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PL-11-1728Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. PL t / - (72t Master Permit No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): � • for „ea_ Phone #: 3 v S Address: U/3/ kA.) 4 ? sr City: t.4f State: Ct, Zip: 3 3 I .f'6 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Folio/Parcel #: 4r ,uAJ 13 cr Miami Shores County: l!2 /—cl --6/7— tae) NO Is the Building Historically Designated: Yes Miami Dade Zip: CONTRACTOR: Company Name: 7/e1` CI P44; 4t' Address: /993 AA-.) ,2 61 QM' City: Qualifier Name: State Certification or Registration #: Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone #: Flood Zone: Phone #: 36S Si 6 7V`7 State: Zip: 7,7 /C. J' Phone#: iewertgi Value of Work for this Permit: $ 273 e b D Square/Linear Footage of Work: Type of Work: °Address °Alteration Description of Work: (�le ONew p' �. epair/Replace °Demolition ******** **************x ********* ******* Fees************ * ***** ** x********** ********* ** * Submittal Fee $ ,. • ;�► Permit Fee $ S� v . C). CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 Boni1h 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 inspec . n ' ..1 not be approved and a reinspection fee will be charged. Signs The for day of Signature Owner or Agent trument was acknowledged before me this C9'.3 The fore ,20H ,by , day of trument was acknowledged before me this ,20,1, by who is personally known to me or who has produced who is personally known to me or who has produced as identification d who did take an oath. NOTARY PUBLIC: As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expir ` KEMBLE ETTRICK o , MY COMMISSION # DO 891340 EXPIRES: September 14, 2013 •:;F • ••o;:•- Bonded Thru Notary Public Underwriters ',8G Sign: Print: My Comm COMMISSION a d DD 891340 EXPIRES: September 14, 2013 fa,„ Bonded Thru Notary Public Underwriters ********* ******************** sks k�ksksk�k* �ks N�k�k�k�k�N: k�N�k�k�k�kNi :�sksi:ak *�ksN�#�k�k�k****ik�k k�k�k�k�ksA�kN�nN *+kikak *�k�kN��NHa�k** NHSeR�k�k�kik *�NN�HQSk+k�kok*** 1 gi7/ APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Zoning Structural Review Clerk ch i-- cna BUILDING PERMIT APPLICATION FBC 2004 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305) 756.8972 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Tiitleholder) Owner's Ad 14,} ss 6, 93 T RECEIVED SEP 2 2 2011 Permit No. P1----1(---172eD Master Permit No. Mechanical Roofing City ;1 Tenant/Lessee Name State 0./1201i Zip Phone # Job Address (where the work is being done) „,/,,,d £ 9 -3 7 7 City Miami Shores Village County Miami -Dade Zip 337 FOLIO / PARCEL # /f S!— ( 4(7-ao . o Is Building Historically Designated YES NO Contractor's Company Name Ilk es' Contractor's Address , ijk) ,24" City Qualifier Name % f (an � ? one # 2 as' 6 S7 % State Certificate or Registration No. Certificatc of Competency No. Phone # gores' r 7t�s State Zip 5310" Architect/Engineer's Name (if applicable) Value of Work For this Permit $ • 16 Type of Work: []Addition ['Alteration Describe Work: Square / Linear Footage Of Work: ['New Repair/Replace (] Demolition * * * * * * * * * * * * * * * * * * * * * ** ***, rat * * *,t * * ** , F , , , ,� ** * *.