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PL-13-2035Inspection Worksheet Miami Shams Village 900.50 N.E. Intl Avenue NOW Shores; ;FL 0hono. (305)796 -2204 Fox. (305Y760-11972 Inspection Number: INSiP- 207392 Permit Number: PL-943-2036 Scheduled Inspection Date: Bch 00, 2094 Permit Type: Plumbing . Residental inspector: Diaz, 0srr0da inspection p T�pe: Final owner BISCHOFF$ HERMAN Work Classificadon: Addition/Aftaration .lob Adclress:1025 N.E 91 Terrace Miami shores, FI. Rhone Number Para[ Number 11390MOO20 Project <NONEa Contractor: XLEBER PLUMBING CO Phono: (302)3 - 00.82 Building 'Depaftment,Comments PLUMBING WORK FOR BATRROOM REMODEL c pis ptnFneri� 1NSPECTEjr3COMMENTS Fe(se In�Opeo�or CQmmet�ts Passed CRE=ATED AS REINSPECTION FOR INSP -f96M a les �r be flush with slower floor -�( G�� Failed Correction Needed Re-Inspeetion Fee No AdMonW rrnspeftm pan be-scheWed UW m4mpeaion fee is paid. For Inatteoitions please cap., ($05)702.4 Ifl�rch ft 2014 Rage ,24 of 44 hym im wiw CERTIFICATE OF LIABILITY INSURANCE I i14 1112113 THIS CERTIFICATE 18—ISS M— AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGIffS UPON THed E-FtTWICATE 146CWR:Tl#S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E)MO OR ALTER THE COVERAGE AFFORDED BY THE POLIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING VOUREMS). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT! If the i9raficat-a —hofftr Ig an A-V­ DITIONAL RSURED, the polfqf" must he anclorsM. It SUORCM-11ION 19 WAIVED. -W4 t* We 10mis SYW CondhItIft of Me paINW, certe* poftim may require an eadwMmmL A eWemnt an thb C0008M do" nm —010 ffffift to" pfumnicm Great Florida insurance - Pirtacreat 11206 S Dixie Highway 101 Miami, FL 33156 Phor* (305) 256-06% Fax (735) 522 -1889 o Weber Piumbfipj Co. 8760 SW 155M Str MiarN, FL 33157 wSUR@RC: COVERAGES CERMCATE NUMBER: R9VI8= "Umew. INDICATED. NOTVMSTANOM ANY REQUIR111fENT. TERM OR CONDITION OF ANY CONTRACT OR OTHR DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE PORM40E AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUIUECT TO ALL THE TF.%M EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LwTs smown mAy NAME sm" ReDuoED ey PAID CLAWS OF DAVAtANC2 Ln= GENERAL UABLITV 0CCU1vwxCE CoMMM=LwNEMLwftwY s too MED EV 3 F I 1-j cLww4mx �ii oem 101&VL00020250 Mw—ft—T --7 —�j A 07rna013107=0114! 11 GENIL A010REGATE LMUT APPLES PER PRODUCTS -COMPXPAW�� p"Y.- JP0 Loc AWOMOBILE LIABILM CONOMIED swim Lim ANY AUTO I 1 in- �Ywjuw Mw pamm) a ALL OWNED AUTOS TY DAMAGE a "REV MiTas UMBRELLALIAS OCCUR AGGREGATE DMUCTM Tit— AM E1~V1WLUW8J1TT VIE E.L. ACCM9NT 2 I. N I AJ r_-. EL ONEW awilwye CERTIFICATE HOLDER F- Milarni Shona Building and zo" 10050 ME 2nd Ave M115111L Fl. 33138- ACORD 251200M1 OF e k nlst"— LWrj JI BHOUILD ANY OF THE ASIM DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT" DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCOROAMM WITH THE POLICY PROVISIONS. 0 lose-2008 ACORD CORPORATION. AD rWft reury The ACORD nme and NW are registered marks of ACORD . . . . . . . . . . . . . . zz 33157 s g &10 PAYMOAUUMMVED WMG COMPAW- _6 BY TA)MONAECTOR 10 $45M x/10/2013 TXH51 -4S-019384 any gwA (fie RECEwh ohm W. sec ............ IMEBW4 8760 SW 155 PALMETTO SAY FL 33157 DtSPLAY AS REQUI L12066800790- X-M LAWSON SECRETARY �ty,:LAW, ate. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 9/17/2013 PERSON: KLEBER FEIN: 650686444 BUSINESS NAME AND ADDRESS: KLEBER PLUMBING CO 8760 SW 155 STREET MIAMI FL SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS EXPIRATION DATE: 9/17/2015 DONALD E 33157 Pursuant to Chapter 440.05(14), F.S., an offrcer 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 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade fisted on the notice of election to be exempt. Pursuant to Chapter 440.05(13), 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 on the certificate to meet the requirements of this section. DFS- F2 -DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07 -12 QUESTIONS? (850 )413 -1609 officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under this chapter. 