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CC-13-31
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 187953 Permit Number: CC- 1 -13 -31 Scheduled Inspection Date: March 25, 2013 Inspector: Bruhn, Norman Owner: HOLDINGS LLC, PAJOVI Job Address: 559 NE 87 Street Miami Shores, FL 33142- Project: <NONE> Contractor: UNIVERSAL HOME REMODELING INC Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132060200990 Phone: (954)709 -6659 Building Department Comments RE FRAME STORE FRONT (WEST SIDE) AND REPLACE GLASS WITH TEMPERED UNIT# 575 NE 87 ST Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed �SS Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 22, 2013 For Inspections please call: (305)762 -4949 Page 47 of 48 S Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 B 44-DP(uP DING PERMIT APPLICATION Permit Type: JOB ADDRESS: BUILDING 5'I S" tr -F- Qi - Permit No. Alt JAN u , B Y: 0 Master Permit No. ROOFING City: Miami Shores County: �� . Miami Dade Zip: "'S'? Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): G 14© r�w� ® 1 P G Phone#: ®, ' �-� (30+- Address: \`S \.\-- l4 .110 ^ 22 City: OA \ M\ State: L© Zip: 331CL Tenant/Lessee Name: " " T G /41U- Phone#: IO2 Email: CONTRACTOR: Company Name: Address: t 6712-61 1" ' City: C_ `, Qualifier Name: 0 CL, free - State: hone#: 9 1-169 -(06 � a State Certification or Registration #: Contact Phone#: DESIGNER: Architect/Engineer: CAC, t S^ Zip: .33332 Phone#: 9 6v ;® 'coCe J Certificate of Competency #: Email Address: 11111571 • Phone #: �+�..r�_ Value of Work for this Permit: $ .Q 600— Square/Linear Footage of Work: Type of Work: °Addition Description of Work: g °Alteration New epair/Replace °Demolition Color thru tile: ***** ******* ********* ******+x**** * * * ** * Fees*** ***m**************** * * * ** x *** * * * ***+x ***** Submittal Fee $ Permit Fee $ Jf� Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ j%1 • CO CCF $ CO /CC $ DBPR $ Bond $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of s,ch posted notice, the inspection will not be approved and a reinspection ee ll b5 charged. Owner or Agent The foregoing instrument was ac ..owledged befo a me this day of!_x > . 200 ,by who is personally known to me or-whe4mbpredu eed NOTARY PUBLIC: Sign: Print: 7" *saentification_and nd_whe did take-an oath. My Commission TARY oF xp t� lliN =Com fission # E075890 '�•.. ,.::' Exp. : MA1$. 23, 2015 *a� *x�**** * * *�x�x1nNDxtic i1'=�x *�xDD *** * * ** axe * *** ********* ** ******************* ***. x**** ** **** **************** Contractor The foregoing instrument was acknowledged before me this C day of 5 \W ,20a,bylk) P \.4 L cp, who is personally known to a or..avlieastced as identification and who did take an oath. NOTARY PUBLIC: Sign``" \vim Print: My Commission APPROVED BY Plans Examiner Structural Review (Revised 3 /1212012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk Permit No: 13 -31 Job Name: January 8, 2012 Building Critique Sheet Page 1 of 1 1) Provide a plan showing the location of the work with a description of the scope. The repairs must be completed to match the original store front Product approval. Provide that approval and identify the appropriate details. Pr Folio 11- 3206 - 020 -0990 Property Address 559 NE 87 ST Owner Name(s) PAJOVI HOLDINGS INC Mailing Address 1515 NW 22 ST MIAMI FL 33142 -7413 Primary Zone 6200 