* *, * * * * * * * * * **** * * * * * * *** * * *** ** ees Submittal Fee Permit Fee $ /5-6 CCF $ CO /CC Notary $ '" Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ 11 9 '0 0 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 w no' be approved and a reinspection fee will be charged Signatur irOwner or Agent Contractor The foregoing instrument was acknowledged before me this 0 g �� The forego instrument was acknowledged before me this day of 2011, by , day of ,20 ` , by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUB Sign: (3X71! Print: My Comm c MV COMMISSION # fiE0eb880 * * * * * * * ** EXPIRES Min 18.2015 ices: �kttwewolaryBeMiCe.con, APPLICATION APPROVED BY: (Revised 02108106) Sign: Print: My C ** P1RES: September 14, liroNFIViffit:Notaiy Public Underwriters * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Pamela Williams PERMIT #:13 -SC- 1369170 APPLICATION #: AP 1047187 DATE PAID: FEE PAID: RECEIPT #' DOCUMENT 0: PR854524 PROPERTY ADDRESS: 68 NW 93 St Miami, FL 33150 LOT: 3 PROPERTY ID #: BLOCK: n/a 11 -3101- 017 -0030 SUBDIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT , GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ A [ N [ K [ D [ R [ 750 ] GALLONS / GPD 0 ] GALLONS / GPD 0 ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS DOSING TANK CAPACITY [ Existign Septic Tank to remain 200 ] SQUARE FEET 0 ] SQUARE FEET CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS 8[ ]DOSES PER 24 HRS #Pumps [ ] bed configuration drainfiite SYSTEM SYSTEM [ ] FIT.T•FD [ ] MOUND [x] BED [ ] A TYPE SYSTEM: [x] STANDARD I CONFIGURATION: [ ] TRENCH N F LOCATION OF BENCHMARK: F.F.E., 13.00' NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00] INCHES O T H R SPECIFICATIONS BY: APPROVED BY: [ 25.20][ INCHES FT ][ ABOVE LOW BE BENCHMARK /REFERENCE [ 53.20 1 [p INCHES t FT ] [ ABOVE BELOW BENCHMARK /REFERENCE EXCAVATION REQUIRED: [ 40.00] INCHES POINT POINT *Invert elevation of drainfield to be no less than 9.06 ft. NGVD. *Bottom of drainfield elevation to be no less than 8.56 ft. NGVD. `Install 12" of slightly limited soil under the bottom of the drainfield. - Perimeter of excavation area shall begat least `2 :ft wider and longer than the proposed absorption bed or drain trench. "THIS PERMIT IS NOT FOR " ADDITION(s) ". DATE ISSUED: DH 4016, 08/09 Incorporated: Carlos M Icaz Carlos M 'coma 09/16/2011 TITLE: TITLE: Dade (Obsoletes all previous editions which may not be used) 64E - 6.003, FAC The contractor (or desljnde) is required to perfoi as "'A' soil boring adjacent to the drainfield excavation at the time of final inspection. Prior to Final Approval, the DOH inspector shall witness the soil boring and compare the results to the original site evaluation submitteef. A reinspection tee will be assessed if the contractor is not ,r. lobsite at the 1.r;:nrged rim.• EXPIRATION DATE: 12/15/2011 SE452141 CHD Page 1 of 3 q\15\11-.L0 BUILDING PERMIT APPLICATION Fsc zo 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 Permit No.1�" 14'4, ° t F wI No. Permit Type: PLUMBING OWNER: Name (Fee Simple Titleholder): 76 ® A t i_/ 4 g Phone#: J1'5(55 6 aR Address: lq _Of/ W 5-74 ! ag • City: ///Q /E'C1�% State: � Zip: t;3301� Tenant/Lessee Name: 47,/Q�i e E2 //t%j1' Phone #: Email: (� JOB ADDRESS: City: Folio/Parcel #: Miami Shores County: /s�a060414 0 Miami Dade Zip: dgic369) Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Com a any Name: Address: City: Qualifier Name: a Phone #: State: - -,f�R(b1i- ic.