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DEMO-12-2415��1 . N 03 2014 Miami Shores Village CR �aN � Buildin Department �� Zl gBY i� 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 I Tel: (305) 795.2204 Fax: (305) 756.8972 ` INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING . PERMIT APPLICATION Permit Type: BUILDING% JOB ADDRESS: FBC 20 Permit No. Master Permit Nomorin. ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcelk Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name YIN HAKZ b ANuL• `YAM �n8#: _- 11a. 10 0**- � � (Fee Simple Titleholder):�M'[� Tenant/Lessee Name: Phone#. Email: ame: Phone#: ti 1G/ •�� • �.� d l Address: City: _ Qualifier Name: State Certification or "7 stration #: LV ?�'• '" a j / Contact Phone#: 1 • TU - • IL-" I Email Address: of DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ 3 r 500 ' Square/Linear Footage of Work: Type of Work: OAd Description of Work: Color thru tile: ORepair/Replace Submittal Fee $ Permit Fee $ 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 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. c "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 ,,COMM ENCEMENT:' - Notice to Applicant: ,As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absencel of suc ,osted inspection will not be approved and a reinspection fee will be charged. I Signature Owner or Agent The foregoing instrument .was acknowledged before me this day'of , 20 -B, by Os WW M l 1 k6 - � who is personally known to me or who has produced LC 6hVeY--Ll( a1 As identification and who did take"ail oath. NOTARY PUBLIC: Sign: Print: V -10a My Commission Bipires: APPROVED BY , all BAR A 'BABA A- ES EXPIRES: March TEP ?:.2014 Arno-1-Pl- iMY COMMISSION # DD 955300 i Boded Thru Notary Public Underwriters The foregoing instrument was acknowledged before me this day of kC 20 .J 3 , by ,&ya j m e(O", who is personally known to me or who has produced- �tty l 1. as identification and who did take an oath. N'0 Plans Examiner Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: My Commission Expires' BARBARA A ESTEP MY COMMISSION # DD 955300 EXPIRES: March 29, 2014 Bonded Thor Notary Public Udenvdters ���+�akak�didaskake&skdispHa �DkdsA'�$e�d`�sA d<$ca�adad�$��ek$tnk�a@��geskda+k+Rak$es$� Zoning Clerk C STA=TE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION -c CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH " TALLAHASSEEMONROE STRFLT32399-0783 ADEBISI, SURAJ MOFOLORUNSO DEEN CONSTRUCTION COMPANY 5881 NW 192ND ST MIAMI LAKES FL 33015 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better.. For information about our services, please log onto www.myfloridalleense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! (850) 487-1395 f STATE OF FLORIDA AC# 6 3 2. 140 3 } e DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION' I - CGCO58357 08/30/12 128061295 CERTIFIED GENERAL CONTRACTOR ADEBISI,`.;SUR.AJ MOFOLORUNSO DEEN CONSTRUCTION COMPANY IS CERTIFIED under the provisions of Ch.489 Fs expiration dates AUG 31, 2014 L12083002674 DETACH J�' THIS'DOC fM� En'T H S AaCO iED B'ACr ; ROU R �'� C OPR "hI�TI : G � k FNE -"R '�s;,�$.a�,Sur.�,.,.rt..t:.M� A\J# FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L12083002674 1-08/30/201 Z 1128061295.. ICGCO58357 The GENERAL.CONTRACTOR` Named below. IS CERTIFIED. Under the provisions of Chapter 489 FS. Expiration date: AUG 31., 2014 ADEBISI SURA) MOFOLORUNSO DEEN CONSTRUCTION COMPANY 5881 NW 192ND STREET MIAMI FL. 33015 RICK -SCOTT KEN LAWSON GOVERNOR SECRETARY sus,. 