COMMERCIAL - ARTERIAL Use Code 0011 RETAIL OUTLET Beds /Baths /Half 0/2/0 Floors 1 Living Units 0 Adj. Sq. Footage 5,366 Lot Size 13,000 SQ FT Year Built 1960 Legal Description As EL PORTAL SEC 4 PB 12 -56 LOTS 20 THRU 23 INC BLK 23 LOT SIZE 100.000 X 130 OR 20761 -3436 0902 2 (2) OR 20761 -3436 0902 02 Current Previous Year 2012 2011 Land Value $234,000 $234,000 Building Value $223,316 $226,602 Market Value $457,316 $460,602 Assessed Value $457,316 $460,602 Current Previous Year 2012 2011 Homestead $0 $0 2nd Homestead so $0 Senior $0 so Veteran Disability $0 Civilian Disability $0 $0 Widow(er) $0 $0 Disclaimer: MIAMI -DADE COUNTY OFFICE OF THE PROPERTY APPRAISER PROPERTY SEARCH SUMMARY REPORT Honorable Pedro J. Garcia Property Appraiser A N Aerial Photography 2012 Current Previous Year 2012 2011 Exemption /Taxable Exemption /Taxable County $0 / $457,316 $0 / $460,602 School Board $0 / $457,316 $0 / $460,602 City $0 / $457,316 $0 / $460,602 Regional $0 / $457,316 $0 / $460,602 Date Amount Recording Book -Page Qualification Code 9/2002 $510,000 20761 -3436 Deeds which include more than one parcel 9/2001 $0 20030 -4665 Sales which are disqualified as a result of examination of the deed The Office of the Property Appraiser and Miami -Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information and GIS positional accuracy. No warranties, expressed or implied, are provided for data and the positional or thematic accuracy of the data herein, its use, or its interpretation. Although this website is periodically updated, this information may not reflect the data currently on file at Miami -Dade County's systems of record. The Property Appraiser and Miami -Dade County assumes no liability either for any errors, omissions, or inaccuracies in the information provided regardless of the cause of such or for any decision made, action taken, or action not taken by the user in reliance upon any information provided herein. See Miami -Dade County full disclaimer and User Agreement at http: / /www.miamidade.gov /info /disclaimer.asp. Property information inquiries, comments, and suggestions email: pawebmail @miamidade.gov GIS inquiries, comments, and suggestions email: gis @miamidade.gov Generated on: Tuesday, January 08, 2013 A & A DESIGN GROUP, INC. Phone: 561 -706 -5161 CONSULTING ENGINEERS Email: hiliuhbilitan(ii).:-yahoo.com 22636 Blue Fin Trail, Boca Raton, FL 33428 January 4, 2013 Building Official City of Miami Shores Building Department Re: 575 N.E. 87th Street, Miami Shores, Florida Dear Building Official: Please be advised that on January 3, 2013 we have inspected the exterior aluminum framing store front damages. We recommend repair framing by connected each members with 1" X 1" X 1/4" aluminum strap angle with #12 aluminum screw each side of the connections and anchor top and bottom framing to ceiling and floor with 3/8 "diameter TAPCON min. 5" long @ 12" O.C. with epoxy and installed tempered impact glasses. If you should have any further questions please feel free to contact us at the above number. Sincerely, A & A DESIGN GROUP, INC. Consulting Engineers CA. Lic. No: 29225 Reza Javidan, PE Florida Professional Engineer # 60223 1/7/13 Proof of Coverage EPF ArttrATElk, CHIEF ` FLORIDA 13EPAItTMENT OF FINANCIAL SERVICES • WC Home Exemption Detail Page This database was last updated Sunday, January 06, 2013 12:11 