DS-14-1824 (2)Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-218244 Permit Number: DS -8-14-1824
Scheduled Inspection Date: September 12, 2014 Permit Type: Driveways/Sidewalks/Slabs
Inspector: Rodriguez, Jorge Inspection Type: Final
Owner: GAIQUI, MARITZA Work Classification: Repair
Job Address: 1450 NE 101 Street
Miami Shores, FL Phone Number
Parcel Number 1132050240040
Project: <NONE>
Contractor: ALL JER CONSTRUCTION CORP Phone: (786)348-9180
tiul
comments
REPAIR EXISTING DRIVEWAY, REMOVAL OF EXISTING
WALKWAY AND INSTALLATION OF OLD CHICAGO
PAVERS, INSTALLATION OF TILE ON FRONT AND SIDES
PORCHES.
INSPECTOR COMMENTS False
September 11, 2014 For Inspections please call: (305)762-4949 Page 17 of 35
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
September 11, 2014 For Inspections please call: (305)762-4949 Page 17 of 35
BUILDING
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
I BUILDING ❑ ELECTRIC ❑ ROOFING
AUG A 1- 2014
FBC 20 10
Master Permit No.�
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
PLUMBING f--� MECHANICAL [PUBLIC WORKS Ej CHANGE OF CANCELLATION [:] SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: �0 A) SE�-
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: is the Building Historically Designated: Yes NO_
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder):_,L,. r : t", . Phone#:
Address: I y6o N6 \j0i ST
City: M`, R w.` S1nOcPS State: Zip:
Tenant/Lessee Name:
Emai!:
CONTRACTOR: Company Name:
Address: V1101,4j
City: ' s \V'G4
Qualifier Name:
State Certification or Registration #:
411,4-79
I1
1 Zip: 'D.3 1'7.5*
Phone#: t & m� ``0
of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: _City: State: Zip:
Value of Work for this Permit -._fes Square/Linear Footage of Work:—
Type of Work: ❑ Addition Alteration ❑ New ' Repair/Replace ❑ Demolition
DeseriptionofWork: �r2Te� A,14 can 0�6 ex�J�
n(– CV%'.[ i t())�1e��rusa:,.t�r.� �.� cx� ;ie tea. ttJN�e tL s'� P'�JeD.e � S
-�pedfy color of color thru tile:
Submittal Fee $ �–Jw Permit Fee $ ( 2-S 00 CCF $ !� • CO/CC $
Scanning Fee $ e Radon Fee $, L .AOO `_ DBPR $ ®� Notary $
Technology Fee $ i Training/Education Fee $ Double Fee $
Structural Reviews $ _ Bond $
TOTAL FEE NOW DUE $102-- qb
=1 _ 02-
I I ievised02/24/2014) ro
®"- 40
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
�_ day of AOQQS _, 20 `4—_,_, by
who' personally nown to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sign: )C � /�, a ,
�
Print: �t•�-1,eJ , rus,C/", 5. _
The foregoing instrument was ``owledged before me this
_ day of LS �T, 20 i� . by
T2SQ who is personally known to
me or who has produced :7,2 tlZ\ ()as
identification and who did take an oath.
NOTARY PUBLIC:
Seal: Seal.
• SMM CAMISSWMCASAIS
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:.� W 00kWSM # EE220718 =. MYCOLUSSM EE# 220118
'. EXPIRES: July 31, 2016
'`; •• Bided F ?
` EXPIRES: July 31, 2016
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APPROVED BY Z7 1(11 Plans Examiner l Zoning
Structural Review Clerk
(Revised02/24/2014)
40STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESS=IONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
JEREZ, JOSE ANGEL
ALL JER CONSTRUCTION CORP
12294 SW 29 TERRACE
MIAMI FL 33175
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.myfloridalicense.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 constar 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!
DETACH HERE
IS CERTIFIED under the provisions of Ch.48% fS.
60MIM date : AUG 31; 2016 L1 26
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION. INDUSTRY LICENSING BOARD
CCC7
Named below IS CERMF
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Expiration -date: AUG 31,
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Report Viewer Page 1 of 1
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' Compensatlon law.
EFFECTIVE DATE: 5/31/2013 EXPIRATION DATE: 5/31/2015
PERSON: JEREZ JOSE A
FEIN: 208427890
BUSINESS NAME AND ADDRESS:
ALL JER CONSTRUCTION CORP
12294 SW 29 TER
MIAMI FL 33175
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL PLUMBING NOC AND HEATING, VENTILATION, ROOFING -ALL KINDS
CONTRACTOR DRIVERS AIR -GOND AND DRIVER
aao °Rm�e°Inam mm W. ids m°�,°�m 'eHw we a m aao"�(+� F.er � r Zd au . nem°
DFS-F2-DWO.252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)4131609
https://apps8. fldfs.comlcrreportviewerlreportV iewer.aspx?data.=kdvpginc9D7Q3 gH6TER6... 5/31/2013
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner - Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project
prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate
officers or members of a limited liability company (LLC) in the construction industry may
elect to be exempt if
1. The officer owns at least 10 percent of the stock of the corporation, or in the case
of an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members
are allowed to be exempt. Construction exemptions are valid for a period of two years or until
a voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village
does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be
personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your
insurance carrier since most property insurance policies DO NOT cover this type of liability.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Owner
Print Name: ;
Signature:
State of Florida)
County of Miami -Dade)
Sworn to and subscribed before me this
day of , 20
By
(SEAL)" "L SURI NCS
Tvne of Identif = dur-O FIRES: July 31,2
Contractor
Print Name: -::�-o 5e-�
Signature:
State of Florida )
County of Miami -Dade )
Sworn to and subscribed before me this
day of Aujq S� _,20 4
204.
By S C aloo,-"
of