DS-13-1872 Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-199917 Permit Number: DS-8-13-1872
Scheduled Inspection Date: October 03, 2013 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez,Jorge
Inspection Type: Final
Owner: DE LA ROSA,TANYA Work Classification: Addition/Alteration
Job Address:9713 NE 2 Avenue
Miami Shores, FL 33138- Phone Number (305)756-6110
Parcel Number 1132060134220
Project: <NONE>
Contractor: ALL PROFESSIONAL CONSTRUCTION &DESIGN, INC Phone: (954)439-0359
Building Department Comments
REPLACE CONCRETE SIDEWALK FOR PROPER Infractio Passed Comments
DRAINING INSPECTOR COMMENTS False
Inspector Comments
CREATED AS REINSPECTION FOR INSP-199555. CREATED AS
Passed REINSPECTION FOR INSP-197501. No permit posted. Must finish
landscaping
Remove all dirt and fill
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
October 02,2013 For Inspections please call: (305)762-4949 Page 16 of 27
Miami Shores Village
Building Department fl
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 AU6 16 205
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949 211 Y ......
IC 20
BUILDING Permit No.
PERMIT APPLICATION Master Permit No
Permit Type: BUIELDIN ROOFING
JOB JOB ADDRESS. S C4 tL)(�,;7
City: Miami Shores County: Miami Dade
Folio/ParceW
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder)-:70 n m a (i e- o, Ds 0 Phone#:
Address: 300 �
City: P-A) State: zit):...-3 3
Tenant/Ussee Name: !�kljycs Phone#:
Email:
OVAL_
,
CONTRACTOR:Company Name: IAIC Phone#:
Address:
City: State:
'P
Qualifier Name: _502-S 0t� fe -Ttr_ Phone#: 194 14 3c(—09�q
State Certification or Registration#: rrG 1.9 S5 2-2, Certificate of Competency#: 3 a�- -9 o q
-0 011 0 1"1 ,
Contact Phone#: Email Address: c1, b1Ry VIC+CUO�1
DESIGNER:Architeciffingineer: Phone#:-
Value of Work for this Permit:$ M_0 Square/Linear Foo of Work
Type of Work: LIAddition L3AIteration L3New 67erp:/Replace LIDemolition.
Description of Work: Appla6e coxcne,�P, �;i do,wdL Po,-
I
2roper c rcokAiv
Color thru tile:
Submittal Fee$ Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ ---Bond$
Notary$ TraininglEducation Fee$ Technology Fee$
Double Fee$ Structural Review$ TOTAL FEE NOW DUE
Bonding Company's Name(if applicable)
Bonding Company's Address
City I r 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$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment: Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent Contractor (/
The foregoing instrument was ac owledged fore this The forego' g instrument was ackn led ed bef me s t�
day of ,20 ,by � day of S(,20 ��,b
identification and who did take an oath
� ratification and who did take an oath.
NOTAR P JBLIQ N TARY LIC: '
0
S �aa
Sign. o F,otida a p15
Sip-
"o, SeP2 p„b' sSep -ova
Print: �acY oo Z�1�ssn Print' Noca�y ExP"e �12a8 so•
M Commission Expires: Waicona\N°tact
My P - <; c Intou9h My Commission
APPROVED BY d Plans Examiner -� zoning
Structural Review Clerk
(Revised 3 112=2)(Revised 07/1007)(Revised 06/10 2009)(Revised 3/15/09)
i J!s
::
2013
Miami Shores Village
I APPROVED BY ATE
ZONING DEPT
f3
SPEC ., PO E SURVEY ELEVATIONS ON DEPT - (`
SUBJ PL art
s•ItlttF:F t
ST i TE A 1-' 11 �715
z_.��._�a—�_i,., .. , �,.> w sin»»1,�_,N° .,,1..• GARY B. CASiEI
r fi .,:,,.t. -R:
r
o . x�lr
.In
� — � arc(°�._�.�°:•'a� X � �1..,.1..:,. ��:��
A .N. D H O U i- E v ,i` Prof Onrd l6nd&mey$
g* I •, —� 1'I`P 1'"•1E T'I fall.°s1I°I'I I I"°T'T"I-Wh to—T-r-y8 12016 S.W.132nd Court
LOCATION MAP aa 331 .