1: APPLICANT INFORMATION First & Last Name: Driver's License Number: A142432511770 Deft of Birth: ,lose State ID Number: 5/17/1951 Social Security Number (last four digits): 5684 Entail Address: Section 2: CONSTRUCTION INDUSTRY APPUCANT ($50 FEE REQUIRED) Officer of a Corporation (Construction) Corporate Title: VICE PRESIDENT Section 3: Aviles State: FL This section should be completed with information specific to your corporation or to the limited liability company in which you are a member. The name of the corporation or limited liability company listed on this application MUST match the name of the corporation or limited liability company as registered with the Florida Division of Corporations. Name of Corporation or LLC: Kleber Plumbing Co FEIN: 65- 0686444 IF YOU NEED TO APPLY FOR A FEIN, CLICK HERE Business Name (DBA): Weber Plumbing Co Phone: (305)238 -6682 Applicant's Address of Record: 13118 SW 91st Place City Miami State: FL Zip 33176 County: Miami -Dade Click on the arrow(s) next to the text box(s) to view a list of available Scope clas ificationsittrades for the form type chosen in Section 2. Click on the appropriate scope to select. If you are unsure as to which classification/trade to choose, please contact (lour workers' compensation insurance carrier. If you do not have a workers' compensation insurance policy, contact the National Council on Compensation Insurance (NCCI) at 1 -800- 622 -4123 option 5 to obtain a classification code. Scope 1. ark �� Plumbing NOC Scope 2: Scope 3: Scope 4: Section 4: rho corporation of which you are an officer or limited Hability company of which you are a member must be registered and In ACTIVE status NM the Florida Division of Corporations. Applicants applying as an officer of a corporation must be Wed as an officer of the Corporation with he Florida Division of Corporations. List the document number on file with the Florida Division of Corporations. '96000064792 motion S. 'ursuant to Chapter 489, F.S. (contractor licensing law), list certified or registered licenses related to the scope of business or rade Wed in Section 3 held by the applicant, or the certified or registered license numbers held by the qualifier for the x?rporation or limited liability company fisted on this application. The business name listed on the license MUST match the name )f the corporation or limited liability company as registered with the Florida Division of Corporations and on this Notice of Election o be Exempt. No DBPR License Listed CFCO21432 NOTICE OF ELECTION TO BE EXEMPT NOTICE OF ELECTION TO BE EXEMPT 11111/13 4:45 PM Please enter your Driver's License or your Identification Card Number and your Last Name. Applications updated after 5:30 PM will be received by the Division the next business day. Note: If vour application is for the construction industry. your application will be saved after the orocessinq fee has been submitted to the Division. Please select which ID to search by: • ;'State Driver's License Number. or 'Florida Identification Number. State Issued: Florida Driver's License: A142- 432 -51- 177 -0 Last Name: Aviles Enter eadt E00143248 Jose Aviles Kleber Plumbing Co Completed Successful If an application number is displayed, you may click the button (above) to view. print or update your application or to orint your Certificate of Election to be Exempt. If an application number is not displayed. your application was not submitted to the division. Please complete and submit a new application. Copyright 2010 Florida