® Q2 Phone #: State Certificatio or Regi tration #: c -rcx; il_e Contact Phone #: Zip: Certificate of r ompetency #: 7 -7` DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ © ©� Type of Work: ❑Address DAlteration Description of Work: l 0 ' ij-) Cr // ? Square/Linear Footage of Work: ONew Repair/Re lace ❑Demolition 1hp47e & AM a * * * ** *** * ***** x** **+x**+x ****:x**+x*** ***** Fees: x: x****** ******** *+ x** **** ** *************:x**** Submittal Fee $ Permit Fee $ /637 e) Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ I 91 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 -to p j (1 ©6 i '�l lue c�''g'�j �'� a . Application is hereby made to obtain a permit to d 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 At'FIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER . OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinsp 'ction fee will be charged; Signature Owner or Agent The foregoing instrument was acknowledged before me this 36 day of Al., v s ' 20 Il , by t 1 z E e -1-)4 °.2 who is ersonally known o me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: actor The foregoin ins ent was acknowledged before me this ( day of , 20. rt , by who is personally known to me or who has produced 1 as identification and who did take an oath. NOTARY PUBLIC• `^^ Print: �� V, a Y -n t. 1 Gt Z z- t c� My Commission Expires: ° ' 4�'o JOHANNAMAZ EO , * MYCOMM1SSIONIfDD803809 APPROVED BY e EXPIRES: September 27, 2012 %amp, BondwalmlBudONo ySeml Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Sign: Print: My C gaillill a rile. i(''- Public - State of Florida !�Z i,Mary y Comm. Expires Jul 27, 2013 ..."P's ,�,�,:�,�a,- Commission # DD 911349 ' %�e° tis -4 Bonded Through National Notary Assn. Zoning Clerk Property Information Map Property Information Map My Home Miami -Dade County, Florida Aerial Photography - 2009 0 28 ft This map was created on 11/16/2011 921:45 AM for reference purposes only. Web Site © 2002 Miami -Dade County. All rights reserved. Page 1 of 1 Summary Details: Folio No.: 11- 3206 - 013 -4210 Property: 9723 NE 2 AVE Mailing Address: 7800 NE 2ND AVE LTD 419 W 49 ST #105 HIALEAH FL 33012- Property Information: Primary Zone: 6100 RESTRICTED COMMERCIAL CLUC: 0011 RETAIL OUTLET Beds /Baths: 0/0 Floors: 1 Living Units: 0 Adj Sq Footage: 9,459 Lot Size: 12,350 SQ FT Year Built: 1948 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 10 & 11 BLK 31 LOT SIZE 95.000 X 130 OR 17437- 1378 1196 4 (2) OR 17437- 13781196 01 Assessment Information: ear: 2011 2010 _ Land Value: $247,000 247 000 Buildin. Value: $347,740 '.348 08 Market Value: $594,740 s.595,085 ssessed Value: $594,740 ; ,; Taxable Value Information: Year: 2011 2010 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $0/$594,740 $0/$595,085 County: $0/$594,740 $0/$595,085 City: $0/$594,740 $0/$595,085 School Board: $0/$594,740 $0/$595,085 Sale Information: Sale Date: 11/1996 ale Amount: .0 Sale O/R: IIEMETZMIIIMIll ales ales which are Qualification • isqualified as a result of Descri 'lion: examination of the deed View Additional Sales http: / /gisims2.miamidade.gov /myhome /printmap. asp? mapurl = http: / /gisims2.miamidade.g... 11/16/2011 Jan X12 07 04:57p James Q. Fisher UNIFORM STATUTORY FORM POWER OF ATTORNEY (California Probate Code Section 4401) 41 -1344 p2 Noy 1 6 BY: yx! — NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM POWER OF ATTORNEY ACT (CALIFORNIA PROBATE CODE SECTIONS 4400-4465). IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER HEALTH -CARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO. 1 35 NW 54 ST LC 330 NW 71 ST LC 668 NW 62 ST LC 746 NW 62 ST LC 12955 NW 7 AVE LC 1744 NW 36 ST LC 6145 NW 7 AVE LC 1201 NW 54 ST LC 7800 NE 2 AVE LC 7155 NW 2 CT LC 1536 NW 36 ST LC DOLPHIN PLAZA LC (YOUR NAME AND ADDRESS) appoint LIZA E. MENDEZ (NAME AND ADDRESS OF THE PERSON, APPOINTED, OR OF EACH PERSON APPOINTED IF YOU WANT TO DE=SIGNATE MORE THAN ONE) as my agent (attomey -in- -fact) to act for me in any lawful way with respect to the following initialed subjects: TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE UNE IN FRONT OF (N) AND IGNORE THE LINES IN FRONT OF THE OTHER POWERS. TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE GRANTING. TO WITHHOLD A POWER, DO NOT INITIAL. THE UNE IN FRONT OF IT. YOU MAY, BUT NEED NOT, CROSS OUT EACH POWER WITHHELD. INITIAL jt SAY (A) (B) (C) (0) (E) (F) (G) (I) () (K) (L) (M) (N) Real property transactions. Tangible personal property transactions. Stock and bond transactions. Commodity and option transactions. Banking and other financial institution transactions. Business operating transactions. Insurance and annuity transactions. Estate, trust, and other beneficiary transactions. Claims and litigation. Personal and family maintenance. Benefits from social security, medicare, medicaid, or other governmental programs, or civil or military service. Retirement plan transactions. Tax matters. ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL ANY OTHER LINES IF YOU INITIAL. UNE (N). SPECIAL INSTRUCTIONS: ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS UMITiNG OR EXTENDING THE GRANTED TO YOUR AGENT. NONJC•19 (Rev. 04(0112005) Martin Dan's Essenfa! FormsTM POWERS UNIFORM STATUTORY FORM POWER OF ATTORNEY RJR Jan 12 07 04:58p James Q. Fisher i 213 - 341 -1344 p3 AGENT MAY HANDLE ALL MATTERS REGARDING CITY OF MIAMI AND MIAMI —DADE COUNTY, BUILDING PERMITS, FILES, LICENSES, ETC. UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL IT IS REVOKED. This power of attorney will continue to be effective even though I become Incapacitated. STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER OF ATTORNEY TO CONTINUE IF YOU BECOME INCAPACITATED. EXERCISE OF POWER OF ATTORNEY WHERE MORE THAN ONE AGENT DESIGNATED 111 have designated more than one agent, the agents are to act IF YOU APPOINTED MORE THAN ONE AGENT AND YOU WANT EACH AGENT TO BE ABLE TO ACT ALONE WITHOUT THE OTHER AGENT JOINING, WRITE THE WORD "SEPARATELY" IN THE BLANK SPACE ABOVE. IF YOU DO NOT INSERT ANY WORD IN THE BLANK SPACE, OR IF YOU INSERT THE WORD "JOINTLY", THEN ALL OF YOUR AGENTS MUST ACT OR SIGN TOGETHER agree that any third party who receives a copy of this document may act under ft. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. ( agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. Signed this / 12th da of anuary, 2 007 • MANAGER (YOUR aNAtURE) (YOUR SOCIAL SECURITY NUMBER) State of CALIFORNIA County of LOS ANGELES BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBIUTIES OF AN AGENT. NONJC -019 (Rev. 0410112005) Marlin Dean's Essential ForrnsIM UNIFORM STATUTORY FORM POWER OF ATTORNEY RJR Page two Jan 07 04:58p James Q. Fisher 213-341-1344 p.4 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT � "`�, ti,.t.�• ^1^�a � ;�nsr•,n a n�..yi.�i�. n n�..,� �q�• ww,.,�n -.M1� +�; �r'.���,".;�i '��,"i�!'`�s .�"'�. f \' R7` f, •`�:�^••Sa+ar.:�„� e. :!C.'ti�+G.�.��.ttia.;..e.sC7%.'. v:.�ir:•sar"� Y.... .�v`.•:�4'}e ..ti•.�?s..r....8t.•s.«✓v... • tr_v3. �� _•.Y..•/1Z4.�e.:.Ca'%:G�:+�::L .".�»n'. ��/(' Il(i u iS A State of California County of [,-0,c• ' &f- Orti (VI tt a N. / 2 f A bt .1 before me, or personally appeared K. SAVAGE Commission # 1550160 Notary Public - Catitotnia Los Angeles County MyComm. Excites Feb 5. K..-5 7111:611. Name anc olacette^.. 