NOTTO9CAtE
TEL: (305))253-9721)
.�Q t, '' (305)253-6767
y y LEGAL DESCRIPTION: Uk
•' , t t 4 ,r• F t• _ '_ Lots 13.&14,in 8100 31,of A?9MM ME=WS
•; > Sr vlav.Y occordsrg to the Pht thereof as ,... *.
recorded in Plat Book 10 Itt Pope 70 of the PhYle
l < N 1, ♦o- `r Records of Miami-Dade County,ne ida S
CERTIFIED TO: Z
W b o
h m -•` o-8 ,,l e t Q
i ` , F Q CCJJ O PROPERTY ADDRESS:
971s NE 2nd.a F1 33
Yrgmr Shores, Fl 33139 Lj
♦� Q ��,1_gib., �o-`�' ¢ °3 SURVEYOR'S NOTES: ¢.
l ,p e , ♦ - ,`p v3 1)The stow ocpttawd Propa'!y was suveyea and desamea LU
\4' : ♦' ('�� based on the otw4 legal Description, Mb+ided by grant �y
An bearings and distances shown hereon are recorded and Q L4
r✓ measured unless otherAbe shown. V K
3)The[ends Ahown hereon Arena not abstracted for easements ar
1Y other recorded encumbrances not show an the plat and the j LLI
.• W some.N any may not be ahem.on this section.
4)Faa mttene mw/a feelings that may arms beyond the J
bAA^mrY Mss of the parcelhorabn described are not shorn W
Ew ati ns,we Z t�
3).Fw t ea ore boned On the enter ft Oeof the fertteol Datum 1928. aL
6)Fenm 9e9 are to be the ranter MO ofthe fence. IF .j.
® _ f 7)Watt tlec am in tom of the eat.
8)AmagMp subject to opinion de the Tttie.
> 5 9)(M�rgranf utilities are not depleted hares. X
. \/ ,`g+�"f} 10)Zoning sin Setbacks am not wrined by.this surrey. w �Lt
1r�j ` 12)Mie ni—Dade Cmmty Benchmark/N-599 Sewtia,.9.6V NGW29 Z Q
Q SURVEYOR'S CERTIFICATE �i
6+ the Yby rBty that:this eurwy meets Ne minimum technka standards LL
set forth bythe FlorIdO-ltoord of SurwyaS end Mappers In Chapter 61677-6
C-1— Florida Admbdshatiw Code,pursuant to Section 472,027.Florida Statutes,And Is LU
7 trm and correct to tin beet of my kAaided9e and t>BSei 9 NE
LEGEND O to NOT VAUD UNLESS SEALED MID EMBOSSED t91N SURVEYORS SEAL z
&oo
OX INDUS!VARK: BASES : r�E TT. � VAMC TRAmsy ORM M b � � �� � _��/+ Qate of iloid wrk x/24/2013 L � OrD
»p Pas . POW or pg a{{�{ ^rye`[' —L7
9 rF.flPY.: ROOW aVAAW SEW} rdpW. A : A T a TANOEII7 �-]�. ! LL s[Bessad taN$1E BIOCN SOakRWE pper{{ pppy Nagy 0.F ar�i�ra�a
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YL : 01010 ONE Q. : ELEyAl10NU1UT4I.WE8 . Pa.' : or:. QWYA9F[ LME ° LNW iu�al�.A EA9EYdT v
case, LU : �NAR ratE. . : r 0.1DN,mrANt UE: ',m GARY B. CASTEL
FP.E. -MM-FLOOR O"A90N P.P..saw Pam PoLE Age .'et7 SHEET
Registered Land Surveyor No. 4129 OF 1
State of Florida.
C Fig 20-113RO696 32
OR 8k 28801 Ps 2485; tlas 1
RECORDED 09103/2013 11:01:57
HARb1EY' RUVINY CLERK OF COURT
NOTICE F COMMENCEMENT MIAMI-DAME COUNTYr FLORIDA
A RECORDED COPY MUST BE POSTED ON THE JOS SITE AT Tilip.OP F,jWIMpECTiON L AIST PAGE
PERMITNOflffl TAX FOUO•NO.
