PL-17-3200Miami Shores Villa g e . JAN ° 2013
e
Building Department��
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fag: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit No. *v
PERMIT APPLICATION Master Permit No. P—C I y 2J
FBC 20 tD
Permit Type: PLUMBING - - - -
OWNER: Name (Fee Simple Titleholder): C Fm Sm I'rE G lC H 0 `D ! NQ S r C Phone#: ( 11G ) 94 ( —4 9 90
Address: 3 r N& It a &r.
City: M (A VW ( S HO & E3 State: Pl— Zip: 3313
Tenant/Lessee Name: - rJ / A' Phnne#- A) / A-
Email: i C rvt e de ry s C°� ao . Co M
JOB ADDRESS:
3S NE 10 sro
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #: It 3"(0 - 0 13 r o a- `t o
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: �- �� • A - Pt WA -I Q , Phone#: D 014771 Y- C / V-
*
Address: y ) ri S•
City: State: N" NA- Zip: ► �S
Qualifier Name: _ "j Phone #•
State Certification or Registration #: C F C a 7 7 Certificate of Competency #: ro / �a
Contact Phone #: S�—&A °f a �Piv f Lf Email Address: q _b_o(ai�•t ,'1 s, G®K o �} �,a�, �.� ,
DESIGNER: Architect/Engineer: 'U Phone#.
Value of Work for this Permit: $ F-7) at ®,w SquamfLinear Fre of Work:
Type of Work: OAddress OAlteration ONew �Kepair/Replace ODemolition
Description of Work: kt t xo�m4two 1,.x ,A iv r4 C S; /� �� C�.4 Sk.P/�►,,
Cx l Ir�'r 6t
Submittal Fee $ Permit Fee $ 150 • CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $__]_ boy I '
Bonding Company's Name (if applicable)
_ 4
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
zip
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, BEATERS, 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 appro nd a reinspection fee will be charged.
A
Signa P Signature 41, L
O er or Agent o tractor
The foregoing instrument was acknowledged before me this to
day of —, 20 , by ILQ" K . V'P4 eU6 g
who is personally known to me or who has produced
Vl
CLAM— As identification and who did take an oath.
NOTARBLIC:
Sign: i v
Print:
My Commission Expires: w
* WCOkgkllSSM #FF045174
EXPIRES: A** 13, 2017
B=WT"WNdVySuWm
The foregi�M nstrument w��ass acknowledged bef, re this W' "'
day of 20 __ L, by �"I ^ ar G1,
who is personally known to me or who has producedkV—�--5
_as identification and who did take an oath.
NOTARIrPUF AC:
Sign:
Print: P0 S
My Commission Expires:
* W0000- FF045174„
EXPIRE& AWW 13, 200-'
APPROVED BY / - 8 -1 y Plans Examiner Zoning
Structural Review Clerk
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
9 STATE Of FLORIDA
DEPARTLBNT OF Bummss Ajw PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LXCMS33M BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
m
GARCIA, LUIS ALBERTO
A P A PLUMSING CORPORATION
8741 SW 49TH STREET
MIAMI FL 33165-6701
(850) 487-1395
COngratulatiorwl With this gmm you become one of the newly one million
Floridians Qcer�ed by the Department of Business and Professional Repletion.
Our proftesloneds and businesses range lkorn architects ID yacht brokers. fhmn
Domm Darbeque restaurants. WW lhey k9V RmWs econorny Mmg-
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CFC14'183 ..05/2 /12.
Every day we work to improve the way we do business In order to serve better-
YOU
.
For liftmiation about: our Servhxm please log onto WWW I I no----
There you can f Ind mom Irdbmallm about our dd1MWvhskk=w=m the
PLt=XN(; CO RX M-zli*
linpactryou, subscribe to department newsleften; and ffwm
re ]WOR 1051i",
Dommiefirs inniatives. ..........
OW ffftdon at the Dqwkrmd Im Ucense- d Re
EW lently. gulate Fairly. We
=Rft* W" to serve you better so that you can Sam your cuskamm
Thank you for doing bastrum In Fkftt% am m1glatulafths on your new 11cersel
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bcOiration date: AUG 31, 2014!
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MIAMI FL IS
SEQ#ra2032900909
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KEN LANSON
Ait;.a,
SECRETARY
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Local Business Tax Receipt T_
Miami -Dade County, State of Florida
THIS IS NOT A BILK— DO NOT PAY
LB
6281687 .
