ,7 E'L Es nJ
/o, zoo
My Commission Expires:
* * * * * * * * * * * * * * **
APPROVED B
The fore ing instrument was acknowledged before
o day of UST , 20 10 , by 6 if 5 SE:
who is personally known to me or who has produce
■ re-- D•1- • as identification and who did
NOTARY PUBLIC:
Sign: //���
Print: f7? 57 k
My Commission Expires: (S'ee7 /b/ (A8/ 0
Plans Examiner Zoning
Engineer Clerk checked
(Revised 07!10 /07)(Revised 06/10/2009)
T�V
TECH, INC
CLCCTRICAL CONTRACTOR
STATE OF FLORIDA ACit • • 7. 7
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
ER13014164 9..2/16/08 087038404
REG ELECTRICAL CONTRACTOR
DURAN, YASSER
YD TECH INC
(INDIVIDUAL MLT$T MEET ALL LOCAL
LICENSING REQUIREMENTS PRIOR
TO CONTRACTING IN ANY AREA)
HAS REGISTERED under en* provisions or 01.489
Napir.oion d.t.• AUG 31, 2010 1.0a12160aiaa
DU nvann vn ER
Is certified under the
ALI OTOR th NT R on:melons of Chapter 10 of Miami -page County
CTING UNTIL 09130!`2
BusCQt 4 Trades i�ng scare
$ CERTIFICATE OF COMPETENCY
08E000799
YD
TECH INC
D.B.A.:
iF FLORIDA
!WENT OF FINANCIAL SERVICES
1 OF WORiCERB' COMPENSATION
RUCTION INDUSTRY
CATS OF ELECTION TO BE EXEMPT FROM FLORIDA
RS' COMPENSATION LAW
1VE 01/08/2009 EXPIRATION DATE: 01/03/2011
rh YASSER DURAN
2831330448
:SS NAME AND ADDRESS:
ING
NW 52 AVE 1203
I, FL 30014
OF BUSINESS OR TRADE:
{sr RED ELecYRICAI, CONTRACT
IMPORTANT
Pursuant to Chapter 440.0S(14). F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
I- under this section may not reoever benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(124, F.S.., Certificates of election to be
H exempt.. apply only within the scope of the business or trade listed an
C. the notice of election to be exempt.
R
E Pursuant to Chapter 440.05113). F.S.. Notices of election to be exempt
and certificates of election to ba 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? (8504 413 -1p09
vd
61Z09 1.179M
ONI H091 OA £0 01, 60 rrIV
1 N.A 4VLL.c4.1 %en
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
RECEIPT NO.
BUSINESS NAME 1 LOCA7lON
YD TECH INC
15765 NW 52 AVE
OWNER :YD TECH INC
30- 6629969
MIAMI -DARE COUNTY. STATE OF FLORIDA
PURSUANT TO COUNTY OObE SEC. 10-24
EXPIRES SEPT. 30, 2010
Cl VIP A BIU.Qia0079P9 Y
Stir. %JACK" OF Rtt.ELrT run
A LIST OF NONPARTICIPATING
MUNXCIPALITXES
Receipt holder must
register In the city
where work I$ to be
done.
PAYMENT I NED
—V�00200022
000200.00
MIAMI-DADE CO
TAX COLLECTOR
140 W. FLAGLER ST.
1st FLOOR
MIAMI, FL 33130
PAID
MIAMI, FL
PERMIT 110.231
RECEIPT HOLDER MAY DO
8US1NESS AS A CONTRACTOR
AS SPBCI11 0 HEREON.