AM. Return to Previous Page 1,, 1, /,',, 1, ,•. , • ,,, >,• , • WC Databases ANGELICA DUTRA ANGELICA DUTRA IR Feb 14 2010 VP May 15 2002 Sep 10 2012 Jul 21 1997 ANGELICA DUTRA ANGELICA DUTRA FR Feb 14 2012 Dec 31 2003 Sep 10 2014 Construction Construction Construction Click Here to View Activities Listed on Exemption Click Here to View Activities Listed on &emotion UNIVERSAL FLOOR COVERING INC UNIVERSAL FLOOR COVERNG NC Click Here to View Activities Listed on Etemotion IdtklaSALLEQME REMODELNG INQ Dec 31 1999 Construction L Return to Search Pagemi https://apps8.fldfs .com/proofofcoverage/ExemptionDetail.as px?pr_personid= 000125400 Click Here to View Activities Listed on Exemption 1/AL iLE & CARPET BY ANGELICA INC CFO Horne 1/1 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave. Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Business Name: UNIVERSAL HOME REMODELING INC Owner Name: DUTRA, ANGELICA A Business Location: 19251 N GARDENIA AVE WESTON Business Phone: 954-709-6659 Rooms Seats Employees 1 Receipt #:GE ERALl CONTRACTOR (CERT Business Type:GENERAL CONTRACTOR) Business Opened:lo /11/2012 State /County /Cert/Reg: CGC 1515 515 Exemption Code: Machines Professionals Number of Machines: For Vending Business Only • Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 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 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. Mailing Address: UNIVERSAL HOME REMODELING INC 19251 N GARDENIA AVE WESTON, FL 33332 2012 - 2013 Receipt #01C -12- 00000414 Paid 10/11/2012 27.00 RRfWARn rnI IMTV 1 nh.A I PP PQINJCCC TAY ocr+cInT CCE09072012 00000.jpg - Gmail t)1 ) RA.. (ill]. censee De' .eta: Information Name: Main A dd ress Ljcense License Information , • • • r- iiconse Nmi-er: Status: Special Qualifications Construction Business f rn 44: c0 nip t4i _ oiilg Business As: Page 1 of 1 DUTRA, ANGELICA A (Primary Name) UNIVERSAL HOME REMODELING INC. (DB 19251 N GARDENIA AVE WESTON Florida 33332 BROWARD Certified General Contractor Cert General CGC1515515 Current,Active 05/2912008 08[31:2G14 Qualification Effective 05/29/2008 https://mail-attachment.googleusercontent.com/attachment/?ui=2&ik=dec80773b3&vievv=at... 9/7/2012 PROPERTY LOCATION / N N.T.S. STOREFRONT VIEW N.T.S. SCOPE OF THE WORK: REPAIR EXISTING STOREFRONT FRAMING ASCE 7 -2010 LATERAL DESIGN LOAD (PSF) WIND LOAD DESIGN ASCE 7 -2010 ZONE AREA WIND VELOCITY IMPORTANT FACTOR EXPOSURE CATEGORY INTERNAL PRESSURE COFFICIENT 175 MPH 1.0 "C" + 0.18 (SQ.Fr.) 0 STOREFRONT VIEW N.T.S. SCOPE OF THE WORK: REPAIR EXISTING STOREFRONT FRAMING a = 5' -0" did � °E a Q Evi eNv Nal 2 QtiRaR E Na PURPOSE PERMTT JOB NUMBER 2013 S -1 ASCE 7 -2010 LATERAL DESIGN LOAD (PSF) TRW. ZONE AREA (SQ.Fr.) 0 0 10 +40 -43 +40 -53 20 +38 -41 +38 -49 50 +36 -39 +36 -45 100 +34 -37 +34 -41 200 +32 -35 +32 -38 500 +30 -33 +30 -33 a = 5' -0" did � °E a Q Evi eNv Nal 2 QtiRaR E Na PURPOSE PERMTT JOB NUMBER 2013 S -1 • 450-8 HEADER 450-8 HEADER AT CENTER AT OFFSET HUNG DOORS HUNG DOORS (1 � 2 3 3116" BOTTOM RAIL (SHOWN) 9 1!2" BOTTOM RAIL (ADA OPTION) 71/2 BOTTOM RAIL (SPECIAL ADA OPTION) 0 2 1/8" TOP RAIL FOR 1/4" OR 1" GLAZING CONTINUOUS GEAR HINGE Q 2" NARROW VERTICAL STILE \ 38" DO /1 35" DO 3 3/18" BOTTOM RAIL (SHOWN) 91/2" BOTTOM RAIL (ADA OPTION) 7 1/2 BOTTOM RAIL (SPECIAL ADA OPTION) CONTINUOUS HEADER FOR SMC (8) CONTINUOUS HEADER