BUSmtESS N"En.QCA 014 RECO" NQ. EXPIRES
A P A PLUMBING CORD RENEWAL SEPTEMBER 30 2014
7075 SW 46 ST 6"7W9 Must be dtaphWW at platce of business
MIAMI FL 33155 Pursuant to County Code
Chapter SA — Art 9 & 10
SEC. TYPE OF BUMESS
QtNNER PAYMENT RECEIVED
A P A PLUMBING CORP 196 PLUMBING CONTRACTOR BY TAX COLLECTOR
Worker(s) 1 CFC1427783 $75.00 08/05/2013
CREDITCARD -13- 004834
This Local Busiaess Tax Re9eipt0811 cmdhms 10VISOUt of the Local Business Tax. The Receipt is ant a license,
penaiL or a coffiftW
4mgftkglwWw*squaoft-Womtedobudoess. Holder mast comply vrit6 airy povermaeaw or
asngovermuemal "*WOW Mwsaml regnAements w" aWytothe business
The RECEIPT N0. above must be displayed on all commercial vehicles -WKwul -Dade Code Sac ea-all.
For more lutarmation, visit
9
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Producan: Uon Insurance Company This Cretaleata rs ksued as a nt i tbpof only and oonfets
2739 U.S. Highway 19 N. IlgiftopondmCwtNicaftHolder. Tbs Cetfflitcate dam na amend,
� ltd
Holiday, FL 34691 oratmec a b►dnt below.
(727) 938 -5562 Irann; Afforn9 Coverage fWC #
lamed., South East Personnel Leasing, Inc. & Subsidiaries houlark uon CaRpm 11075
2739 U.S. Highway 19 N. 111suffirlk.
Holiday, FL 34691 h --awC.
Wi9trespetxe Wtft aft r maybe prmay pertft ft knumice afforded by
imam Omn may have been reduced by paid dabr.s
L'M i Type of itxituarm Pnlit y Ntunber
019M, sxdUd s, arat cafWrewts a euM p A>
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Mft
A Workers Compeneallon and WC 71949 01101/2014 01/0112015 x I WC Sletu- I 0TH- .
EmptoyeW Liabi fty to LimitB ER
Any popletmWbWamutln officednmrdw EL Each Accident 57,GW,0W
GuAldw fjo E.L Die- Ea Employee $1,000,00
dYe% desaibe under special ptovislats below
EL D - Ply Lhrdts I S1.tms=
other Lion Insurance Company Is A.M. Bea Company rated A- Excellent AMB * 12616
Descriptions of Opere tonefLoca6otmNehicles Enduslons, add by Endorsomen0 i Provisions: Olat ID: 37- 66-197
Coverage only aPOW to active emptayeel[s) of South Emt Pers mel Lem, Mt & SubsIdWes that are leaW to the folowfng °diett CanpaW:
APJL Plu ntft Cmpwatton
Coverage only apples to Wtsies incurred by South Fast PetsmW Legg, D= & S ftd vies active ems;, White wart" In: FL
Omwage daes rot apply to staWtory a tptoyee(s) or hulepaidett eattractm(s) of the ata t cmnpany or any+ other ertky.
A lst of the active employee(s) leased to the Gent Company can be obtebted by faft a request to (727) 937 -21M or by oft (727) 936 -5562.
P"ded
FAX M 033,3B25/ ISSUE 12- 27--13 (ND)
Miami. Shores village Bldg Dept b18WWWMGrW1eWWtoM8R3DftOVx1ft1 rroraa to the c Ifflufatofft rremed to no te, but s to
10050 its 2nd AvE do sm than f �PgrOObBPgMorflabMiyofwWkbdupontehumfts 91 1gormpmeentaam
Miami. Shores, 1% 33138
• 9
ercnt- UwatU t IF
Commercial Genend LWAty
Cila nt8 Made ❑ owur
Each OaameM
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rented t (EA
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tAed Ergs
e 6t
Pel Adv 0
a99re9ate Bm6 applies per
pwq ❑ Pro)aCc ❑ LOC-
GMUNWAggegate
P -pAgg
oMMLE LUUNLrrY
Any Auto
Owted Autos
SdoduledAWOS
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NoM)wtsd Autos
CombbtedShMtetbra
(EAAW"
(PerA )
Ropeity
(PGrA
EXCESSRMORELLA LL40ILrrY
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Each Qaamence
„tee -
A Workers Compeneallon and WC 71949 01101/2014 01/0112015 x I WC Sletu- I 0TH- .
EmptoyeW Liabi fty to LimitB ER
Any popletmWbWamutln officednmrdw EL Each Accident 57,GW,0W
GuAldw fjo E.L Die- Ea Employee $1,000,00
dYe% desaibe under special ptovislats below
EL D - Ply Lhrdts I S1.tms=
other Lion Insurance Company Is A.M. Bea Company rated A- Excellent AMB * 12616
Descriptions of Opere tonefLoca6otmNehicles Enduslons, add by Endorsomen0 i Provisions: Olat ID: 37- 66-197
Coverage only aPOW to active emptayeel[s) of South Emt Pers mel Lem, Mt & SubsIdWes that are leaW to the folowfng °diett CanpaW:
APJL Plu ntft Cmpwatton
Coverage only apples to Wtsies incurred by South Fast PetsmW Legg, D= & S ftd vies active ems;, White wart" In: FL
Omwage daes rot apply to staWtory a tptoyee(s) or hulepaidett eattractm(s) of the ata t cmnpany or any+ other ertky.
