FW-12-2196 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-196060 Permit Number: FW-11-12-2196
Scheduled Inspection Date: July 30,2013 Permit Type: Fence/Wall
Inspector:.Rodriguez,Jorge
Inspection Type: Final
Owner: MIAMI SHORES, CENTER LLC Work Classification: Masonry
Job Address:160 NE 99 Street
Miami Shores, FL 33138-
Phone Number (305)864-8885
Parcel Number 1132060132250
Project: <NONE>
Contractor: RESTORE CONSTRUCTION GROUP INC Phone: (954)985-5353
Building Department Comments
115 X 5' CBS WALL Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed 9a CREATED AS REINSPECTION FOR INSP-181792. Need complete permit
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
July 29,2013 For Inspections please call: (305)762.4949 Page 30 of 34
Miami Shores Village
Building Department NOV Nov 1 K012
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 `' '
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 20 LO
BUILDING Permit No.
PERMIT APPLICATION Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 0(0® NE 9 94 h Stet
City: Miami Shores County: Miami Dade Zip: 31
Folio/Parcel#: I I® 3 00 G° ®1,3- ?Z)50
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder): M i A rn) Shores t 'en1r , L.L C Phone#($O
Address: a710 :7 1 *,Ce 1 I S y i+e 309
City: M i am i Se-OCh state: Fi o r i d o Zip: 3 5)14 9
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: 12p—sfore C.V14t e l o vi GLOB 1nC°Phone#: 9S14
Address: J O B.f 9 e, Cu v C i N-. lAn it 3
City: Pllemloro e PC A State: I='0 y+ Cl G,- Zip: S30C>
Qualifier Name: :reAjn C C. 0 Phone#: 51(91 _)5(d 7 LI 8 L4
State Certification or Registration#: C C.-7 C Certificate of Competency#:
Contact Phone#: Email Address:
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ / �( Square/Linear Footage of Work: It S�
Type of Work: ❑Addition/ ! ❑Alteration J ONew ORepair/Replace ODemolition
Description of Work: t 6l Cgs- 6 �i,L /(�'L�
Color thru tile:
Submittal Fee$ Permit Fee$ f CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$ do A
TOTAL FEE NOW DUE$ •
I r
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 approved and a rWectionf wil l be charged.
Signature Signature
Owner or Agent Contr or
The foregoing instrumeilt was acknowledged before me this A The foregoing instrument was acknowledged before me this_,
day of ,20/&by day of Atlern,- ,20 , ,by J"a,? Ca-q-ka ,
who is personally kno n 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 PUBLIC:
Sign: (C Sign:
Print l!'V�®u Print: �y �'a S e@ r,1 +�rnthia S.Abramsorl
��
+py, G^?+MISSION#EE107312a
My Commission Expires: My Commission Expires:
OR I e
Fy q_S:JUN.27,2019
�ari 'ea Commission#DD 946625 °�i""o'
°1 " 'h'w'jy.F,A30NNOTARY.cortQ
'i My Commission Expires
r 14, 2013
/ /
APPROVED BY /d �k�'4 clans Examiner l C Zoning
tt t Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
I
n
rnr awe Miami shores Village
Building Department
Wrlr' 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel:(305) 795.2204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS j
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE NTH YOUR INFORMATION FOR A$30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
' I
I
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C.—COPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPTH
D. COPY OF WORKERS COMPENSATION(EITHER CERTIFICATE OR EXCEMPTOON)
I
IF CONTRACTOR HAS A MIAMI DN3E COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D.. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW.
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES,FL 33138
■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME:_ �P-S$o` C= ccx +ruC-bopt &i0L)jQg l ytC
BUSINESS ADDRESS: 33g9 kyyibrc*F r +CITY ollsjwooJ
STATE Fioir+ d CL ZIP CODE 33n a- 1
BUSINESS PHONE:( 1 9 FS 6;3S3 FAX NUMBER 9,5 J S15 Co
CELL PHONE(-S&(1 (0 QUALIFIER'S NAME: L' �ro
QUALIFIER'S LIC NUMBER: Ccn c- Is IS 03—)-
E-MAIL ADDRESS(IF APPLICABLE): Ct re&icaf e.c®n�jr y onoy m coal
CraaWd on MOM BY MM I IM 30M NILOV
e
,s4°°' CITY OF HOLLYWOOD
t ` TREASURY SERVICES DIVISION
LOCAL BUSINESS TAX RECEIPTING
2600 HOLLYWOOD BLVD, ROOM 103
HOLLYWOOD, FL 3302Q
a
RESTORE CONSTRUCTION GROUP INC
3149 J P CURCI DR - BAY #3
HALLANDALE FL 33009
4505 40802
b CITY OF HOLLYWOOD LOCAL BUSINESS TAX RECEIPT PRINT DATE: 9/20/12
THIS IS YOUR LOCAL BUSINESS TAX RECEIPT. PLEASE DETACH AND POST IN A CONSPICUOUS
PLACE AT THE BUSINESS LOCATION. PLEASE DO NOT REMIT ANY PAYMENT.
