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BPP-13-1802Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INS P- 206510 Scheduled Inspection Date: February 12, 2014 Inspector: Rodriguez, Jorge Owner: GAVIRIA, JAIRO Job Address: 615 NE 97 Street Miami Shores, FL Project: <NONE> Permit Number: BPP -8 -13 -1802 Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1132060171850 Contractor: BLUE MARLIN CONCRETE FINISHING CORP Phone: (786)312 -6262 Building Department Comments POOL RESURFACE, RE TILE INSIDE AND POOL DECK intracuo rassea comments INSPECTOR COMMENTS False Inspector Comments CREATED AS REINSPECTION FOR INSP- 196940. Gates must conform to Passed child safety locks Failed Correction ❑ Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 11, 2014 For Inspections please call: (305)762 -4949 Page 16 of 39 OM �6. S - Miami Shores Village Building Department 'W50 N.E.2nd A Tel: (305) 795,2204 ' ��� 33138 INSPECTION'S PHONE NUM ER.- x.8972 (30M 762.4949 BUILDING PERMIT APPLICATION Permit 7hm: JOB ADDRESS: y� lctv� AUG 4 8 263 ` FBC 20 Q Permit No. `°' Master Permit Na_ ROOFING Lily: _ fAfllf Slmnes COW Q ��e����, - ��.�r.�....�. Iiy: M:an,i Da Is the J1WM4 WOMlaft mated: Yes NO mood Zam: OWNER: Name (Fee Simple Titlebolder): ® G°6 6 a" Fity: �l.:i�c�`c ��p�°' � State• °�� �� .r: �.� I � T�ante Name: Ewai1: .— CONTRACTOR: Company Name: City: ��- ,+ ��� # State Certi!%mion or Registration #:�' D-506,6257 �2m '26 2 PWWICM of CQmpatency #; C011taCti — msa7 Address: DES��NE>t: Arci�itecl/Enginoa: ono#: Value d Wb* for tbb Permit: $ Typo d Woxle ❑Addition r a Wor10 - OAltesmion DNew ',aifn;./Q..A...... vesuloft afwork; :9,0 =: Submittal Fee $ Permit Fee $ CCF $ COK;C $ Yoe DBPR $ — NotM $ T=WnWEft=don Fee $ Tecbnalou Fee $ Double Fee $ Struct@a1 Revka $ �_,_ TOTAL FEE NOW DUE $ . Bondtdg Company's Name (if applicable) Bonding Company's Address city - state zip Mortgage Lender's Nam (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 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, WBLIS, POOLS, F''URNAQ$ , BgU41RS, HEATERS, TANKS and AIR CONDIT IONEM, ETC..... OVVNMIS AFFMAVIT: I oer* 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 DIPROVEMENTS 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 certfned copy of the recorded notice of commen t be posted at the job site for the fast inspection h occurs seven (7 days after the building permit is issued. In ab a of such posted notice, the inspection will not be app . ed and a rems� n fee will be charged. The day is Sign: Prim: MyC Owner or Agent (� 1.actor dent was ow`l me this ° The forego, �instrnment was ackmowbef try this 20 D b I y� day of 20LI by �o to me or who has o is personally known to me or who has.produced ��/f!e1- identification and who did take an oath. Lfre,,b a as identi8catimr and whb - did take an oath. [C. NOTARY PUBLIC: I, //1 -L. I I k .4 r '= Notary 201 Sep 23, 5 Print: .J'. ^�e Commission Assn. MyC "` 040 Bonded Through National Notary - EXPIRES: January 2, 2015 Bonded Thru Notary M* Undew tens APPROVED BY Structural Review (Revised 3/12120I2Mvind 071Io/07)tRevhW ofinoR009)(Rr&w 3/1sm) V s Zoning Clerk Miami Shores Village Building Department CONTRACTORS' REGISTRATION 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. \COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. V10' 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 WORKERS 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 ............................................................ ............................... COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: T(:-: 0 145, BUSINESS ADDRESS: II' Mcl (o S l) 15q PL CITY 1A ry1 k NIJ STATE _�7 ZIP CODE 3 30 35 -6 aJv BUSINESS PHONE: (51411 ��� -' �✓ !��Z FAX NUMBER �J ) CELL PHONE 0&) 3J2 QUALIFIER'S NAME: W/. e-S c?6J� QUALIFIER'S LIC NUMBER: s do s� E -MAIL ADDRESS (IF APPLICABLE): bose-s Created on 3119109 BY MLDV 1 RV 3126109 MLDV 1 RV 6127111 AS PERMIT # tfV I 02- CONTRACTOR: 661 SUBMITTAL DATE: A a ADDRESS: S C NAME: min RESUBMITAL DATES: PROJECT TYPE: oj �v STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL BLDG A CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 08/01/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER 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 policy(ies) must be endorsed. H SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain polices may require an endorsement A statement on this cerlificate does not confer rights to the certificate holder In lieu of such endorse s . PRODUCE: CARRERA INSURANCE- KENDALL 135W SW 88 ST STE 235 MIAMI FL 33186 Franklin Davila PHON 305- 385 -2886 PAX Na 305- 385 -8275 ADORES& fdavila@carrerakwurance.com INSURER(S) AFFORDING COVERAGE NAIL 0 INSURER A : Granada Insurance Company 0 BBURED BLUE MARLIN CONCRETE FINISHING CORP 17796 SW 154 PLACE Miami FL 33187 INSURQt B : 08101/2013 INSURER C: EACH OCCURRENCE INSURER D: DAMAGETO PREMISES omffvnce J INSURER E: MED EXP (Any ore Person ) INSUM F : PERSONAL a ADV INJURY 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. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TYPE OF INSURANCE AWL SUOR ACCORDANCE WITH THE POLICY PROVISIONS. POLICY F�F EXP LIMITS A GENERAL LL48U Y COMMERCIAL GENERAL LIABILITY CLAIMS•MADE ❑ OCCUR Binder 1319273 08101/2013 0810112014 EACH OCCURRENCE $ 500,000 DAMAGETO PREMISES omffvnce J $ 100,000 MED EXP (Any ore Person ) $ 5,000 PERSONAL a ADV INJURY $ 500,000 GENERAL AGGREGATE $ 500,0W GEWL AGGREGATE LIMIT APPLIES PER POLICY Pi LOC PRODUCTS - COMPIOP AGG $ 0 $ AUTOMOBILE LIABILITY ANY AUTO � SCHEDULED HIRED AUTOS �O CEO Ea a SINGLE LIMIT $ BODILY INJURY (Per persr) $ BODILY INJURY (Per ) $ PRO DAMAGE $ $ UMBRELLA LUUB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ RETENTION 11 $ WORKERS COMPENSATM AND BIPWYEW LJ�RJTY YIN ANY PROPRIETORIPARTNERIEXECUTIVE F (Man In NH) EXCLUDED? "YY�� wwar DESCRIP ION OF OPERATIONS beloor N / A YM STATU- I O ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMrr $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atlach ACORD 101, Addwonw RWOMM SchedUI% H more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) U 19WZ010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shone Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave aunwR ¢ED REPI ENTATnrE Miami Shores, F 33138 L ACORD 25 (2010105) U 19WZ010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFPATWATM 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: 12/11/2012 EXPIRATION DATE: 12/11/2014 PERSON: ROQUE ULISES FEIN: 460563753 BUSINESS NAME AND ADDRESS: BLUE MARLIN CONCRETE FIN 17796 SW 154 PL MIAMI FL 33187 SCOPES OF BUSINESS OR TRADE: CONCRETE CONSTRUCTION IN CONNE Pursuant io Chapter440.05(14), F.S., an ofifter of a ocrporanon who elects exemption from this chapter by erg a certllicate of election wrier t is section may not recover beneft or oompensatlon undertids chapter. Pwsaam to Chapter440.05(12), F.S., Certificates of election to be exarnpt... apply only wtlhhr dw swpe of the business ortrade Ibted on the notice of election to be exempt. Pursuam to Chapter 440.05(13), F.S., Nodose of election to be exempt erM testes of election to be exempt shall be subject to revocation if, at arty firs after the MM of the notes or the Issuance ofthe ceNflcate, the person earned on the notice or certitcete no WW rneefs the requiremems of this section for issrmrrce of a certificate. The depertnrera shay revoke a cartilage at any time forfa5we of the person named on the ceNtrate to user the requkemems of this section. DFS- F2- DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850)4131609 e T B k Construct Trades Q I�g Board BUSINESS CERTIFICATE OF COMPETENCY 12BS00529 BLUE MARLIN CONCRETE FINISHING CORP �` D.B.A.:, � Y OQUE ULISES Is certified under the provisions of Chapter 10 of Miami -Dade County Local Business Tax Receipt Miami —Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 7158459 BUSINESS NAME/LDCATION BLUE MARLIN CONCRETE FINISHING CORP 17796 SW 154 PL MIAMI, FL 33187 LBT-1 RECEIPT NO. EXPIRES NEW BUSINESS SEPTEMBER 30, 2013 7435558 Must be dispiayed.at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS BLUE MARLIN CONCRETE FINISHING 196 SPECIALTY BUILDING BY Ax COLLECTOR CORP CONTRACTOR rim I u IcFc anni iF 75.00 08/05/2013 Worker(s) 1 12bs00529 0226 -13 -000691 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 holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT ND, above must be displayed on all commercial vehicles — Miami —Dade Code Sec go —276. M ®11=1111 I For more information, visit www.miamidade.govkaxcollector TO: CITY OF MIAMI SHORES FROM: BLUE MARLING CONCRETE FINISHING CORP DATE: August 6h, 2013. REF: MIAMI DADE COUNTY MUNICIPAL CONTRACTOR TAX AFFIDAVIT I am writing this affidavit because I don't have Municipal License the reason is that I don't physical address, I checked in the Miami Dade County for Home Business Use and they told me I do not qualify- - for this also I checked in my City and they told me that I need physical location but I work in the same place of work where I am performing the job. My office in is my home where I prepare invoices, estimates, quotes, bills, different payments. blue Marlin concrete .Finishing Corp State of Florida County of Miami -Dade I, the undersigned Notary Public, do hereby affirm that Ulises Roque personally appeared before me on the August 6*, 2013, and signed the above Affidavit as his free and voluntary act and deed. MARWA WCMQMM#ff051M z 2016 Notary Public & u Commission Number, Expires: a/xf i o� dl Today �� . { 9 AUG 0 8 Ca I� 'A /? �y t' Miami Shores Village APPROVED DATE ZONING DEPT 3 BLDG DEPT iJ Awl SUBJECT TO COMPLIANCE WITH ALL FEDERAL STATE AND COUNTY RULES AND REGULATIONS O e3� 0 3 � e g�. I I Q j o o' .t a , I � t A av"