STATE OF FLORIDA F
COUNTY OF MIAMI-DADE:
THE UNDERSIGNED hereby gives notice that.improvements will be made to certain real
properly,and in aboor lance with Chaoter7l�,Florida Statutes,the following information
Is provided In this Notice of Commencement
g r Space above reserved for use of recording office
1.Legal description of pro d st t/ ress: �r e
Alf L&01
f
2.Description of improvement: RejQ62y cam¢
3.gwner(s)name and address:
Interest In property: 9
..
Name and address of fee simple titleholder.
4.Contractor's name,address and phone number. r ( C I
1
5.Surety:,(Payment bond required by owner frdm contractor,if any)
Name,address and phone,number.
Amount of bond$
6.Lender's name and address:
7.Persons within the State of Florida designated by Owner upon whom notices or other documents may served as provided by
Section 7.13.13(1)(a)7.,Florida Statutes,
Alame;address and,phone number:
8.In addition to himself,Owners designates the following persons)to receive a copy of the Lienor's Notice as provided In Section
713:1'3(1)(b),Florida Statutes.
Name,address and phone number:
9.Upiration'date of tins Notice of Commencement
#the expiration date is 17yea4orn the date of recording unless a dffferaht date is epe med)
,5 AN RESULT IN NG TWIC EFOR
WARNING TO O EW ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OE THE NOTICE OF COMMENCE NT ARE
IMPROPER PAYMENTS UNDER CHAPTEFI 713 PART 1 S 1 1 IA � TWICE FOR
iMPROVEMENTS TO YOUR PROPERTY NOTICE OF CIO °° p0$TED O of FORE THE
FIRST INSPfE O+N. YOU INTEND TO TAIN FINANCINGRM i , tadVh4TTORNEY �f8 G WORK
OR RECORI7IN O R NOTICE OF COM NCEMENT, i. '
7ng�nal pled in this�y r ►n day of p
Signature(s)o (s)o }` rsrmr�rnPraam,a:_nngp, rA D 20 u'
Pre By ti. - �iirfilESS miclaa SeaB. Oa
Print Name I: :. 5 .. 1ARVEY RU of c?. ,� ® ,
Title/Office o r-e-I 'q---r ta.b .4v
STATE OF FLORIDA
COUNTY OF MIAMI-DARE
The fo` Ding inst was ten ,before me this day of ,
Ety
Individuall or ❑as U 7, for
i3 Personally known,dr produced the following type gfidentftation:
Signature of Notary.Public: NA Aaa
Print Name:
(SEAL) -_w ,,,,,, IA v. ILLOS
fr
Notary Public-State of ftorida
Under`penalties of perjury,l de . that I have read the foregoing aril °
° ?My Comm Expires Sep 23.2015
-s" °U- Commission#EE 128810
that the facts' ted in`it are e,'to the best of my knowledge and belief. ;:F�F c�a�.
PURMNT QOSECTION 99l
Bonded Through National Notary.Assn,
Signa ( f Owner(s)or erl,)°s Authorized Offlcer>Director/Partner/manager
By By
123.01.62 PAC4E 3 3110
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
BERTA, JOCO JOZSEF
ALL PROFESSIONAL CONSTRUCTION & DESIGN INC
T C
18UREL LN #D FL 33319
5TA7E.O FL{3RIDA AC#6 499608
..
Congratulations! With this license you become one afthe nearly one million DEPART YT OF Bl'JSIXkSS �A D
Floridians licensed by the Department of Business and Professional Regulation. PROFESSI REGULATION.
Our professionals and businesses range from architects to yacht brokers,from
boxers to barbeque restaurants,and they keep Florida's economy strong.
CGC151392; . t14 `/12J 2 128007439
Every day we work to improve the way we do business in order to serve you better
For information about our services,please log onto www.myflaridalleense.com CERTIFIED CO3XTRACTOR
There you can find more information about our divisions and the regulations that ; BERTA, 'JOIC z931F
impact you,subscribe to department newsletters and learn more about the ALL PROFS $iTO ` INSTRUCTION &
Department's initiatives. `r
Our mission at the Department is:License Efficiently,Regulate Fairly.We
constantly strive to serge you better so that you can serve your customers. IS eERTIF19b un4sr the oiovlafonA of ch,46..9 F8
Thank you for doing business in Florida,and congratulations on your new license!
asp mti=seta:.AUG 3.1. 2014 t:L2071200883
DETACH HERE
AC# 619960.8 STATE OF FLORIDA
DEPART IT t3F HIISINES AND
PROFESSIONAL 'REGULATION`
. CONSTRUCTIAN I IISTRY LICENSING BOARD SEQ#L12071200863
LICENSE NHR
07 .12 2012 128007439 CGG1513922.
