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PL-13-26600 'mot Inspection Worksheet Miami Shores Village C 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 203571 Permit Number: PL -11 -13 -2660 Scheduled Inspection Date: February 05, 2014 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: , Work Classification: Addition /Alteration Job Address: 9425 N MIAMI Avenue Miami Shores, FL 33150- Project: <NONE> Contractor: LEZAS PLUMBING CORP tsuimmg ueparEment comments REPLACE KITCHEN SINK Phone Number Parcel Number 1132060130510 INSPECTOR COMMENTS False February 04, 2014 For Inspections please call: (305)762 -4949 Page 16 of 47 Inspector Comments Passed Failed Correction Needed ❑ Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. February 04, 2014 For Inspections please call: (305)762 -4949 Page 16 of 47 Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING FBC 20 LD Permit No. P L Master Permit No. Q_c_ �,S Y JOB ADDRESS: - /'7ZS N. -a -- "ke City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: // - 3mo — O/ 3 , d5., D Is the Building Historically Designated: Yes NO ✓ Flood Zone: OWNER: Name (Fee Simple Titleholder): W l e 4-1 [-j.z 4-kl e- City: State: fl— Zip: 3.T /' U Tenant/Les/see Name--� Email: %�Gg ��YD (:- `A 4,0,0- 401,W CONTRACTOR: Company Name: t-GGrf P -11 Address: 00441 V%\K) ' City: I I I li Qualifier Name: 9 �- zip: `3312 Phonek A %_. ?" • ?? 3� State Certification or Registration #: C F �__ �`J� ��� Certificate of Competency #: -t Contact Phone#: ^ K - _9o4,13_80 Email Address: DESIGNER: Architect/Engineer: Phone#: i Value of Work for this Permit: $ _ Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New Aepair/Replace Description of Work: Submittal Fee $ Permit Fee $ loo CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ ❑Demolition Bonding Company's Name (if applicable) 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, 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 rei Wction feg will be charged ®, Signature Signature Owner or Age n Contr or The foregoing instrument was acknowledged before me this The forego' g ' strument was acknowledged bf �fore me this._ day of �, 20 by 11P<-t-7,' day of , 20f , by 6Y& who i rsonally kno me or who has produced who i rsonally known to me or who has produced As i ntification and who did take an oath. as identification and who did take an oath. APPROVED BY &-&V'7 Plans Examiner zoning Structural Review Clerk (Revised3 /1=012)(Revised 07 /10107)(Revised 06 /10/2009)(Revised 3/15/09) t o® CERTIFICATE OF LIABILITY INSURANCE F DATE 1112fMM1DD1YY) 0/13 PRODUCER Franklin Insurance Group 8672 SW 72 Sfieet Miami, FL 33143 Phone (305)630 -3923 Fax (305 )675-5964 MIAMI SHORES VILLAGE BUILDING DEPARTME THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Leza's Plumbing 9448 NW 13 Street MIAMI, FL 33172- OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. INSURER A. Intemational Ins Co of Hannover Limited 086486 INSURER B: Rated AM AXV MAIKEL WONG INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'4 g TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MWDD POLICY EXPIRATION DATE 9OWDIM LIMITS A © GENERAL LABILITY ® COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS MADE 0 OCCUR © DED PD/BI 5000 IG012001791 -02 10/31/13 10/31/14 EACH OCCURRENCE 1,000,000 PREMISES EaEOMV ce 50,000 MED EXP (Any one person) 5,000 PERSONAL BADV INJURY 1,000,000 © CONTRACTUAL LIABI GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY Rj PROJECT ❑ LOC PRODUCTS - COMPIOPAGG 2,000,000 ❑ AUTOMOBILE LIMLITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO D AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICER I MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below ❑ W STATU- ❑ OTH- T f LIMI E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION AUVKU AD (6UU7 /UU) Wr 0 ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE BUILDING DEPARTME 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2Nd ave THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES, FL 33128 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MAIKEL WONG AUVKU AD (6UU7 /UU) Wr 0 ACORD CORPORATION 1988 ACCORD CERTIFICATE OF LIABILITY INSURANCE 11/19/13 PRODUCER DANIA GONZALEZ INS.AGCY INC 9517 SUNSET DRIVE MIAMI, FL 33173 Ph: (305)5988600 Fax :(305)5984050 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A. ALLSTATE INDEMNITY COMPANY NAIC code: 524210 INSURED LEZA'S PLUMBING CORPORATION. 9448 NW 13 ST MIAMI, FL 33172 COMPANY I3. TECHNOLOGY INSURANCE COMPANY NAIC Bode: 42376 COMPANY c COMPANY D THIS IS TO CERTTFYTHAT THE POLICIES O INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED ,M WMISTANDINGANYREQUIRENE' NTTERMORCOMMONOFMAYC& TRACTOROTHERDOCUMEN TWITHRESPECT'TOWHICHiHIS CRIMPICAITL MAY BE ISSUED OR MAY PERTAIN, THE INSURANC EAFFORDED BY THE POLICIES DESCRIBED HEREON IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS. CO 4TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFE I DATE D POLICY EXPIRA DATE D LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCURRENCE OWNERS & CONTRACTORS PROT GENERAL AGGREGATE PRODUCTS- COMP/OP AGO PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (ANY- ONE FIRE) MED EXP (ANY ONE PERSON) CONTENTS A AUTOMOBILE LIABILITY X ANY AUTO X ALL OWNED AUTO 7 SCHEDULED AUTOS X HIRED AUTOS X NON -OWNED AUTOS 648637056 6/21/2013 6/21/2014 COMBINED SINGLE LIMIT 2,000 000 BODILY INJURY (PER PERSON) BODILY INJURY (PER ACCIDEN PROPERTYDAMAOE UNINSURED MOTORIST (SS) GARAGE LIABILITY ANY AUTO AUTO ONLY -EA ACCIDENT OTHER THAN AUTO ONLY B EXCESS LIABILITY UMBRELLA FORM OTHERTHAN UMBRELLA FORM X WORKER'S COMPENSATION AND EMPLOYEE LIABILITY THE PROPRIETOR/ PARINER5/EXECUTIVE IIINCL ( ) EXC TWC3296599 6/21/2013 6/21/2014 EACH OCCURRENCE AGGREGATE (X) WC STATUTORY LIMITS OTHER EL EACH ACCIDENT 1,000 000 EL DISEASE - POLICY LIMIT 1,000,000 EL DISEASE - EA EMPLOYEE 11000,000 DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES/SPECIAL ITEMS v '3 MIAMI SHORES VILLAGE BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELL LED BEFORE THE 100500 NE Vu EVE: EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL MIAMI SHORES, FL 33128 "DAYS WRITTEN NOTICE TO CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION O LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR EM ATIV f S AUTHORIZED REPRESENTATIVE -4 CERTIFICATE OF LIABILITY INSURANCE DATE 01/2�1/14 PRODUCER Franklin Insurance Group 8672 SW 72 Street Miami, FL 33143 Phone (305)630 -3923 Fax (305)675 -5964 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC S INSURED Leza's Plumbing 9448 NW 13 Street MIAMI, FL 33172- INSURER A: Intemational Ins Co of Hannover Limited 086486 INSURER B: Rated AM AXV INSURER C: INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L ADD'L N D E TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIM POLICY EXPIRATION DATE MMIDD LIMITS A ❑ GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY ❑❑ CLAIMSMADE OCCUR � DED PD/BI 5000 IG012001791 -02 10/31/13 10/31/14 EACH OCCURRENCE 1,000,000 PREMISES (Ea RENTED occure ce 50,000 I&ADVINJY PERSONAL 1,000,000 0 CONTRACTUAL LIABI GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY 95 PROJECT ❑ LOC PRODUCTS - COMP/OP AGG 2,000,000 ❑ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS ❑ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY ❑ OCCUR ❑ CLAIMS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILnY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below _ ❑ ORY LI AIT3 ❑ ERH E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 25 (2001 108) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MAIKEL WONG CORPORATION #624934C ppgg gg��SggT��ATgE OF FLORIDA DEPARTN S%UC�ID iNDUSTRYRLI IM80RARD�TION SE00 L12080601004 08106120121:128030836 LCFCOS7923' The PLUMBXNG CONTRACTOR Named below IS CERTIFIED s Under the provisions of Chapt Expiration date: AUG 31, 2014'. • LEZA, ERICA LEZA'S PLUMBING CORP MIAMI 13 ST MI FL 33172 RICK SCOTT GOVERNOR Y AS REQUIRED BY LAW -SOL KEN LAWSON SECRETARY . -. i•�` tamer Y AS REQUIRED BY LAW -SOL KEN LAWSON SECRETARY �eaa 00,Cbuvtt�,�'$Wte -of Florida 48 - ieal� 1 sw IV nu Mac to ditOWW at VIM of auk @i71 PurguM to Couw Code Chapar 9A - Art, 9 & 10 OW?A sec. tirPe OF 0 PAYM*W iMCSroeo 1AW PLUMBING CORP 196 PWWMWNTRACTOR BY TA7 OCLLBCTOlt Wtlt (s) t CFC067W $45.00 07/24/2013 TXHS1- 13- 034446 This low! 9mitu lux Race ooa f ontaffttmi Bnsiaass Tax. The Racopr is rm s kwum patadGir a aarti lia of tlro s awl a►dat uw. m* H�Ntu mm wa6 an goi mumnisl or lawaiai � vrhich Ito the t %BECEIP=aDov *Wb*Oiapla 4*sallcommwelai+rcht P,adaSu ACCORD CERTIFICATE OF LIABILITY INSURANCE 01/20/14 PRODUCER DANIA GONZALEZ INS.AGCY INC 9517 SUNSET DRIVE MIAMI, FL 33173 Ph: (305)5988600 Fax:(305)5984050 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A. ALLSTATE INDEMNITY COMPANY NAIC code: 524210 INSURED LEZA'S PLUMBING CORPORATION. 9448 NW 13 ST MIAMI, FL 33172 COMPANY & TECHNOLOGY INSURANCE COMPANY NAIC code: 42376 COMPANY C. COMPANY D INSURANCE LISTED BELOW HAVE THIS 1S TO CERTIFY'1'HAT THE POLICIES 0 YE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANYREQUBtfiMENT.TERM OR CONDITION OF MAYCONTRACT OROTHER DOCUMENT WITH RESPECTTOWHICHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANC EAFOORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD) CLAIMS. CO LT R LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFE DATE D POLICY EXPIRA DATE D LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCURRENCE OWNERS & CONTRACTORS PROT GENERAL AGGREGATE PRODUCTS- COMP /OP AGG PERSONAL & ADV INJURY EACH OCCURRENCE FARE DAMAGE (ANY ONE FIRE) N ED EXP (ANY ONE PERSON) CONTENTS A AUTOMOBILE LIABILITY • ANY AUTO • ALL OWNED AUTO X SCHEDULED AUTOS • HIRED AUTOS • NON -OWNED AUTOS 648637056 6/21/2013 6/21/2014 COMBINED SINGLE LIMIT 2,000,000 BODILY INJURY (PER PERSON) BODILY INJURY (PER ACCIDENT) PROPERTY DAMAGE UNINSURED MOTORIST (SS) [POTHER GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY EXCESS LIABILITY UMBRELLA FORM THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE B WORKER'S COMPENSATION AND EMPLOYEE LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE [ ] INCL ( ) EXC ITWC3382955 1 1211/2013 12%1/2014 (X) WC STATUTORY LIMITS (_)OTHER EL EACH ACCIDENT 1,000,000 EL DISEASE - POLICY LIMIT 1,000,000 EL DISEASE - EA EMPLOYEE 1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /SPECIAL ITEMS Waiver of Subgrogation for Workers Comp. MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BUILDING DEPARTMENT EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10050 NE 2nd AVE, 30 DAYS WRITTEN NOTICE TO CERTIFICATE HOLDER NAMED TO THE LEFT. MIAMI SHORES, FL 33128 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION 0 LIABILITY L OF ANY IND K UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. i AUTHORTZED REPRESENTATIVE