ELECTRICAL CONTRACTOR
00 NOT FORWARD
YD TECH /NC
PASSER DURAN PRES
15765 NW 52 AVE 203
HIALEAH FL 33014
}} }} i } tt} f FF ] 9
2O0S LOCAL BUSINESS TAX RECEIPT 20'1t1
MIAMI-DADE CO SY - STATE O OF FLORIDA
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY CODE CHAPTER SA - ART. 9 & 10
THIS 1:4 NO'l A HILL -- DO NOT PAY RENEWAL
RECEIPT NO. 662996-9
CC * 08E000799
203
636243 -8
BUSINESS NAME f LOCATION
YD TECH INC
15765 NW 52 AVE
33014 MIAMI GARDENS
FIRST -CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMW NO. 231
OWNER
YD TECH INC
Soc. Type of Business
196 ELECTRICAL
TIRE B ONLY A LOCAL
pUBNERS Tot RECEIPT. R
OOes NOT ,eiMry THE
MOLDER
EXISTING STONY ANT
Or
:oNIM3 LAWS OF TIC
MON EIEMMPPTT NON
mune eRINI* Fpm ANY UCEENE
NSE
B�EpQU REO 9Y 11�:`1/� a
tN! NA LDa 'QUALB�1QA•
TWrNa
PAYMENT PecVE4
REAMLOADH O COUNTY TAX
COLL
10/01/2009
02230020001
000049.50
SEE OTHER SIDE
z'd
CONTRACTO R
61709 61T508
WORKER'S
1
DO NOT FORWARD
YD TECH INC
PASSER DURAN PRES
15765 AVE
HIALEAHWFL233014203
ONI HOal CA ££0 0I 60 fib`
AUG /10 /2010 /TUE 03:32 PM
P. 001/001
46—.....---- ii;p CERTIFICATE OF LIABILITY INSURANCE
DATE (Mpl /DIrryyy).
08710/10
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. •
'
• IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED, the policy(ies) Must be endorsed. If SUBRO4:;ATION 1$ WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this aertdicete•does not confer rights to the
Certificate holder in lieu of such endorsement(s). . • .
All INSR
PRODUCER' ,'^ • ' '
Q(13lity•Insurance Agency, • • ••• • ..c, . .. • . • • . . •' ":,• •
1290E. 4th Ave.
Hialeah, FL 33010
Phone (305)805 -2210 Fex (305)805.2214
CONTACT
FCIC#G12836550
?"•
(MW. • Or
Dhows . Fax
(A/C NA Pet IALCata);
E -)seaplE�i
PRRODUCER
•
CUSTOMER ID lk
GENERAL LIABILITY
.% • COMMERCIAL RCIAL GENERAL LIAtT1LITY
INEURER(S) AFFORDING COVBRAGE
INSURER A:
NAIC#
•
• GL283650
•
INSURED
YD TECH ; '
" "
15765 NW 52 Ave # 203
Miami, FL 33014-
• (3055) 621- 2355 • •
r- nvc- Ar.cc. ,___._._.___.____ - --
•
INSURER B •
EACH OCCURRENCE
$
INSURER C:
2000000
PREMISES oawlE micel
INSUNEIi b':
1000000
INSURER E
MED EXP.(Any one person)
3
INSURER F :
5000
.
THIS
INDICATED.
• CERTIFICATE
••
IS TO CERTIFY THAT THE POUCIE$ OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
AND CONDITIONS OF $UCH.POLICIES. LIMITS SHOWN MAY•HAVE BEEN REDUCED BY PAID CLAIMS. '
g.EREXCLUSIONS
ICTR
TYPE OF INSURANCE
All INSR
wvn
POLICY NUMBER
lMOLICY E YY!
(MW. • Or
LIMITS
'
GENERAL LIABILITY
.% • COMMERCIAL RCIAL GENERAL LIAtT1LITY
•
•
• GL283650
•
09/21/2009
09/21/2010
•
EACH OCCURRENCE
$
2000000
PREMISES oawlE micel
$
1000000
• ❑ GLAIMB -MADE • OCCUR
MED EXP.(Any one person)
3
5000
■ •
PERSONAL a ADV INJURY
$
1000000
II
GENERAL AGGREGATE
$
2000000
GENII AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO
$
1000000
• POLICY ❑ !NT- ■ LOC
S
AUTOMOBILE LIABILITY
AYAO
❑ ALL OWNED AUTOS
In SCHEDULED AUTOS
HIRED AUTOS
COMBINED SINGLE LIMIT
(Ecdenl❑
S
•
BODILY INJURY (Per pen?dn)
$
BODILY INJURY (Per accident)
$ •
PROPERTY DAMAGE
(Per acddrnI)
$
• • NON -OWNED AUTOS
•
'$
$
••
•
11 UMBRELLA LIAR ■ t]CCI IR
•
EACH OCCURRENCE
$
❑ EXCESS UAB ❑ CLAIMS-MADE
AGGREGATE
$
DEDUCTIBLE'
$
El
L 1 REi ENTION
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROpRIETOR/PARTNER/EXECUTNE
OFFICE<EMBEER EXCLUDED? C
N I A
•
•
. .
