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EL-13-2359Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number. INSP - 205388 Permit Number: EL -10 -13 -2359 Scheduled Inspection Date: January 08, 2014 Inspector: Devaney, Michael Owner: ALVARO JOSE HUERTA, PATRICIA CI CRIA DADDATCDDA CIJADTT Job Address: 1566 NE 104 Street Miami Shores, FL Project <NONE> Contractor: ELECTRICAL SERVICES JC INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1122320320390 Phone: (305)244 -8628 Building Department Comments REPLACE KITCHEN CABINETS Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments January 07, 2014 For Inspections please call: (305)762 -4949 Page 20 of 27 • Miami Shores Village I, �.� Building Department Al OCT 1 6 20i3 ii 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 [-:,'.`Y —e I- — INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 10 Permit No Cpl jr ° 3S' Master Permit No. 52.C.1 �C 5 Permit Type: Electrical JOB ADDRESS: 15 D LE lc) 4- "51-* City: Miami Shores County: Miami Dade Zip: 3 -313 Folio/Parcel #: 11 - ? Z2Z- 03 2 -0390 Is the Building Historically Designated: Yes NO i- Flood Zone: OWNER: Name (Fee Simple Titleholder): A'tv0(0 /P cc.* , ' hone#: -c(3-2P-12-&2 Address: 15 roka Lie. I C?4.+ k `C It' City: , c.tyY11 .5 -e3 State: P( Zip: 331 5 g Tenant/Lessee Name: Phone #: Email: f Pei p L`'t/ -rn .L.O' ► .,c. ,,, . s,,o, ,...0 Iv ty �CItAC -fBRr Company Nam Address: 1-14 0 s LOL Phone #: (�/ otyu 8'4°18 City: f t ` 1l State: Zip: 3 31 % S Qualifier Name: E vo n C' . PO l �` rl 0 Phone #: State Certification or Registration #: 13 ©O 6?-5- 67 e) Certificate of Competency #: Contact Phone #: ..4 `I 86 Email Address: DESIGNER: Architect/Engineer.. Phone #: (VaIue of'Work -for= this- Per-mi : $ -- -'_5 .1•)-® Square/Linear Footage of Work: 3 5 fee+. Type of Work: ClAddress ❑Alteration Description' of Work:: it 4 ODemolition :'aro , < °A' 'G r:c:1..Ytr°4:f�f * * * * * ** * * * * * * * * * * * * * * ** * * * * ** * * * * * * * * *F ************ * * * * * * * * * * * ** * * * **** * * * **** * * * ** /4"mr� 30®x® Submittal Fee $ .5.6cr ti.,,,P,(.7, Permit Fee $ 16700X1) 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 City 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 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 f such posted notice, the inspection will not be approved and a reinspection fee will be charged :: Signature"i c*. Owner or Agent The foregoing instrument was ackno ged before ��r Contractor /9 The foregoing iinnsttrrument was acknowledged before me this /1 day of , 20/.3 , by i Gies. L415a.k/�Cc day of 0 et- , 20 13, by %l i,.�-)D.� C. �6/ 1(t t), who is personally known to me or who has produced PG QeltQ# who is personally known to me or who has produced LiCari 5'e As identii cation and who did take an oath. - 7) L as identification and who did take an oath. NOTARY PUB Sign: Print: My Commiss n Expires:'' 1 •u r.: • i.. A O .1 �= Notary Public - State of Ftorida ,s My Comm. Expires Apr 25, 2016 .!„z ar Commission # EE 192788 ************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * ** * ********************** * * * * * * * * * * * * * * * * ** * * * * * * * * * * * ** APPROVED BY /SVW----' Plans Examiner Zoning Structural Review Clerk (Revised 3 /12/2012XRevised 07 /10 /07XRevised 06 /10/2009XRevised 3/15/09) Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES 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 EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT 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 WORKERS COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 i COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: ell es' Se rV I Cis . C hC. BUSINESS ADDRESS: 4401 sW 10 2 AA CITY fr(I i r STATE FL ZIP CODE 3-1.6 5 BUSINESS PHONE: ( 305 ) 2-44 66728 FAX NUMBER ( ) CELL PHONE ( ) QUALIFIER'S NAME: 1305-t e. QUALIFIER'S LIC NUMBER:ea-1300 5.66® E -MAIL ADDRESS (IF APPLICABLE): Created on 3119/09 BY MLDV / RV 3/26!09 MLDV I RV 6127111 AS Oat 0813 09:30p Juan C Portillo • 305 364 5891 p.1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 PORTILLO, JUAN CARLOS ELECTRICAL SERVICES JC INC 4401 SW 102ND AVENUE MIAMI FL 33165 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants. and they keep Florida's economy strong. 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.myfforidalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! STATE OF FLORIDA. DEPARTMENT OF BUSINESS AND 9vr PROFESSIONAL REGULATION EC13005560 = ISSUED: 09/24/2013 CERTIFIED ELECTRICAL CONTRACTOR PORTILLO, JUAN CARLOS ELECTRICAL SERVICES JC INC IS CERTIFIED under the provisions of Ch.489 FS. Expiration date • AUG 31. 