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PL-13-2456 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores,FL Phon e•. 305 795-2204 Fax: (306)756-8972 ( } Inspection Number: INSP-202189 Permit Number: PL-10-13-2456 Scheduled Inspection Date: November 19,2013 Permit Type: Plumbing- Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: GARCIA,JOHN Work Classification: Sprinkler System Job Address:168 NW 104 Street Miami Shores,FL Phone Number Project: <NONE> Parcel Number 1121360131370 Contractor: S A J IRRIGATION INC Phone: (786)237-6210 Building Department Comments LAWN SPRINKLERS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Ef Rw,,N1, Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. as For Inspections I November 18,2013 p please e call: (305)762-4849 Page 17 of 31 Il • Miami Shores Village f� v� Building Department OCT 3 0 2013 1 (( 10050 N.E211d Avenue,Miami Shores,Florida 33138 BY: 3 I 9 Tel:(305)7952204 Fax:(305)756.8972 O INSPECTION'S PHONE NUMBER:(305)762.4949 • FBC 20 BUILDING Permit No. PERMIT APPLICATION MasterPermiMPI 13 Permit Type: PLUMBING JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 3 3 `- Folio/Parcel#: Z Is the Building Historically Designated:Yes NO Flood Zone- OWNER:Name(Fee Simple Titleholder): phone#; _ `7 Address: ! q ,L1 uj In a S-t ff City:—1 l�6�' lam' ,—� tom-°-� Ste` Zip:_ a,� 122 Tenant/Lessee Name: = Phone#: --� Email: CONTRACTOR:Company Name: YVL' (�A h(► Phone —� Address: g. g) 71 SIC j t e/ City-- _L( m f State• Zip: �-Z Qualifier Name: WAa_n Phone#:� �' State Certification r Registration Certificate of Competency#• Contact Phone#• — Email Address cd pm "-2- DESIGNER:Architect/Engineer. Phone#: Value of Work for this Permit:$-Z Square/Linear Footage of Work: Type of Work: OAddress OAlteration tKew ORepair/Replace ODemolition Description of Work:-- r. A � ^ k�kkkdedrirtkttRkk9a4,k,�e�rirdnAnkdnk9F�nlkirirk�r,k�Y,k4nkTrF�Ydtinink4titt4fkk�vk&t4dnkk,RWrdnirtr#dtir9nkfnkdaTnkk,Snk�eirtnT inkekitir Submittal Fee$. Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ I 7'- `7P Bonding Company's Name(if applicable) c 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 EAPROVEMENTS YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CO S T WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y N TICE OF COMMENCEMENT." Notice to Applicant. As a co ndi ' n to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith t at a co of the notice of ement and construction lien law brochure will be delivered to the person whose property is subj to att hment. Also ae ertified py of the recorded notice of commencement must be posted at the job site for the first ' ectwn w i+sh occurs seven (7) d after he building permit is issued. In the absence of such posted notice, the inspection not be o ed and a reinspec n f will b charged. Signature Signature Owner or Contractor The foregoing ins ent ac owledged before me this The foregoing instrument was acknowledged before me this day of 20 day of ACT .20 13 by who is personally known to me or who has oduced who is p y —7 �Apr personally known to me or who had produced��� b 0As ideenntificcatton an'd who did take an 6ath. 10 610 T,)w identification and who did take an oath. NOTARY PUBLIC: G NI ,i,ll,,ra NOTARY PUBLIC: 4 Ar Sign: ' Sign: Print: =� Print _ ' , My Commission Expires: o,'. "o � ��� My Commission Expires: •....p.. \`� ,. ®•, �,��/OAR"' ��° tk&dF4nYak�aR�tnktir�ir4tskakl t*iF�Y3t9rtkir&dt&drieakiednkdtekaF�Y�trdr+Y+ink��k4r�nYiFdFiririY+t4rA�a&ia&dt9F&ie4r4rdr4rdtiraUieiFirat&drakdtdnY�4Aasktk�tVtirtR� 4R�4kfr &�kak i /I!l11111111����� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3/1=012)(Rwised 07/10/07XRvAsed 06 110/2009)(Rwised 3/15/09) a ` TQB._ Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 12P000188 S A J IRRIGATION INC _D.B.A.: MANCA ARTURO Is certified under the provisions of Chapter 10 of Miami-Dade County 1 i _. - - TRADE(S) UALIFYING Q 0003 LAWN SPRINKLER Charles Uerg�er P:E. Seereb of:tfte 6ssrd www,rn�mWede.goVJdevelepman< r 6 ` R' DATE OF LIABILITY INSURANCE �'°°'Y""Y' 10/28/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. 