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RF-14-290Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 P / / 3 -2�013 Inspection Number: INSP- 208926 Permit Number: RF -2 -14 -290 Scheduled Inspection Date: March 19, 2014 Inspector: Rodriguez, Jorge Owner: BALDWIN, CATHERINE Job Address: 126 NE 106 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: JUVAL CORPORATION Building Department Comments SOLAR WATER HEATER ROOF REPAIR AROUND EQUIPMENT LEGS. Permit Type: Roof Inspection Type: Final Roof Work Classification: Repair Roof Phone Number Parcel Number INSPECTOR COMMENTS False 1121360050060 Inspector Comments Passed �/%�, CREATED AS REINSPECTION FOR INSP- 207261. Pass plumbing first. 91;/ " � I Provide pitch pans for anchors Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 18, 2014 For Inspections please call: (305)762 -4949 Page 34 of 51 I k Miami Shores Village �- Building Department FED 14 28% 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 j Tel: (305) 795.2204 Fax: (305) 756.8972 f _Y: INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING Permit No. IF I 'l PERMIT APPLICATION Master Permit No. Z6 0 3 Permit Type: BUILDING ROOFING JOB ADDRESS: 1 Z b t�) E ' ® • S �- City: Miami Shores County: Miami Dade Zip 0 3 Folio/Parcelt Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):_ Ca _�keb Phone 4h6S '� J zl 62 Address: 1_ Z 6 % E ( 0 6 S City: !(1� State: , zip: 3 3 13 , Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name: ) aL l �� Y'� Phone #: Address: _( 3 Q d S( A' J � -Z )_7 G� city:o01Y11 state: Zio: c '7 S Qualifier Name: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer.phone #: Value of Work for this Permit: $� Square1Linear..Footft -e of Work: I, o S Type of Work: ❑Addition ❑Alteration ONew ORepair/Replace ODemolition Description of Work:,1(° 1 C1i i��- •�' Color thru tile: Submittal Fee $ 5-0 - Q () Permit Fee $ CCF Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ MCC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE - a 3a' 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 broc ll be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of com icem t must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue n the sence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Owner or Agent The foregoing instrument was acknowledged before me this 2/ The foregoing instrument was acknowledged before me this day of , 20 -&-, by 6121 1", 0 day of , 20 J ,, by 96 , who is personally known to me or who h roduc who is ersonally =known me or who has produced :.and -,1,n ,a..�. � take oath. ,�. ALEXANDER JOSEPH PAVLINEK •`�Ck ArommisroN7E. PAVLINEK NOTARY PUBLIC:: : MY COMMISSION >>E EE859471 NOTARY P -? peE859471 EXPIRES Deeem 19 2016 ''a EX1 6 40 3se o1ss �.� 4 7388.01 Sign: Sign: My Commission Expires: APPROVED BY ALEXANDER JOSEPH PAVLINEK MY COMMISSION # EE859471 EXPIRES December 19 2016 #?/, Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) My Commission Expires: f 2, !9' /JP Zoning Clerk POIiCV Number: PGLS003975 -13 Date Entered: 02 /12 /2014 .A400R° CERTIFICATE OF LIABILITY INSURANCE 2/12/ 2 /12M/2014 DD/14 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 pollcy(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 MULTIPLE INSURANCE COVERAGES, INC. 8772 S.W. 8TH STREET MIAMI, FL. 33174 CONTACT NAME: PHONE (305)559 -5453 ac No: (305) 559 -5021 1 ardo@ multi leic.com ADDRESS: P P INSURERS AFFORDING COVERAGE NAIC # INSURER A: REPUBLIC- VANGUARD INSURANCE COMPANY PGLS003975 -13 04/25/2013 INSURED JUVAL CORPORATION INSURER B: $1,000,000.00 INSURER C : $ 100,000.00 MED EXP (Any one person) 2040 SW 123 CT MIAMI, FL 33175 INSURERD: $1,000,000.00 INSURER E: INSURER F: $1,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC VVYCKAbC3! CENTIFICATF NIIRfIRFR• DC\ /IQI!►LI LIN 111ADC12. 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMO/ C EFF PO ppY EXP LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR PGLS003975 -13 04/25/2013 4/25/2014 EACH OCCURRENCE $1,000,000.00 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000.00 MED EXP (Any one person) $ 5,000.00 PERSONAL &ADV INJURY $1,000,000.00 GENERAL AGGREGATE $1,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $3-1000,000.00 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA UAB EXCESS LIMB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? 0 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) HOME IMPROVEMENTS / REMODELING / ROOFING MIAMI SHORES VILLAGE 10050 NE 2nd Avenue Miami Shores, F1 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE .AURINDO R PARDO ' ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBGss.com; impressive Publishing 800 -208 -1977 11-19-2012 JEFF ATWATER STATE OF FLORIDA a CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION N * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW a CONSTRUCTION INDUSTRY EXEMPTION a Co m This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. a N EFFECTIVE DATE: 11/1912012 EXPIRATION DATE: 11/1912014 n PERSON: RAMOS ISMAEL FEIN: 200804483 BUSINESS NAME AND ADDRESS. LL JUVAL CORPORATION DBA GABLES ROOFING 2040 SW 123 COURT MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: 1- ROOFING - ALL KINDS AND DRIVER 2- LICENSED RESIDENTIAL CONTRACTR IMPORTANT Puraaanl to Chapter 440 . 05114}, F.S., an oflicer of a corparatlon who elects exemption from this chapter by filing a certificate of eloaioo ender this section may not recover benefits or Compensation an"I this chopter. Pursuant to Chapter 440.06112!. F.B., Certificates of election to be exempt._ apply only within the scope of the business or trade listed at the dacha of election 10 be exempt. PUNIC! to Chopler 44406(131, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 11, at soy time after the filing of the notice of the issuance of the tertl(itate. the person coated on the notice ar N caltuicate as longor meets the requirements of this section for issuance of a cettificate. The dopatmeol shall taroks a centiicste at any time for failure of the person �f nomad no the coni tale to meet The requirements of Ibis soclloa. QUESTIONS? 1950? 413 -1609 OWC -252 CERTIFICATE OF ELECTION TO AE EXEMPT REVISED 01 -11 Go Go U. LL �tZC. 1 33 o6S5 m E N E O LL m r