•
•
WC STATU. 57.
n TORY L INInT3 • ' • ■
EL EACH AGCmENT
$
andaMly In NH)
.`PJPT 0 OF OPERATIONS below
E.L DISEASE - EA EMPLOYE
$
E.L: DISEASE - POLICY LIMIT
$
•
•
DESCRIPTION OF OPERATIONS / LOCATIONS (VEHICI:ES (Attach ACORD lot, Additional Remmrka Medal*, if mote Space it required) •
• • • •
•
• •
•
iMteriCINATC urn, rtan
. MIAMI SHORES VILLAGE
10050 NE 2 AVE
MIAMI S) -CORES FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE :HEREOF, NOTICE WILL OE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZ2D REPRESENTATIVE
ACORD 25 (2009109) QF
ORD CORPORATION. All rights reserved.
RD name and logo are registered marks of ACORD
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 149961
1
u
Permit Number: PL -8 -10 -1440
Scheduled Inspection Date: August 20, 2010
Inspector: Hernandez, Rafael
Owner: GARCIA, ERNESTO
Job Address: 1296 NE 105 Street 2
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ISMAEL DEL ROSARIO
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1122320810020
Phone: (786)298 -1213
Building Department Comments
REPLACE PLUMBING FIXTURES, TOILETS, AND
LAVATOIRES IN TWO BATHROOM REMODEL
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
August 19, 2010
For Inspections please call: (305)762 -4949
Page 17 of 22
1
1
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
Applicant
1296 NE 105 Street Number: 2
Miami Shores, FL 33138-
1122320810020
Block: Lot:
ERNESTO GARCIA
Owner Information
Address
Phone
Cell
ERNESTO GARCIA
1296 NE 105 Street
MIAMI SHORES FL 33138 -2143
Contractor(s)
ISMAEL DEL ROSARIO
Phone Cell Phone
(786)298 -1213
FLORIDA LATIN PLUMBING CORP (786)515 -3177
Valuation:
Total Sq Feet:
$ 1,000.00
150
1
Type of Work: PLUMBING
Type of Piping: BATHROOM REMODEL
Additional Info:
Bond Retum :
Classification: Residential
Scanning: 1
Fees Due
CCF
DBPR Surcharge
Education Surcharge
Permit Fee
Radon Surcharge
Scanning Fee
Technology Fee
Work without Permit Fee
Total:
Amount
$0.60
$0.75
$0.20
$150.00
$0.75
$3.00
$0.80
$150.00
$306.10
Pay Date Pay Type
Invoice # PL -8 -10 -38659
08/18/2010 Check #: 451
08/11/2010 Check #: 450
Amt Paid Amt Due
$ 256.10 $ 50.00
$ 50.00 $ 0.00
Available Inspections:
Inspection Type:
Top Out
Re Pipe
Main Drain
Heater
Water Service
Final
Water Main
Lavatory
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: 1 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.
August 18, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
August 18, 2010
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
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING
Permit No.
rAUG1 iglIWZD
12010
Master Permit No.