THIS IS NOT A BILL,
uslnecR Niamey RESTORE CONSTRUCTION GROUP INC
Business Location' 3849 PE14BROKE RD
Business Class: CONTRACTOR/GENERAL
Tax Basis: ' . OVER 50 WORKERS
Receipt Number 13 00049631
Receipt Year 10/01/12
Expiration Date: 09/30/13
NEW CwABGES• (itemized Below) 700.00 Comments-
Base Fee 700.00
Additional Charges:
TOTAL NEW CHARGES: 700.00
Penalty Amount: .00
Previous Balance Due: .00
TOTAL AMOK T PAiD,; 700.00
PURSUANT TO STATE LAW, THE LOCAL BUSINESS TAX IS LEVIED ON THE PRIVILEGE OF
DOING BUSINESS WITHIN A CITY'S LIMITS, AND IS NON-REGULATORY IN MATURE.
ISSUANCE OF A, LOCAL BUSINESS TAX RECEIPT BY THE CITY OF HOLLYWOOD DOES NOT
MEAII THAT THE CITY HAS DETERMINED THAT T14E EXISTING OR PROPOSED USE OF A
LOCATION IS LAWFUL. ISSUANCE OF A LOCAL BUSINESS TA.?, RECEIPT DOES NOT
LEGALIZE OR CONDONE THE NATURE OF THE BUS114ESS BEING CONDUCI'Eta IF
C0I4TRARY TO A14Y LOCAL, STATE OR FEDERAL LAWS OR REGULATIONS.
1
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY. LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
•'` „� TALLAHASSEE FL 32399-0783
CASTRO, JUAN ANTONIO
RESTORE CONSTRUCTION GROUP, INC
3849 PEMBROKE ROAD
HOLLYWOOD FL 33021
Congratulationsl With this license you become one of the nearly one million AC. ' :30 2,2.4-
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yaa,t brokers,from �, PR{iF SSIO R.?GULA'TION.
boxers to barbeque restaurants,and they keep Florida's economy strong. .
3
CGC15 637 z` 5 1Y91862I7
d we work to urn a
Every ay prove the way we do business in order to serve you better.
For Information about our services,please log onto www.myftorid&Rcense.com
There you can find more information about our divisions and the regulations that
R
impact you,subscribe to t?AS1'RID, t ;
department newsletters and learn more about the 'i Rgs� } 6"
Deparbinent's initiatives. ,
Our mission at the Department is:Uc rise
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 licensel. - 2s _�' � ag 4$9. Fs
�+cpiacstl+md daLe'eAQt4. �Z,.x.014. :I,7.2Q51.7009-a'9
DETACH HERE
a
STATE QF FL®Ri®A.
DEPARTMENT OF- BUSINLSS AND PROFESSIONAL WULATION
CONSTRUCTION.*, INDUSTRY LICENSING BOARD
SEL12051700979
o • TOM T. I C E NS-9 NBR
05/17/``2-.-01.:2. 111818.6-211:: 6C151503,7.
_,
-The �GENERAL: CONTRP;CTOR
Named-below .IS CERTIFIED..
Under the provisions of .Chapter FS.
Expiration date: AUG 31, 2014
CA.STRO JUAN ANTONIO
RESTORE CONSTRUCTION GROUP, INC
7291 NW' 173RD DRIVE, #104
MIk1`iI LAKES FL 33014
RICK SCOTT 11z.11° Lx=.l}SOxi
GOVERNOR SECRETARY
DISPLAY AS REQUIRED BY LAVA
s
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT '
115 S.Andrews Ave., Rm.A-1 00. Ft. Lauderdale,FL 33301-1895—954831-4000
VALID OCTOBER 1,2012 THROUGH SEPTEMBER 30,2013
DBA:RESTORE CONSTRUCTION GROUP INC Receipt#:GB�RAL CONTRACTOR
Business Name: Business Type:(CONSTRUCTION)
Owner Name:JUAN CASTRO Business Opened:o6/28/2011
Business Location:3849 PEA413ROKE ROAD State/County/CertlReg:CGC1515037
HOLLYWOOD Exemption Code:
Business Phone:954-985-5353
Rooms seats Employees Machines Professionals
50
For Vending Business Only
Number of Machines: Vending Type:
Tau Amount Transfer Fee NSF Fee Penalty Prior Years Cofiec ifon Cost Total Paid
135.00 0.00 0:00 0.00 t}.00 0.00 135.00
t}
E
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
r THIS BECOMES A TAX RECEIPT This tau is levied for the privilege of doing business within Broward County and is
1{ non-regulatory in nature.You must meet all County and/or Municipaiiiy planning
t WHEN VALIDATED 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:
RESTORE CONSTRUCTION GROUP INC Receipt #OIA-11-00008530
3149 JOHN P CURCI DR BAY #3 Paid 07/06/2012 135.00