03-02-2012 ��°q ae cam JEFF ATWATER 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. EFFECTIVE DATE: fJ#:*.-18Ii'S FEIN: 03/02/2012 EXPIRATION DATE: 03/02/2014 ADEBISI SURAJ M 650640206 BUSINESS NAME AND ADDRESS: DEEN CONSTRUCTION COMPANY 5881 NW 192ND STREET HIALEAH FL 33015 SCOPES OF BUSINESS OR TRADE: 1- CONTRACTOR -PROJECT MANAGER, CO 2- CERTIFIED GENERAL CONTRACTOR IMPORTANT. Pursuant to Chapter 440 . 0504), 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 440.0502►, 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 440.0503), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation 11, 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. DUESTIONS? (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 DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW 0 EFFECTIVE 03/02/2012 EXPIRATION DATE: 03/02/2014 PERSON: SURA) M ADEBISI FEIN: 650640206 BUSINESS NAME AND ADDRESS: DEEN CONSTRUCTION COMPANY 5881 NW 192ND STREET HIALEAH, FL 33015 SCOPE OF BUSINESS OR TRADE: 1- CONTRACTOR -PROJECT MANAGER, CO 2- CERTIFIED GENERAL CONTRACTOR IMPORTANT Pursuant to Chapter 440.05041, F.S., an officer of a corporation who 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 440.05112), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the 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 deo " CERTIFICATE OF LIABILITY INSURANCE112/26/2013 LyR THIS CERTIFICATE 18 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 REMEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the cerdflcAe holder is an ADDITIONAL INSURED, the polimAks) must Do ondorsed. If SUBROGATION 19 WAIVED, sua)ed to the tomes and conditlone of the policy, cerWn paliclee may require an andorminent. A statmient on this uet#B=W does not Confer rights to the certlRcM hoidar In lieu of awl; endorssmsnt(s). PRODUCER CONTINENTAL INSURANCE OFFICE 3758 West 12th Avenue Hialeah FL 33012 � NA NE (305)828-7770 RNE NO: 305) 8287701 ���:arianne@GOr�titi�ritalirssurax'iaeOffioe. cam INSURERS) afFagO1NG PZSVERAOE PIA1C8 INsuRER A: REPUBLIC MWO1 2M INSUPUIMCE INSURED DEEM CONSTRUCTION COMPAW 5881 NW 192 ST MIAMI, FL 33015 786-222-210. INSURER B: INSURER C INSURER c): 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 RE 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 CLANS. LyR TYPE OF INSURANCE AML INSR IJFUBR POLICY NUMORR NA&tDD MM/UD LIMITS A GENERAL LIABILITY X COMMeNOIAL GENERAL LIABILITY R OLAIN18-MADE M OCCUR PLGLCO02182-12 0'7/19/13 07/19/14 RACH OCCURRENCE $ 1,000,000 000 PREOAISM ES 000urrM $ 100 O 0 MED EXP (Any tuts person) $ tJ 0 0 PERSONALBADVINJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEWL AGGREGATE UNIT APPLIES PER: X POLICY M PHOT LOC PRODUCTS - COMPlOP Am s 2,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED ULED AUTOS ASU, HIRED AUTOS NON -OWNED OSpqr nt S Ea atxid.e1 BODILY INJURY (Per person) S BODILY INJURY (Par goWera) S g S UMBRELLA LIAROCCUR EXOESS I"OLAIMS-MADE EACH OCCURRENCE $ AGGRGUTEr—r$ DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TiTillRY ANY PROPRMTORIPARTNF11 Da=,mVE OFFROt 9�sUBER pf (NINNU tory In NMI If yss deBChbB uRd9r DESCRIPTION OF 0 ERA IONS below N/A LAB oTH- LIM E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ GAL DISEASE - POLICY umrr $ DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (AMWh ACORD 109, Addifbpr:s► Remarks St boWle, if more spSoe is squired) u MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL 33138 