A lst of the active employee(s) leased to the Gent Company can be obtebted by faft a request to (727) 937 -21M or by oft (727) 936 -5562.
P"ded
FAX M 033,3B25/ ISSUE 12- 27--13 (ND)
Miami. Shores village Bldg Dept b18WWWMGrW1eWWtoM8R3DftOVx1ft1 rroraa to the c Ifflufatofft rremed to no te, but s to
10050 its 2nd AvE do sm than f �PgrOObBPgMorflabMiyofwWkbdupontehumfts 91 1gormpmeentaam
Miami. Shores, 1% 33138
• 9
Poky Number: CL 2638341
Date Entered: 01/07/2014
ACORN® CERTIFICATE OF LIABILITY INSURANCE
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M-M
1 7 201 - -
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 polcypes) must be endowed. 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
aerdficats holder in lieu of such andorsemprAO 0
PRODUCER
Your Options Insurance
882 SW 70th Ave
Miami, FL. 33144
NIUZ Pablo A Matil.la '
PHONE FAX
(888) 406 -0997 (888) 687 -1926
ADOF info@youreptionsins.com
AFFORDING COVERAGE
11AIC B
0=RMA:mxXw VMRNON FIRE IIds CO
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a=Rw A.P.A Plumbing Corporation
7075 SW 46th St
Miami, FL 33155
INSURER a:
3/25J2013
auWRER c
EACH OCCURRENCE
B1aIRa1D:
INSURER E:
MEDEV( one )
"WRER F
PERSONAL &ADP /IMJURY
[ :7<<O N a 11�LH_V141Lr1.`�i =1 ;:1. Z�11111111111111 —;'Z;
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.
ABOVE DESCRIBED POLICIES
TVrEOPINSURANCE
THE EXPIRATION DA HE NOTICE WILL BE DELIVERED IN
POLICY NUMBBR
POLICYEFF
GWINWATWI
POLIOYMW
8000ONYTO
WITIS
A
GENERAL LL48UTM
COMMERCIAL GENERAL. LIABILITY
CLAMAS•MAM ® OCCUR
X
Ci, 2638341
3/25J2013
3/25/2014
EACH OCCURRENCE
$1,000,0000
$100,000
MEDEV( one )
$5,000
PERSONAL &ADP /IMJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GFNL AGGREGATE L INTAPPLIES PER
PoucY LOC
PRODUCTS - COMMOPAGG
$1,000,000
$
AUT+OMOBILS UAMUW
ANYMNO,
SCHEDULED
ALLOVOM AUTOS
HIREDAITOS AUTOS
& Gde t
$
BODILY INJURY(Perpee►ort)
$
i3ODlLYIAUI&iY(Per exJdmtt)
$
$
$
UMBR OA A LUIB
Enos UAS
OCCUR
C AMIS-M
EACIi OC( ICE
$
ANTE
$
OED RETT3mRON S
$
WORIWRSCOMPENBATDON
AND
�
( Y NEW LIABILITY YIN
OFFItEWMEMBER E)Cd
In
If Ws under
DESCR�TI MONSS below
NIA
1MC V
$
E L EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POUCY UMrr
$
DESOPArr=OPOPERATIMILOCATIMIVEHMLE13 (Alfaeh AOORD 101, AddWond RetrmrI Wedtd0. N more spun Is required)
Ceftifloae holder is additional insured as to the general liability insurance
g.?:4:4117[a_NIzz:[•7$07 : a_Ti 7 r .
Miami Shores Village Bldg Dept
ABOVE DESCRIBED POLICIES
10050 ME 2nd AVE
THE EXPIRATION DA HE NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, FL 33138
AUTHORO:®REPRESENTATiVE
CIDWOO
ACORD 26 (2010/08)
01911111-2010 ACORD CORPORATION. Ali rights reserved.
The ACORD name and logo are registered marks of ACORD
Prodtewd ta" Forms Boas Plus solo me- wewYormsBoss can; lmpresdm Pub§Wft WO-x -I 7
Miami Shores Village
Building Department
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
GE MAY ITH YOUR. INFORMATION FOR A $30.00 FEE PER YEAR.
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 EXEMPTION)
IF CONTRACTOR HAS A MIAMI BADE 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)
ii-
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: A P_A- _Vcum 8/Nk 141ce•
BUSINESS ADDRESS: 1' tAj y- 6 Si- CITY KAiLAi
STATE e�; ZIP CODE �+'� I S�-
BUSINESS PHONE: �° �� S'_S"� FAX NUMBER (-�"4
CELL PHONE 1JI y(6 1S0— QUALIFIER'S NAME: h I�'!� S. C�
QUALIFIER'S LIC NUMBER: 6 y c' C tl') "? 7 gN
E -MAIL ADDRESS (IF APPLICABLE): CiTel d? t v Ntik1 !R Ce yi n & bell Sr*;L--+i', f-
Created on 3119109 BY NLDV 1 RV 3126109 NO.DV