The .GENERAL, CONTRACTOR
Named below IS CERTIFIED
Under the provisions of'Chapte FEN'
Expiration date: AUG 31, 2014
BERTA, JOCO JOZST3 '
ALL PROFESSIONAL CO TSTRUCTION , DE
6186 LAUREL LN #D
z
TAMARAC FL133319
RICK SCOTT.: KEN LAWSON
GOVERNOR
SECRETARY
ALLPR-C OP ID:AX
Ate"IC7Rl?A DATE tMMraDn'YYY)
�.,,... CERTIFICATE OF LIABILITY INSURANCE 07131/2013
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 policy(les)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 Phone:561-391-4661 NAME:
Sena&Whitney Corp Office Fax:561-338-6Sa1 °p No
Sena&Whitney,LLC
190 Glades Rd Suite C ADDRESS:
Boca Raton,FL 33432
INSURER(s)AFFORDING COVERAGE NAIC!
INSURER A:Mid-Continent Casualty Company 23418
INSURED All Professional Construction INFER B:
&Design,Inc. INSURER C:
6186 Laurel Lane#D
Tamarac,FL 33318 INSURER D:
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 1S SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUMBER POLICY XP LIMITS WVD
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,
DAMAGETO
A X COMMERCIAL GENERAL LIABILITY 04GL000855981 08P1412012 08/1412013 PREMISES JERENcuErDren ce T $ 100,00
CLAIMS-MADE ®OCCUR MED EXP(Anyone person) $ Excluded
PERSONAL&ADV INJURY $ 1,000,
GENERAL AGGREGATE $ 2r000,
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ ZONION
X POLICY PR LOC $
AUTOMOBILE LIABILITY Ea a�aden SINGLE LIMI $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
PROPERTY
HIRED AUTOS AUTOS WN� Per accident $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAS HCLAIMS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION W S A U 9H-
AND EMPLOYERS'LIA811 ITY Y LI
ANY PROPRIETORIPARTNERIEXECUTIVE YIN N i A E.L.EACH ACCIDENT $
OFNCERA EMBER EXCLUDED?
(Mandatory to NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEFICLES {Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
CERTIFICATE HOLDER CANCELLATION
MIAMiSH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
VILLAGE OF MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE
10050 NE 2ND AVENUE
MIAMI SHORES, FL 33138
®1968-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S.Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000
VALID OCTOBER 1,2012 THROUGH SEPTEMBER 30,2013
DBA: Receipt#:180-7774
Business Name:AL PROFESSIONAL CONSTRUCTION & GENERAL CONTRACTOR (GENE
DESIGN INC Business Type:
CONTRACTORI
Owner Name:BERTA JOCO JOZSEF Business O
Business Location:911 SW 15 ST 203 pened:04/03/2007
POMPANO BEACH State/County/CertfReg:CGC1513922
Business Phone:954-439-0359 Exemption Code:
Rooms Seats Employees Machines
Professsionais
1
Number of Machines:
For Vending 13usin"s only
Vending Tax Amount Transfer Fee 9
NSF Fee Penalty Prior Years Collection Cost Total Paid
27.00 0.00 0.00 0.00
0.00 0.00 27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non-regulatory in nature. You must meet all County and/or Municipality planning
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:
BERTA JOCO JOZSEF
&186 LAUREL IN #D Receipt #01C-11-00012119
TAMARAC, FL ' 33319 Paid 09/13/2012 27.00
i
2012 - 2013
_ — c7ca,r�teiw esn i+n�,se'ry t nn A e nX 19-45%11=00 TA V rarr►rrAn-E-
��,vE,+�`s.
02-15-2012
JEFF ATVVA11ER 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.