305-756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERfippF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLIC)¢PI)EOMSIONS, REPRESENTATIVE 01988.2090 APORD COMORATION. AO rinhts rammad ACORD25(2010/05) The ACORD name and logo are registered marks ofACORD • Locai,Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 3710101 BUSINESS NAMElLOCATION RECEIPT NO. DEEN CONSTRUCTION RENEWAL COMPANY INC 3875011 5951 NW 173 DR #1 MKMG FL 33015 LBT EXPIRES SEPTEMBER 30, 2014 Must be displayed at place ofbusiness Pursuant to County Code Chapter 8A'- Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS NT RECEIVED DEEM CONSTRUCTION COMPANY 196 GENERAL BUILDING BY TAX COLLECTOR INC CONTRACTOR r/O CI IRA.I M AnFRLSI 90.00 12%30/2013 Worker(s) 2 CGCO58357 0224-14-002785 This Local Business Tax Recelpt only coo,�nns payment elthe Local Business Tex. The Receipt & nota license, permit, or a eertiOcatios of the holder's qualiCcadens to do business. Holder mast comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above mmH be displayed on all commercial vehicles aMiamlWade Code Sec W276. muVIODAD For more inlarmatioa,visitlt .BiaalidadegovJtaxcolLector , ) t Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 qq CHANGE OF CONTRACTOR I ARCHITECT Permit N. — U� *7 Owner's Name (Fee 'm le Title H Ider): W I V �V f 1 Pone #:1 Owner's address; N 6c( `f City: State : Zip Code:31, 109 Job Address (Of where work is being done):_ City: Miami Shores AT ,f.i�� �► ►ice 1f1.'' l iL 1.8,1++70 Architect/ Engineer of Record Name: Address: City: State:—Florida Zip e `Phone Zip Lic. Number: Phone #: Zip Code: � - , - 1►�J [��I ivZ'�a� iirlY� �r�u�r!:���Lr�✓��!�T I hereby certify that the work has been abandoned andlor the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal in veme t. Signature Signature owner or Agent —•- _.._ __ Con r ilea The foregoing i ent was akno ed eQd is m o The foregoing ins nt was akno led 110re e this day ,2� L'l� �� ��I this �° day 23 is personaJZ w o me or who has roduced w o is r nal) k o n o me o"produ d Zb Olt bl�s indentification. as indentificatior Notary I s Nota Pu li J Florida Sign: F P b S t 2015 Sign: ',' ,:,,�y Comm. Eap 1e5EEP 28810 , "" _`b`' Notary Public - State of Florida Seal: ' . , _ Seal: h Commission # Assn. ; iwy Comm Ezpires Sep 23. 2015 Bonded Through National Notary°`c Commission # EE 128810 ; ���� Bonded Through National Notary Assn. * Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ® Print your name and address on the reverse so that we can return the card to you. ® Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: 31 to scn S g A. Signature/� — l_ ❑Agent Add. B. Received by (Printed Name C. DateofI D. Is delivery address different from Rem 17 Ye: If YES, enter delivery address below: , O No s. mrvice Type ❑ Certified Mall" ® priority Mail Express, 13 Registered ❑ Return Receipt for Merchandise ❑ Insured Mail E3 Collect on Delivery 4. Restricted Delivery? (Extra Fee) ©Yes ? Article Number (Transfer from service label) ?1113 1710 00111 4 9 2 5 319 0 IS Form 3811, July 2013 Domestic Return Receipt Q.46 $3.10 10.00 1-6. -11 %OV p° 13 ra rrl Sent To fl ►/ K ------------------------- - - - -------- --- G �Pleef - F. or PO Box No.- T . ciry,'seaie; ziP- a% - U "----��,ex „� ms=s• -.:, .. r. %: GRATYGNY BRAN( lJ•S. P:osta+I Se i, �_ = TM ru $ Ir Postage S 05°11;10 PN 1110612013 Certified Fee Sales Receipt Final C3 Return Receipt Fee O (Endorsement Required) ro Pro "de Restricted Delivery Fee C3 Uornestic Mail Onf No ins,nce aq;, Total Po • r deli�e�ry nfo„r�m-„ta on visitor v�eb"�"siie .us •mss Q.46 $3.10 10.00 1-6. -11 %OV p° 13 ra rrl Sent To fl ►/ K ------------------------- - - - -------- --- G �Pleef - F. or PO Box No.