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"