FOR OHCC <50R CONTINUOUS HEADER SMC 1) CONTIN C HEADER FOR OH 1 C "TOP \ ag `\ . ,' 21/8 RAIL OR \ \ FOR 1/4" 1" GLAZING FINGER GUARD Q o g d 8 \\ \ \ \ \ 'r 6 /J // m/j %, a 0 (9+ 0 n 2" NARROW VERTICAL STILE i- /( 1 N. --, 38" DO 2" VERTICAL STILE 3 3116" BOTTOM RAIL (SHOWN) 9 1!2" BOTTOM RAIL (ADA OPTION) 71/2 BOTTOM RAIL (SPECIAL ADA OPTION) 0 2 1/8" TOP RAIL FOR 1/4" OR 1" GLAZING CONTINUOUS GEAR HINGE Q 2" NARROW VERTICAL STILE \ 38" DO /1 35" DO 3 3/18" BOTTOM RAIL (SHOWN) 91/2" BOTTOM RAIL (ADA OPTION) 7 1/2 BOTTOM RAIL (SPECIAL ADA OPTION) 3 3/18" BOTTOM RAIL (SHOWN) 91/2" BOTTOM RAIL (ADA OPTION) 71/2 BOTTOM RAIL (SPECIAL ADA OPTION) S STANDARD ABBREVIATIONS RO ROUGH OPENING FD FRAME DIMENSION DLO DAYLITE OPENING DO DOOR OPENING DD DOOR DIMENSION SMC SURFACE MOUNTED CLOSER OHCC OVERHEAD CONCEALED CLOSER PURPOSE PERMIT JOB NUMBER 2013 S -2 CONTINUOUS HEADER FOR SMC (8) CONTINUOUS HEADER FOR OHCC <50R CONTINUOUS HEADER SMC 1) CONTIN C HEADER FOR OH 1 C i y 21/8" TOP RAIL /J FOR 1/4" OR 1 GLAZING lu ❑ y; Z 0 ti NARROW i- �JJJ / / 2" VERTICAL STILE 36" DO // 36" DLO 3 3/18" BOTTOM RAIL (SHOWN) 91/2" BOTTOM RAIL (ADA OPTION) 71/2 BOTTOM RAIL (SPECIAL ADA OPTION) S STANDARD ABBREVIATIONS RO ROUGH OPENING FD FRAME DIMENSION DLO DAYLITE OPENING DO DOOR OPENING DD DOOR DIMENSION SMC SURFACE MOUNTED CLOSER OHCC OVERHEAD CONCEALED CLOSER PURPOSE PERMIT JOB NUMBER 2013 S -2 INTERIOR , \ 1427 1427 NP22 ' \ NP225 NP225 TNP225 IM425 1M425 DLO EXTERIOR 2" DLO SECTION DETAIL AT / INTERMEDIATE VERTICAL 7116" i y 318" 3/8" / / INTERIOR / % 318" / / INTERIOR > o 6 =N i NP225 (. c`S p —114° TEMPERED GLASS -114" TEMPERED GLASS NP225 M DT550 + cT] IS456 DT550 ( DT550 M' " "J tw1550 1 PURPOSE PERMIT DH299 . CONTINUOUS J " ` Q ., - _A _ GEAR HINGE EXTERIOR 5/16" / 21132" DLO DLO 2 21/32" DLO /112 --P /112"/ / DD DD / EXTERIOR / 3/32" 3/32" /1/2"/ DD DLO 2" / / /� // DO DO 2" DO i _ / / / / SECTION DETAIL @ DOOR JAMB WITH CONTINUOUS GEAR HINGE SECTION DETAIL AT INTERMEDIATE DOOR JAMB 4 a- JOB NUMBER 2013 S -3 INTERIOR NP225 NP225 I 2 J0452 NP225 NP225 25 DLO 15/16° EXTERIOR 4 1/2" 15116" DLO SECTION DETAIL AT INTERMEDIATE VERTICAL 1/4" TEMPERED GLASS SECTION DETAIL AT INTERMEDIATE DOOR JAMB CS R :::: *0 Z aPIXti tLI oN 0 M PURPOSE PER/ET JOB NUMBER 2013 S -4 4 1/2" 1° GLASS \ \ \ N D201 114" GLASS DS047 1 314" SECTION DETAIL AT CONTINUOUS DOOR HEADER FOR OFFSET DOOR WITH SMC 4 1/2' 1" GLASS 1° GLASS SB510 r=1 SECTION DETAIL AT CONTINUOUS SECTION DETAIL AT DOOR HEADER FOR OFFSET INTERMEDIATE HORIZONTAL $ DOOR WITH OHCC 4 112" 1 gz R z lc® 1° GLASS ;IL,. SET II SEAL '^ OVERHEAD CONCEALED CLOSER - \ / tql \ OVERHEAD CONCEALED CLOSER 1 I n v SET II SEAL 1425 ❑ ❑ 1 m 1n M 3 D101 Z� STZ55 Al, DA201 1" GLASS t O J ❑ 1 114" GLASS 1 314" SECTION DETAIL AT CONTINUOUS SECTION DETAIL AT DOOR HEADER FOR OFFSET INTERMEDIATE HORIZONTAL $ DOOR WITH OHCC 4 112" 1 gz 1" GLASS SET II SEAL I OVERHEAD CONCEALED CLOSER - \ / tql \ N .d 1425 � 3 Z� 1" GLASS SECTION DETAIL AT INTERMEDIATE HORIZONTAL NT RPRI EgzkLzcsu p Cd �nn� 0 z oaM PURPOSE PERMIT E W A JOB NUMBER 2013 S -5 3/8 "diameter TAPCON min. 5" long @ 12" 0.0 CS558 8, INTERIOR to D201 1 3/4" CENTER PIVOT EXTERIOR CS558 N D201 1/4" GLASS INTERIOR 1 3/4" 1" GLASS — 7/15" INTERIOR 23/4° NP225 �- J'� NP225 1.1456 PIVOT POINT EXTERIOR DLO 3/8° — 1/4° GLASS D300 PIVOT POINT — 1/8" DLO 1 1/8' DD