2014 L1309240000334 The Department of State is leading the commemoration of Florida's 500th anniversary in 2013. For more information, please go to www.VivaFlorida.org. DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER EC13005560 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 PORTILLO, JUAN CARLOS ELECTRICAL SERVICES JC INC 4401 SW 102ND AVENUE MIAMI FL 33165 RICK SCOTT ISSUED: 09/24/2013 SEQ # 11309240000334 GOVERNOR DISPLAY AS REQUIRED BY LAW VIVA FROMA 0. KEN LAWSON SECRETARY • JEFF ATWATER 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. CHIEF FINANCIAL OFFICER 08 -01 -2012 EFFECTIVE DATE PERSON FEIN: 08/01/2012 EXPIRATION DATE 08/01/2014 PORTILLO JUAN C 455451857 BUSINESS NAME AND ADDRESS: ELECTRICAL SERVICES JC INC 4401 SW 102 AVE MIAMI FL 33185 SCOPES OF BUSINESS OR TRADE: 1- ELECTRICAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05(14), 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 440.05112), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.06(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. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? 1850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 08/01 /2012 EXPIRATION DATE: 08 /01/2014 PERSON: JUAN C PORTILLO FEIN 455451857 BUSINESS NAME AND ADDRESS: ELECTRICAL SERVICES .IC INC 4401 SW 102 AVE MIAMI Ft. 33165 SCOPE OF BUSINESS OR TRADE 1- ELECTRICAL. CONTRACTOR IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who O elects exemption from this chapter by filing a certificate of election L under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be aa exempt.. apply only within the scope of the business or trade listed on Rthe notice of election to be exempt E 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.. 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 Oot 0813 09:31p Juan C PortIllo 305 364 5891 p.2 Municipal Contractor's Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO' NOT PAY CC NO: 12E000307 BUSINESS NAME/LOCATION ELECTRICAL SERVICES JC INC 4401 SW 102 AVE MIAMI, FL 33165 OWNER RECEIPT NO. NEW BUSINESS 7435538 TYPE OF BUSINESS ELECTRICAL SERVICES JC INC ELECTRICAL CONTRACTOR For more imformation.visit MC EXPIRES SEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 200.00 08/05/2013 0229 -13- 000197 Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT A RILL -DO NOT PAY 7049547 BUSINESS NAME/LOCATION ELECTRICAL SERVICES JC INC 4401 SW 102 AVE MIAMI, FL 33165 OWNER ELECTRICAL SERVICES JC INC I RECEIPT NO. RENEWAL 7320054 BT EXPIRES SEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Chapter SA- Art. 9 & 10 SEC. TYPE OF BUSINESS • 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR 75.00 08/05/2013 12E000307 • 0229- 13-000697 This Local Badness Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a Rowse. permit. or a eettification of the holders qualifications to de business. Holder must comply with any govemmeatal or rmngoeetomeatal regulatory taws and taquiremepts which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles- Miami -Bade Code See ell-V8. For more h+farmaticn.vlatt imeasmbMilNik MROD INSURANCE GROUP 9415 SUNSET DRIVE SUITE:200 MIAMI,FL 33173.PH:305- 598 -8541 INSURED ELECTRICAL SERVICES J'C INC 4401 SW 102 AVE MIAMI, FL 33165. CO LTR is :fit 'Z `ire :rr- -,T , - , DATE D .�, ,. T , < 10/24/20 3;; : THI 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,CoVERAQE AFFORDED BY THE POLICIES BELOW. ' COMPANIES AFFORDING COVERAGE COMPANY GRANADA INSURANCE COMPANY A COMPANY B COMPANY C COMPANY D THIS IS TOCER7IFY THAT THE POLICIES OF.INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POLICY pERIOCI INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR:QTHER DOCUMENT WITH RESPECT TO WHICH THIS • CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED B Y 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, TYPE OF INSURANCE POLICY NUMBER GENERAL. LIABILITY X COMMERCIAL GENERAL LAB1Lrry XCLAIMS MADE a OCCUR OWNER'S A ,CONTRACTOR'S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS 0185FL00050991 POLICY EFFECTIVE DATEUlmrs mn 07/12/13 POLY EXPIRATION DATE XMWOrihrtI 07/12/14 WAITS GENERAL AGGREGATE PRODUCTS - COMFIOP ACG PERSONAL A AOV INJURY EACH OCCURRENCE FIRE DAMAGE (My one Ire) SCHEDULED AUTOS _ HIRED AUTOS NON -OwN W AUTOS GARAGE LIABILITY ANY AUTO MED EXP (My are Doreen) COMBINED SINGLE UNIT 52,000,000 $2.000,000 21 000,000 21,000.000 5100,000 25,000 BODILY INJURY (Per person) (Per acciIt INJURY PROPERTY DAMAGE EXCESS LIABILITY UMBRELLA FORM OTHER THAW UMBRSI,LA FORM AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY; EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE WOI (ERs COMPENSATION ANb EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERE/SAMMVE OFFIcERs ARE INCL EXCL S S S S S S OTHER 0185FL00050991 DESCRIPTION OF OPE_ RATIONS /LOCATIONSIVEHICLES/SPECIAL {TENS 07/12/13 07/12/14 Wo 1 STATE. TORY LEMaa ER EL EACH ACCIDENT S EL DISEASE - POLICY UMR S EL DISEASE -EA EMPLOYEE S PREM /OPERS;PROD /COMPL DEDUCTIBLES(500)CLAIM :R„{i/ER-y'rUf!'t,,;l" r 'r :.'..n�G`t `L. :.-� lt'� iu. - 771?f 5 r Ia i e7 ( Y.y:,•n.P��Gdt•�' MIAMI SHORE VILLAGE • l d C l 8b °N r•i ��Jip..•J:Ti^ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE cAmcaLLED BEFORE VT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDSAVOR TO MAIL 3 00 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO bum SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY (W ANY IGN Lon! CeMhaM,. rt'a enc AUTHORIZED REPRESENTATIVE MICHAEL RODRIGUEZ (AGENT) df10d9 33Nddf1SNI GOdW WdWC Mg. 176'100