Department of Fnanciai Services Privacy AccessibllilY ttps: / /apps.fldfs.com /bocexempt /Search Applkation.aspx ?returfl_efror —1 #b Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PRONE NUMBER: (305) 762.4949' BUILDING PERMIT APPLICATION Permit Type: PLUMBING SEP 0 9 20'13 FBC 200 115-- Permit No. Y' 2o( b Master Permit No.A�7) 1,3— JNq JOB ADDRESS: _/ 0"Z 6— �• f % %�'-'V City: Miami Shores County: Miami Dade Zip: 3 3J-T& Folio/Parcel#: _ / / -- 3 2,0-4— — ®D ! - 00;A ?9 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple T[204r- state. Zip: Tenant/I.essee Name: Phone #: Email: CONTRACTOR: Company Name: �'� 1 L�'� F %p P1 ire 8) A-R C @nr Phone#:.3 O✓ . k $' G G 1r --k Address: City: Qualifier Name: 12 --1k Zip: 3 3> S 7 State Certification or Registration #: C: /-C` 0 oa / V3 ° jCertificate of Competency #: Contact Phone#: 3 d -5--A 3 $ 4 G $ a Email Address: 111 F g 1;74 PL al" a J f ?d DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ A O 0 d a " Squared ear Footage of Work: Type of Work: OAddress HAeration ONew ORepair/Replace ODemolition Description of Work: Q�j j�.erpyn dFdr�k it ,kdr *,YdrsTr t�kak,kir,4�rsteir rx,k,YsY r,Y,r****** **Fees,Y *,k,Y,; *** *qtr** 99dr k�kdr *irsk k*ia,Y�k rfsr,Na *dr�e t�Y�k,Y&,T�r�r* e. Submittal Fee $ Permit Fee $ f '` CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address t 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 IlVIPROVEMENTS 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 reiection fee will be charged. Agent SignaturejD.,, / Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of , 20 _, by day of .20 by who is personally known to me or who has produced who is personally known to me or who has produced NOTARY Sign: Print: my As identification and who did take an oath. as identification and who did take an oath. NOTARY P Sign: Print: My Commission APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(RvAsed 3/15/09) * * CMIFICATE W ELECTION TO Of EXEM FROM FLORIDA WORKW COWENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt fmm Florida Workers' Compensation law. EFFECTIVE DATE: 09/1812011 PERSON: KLEBER FEIN: 650686444 BUSINESS NAME AND ADDRESS: KLEBER PLLMBIN3 CO 8780 SW ISM STREET MIAMI FL 33157 SCOPES OF BUS94M OR TRADE 1- PLUM011110 EXPIRATION DATE 11911712013 IIANNTANT: INmsttrol to OWN 440 . 061141 F.S., as WICOF d a eorporatlaa vft elacts esamptiae from Ws chapter by fitimg a tertrticafe at elocuou udder cafe section may at scorer banafits or compansafiaa under this dtnpter. Pursues to t74apter 44g.Or0i2t F.S., cartdicstes of eiecttau to be exempt.. *my MAY within the nape of the bosftan or trade lhsted on ft notice of aled€ou to be asamyi. Pummel to f3myter 4411.05(131 M. Helices of efeclin in be asempt and call0rtata of eletlla to be esemid anal► its soled to rovetafloo If, at any tame after to Ming of tie malice or the issuance of the certificate, the Vann named as I to #acne or cerrilicae an teager meats IM "Ranam of this sadtas for issuance, e,1 a corfglcete. The, depsrtaaai {nail revoke s carHRceie st any time far faliare of the Penns Gained on the carlykant to tam din requirements of thta sulfa. QUESTIONS? {850) 413 -1609 f)WC -262 CERTIFICATE OF MOTION TO K EXEMPT REVMEO 01 -t1 07 -22 -2011 * * CERTIFICATE OF ELECM TO BE EXEIII T FTIDIVI FLORIDA WORKERS' C OLIPMA'T'M LAW * CONSTRUCTION INDUSTRY EXEMPTION This lmttifies first the ilidividual listed below has elected to be exempt from Florida WorkeW ConVensation laws. EFFECTIVE DATE. 07/22/2011 PERSON: "ILES FEIN: 650686444 BUSINESS NAME AND ADDRESS: KLEBER PLUMBING CO 8780 S V ifflM STREET MIAMI FL 39157 SCOPES OF BUSINESS OR TRADE: 1- PLUMBING EXPIRATION DATE: 0712112013 • y'_ WMRTANT: Pa►anani to i3saptar 440 . 