DO SECTION DETAIL AT 450 -S DOOR HEADER SECTION DETAIL AT 450 -S DOOR HEADER AT AT CENTER HUNG DOOR WITH PIVOT CD OFFSET HUNG DOOR WITH SMC OR FLOOR CLOSER 0 SECTION DETAIL a(7, DOOR JAMB W/ FINGER GUARD 3 PURPOSE PERM 5 I JOB NUMBER 2013 S -6 CITY COPY APR21JED j i_) ZON.IING DEPT BLDG DEPT SUBJECT 1.0 CGMRI.S.PNCE WI [H ALL FEDERAL STATE AN CL LIN, 7 RLLES AND REGULATIONS BY NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE .POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. CC ( ') <3 TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI-DADE: 1 1 II I I 11 1 I 11 1111 1 I 11111 1111 1111 CFN 210 1.3RC: 1 3 11014 OR 13k 28521 P9 0170; tl*s) RECORDED 03/07/2013 1525:57 HARVEY RUVINp CLERK OF COURT MIAMI-DADE COUNTY? FLORIDA LAST PAGE 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. -4. Legal descriptionhogyrepry an 2. tea addr fieletweriele t e .14 Owner(s) name and address: Interest in property: ----- -- Name and address of fee simple titleholder: 4. Contractor's name address and phone number: 1,0004" 4- 5 75 x.,„ 0, 7 5. Space above reserved for use of recording office 5. Surety: (Payment bond required by owner from conp.ror, if any) Name, address and phone number: 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 713.19(1)(a)7., Florida Statutes, _ Name, address and phone number 't't kTiltlg FLOMEA, 01..itUiV i.14,411 / *PC' C TFFY Pot this i43z, iTtP nPpy of Amount of bond $ Mary 7' AV q 8. In addition to himself, Owners designates the following person s tostrechenciflveafics: of. s.:7zeps jutinneq 14:1';i:' PS 1,\ dram " ifrAwkwirearPiarimitimpi, foe. 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a dffferent date Is specified) 713.13(1)(b), Florida Statutes Name, address and phone number n WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. \--'Signature(s) of Owner(s) or Owner(sy Authorized Officer/DiVr/Partner/Manager Prepared By 17-00 f24-4.404/ /9/4, Prepared By Print Name Print Name Title/Office — di-efr 4T — 1121-likt.,frlitle/Office STATE OF FL; RIDA COUNTY OF MIAMI-DADE The foeing ins me was acknowledged before me this 7 day of /364-.06e/t/ By / U Individually, or r% as -4* for Wgersonally known, or U od/ uced the following type of identification: Signature of Notary Public: Are rtILIP:„,„ / Ar *Te-1-W411" Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92425. FLORIDA STATUTES Under penafties of perjury, I declare that I have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. 14046 ...,4e,,ve-A&2 ., '4) • RICHARD EDWARD SANG IT., a- commission 0 DD888918- # Expires July 13, 2013 SInature(s) wner(s) or,er(sys-Anthorized Officer/Director/Partner/Manager who signed above: By 123.01-52 PAGE 3 3/10 I/ /46 iree44- 7-0 fia.,0/.465, JEFF AIWA Ft CHIEF FINANCIAL OFFICER S STA DEPARTMENT DIVISION OF This certifies tt TI DATE: BUSINESS IVE. A 1 92S1 WESTON iidual listed below 09/1012012 SCOPES OF U 1- L2► °_ section may net r scope of the _beakless O election to be exempt shall certificate me longer meets named OR the certifleaie to meet A AVE FL 2 f eI -10- 2012 AT * PI RATION 4 : /1012014 I, r. Pursuant to Cbeptet R4A D5 lea to be exempt. Pars met to as time alter the filial of the lot iasaance of a certificate . The -252 CERTIFICATE OF ELECTI PLEASE EXEMPT REVISED 01-11 UT OUT THE CARO BELOW AN 11 e apply only to el on to be exempt and earth kat°, the persea