e
Owner's Name (Fee Simple Titleholder) EP -4" t) (P Phone # c-16) Oro 303'
Owner's Address C 29(.6 C \ Os' cr-
City tietvw, 6L1 Lbtas State
Tenant/Lessee Name
Email
Zip '3-5 U3$
Job Address (where the work is being done)
Phone #
)(Loup 1E- cod sT �—
City Miami Shores Village County Miami -Dade
FOLIO / PARCEL #
Is Building Historically Designated YES NO
f/077A Leifran P rI,n`
J
Zip 3313
Contractor's Company Name
Contractor's Address � / 3 1 Z Yive ei 9F en'
City 1-11'0 /- 9 State %l"'(— Zip 3 3/ 3 2
Qualifier Name /4-.7 /1/4-012/ j61d Phone # 7-44 5l pJ 3 19
State Certificate or Registration No C fC / 'f2 ?660 Ccrtificate of Competency No.// CFC / /2.7- �� 0
E -mail Pria Mb yaham. e'i
hone #
Fie
Flood Zone
7-S16 -513 = 313
Contact Phone 94/6° -° 3 in-
Architect/Engineer's Name (if applicable)
o
Value of Work For this Permit $ 6 �'
Type of Work: ❑Addition ❑Alteration
Phone #
Describe Work:
any
l /ace � a platen
/ay
Square / Linear Footage Of Work:
]NeW a; P"''<epair/Replace
❑ Demolition
loffi 2-
******** * * * * * * * * * * * ** * * * * *r * * * * * * * * * * ** Fees * * * * ** ****** * * * * * * * * * * * * * * * * * * * * * * *:* * * * * **
Submittal Fee $ Permit Fee $
/5
Notary $ Training/Education Fee $
Scanning $ Radon $ DPBR $
Double Fee $ Violation date: ss�� %�
Structural Review. $ Total Fee Now Due $ a/51 (1 • tO
CCF $
CO /CC $
Technology Fee $
Bond $
See Reverse side ->
Bonding Company's Nanie (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 4, 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 s h posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing goii�ng instrument was acknowledged before me
��
day of ►'? Cr-O S?, 20 jq by EIe NEST
who is personally known tp me or who has produced
y
I�• L • ) L • As identification and who did take
NOTARY PUBLIC:
Sign:
Print:
Co .a tractor
e fore , oing instrument was acknowled
y of ftV t, ST , 201 0, by W a
ed before me
ra -pt N 31
ho is personally known to me or who has produced
/c • L. 4 • as identification and who did take an
NOTARY PUBLIC:
My Commission Expires: ',, Sl .f f q 2. d/ b
Sign:
Print:
My Commission Expires: P 7T 1472 201 O
,,e
******* ***** * * * * *** **?c * * * * * * ** * * * * * ** *** 2k*********************************** ** * * * ** * * * * **** * * * ** * * * * * ** * * **
APPROVED BY
Plans Examiner Zoning
(Revised 07 /10 /07)(Revised 06/10/2009)
Engineer
Clerk checked
09 -30 -2009
ALEX SINK 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:
09/30/2009 EXPIRATION DATE 09/30/2011
MENDOZA - BLANDON WILLIAM
263323511
BUSINESS NAME AND ADDRESS:
FLORIDA LATIN PLUMBING CORP
2011 NW 33RD STREET
MIAMI FL 33142
SCOPES OF BUSINESS OR TRADE
1- CERTIFIED PLUMBING 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 440.05412), 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 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
WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
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 09/30/2009 EXPIRATION DATE: 09/30/2011
PERSON WILLIAM MENDOZA- BLAM®ON
FEIN 263323511
BUSINESS NAME AND ADDRESS:
FLORIDA LATIN PLUMBING CORP
2011 NW 33RD STREET
MIAMI, FL 33142
SCOPE OF BUSINESS OR TRADE
1- CERTIFIED PLUMBING CONTRACTOR
F IMPORTANT
O 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
I- under this section may not recover benefits or compensation under this
D chapter.
H 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
Ethe 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.
VC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
POST THIS DOCUMENT IN A CONSPICUOUS PLACE.
NOT TRANSFERRABLE OR VALID AT ANOTHER ADDRESS
UNLESS APPROVED BY THE FINANCE DEPARTMENT,
CITY OF MKMI 444 S.W.2 AVE 6TH FLOOR, MIAMI, FL 33130,
PHONE (305)416-1918.
EFFECTIVE YEAR OCT. 1,2009 THRU SEP. 30, 2010
FIECpfPT FOR FLORIDA LATIN PLI.IMBING CORP
ISSUED NOV 18, 2009 - TOTAL FEE PAID $125.00
. . , .
, . . .
...... AC.COUNT NUMBER 484 098.
,00711228
RgcopT,NymEeR
190828-0002-
:,:FLORIDA =LATIN PLUMBING CORP
.
LOCATtON
1730 BISCAYNE BLVD #201E10
•
'4040*7ei N OMPLIANCE
TO ENGAGE IN OR MANAGE
THE OPERATI�N ADMINISTRATIVE OFFICE
• DtANAM. OMEZ
e • 'Director
OLJ y" ( 1;1:1/)
THIS IS NOT A BILL.
DO NOT PAY
This issuance of a business tax receipt does not
permt the holder to 1.4olate any zoning laws of th e
City nor does it exempt the holder from any license
or permits that may be required by 18W.
This document does not constitute .0 ,ctertiftcabon
that the holder is quitted tat engage in the
business, prpfession or comma= specitted herein.