- T . ciry,'seaie; ziP- a% - U "----��,ex „� ms=s• -.:, .. r. %: GRATYGNY BRAN( ru $ Ir Postage S 05°11;10 PN 1110612013 Certified Fee Sales Receipt Final C3 Return Receipt Fee O (Endorsement Required) C3 Restricted Delivery Fee C3 (Endorsement Required) Y (%- Total Po Q.46 $3.10 10.00 1-6. -11 %OV p° 13 ra rrl Sent To fl ►/ K ------------------------- - - - -------- --- G �Pleef - F. or PO Box No.- T . ciry,'seaie; ziP- a% - U "----��,ex „� ms=s• -.:, .. r. %: GRATYGNY BRAN( NIANI. Florida 331689998 1158540112 -0097 (800)275-8777 05°11;10 PN 1110612013 u-„J�'— Sales Receipt Final Product Sale Unit Qty Price price Description_— _ POhIPANO BEACH FL 33073 Zone - First -Class Nail Letter 0.60 oz. Fri 11;08/13$2.55 Scheduled Delivery 0a5; Return Rcpt (Green Card) $3,10 @@ Certified 70131710000149253190 $0.46 Label #: $5,65 Customer Postage Subtotals $5.65 Issue PVI; $5.65 Total: Paid by: $5.6` Debit Card x(XXXY,XXx:<Xxa1e1 Account #: 000466 Approval #' 337 Transaction #: 23 903520641 003656 Receipt#; 0101 For inqiries 90 USPS comrorkins callo1-800-222 1811.to Or call Order stamps atOs ®'usPs�com/clicknshiP 1-800-Stamp24. G to print shipping labels with postage. other information call 1-800-ASK-U5P5. other*info** �:** ************w*•�*h**d+'�+****'h'++:-'toot**f+****t and where you want Get Your mail what' i' office Post e Box. Sign up with a secure oboxes. a box online at usps.com)p Bi ll#: 1000305728397 Clerk: 13 All sales final on stamps and Posta Refunds for guaranteed services or Thank you for your business toot****x**********:5*f. •+ HELP US SERVE YOU BETTER Go to: httPs://postalexperience.co+t TELL POCENT STAL EXPERIENCE YOUR OPINION COUNTS Customer COPY .. ABDULSAMAD MUKHTAR 15 NE 104 Street. Miami Shores, Florida 33138 Ph. 786-718-0444 November 1, 2013 Simpson Home Inc. 7937 Pine Creek Lane Coconut Creek, Florida 33073 Attn: Paul A. Simpson RE: Change of contractor- Demo Permit # 12-2495 15 NE 104 Street. Miami Shores Florida 33938. Dear Mr. Simpson, DEC 0 2013 Please accept this letter as an official notification that your company, Simpson Home Inc. has been removed as the contractor on record from the building department at Miami Shores Village Hall. A change of contractor process with the appropriate municipality or jurisdiction has been initiated and its expected to complete in a matter of days. If you have any question or clarfcation, please do not hesitate to call me at 786-798-0444. Thanks for your cooperation and understanding. Sincerely. A ulsamad Mukhtar (®caner) Cc. Miami Shores Village / Ung Defi-O J 2 -- 2l -. Cflnat(fE l+hkRrsf,pbpur y�u1<tfTi�2 Is SvRe�T VVl (M✓l I sf Fd✓L�' t Dow[, Z�pW 5 cop C-1 C;M K ( T (-t+M f0lA P+'T 0 Otl'l) l< Q--�a'u�L� V � ��c�Qce�-i �-� 7`C�'E WD 4=4 Az z lb A) Lo Alk nW LA 7yi-)w I (-� pq)DKA / Cr V 4 la Miami Shores Village BY �F DATE DFPF IMCE M M ALL FEDERAL d!_•I c7" -VIr-) P'GULATIONS o4 e i -/, ME 249, 2013 mlam► SW5 V�&* ooh a R,� Ava,L mjd4j� J�Oroj I FL s3of DEC 2.6 2013 MaUT"IO0fqlV4dT` �nwm+wtROV4,t ft. �i313b' p I&m "a -t� 71,5 P,A614 i or, ft TA�L la.fe'r as a�, o�u�(,a�s+� a�. 4 -ow - w� fi venue' { mkpo: Ib- �e.•wl:{�an l.ovk is nsd" w+y/w�ry'r� wiirdcla� In {�.,r�e a fro- ctlM�4'�'°n �µrt� a.�r=a� �✓a'�� lm 'fta am6anN1 � S r Al"ktiimov 04 cst�.t s lel �-86���g-���i