4ane DO . N N®na Del Sig CS) e sor naliy known to me O proved to me on the basis of satisfactory evidence 10 be the person subscribed to the acknowledged to me the same in capacityltef, and that by /her/their signature($'on the instrument the person(s); or the entity upon behalf of which the person,(s' acted, executed the instrument. whose name are within instrumen and al /she/they executed eritheir uthorized OPTIONAL Though the information below is not required by taw, It may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this toms to another document. Description of Attached Document Title or Type of Document: Document Date:' C•V'[L{ 1 /! ►4 ,ra' / sit. Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer Signer's Name: ADDI Vi. Number of Pages: O individual D Corporate Officer — Title(s): • Partner — O Limited U General • Attorney -in -Fact O Trustee O Guardian or Conservator O Other: Signer Is Representing: Too Cr thunb here .0;::kXW *V-W �V }�V,t��N'X;s=9;"XVYYV v , lt! ia t.. ,.Vaet :.ie g I "Y t. d •`uv �VW3 V `W.it V� �IYn•G• V'4- W :.n-WC1 X;;C.; N 1999 National Notary Asscdalot - WM Oa Soto Ave. P.O. Bat Q482 • (2uyalvath. CA gt319.2462 • wmrtathnatnetarywg Prod. Na eW Reenter. ON Tol.hee 14Xt•8r8.6W Ac# DATE s AT ::H NUMBER O6f15 /ufrio_ 49it) oT170_ e PLUMBING- COMM e L below IS 'C TIri 3 Under the provisions of Cba B:xpiration date: AUG 31, 201, CHAVEZ, NICOLAS N . C H PLUMBING INC 3121 NW 2 8rtH ST MIAMI CHARLIE CRIST GOVERNOR ISPLA EQUIRE=(Y L MIAIVIRDADE;COUNTY 20 TAX COLLECTOR 1.90 W. FLAGLER St #St FLOOR MIAiME, FL 33150 Pk1i 1562 5-5 BUSINESS NAME 1 LOCATION NCH PLUMBING INC 1045 NW 134° ST 33168 NORTH- MIAMI OWNER NCH LOCAL BUSINESS TAX RECEIPT MIAME-DADE COUNTY - STATE OF FLORIDA 1EXPERES SEPT. 30, 2011 UST BE DISPLAYED AT PLACE OF BUSINESS SUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 THIS IS NOT A BILL — DL'? NOT PAY RENEWAL RECEIPT NS. 156; STATE# CFC037076 FJRST -CLA U.S. POSTA PAID TAMAMt, Fl PERMIT NO. P5 -5 f Business TMs is AP Bit/0 CO ; BU$tNESS TAX RECEIPT; iT DOES. PLOT PERRY THE HOLDER TO. 410 TE ANY -- f. t#StiNG REG�ULAT$RY OR, LAWS OF THE OR CRIES. NOR EXET. THE PROM ANY OTHEfi OR UCENSE BY LAW. THIS IS ERTIMATION OP ER'S c A14R PAYMENT MIAMI-CADS U TOR COUNTY TAX 09/28/2010 09010432001. 000045.00 SEE OTHER SIDE DO NOT FORWARD NCH PLUMBING INC NICOLAS E CHAVEZ PRES 1045 NW 134 ST N MIAMI FL 33168 ] stittttilats/ �lttl saiss�ssl�sssli ►sPPt�sslalss�esis�s�t}}�ou� �os3gg,/ -µg /),. RPC Real Property Care Commercial and Residential Property Management Services 419 W. 49 Street, Suite 105, Hialeah, FL 33012 305 - 556 -6627 Office * 305 - 556 -0343 Fax www.realpropertycare.com August 25, 2011 RE: 216 NE 98th Street, Miami Shores, FL 33138 — Jorge Espinosa To whom it may concern: Please be advised that I, Pedro F. Hernandez, do authorize Liza E. Mendez, an officer of Real Property Care, Inc., the registered agent of 7800 NE 2 Ave, LC to sign the applications as an agent appointed by the owner with a Power of Attorney. Tenant will be responsible to hire the contractors for the plumbing, electrical and mechanical work and all the costs. If there are any further questions please feel free to contact me at (305) 556 -6627. Pedro F. Hemandez Real Property Care, Inc. State of FI o --r, County of D ,-d €- The foregoing instrument was as acknowledged before me this it- 2 (e - Z ®1 f by F !