9 SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ANTHONY HAZARD NAME: A.Hazard Insurance Agency PHONE , (305)247-4004 C No): (305)247-2999 1008 NW 1st Ave. L AnnRimn. hazardins@aol.com Homestead,FL 33030 INSURE R(41)AFFORDING COVERAGE NAIC# Phone (305)247-4004 Fax (305)247-2999 INSURERA: GRANADA INSURANCE CO INSURED INSURER B SA.J.IRRIGATION INC INSURER C: 13003 SW 195 Street INSURER D: MIAMI,FL 33177- (786)237-6210 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/D MM/DO GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000.00 PREMISES Ea occurrence) $ ❑ ❑ CLAIMS-MADE W OCCUR 0185FL00035645 MED EXP(Any one person) $ 5,000.00 A ❑ Y 04!192013 04/19/2014 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000.00 ❑ POLICY ❑ PRO- 1:1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accdent ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OSNE ❑ SCHEDULED BODILY INJURY(Per accident $AUTOS NON-OWNED PROPERTY DAMAGE $ ❑ HIRED AUTOS ❑ AUTOS Per accdent ❑ ❑ $ ❑ UMBRELLA LIAB [:]OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC STATU- ❑OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yea,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 N.E.2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,Florida 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORA ON. All rights reserved. ACORD 25(2010 105)OF The ACORD name and logo are registered marks of ACORD I 05-08-2012 JEFF ATWATER 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: 05/08/2012 EXPIRATION DATE: 05/08/2014 PERSON: SALAMANCA ARTURO FEIN: 454493970 BUSINESS NAME AND ADDRESS: S A J IRRIGATION INC 13003 SW 195 ST MIAMI FL 33177 SCOPES OF BUSINESS OR TRADE: 1- LAWN MAINTENANCE 2- SPRINKLER INSTALLATION IMPORTANT. Pursuant to Chapter 440 . 05114), 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 it, 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. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 OUESTIONS? (850) 413-160' PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES F CONSTRUCTION IMPORTANT DIVISION WORKERS'COMPENSATION Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA *,",--m WORKERS'COMPENSATION LAW L under this section may not recover benefits or compensation under this D chapter. EFFECTIVE: 05/08/2012 EXPIRATION DATE: 05/08/2014 PERSON: ARTURO SALAMANCA 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 FEIN: 454493970 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: S A 1 IRRIGATION INC E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt 13003 SW 195 ST and certificates of election to be exempt shall be subject to revocation MIAMI, FL 33177 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 SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- LAWN MAINTENANCE 2- SPRINKLER INSTALLATION section. QUESTIONS? (850) 413-1609 CUT HERE Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 N -Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL-Di)NOT PAY LBT 6989884 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES S A J IMGA-nON INC RENEWAL 13003 SW 195 ST SEPTEMBER 30, 2014 f� IWI,FL 33177 7286616 Must be displayed at place of business Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS S A J IRRIGATION INC 196 SPECIALTY PLUMBING BY TAX RECEIVED CONTRACTOR 8250 10/29/2013 Worker(s) I 12P000188 0229-14-000365 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, Permit,or a certification of the holder's qualificadons,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIFT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a 278. For more information,visit wwuymiapldadS.go_q�tatccgl�eetor Municipal Contractor's Tax Receipt Miami-Dade County, State of Florida -THIS IS NOT A BILL-DO NOT PAY M C CC NO: 12P000188 BUSINESS NAME&OCATION RECEIPT NO. EXPIRES S A J IRRIGATION INC NEW BUSINESS 13003 SW 195 ST 7440206 SEPTEMBER 30, 2014 MIAMI,FL 33177 Must be displayed at place of business Pursuant to Cowry Code Chapter 8A-Art.9&10 OWNER TYPE OF BUSINESS S A J IRRIGATION INC SPECIALTY PLUMBING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR 175.00 10/29/2013 0229-14-000365 MAMA= For more information,visitwww.miatolda o.aovltaxcollector r now