The docuizent inckcates partentbf the business
tax receipt only.
iii r,
493 -'
BUSINESS MANE LOCATION
FLORIDA LATIN PL'
2011 NW 33 "ST_
33142 IIIANI
OWNER
FLORIDA LATIN 'PL!
PLUING
TWA I ,OSLY •A LOCAL
DOES R
T1Ea
HOLDER TO VOLATE
IDASTWG REGULATORY-OR
MOW JAWS OF THE
WOW! •cN Caw& WOW
WILDER WAWA OW OTHER
REOWNED BY LAW. TWA W
THE
P
C
;r7
/03/20
45.00
SEE OTHER SIDE
DO NOT FORWARD
FLORIDA LATIN PLUMBING CORP
WILLIAM MENDOZA
2011 NW 33 ST
MIAMI FL 33142
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STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
MENDOZA BLANDON, WILLIAM
FLORIDA LATIN PLUMBING CORP
1730 BISCAYNE BLVD 201 -E 10
MIAMI FL 33132
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 OF FLORIDA
X15
OFESSION
08/11/2010
10:33 MORGAN INSURANCE 4 13057568972
CERTIFICATE OF LIABILITY INSURANCE
NO.884 D001
DATE (MM/DDIYY)
05111/10
PRODUCER Morgan Insurance Group
13155 SW 42nd Street, Suite #107
Miami, FL 33175
Phone (305)222-5001
Fax (305)222.9006
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
NAIL #
1995 -'LOGS ACORD CORD ORATION.
INSURED • Florida Latin! Plumbing Corp
173.0 Biscayne 81Yd 201 -E10 .
Miami, FL 33132
(786) 5153177
INSURER A: SEMINOLE CASUALTY INSURANCE COMP
INSURER B:
INSURER C:
INSURER D:
INSURER E.
COVERAGES .
THE POuci s OF INSURANCE LISTED 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 MAYBE ISSUED OR
• MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
INSR
CM
ADM.
IMMO
TYPE OF INSURANCE
POLICY NUMBER
POUCY EFFECTIVE
DATE IM MIDDIYYYYI
POLICY FXP1MTrON
DATE MIND YYiflrl
LIMITS
• MIAMI SHORE, FL 33138
A
1
GENERAL LIABILITY
J COMDVIERCIAL GENERAL LIABILITY
Sc1000i06730
•
10/05/2009
•
1
10/05/2010
EACH OCCURRENCE
$100,000
PREMISES acomenoe)
'0�
❑ ❑ CLAIMS MADE • OCCUR
❑
MED EXP (Any one person)
$5,000
PERSONA[, & ADV INJURY
$1,000,000
• '
•
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
❑ Pouov • PROJECT ❑ LOC
PRODUCTS - COMP/OP AGG
$2,g00,000
•
'
•
AUTOMOBILE LIABILITY
'
•
COMBINED SINGLE LIMIT
(Eaaccident
IN ANY AUTO
❑ ALL OWNED AUTOS '
❑ SCHEDULED AUTOS
BODILY INJURY
(Per person)
•
•
II HIRED AUTOS
BODILY INJURY
(Per accident)
❑ NON OWNED AUTOS
•
(Per DAMAGE •
(Per accident)
El
1:1
0 LIABILITY GARAGE LIAB
❑ ANY AUTO
❑
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
•
AUTO ONLY:G
EXCESS / UMBRELLA LIABILITY
❑ OCCUR • CLAIMS MADE
•
EACH OCCURRENCE
AGGREGATE
•
■ DEDUCTIBLE •
•
• RETENTION $
"""-'
•
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY '
ANY PROPRIETOR / PARTNER 1 EXECUTIVE
OFFICER / MEMBER EXCLUDED?
(Mandatory . in NH)
if yEs, AL PRO PROVISIONS
SPECIAL PROVISIONS below
•
IN WO STAqLTU�- III OTF1-
TORY LIMITS ER
E.L EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
DISEASE - POLICY UNIT
•
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
•
CANC
•
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EKPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
MIAMI SHORE VILLAGE
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
BUILDING DEPARTMENT
THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
10050 N.E 2ND AVE
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
• MIAMI SHORE, FL 33138
AUTHORIZED REPRESENTATIVE
"�
FAX 305-756-8972
4'"'G� ---- .
Arno ,Ia Minem4% AC
M tights reserved.
The ACORD name and logo are registered marks of ACORD