-Fd "r-1 r -n �► a , who isOersonally know�r to me or rho has produced identification. ' * . � ANNA' MAC® In witness hereof, I hereunto set my hand and cial seal. % * MYG"MMISa!eP DD 9 EXtftRi.3. Member 27, 291 oe° &.reds 'NM Bait Nosy Sera* Serving South Florida's Real Estate Market Over 35 Years Experience A Division of Pedro Realty, Inc 15:51 SEP 12, 2011 FR: AMANDA #82069 PAGE: 1/1 A� Cr CERTIFICATE OF LIABILITY INSURANCE 9/12/20 1 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certlflcate holder In lieu of such endorsement(s). PRODUCER Eastern Insurance Group, Inc. 9570 SW 107 Avenue Suite 104 Miami FL 33176 ,C�°MEACT David M. Lopez MIL, Ext): (305) 595 -3323 FAX No): (305)595 -7135 RAILS: ADDRES csr @easterninsurance.net PRODUCER 00000187 CUSTOMER ID i3: INSURER(S) AFFORDING COVERAGE NAICS LIABILITY COMMERCIAL GENERAL LIABILITY INSURED N.C.H. Plumbing, Inc. 1045 NW 134 Street Miami INSURER A :Granada Insurance Company 0185EL00009462 INSURER B :CastlePoint Florida Insurance 5/24/2012 INSURERC: $ 1,000,000 INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : FL 33168 INSURERF: OCCUR CERTIFICATE NUMBERMaster 11- • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR suM WVD POLICY NUMBER POLICY EFF (MM /DD/YYYYL POLICY EX? (MMIDD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 0185EL00009462 5/24/2011 5/24/2012 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP /OP AGG $ 1 , 000 , 00 0 POLICY PO - JECT LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ _ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y /N ANY OFFICER MEMBER EXCLUDED? CUTIVE ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCP760504700 9/23/2010 9/23/2011 WC STATU- OTH- $ TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 $ 1,000,000 E.L. DISEASE - EA EMPLOYEE E.L. DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Plumbing Contractor ("FR TIFIr`ATC uni nce ON (305)756 -8972 Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores, FL 33138 ACORD 25 (2009/09) INS025 (200909) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE David Lopez /ANA O 1988 -2009 ACORD CORPORATION. All rights reserved: The ACORD 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- 164358 Permit Number: PLC -9 -11 -1678 Scheduled Inspection Date: September 30, 2011 Inspector: Hernandez, Rafael Owner: Job Address: 216 NE 98 Street Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: NCH PLUMBING INC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134210 -216 Phone: (786)848 -7713 Building Department Comments INSTALLATION OF TANKLESS WHEATER AND A MOP SINK Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 29, 2011 For Inspections please call: (305)762 -4949 Page 6 of 11 Protect Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795 -2204 Parcel Number Applicant 216 NE 98 Street Miami Shores, FL 33138 -0000 1132060134210 -216 Block: Lot: 7800 NE 2ND AVE LTD 1 Owner Information Address Phone Cell 7800 NE 2ND AVE LTD 419 W 49 Street HIALEAH FL 33012 -3602 1 419 W 49 Street HIALEAH FL 33012 -3602 Contractor(s) NCH PLUMBING INC Phone Cell Phone (786)848 -7713 Valuation: Total Sq Feet: $ 850.00 0 1 Type of Work: TANKLESS WEATHER & MOP SINK Type of Piping: Additional Info: Classification: Commercial Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.60 $2.25 $2.25 $0.20 $150.00 $3.00 $0.80 $159.10 Pay Date Pay Type Amt Paid Amt Due Invoice # PLC -9 -11 -42012 09/19/2011 Check #: 470 $ 159.10 $ 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: 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. September 19, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date September 19, 2011 1