P P
EFFECTIVE DATE: 02/15/2012 EXPIRATION DATE: 02/14/2014
PERSON: BERTA JOCO J
FEIN: 223962625
BUSINESS NAME AND ADDRESS:
ALL PROFESSIONAL CONSTRUCTION & DESIGN INC
6186 LAUREL LANE #0
TAMARAC FL 33319
SCOPES OF BUSINESS OR TRADE:
1- CERTIFIED GENERAL CONTRACTOR
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 440.051121, F.S., Certificates of election to be exempt... apply only within be
scope of the business or trade listed on the notice of election to be exempt Pursuant to chapter 440.05031, F.S., Notices of election to be exempt and certificates of
election to be exempt shall be subject to revocation 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 person
named an the certificate to meet the requirements of this section.
QUESTIONS? (850) 413-1609
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA IMPORTANT
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS'COMPENSATION F Pursuant to Chapter 440.05 041, F.S., an officer of a corporation who
CONSTRUCTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of election
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this
WORKERS'COMPENSATION LAW D chapter.
EFFECTIVEc 02/15/2012 EXPIRATION DATE: 02/14/2014 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
PERSON: JOCO d BERTA H exempt.. apply only within the scope of the business or trade listed on
FEIN: 223962625 R the notice of election to be exempt
BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05{]31, F.S, Notices of election to be exempt
ALL PROFESSIONAL CONSTRUCTION & DESIGN INC and certificates of election to be exempt shall be subject to revocation
6186 LAUREL LANE #D if, at any time after the filing of the notice or the issuance of the
TAMARAC, FL 33319 certificate, the person named on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shalt 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- CERTIFIED GENERAL CONTRACTOR section.
QUESTIONS? (850) 413-1609
CUT HERE
+ Carry bottom portion on the job, keep upper portion for your records.
DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11
..••� ALLPR-C OP ID:AX
CERTIFICATE OF LIABILITY INSURANCE 01111
THIS CERTIFICATE 13 ISSUED AS A BATTER 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(Bj AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poilcy(les)must be Endorsed. It SUBROGATION 13 WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on tads certificate does not colder rights to tin
certificate holder In Hsu of such endorsmnent s
PRODUCER Phone:861.3914661
Sena&Whitney Corp Office Fax 561 688- 1
Sena&Whitney LLC
180 Glades Rd Bile C
Boca Raton,FL 33432
AFFOe COVERAGE NAIC i
A:NNd-CmUnent Casualty Company 23418
INSURED All Professional Construction B:
&Design,Inc. mac:
61B6 Laurel Lane#D
Tamarac,FL 33319 94UWJM D:
ICE:
INSURERF:
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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
IM TYPE OF INSIEtANCE POLICY t R L@iR6
GENSULLIABIll." EACH OCCURRENCE $ 1,D00,
COMMERIALGEEALBILI Ea e $A YWO4G4 R 1�•
CLAIMS-MADE aOCCUR MEDEXP(Any one person) $ Exoludet
PERSONAL&ADV INJURY $ 1100%
GENERAL AGGREGATE 8 2,000,11141111
GEN'L AGGREGATELIMT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2x000.
X POLICY P LOC $
AUTOMOBILE LVJMJT• L IT
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ANY AUTO BODILY WARY(Per person) $
ALL
AUTOS OWNED SCHEDULED BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWE PeOra Y $
$
UMBAELI.A LIAB OCCUR EACH OCCURRENCE $
Ei(L�Se LIAB CLAIMS MADE AGGREGATE $
DeD RETENTION S $
W01MM COMPENSATION AND EMPLOVERW LIABILITY
ANY FXCL�cu"'Y� NIA EL EACH ACCIDENT $
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DESCRIPTION OF OPERATIONS be E.L.DISEASE-POLICY LIMIT $
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CERTIFICATE HOLDER CANCELLATION
MIAMISH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPWWN SITE THEREOF, NOTICE WILL BE DEED IN
VILLAGE OF MIAMI SHORES ACCOROMCE WITH THE POLICY PROVISIONS.
BUILDING DEPARTMENT AWHORMFOREPRESSM7016
i NE 2ND AVENUE
MIAMI SHORES,FL 33136 ,ww"'1 "jV
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