PENBROKE PARK, FL 33009
l
2012 - 2013
_ _ _ _ _ tS�lJil�ll�]L1J+_/i 0..i.R Il�9uC l_/�[►_A l.._ _e.B sG�-1-4a.a-£'t?�►_.T<�Aa!Ra!'°,4�9�°v "r.....-—-------__--------- ——
f MST--CLASS
U.S.POSTAGE f
PAID ,
MIAMI,FL
w
s i i y a PERMrr NO.231
683609-3 THIS IS NOT BILL—DO NOT PAY RENEWAL
BUR���AI �UUN RIUCTION GROUP INC STATES CGC151.5037 710987-9
DOING BUS IN DADE CO
' owlv�R
RENSeTORE CONSTRUCTION GROUP INC
Sec.95 VIERAL BUILDING CONTRACTOR WORKi0/S
THIS IS ONLY A LOCAL
BUSINESS TAX R£09M.IT
-DOES HOT PERIM THE
HOLDER TO VIOLATE ANY OR
ZONING N{}REGULATORY HE DO NOT FORWARD
MXWRN REGU TO THE
COUNTY OR CRTIE& NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERITfr OR LICENSE
NOT A�a CERTIFICATION ON OF RESTORE CONSTRUCTION GROUP INC
THE A �AT�H cwattPlCA-
JUAN CASTRO PRESIDENT
3849 PEMBROKE RD
PAYMENT RECEIVE} HOLLYWOOD FL 33021
MIAMI-DADE
COLLECTOR:
07/26/2012
6000607050095 1i}I1ii!# } lttiiil till fill"III ili1l}i!t}} }Jl Ill i1k{{4ill
SEE OTHER SIDE ;
REST AG
CERTIFICATE OF LIABILITY INSURANCE DA 1 1113112
)
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: N the certificate holder is an ADDITIONAL INSURED,the policy(tes) 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
certificate holder in lieu of such endorsement(s).
PRODUCER 305-3647800
BROWN&BROWN OF FLORIDA INC 305-7144401 PHONE
14900 NW 79th Court Suda#200
Miami Lakes,FL 33016-5864 -
Brian Martino ADDRESS:
IN AFFORDINGCOVERAGE NNC4
INSURERA:Amerlcan Safety Indemnity Co. 25433
INSURED Restore Construction Group Inc amnuns:Brldgefield Employers Ins Co 10701
3149 John P Curcl Dr.,Bay#3 ommmc:1-lartford Fire insurance Co 19682
Pembroke Park,FL 33009
INSURER D
INSURER E.
J 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.
NM TYPEOFfNSURANGE � POLICYEFF YEXP LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 110011,00
A X commERctAL GENER&LU►mw ESLI0007141201 07A1112 02/01/13
PREMISES pcpxmrm� $ 50,DN4'GE To
CLAMS-MADE 0 OCCUR MED EXP WW are amaon) $ Exclu
PERSONAL&ADV IN.RIRY $ 1,000,00
GENERAL AGGREGATE $ 2,000,
GEML AGGREGATE UMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,
POLICY PRO- LOC $
AUTOMOBILE LIABILITY
(Eaacddwd) $
ANY AUTO BODILY INJURY(Per Perm) $
ALLOWNED SCHEDULED BODILY BLIURY(Pmaxidm�t) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
HIREDAUTOS Per $
$
UMBRELLA LL48 X OCCUR EACH OCCURRENCE $ 1,000,0
A X EXCESS I" p_A gADE ESUICO1762 10/25/12 02101113 AGGREGATE 11000,
D RETENTIONS $
WORICERSCOMPENSATION X I
W STATU- OTH•YN ANDEIAPLOYE LIABILITY
B ANY PROPMET0uPAF4TNER0mcunvr- 83048393 05131112 05131113 EL EACH ACCIDENT $ 1,0001
OFFICEILMEMBER EXCLUDED? NIA
(Manaaw,y In NH) E.L.DISEASE-EA EMPLOYEE $ 11000,
OMM OF OP EL DISEASE-POLICY LIMIT 1,000,00
I
I
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Atbth ACORD 181,AdOlonW Rmnarks Sdeadaie,ff more apace is mquhed) '
CERTIFICATE HOLDER CANCELLATION
MIAMISH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village
THE ORDAEXPIRATION CE WITH DATE T POLICY PROVISIONS. �� � DELIVERED IN
Building Department
10050 NE 2nd Avenue AUTHORIZEDREPRF.SENTATiVE
Miami Shores,FL 33138
r
O 19882010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD Hants and logo are registered marks of ACORD
e
NOTEPAD RESTO 2 PAGE 2
Rios xAm Restore Construction Group Inc OP ID:AG DATE 11/13112
ompang C - Hartford Eire Insurance Co
Contractor's Equipment Coverage
Policy No. 21MSPP2104
ffective: 07/02/2012 to 07/02/2013
Scheduled Equipment Limit - $140,150
Property Lased, Rented or Borrowed Limit - $100,000
Unscheduled Limit any one occurrence- $50,000
Unscheduled Limit any one item $5,000
Deductible: $1,000