8b1;4% F.S., an editor of a carp men won atects eseaytlfan from this chapter by filing a eartiftoae of alestia new thin seatian may no recover bealits ar tompe,naadan under des dwar. Pursuant to Chow 44(1.0riin F.S- Certificates of election k he DUMP— sWy only witliis the scope of the brstn " ar trade hated a Qo newe d ofar tan to be eaeo*r. Pmsuat to CRapter 40.0603). F.S.. Room M otedfa to be aaampt Ed candkates of eloottoo to be etompl sftMf be subjecl to revocation Ft. d gay tae after as tlflag of the septa or tan Issuance of dm canliltpq the pw=n na"d an the antic* er --..n........ r,. -..-. _.... sk.....rs.e.am .1 rbre aadteo for Immance of a emilleata. Tee deasolmeal 001 revoke a certilicate at say than for fahiura a1 the Parses 064446 -9 TfHS 13 Wr A BILL - I0 NOT PAY auM6Mt ► COMPANY 8760 SW 155 ST 33157 PALMETTO BAY UAL POSTAGE PAID NIAK FL PERMT NM aM REREWAL STATOM111432 0644469 "UMBER PLUMBING. COMPANY 'ITWIMUft CONTRACTOR WORK100lS THIS IS OHtY R LOLAL rt�ISSS rax DOER HOT YHE MM TO NMLATE NO @711{87f71ti MAUI ATOW OA ZON9V0 UM OF UM DO HC T IOWARD COUNTY OR Cff= sm cm It THE HOLD6R iROW Agil oTIM KLEBER PLUMBING COMPANY POW MMMM > AW.T' DON KLEBER TOHOLa cum OF 8760 SW 155 ST T MIAMI FL 33157 PAT,IENr IT � TAX 07/18!2012 60070000643 000045.00 1, Ili) ,, 1i,,,, 11, t, 1, 1„, 1 „1,►1,�,1h,,,,1,1,tl, +l1,,,,,,6 SEE OTWR SIDE AG# 6157095 STATE OF FLORISA DBF ATb%W0X3TRIICT198 I7CCTRYRLICEZI+ SX BOARD _ SEW L12050800790 ++t%,Xbaoz 'won 70670e/2012 117059.858 JCFP02,3.432 . e:' : The PLUMBING: CONTRACTOR Named below to cERTrzzEa :. � •. t7nder the provision of Cha tees Expiration date: ALiG 31, 2014 RLEBER FL ECO 8760 SW 155 ST PALMETTO BAY FL 33157 RICK SCOTT LL OVE'-RNOR Fium -AV AQ D=f%k FIQCn ov 1 ALAI KEN LAWSON SECRETARY From Great Florida Insurance Fax 7665221889 Tue Jul 2 14:51:48 2013 Page 2 of 2 '�-- -- "" CERTIFICATE OF LIABILITY INSURANCE naNODrrrrr) 07// 02/102/113 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(res) 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 endorseme s PRODUCER Great Florida Insurance P'inecrest 11206 S Dixie Highway 101 Miami, FL 33166 Phone (306) 266 0616 Fax (786) 622 1889 22VEACT Tamara Mourino PHONE (306) 266 0616 -r—FA--X No): -MAN ADDR ss: tamara@legacy3insurance.com CUSTOMER In & INSURERS AFFORDING COVERAGE NAIC it INSURED Kleber Plumbing CO. 8760 SW 166th Str Miami, FL 33167 INSURER A: Granada Insurance Co 09730 INSURERS: 2 INSURER C : $ 600,000 INSURER D : $ 100,000 INSURER E: $ 6,000 INSURER F: $ 300,000 ..v.0 - VCn IIrILAIG NUM 6BH: RFVINKIN NIIMINFR. THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ��ggEXCLUSIONS A TYPE OF INSURANCE A ADD S SUB N POLICY NUMBER M YBEYFFPAID C MIOINMY L LIMITS A 0 GENERAL LIABILITY E N 0 0185FL00020250 1 1 2 2 EACH OCCURRENCE $ $ 600,000 PREMISES EaecalrT $ $ 100,000 MED EXP (Any ono parson) $ $ 6,000 PERSONAL 8 ADV INJURY $ $ 300,000 GENERAL AGGREGATE $ $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER: P PRODUCTS - COMP/OP AGG $ $ 600,000 AUTOMOBILE LIABILITY C COMBINED SINGLE LIMIT $ $ BODILY INJURY (Par parson) $ $ ❑ ALL OWNED AUTOS B BODILY MURY (Par accident) $ $ El B PROPERTY DAMAGE $ $ ❑ H R EDDAUTOS A $ ❑ UMBRELLA LIAB ❑ OCCUR E EACHOCCURRENCE $ $ ❑ DEDUCTIBLE TWO STATU- $ RETENTION S $ NIA E E.L. EACH ACCIDENT $ $ E.L DISEASE - EA EMPLOYE $ $ E.L DISEASE - POLICY LIMITI $ $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Alaeh ACORD 101, Additional Remarks Schedule, if more Space is required) Plumber CERTIFICATE H OLDER r.ANrl QI 1 ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Building and Zonln THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g g ACCORDANCE WITH THE POLICY PROVISIONS. 10060 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami, FL 33138 ...� ®1988.2609 ACnRn CnRPARATInN_ All rinhta m "..n.l AL:UKV 25 (20D9/09) OF The ACORD name and logo are reglstered marks of ACORD