oaptod as the make or an arty time far failure of Me patsy UESTIQINS7 (85(8 413-1609 ETAftf FOR FUTURE EFE EFFECTIVE 09/10/2012 PERSON rEL ICA E)UTRA FEIN: 800818940 BUSINESS NAME AND ADDRESS: tVERSAL HOME REMODEIbtG HNC' 18291 d GARDENIA AVE WESTON, FL 33332 1- LI GENERAL CONTRA TOR / 10/201.4 F Pursuem to elects exempt) under this secti 0 chapter. Pursuant E the notice ©' R E Pursuant tai Chapter 44 05113), F.S., Notices cf' lection to be exe and certificates of election to be exempt shell 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 Ion 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. 44005114). F. ram this chapter may not recover e of elect) an under O.05(12). F.S., Certificates of election to be flip the scope of the business or trete listed on be exempt OUESTIQNS? (850) 413 -161)3 bo 0WC -202 CERTIFICATE E CUT HERE on job, k V 03/0712013 11:32 9549560555 COVER ALL INSURANCE PAGE 01101 i ©• CERTIFICATE OF LIABILITY INSURANCE DATEIMIINDWYYYY) 03107/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED MPOR T; 1 the certificate holder is an ADDITIONAL INSUREp the policy(iee) must be endorsed. If SUBROGATION 18 11AIVED, 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 certficate holder in lieu of such endorsement(s). PRODUCER Cover All Inluranca • 5800 W. Atlantic Blvd Margate Margate FL 33083 CONTACT a� I FAK PHONE igm 956 -0006 4IA+O Nok •ut 1NSUREstra AFFORDING COVERALL -- __ JJAJC # visusetA I ACCIDENT INSURANCE COMPANY INSURER B - UNIVERSAL HOME REMODELING INC 19251 N. GARDENIA AVE WESTON FL 33332 resume C 0910712012 INSURER D s EACH OCCURRENCE INSURER E s X INSURER P: ...�r�..v�a 1- t%J II'It:ATE NUMt3ER; REVISION NUMBER: THIS 1S 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 OFANY 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. ADDI.3UBR 1 �4R jpp LIMITS SHOWN MAY HAVE BEEN POUS'Y NUMBER REDUCED POL}CY CM Ilt1111 Y BY PAID CLAIMS. POLE E%P_ Iyylmh ra LIMITS NS.R TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CPP00057404-00 0910712012 09/07/2013 EACH OCCURRENCE c 1,000,000 $100 000 X pAMA9E TO RENTED CLAIMS•MADE X occuR • MED EXP [Anv one aeraen1 $ 5,000 PERSONAL 0 ADV INJURY $1,000,000 $ 2,000,000 GENERAL ACG.BE•GATR GEN'L AGGREGATE UMIT APPLIES PER: I LOG PRODUCTS - COMP1OP AGO $ 2y000000 $ 7 POLICY 1 I .PIFn¢ir AUTOMOBILE LIABILITY ANY AUTO AU 0$ NED HIRED AUTOS AUTOS ULED NON -OWNED AUTOS _ iC �N��(SINGLE UNIT BODILY INJURY (Per person) 0 — $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (pr,. wccldant) E UMBRELLA L1AB RXCESS LIAa F_ OCCUR CLAIMSNIADE EACH OCCURRENCE 1 AGGREGATE $ _. DBD_I 1 RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS* LIABILITY �.! N �ICER/MEMBER EXCLUDEED, ECUTivt� (Mandatory In NH) �,__I If es describe under - P • •F • • • - beow N rA WC STATU- OTN- V I TIIRY 1 IMIYC 1 FR EL EACH ACCIDENT 1 P+ .. DISEASE • EA EMPLOYEE $ E.L. DISEASE -P0 C LIMIT $ DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEH1CLE9 (Attach AOORD 101, AddlflunaI Romerke Schedule. Raw* spece Is required} GENERAL CONTRACTOR CITY OF MIAMI SHORES BUILDING DEPT 10050 NE 2nd Ave Miami Shorn j FAX: 305-759-8972 ACORD 25 (2010/05) CANCELLATION SHOULD ANY OP THE THE EXPIRATION DA ACCORDANCE WITH THE AUTHORIZED REPRES DESCRIBED FOLIC' E CANCELLED BEFORE IEREOF, NOTICE ' ,pt DELIVERED IN Y PROVISIONS. 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD