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EL-14-1354iami Shores Village Building Department 10450 N.E.2nd Avenue, Miami Shores, Florida 33138 TO: (305) 795-2204 Fax: (305) 756.8972 INSPECTION LINE PHONE NUMBER: (305) 762-4919 BUILDING PERMIT APPLICATION ❑BUILDING ® ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS FOC 0 Master Permit No. 1'--I, 1 Sub Permit No.E(-14 — 1,3 54 ❑ REVISION a EXTENSION [:]RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 150 NW 101. STREET City: Miami Shores County. Miami Rade Zip- -33150 Foiio/Parcel#: 11-3101-023-0210 is the Building Historically Designatedi Yes :NO X Occupancy Type: Load: Construction Type: Flood Zone: - I BFE: - FFE: OWNER: Name (Fee Simple Titleholder): RICARDO GONZALEZ phone#:. 786.715.:0071 Address: 465 BRICKELL AVE #3503 City: MIAMI , state: FLORIDA Zip: 33.131 Tenant/Lessee Name: — Phone#: Email: RGONZALEZ(a-BASINGEN.COM _-- CONTRACTOR: Company Name: VERSTEC ELECTRIC, INC. Phone#: 954.214;7952 - Address:_ 4020 SW 108 TER City: DAVIE State: FL Zip: 3332.8 Qualifier Name: FELIPE STECCO Phone#: 954.214:7952 . State Certification or Registration #: EC 13006034 Certificate .of Competency #: _ DESIGNER:Architect/Engineer. JOSE RUBEN JIMENEZ Phone#: 305.582.2836 .. Address: 7950 NW 53 STREET, STE 337 City: MIAMI state:... FLzip: 33.166 value of Work for this Permit: $ Z �® Square/Linear footage of Work Type of Work: ❑ Addition ❑ Alteration ❑ New ® Repair/Replace ❑Demolition Descriptionofwork., KITCHEN AND BATHROOM REMODELING Specify color of color thru tile. Submittal Fee $ Permit Fee $ CCF co/cc$ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ ! (ReAsedQ2/24J2014) % 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. Signatu OWNER The foregoing ilistrument was kk(iowledged before me this (2-5 !dray f A��. 20 by a ` z who is personally known to me or who haA produced 5z`f "-12Z -bi - aq - C) as Print: Seal: APPROVED (Revised02/24/2014) who did take an 150 EXPIRE& J=09, 2018 Signature -° t.4— � CONTRACTOR The foregoing instrument was acknowledged before+ rpe this day of 20 `T by who is personally known to me or who has produced53ZO'ZL�0 tf- 2S1 - 0 as identi'cattadho did take ath. NOTARY PSign: Print: ------ Seal: _ ZOO, Plans Examiner Structural Review )URDES CHANG IMQA&W1V # FF094707 EXPUM: J=09, 2018 4r*��k94�R �k�k9e&EeAe+Rffi�Iroky�gegeyMeKeaeyeeew�A�RBA�B�R�k Zoning Clerk Miami Shores Village 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* D. COPY OF WORKERS COMPENSATION INSURANCE* 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 STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: BUSINESS ADDRESS: 402�-Q 6uJ t 025 TIC—a . CITY 24&J r STATE f:- — ZIP CODEX 32 BUSINESS PHONE: ( ) Zt 1�Z _ FAX NUMBER ( ) CELL PHONE (--) QUALIFIER'S NAME: VDG�'CJ 6x --Q) QUALIFIER'S LIC NUMBER: C 6n 9> -- AV"RUI CERTIFICATE OF LIABILITY INSURANCE DATE 06/2612014YYY) 0/14 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 holier is an ADDITIONAL INSURED, the policy(les) must be endorsed. H SUBROGATION IS WANED, sub)ed 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 Government Insurance Corp. 320 Hialeah Drive Hialeah, FL 33010 Phone (30 883-9398 Fax (305) 885-1936 CONTACT PN8.NE Etl_(305) 883 9398 F c o : (305) 885 1936 L ESS. lnsuranceineod@yahoo.com INs s AFFORDING COVERAGE NAICs INSURER A: Travelers Indemnity Company of America INSURED Verstec Electric Ina C/O Felipe Stecco 4020 SW 108 Terr Davie, FL 33328- (954) 214-7952 INSURER B INSURER C: INSURER D : 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 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. IL RR TYPE OF INSURANCE ADD INSRGENERAL POLICY NUMBER R POLICY EFF D EXP LIMITS A LIABILITY F-1COMMERCIALGENERAL LIABILITY ❑ ❑ CLAIMS -MADE ❑ OCCUR Y 660 -1 8250597 10/31)2013 10/31/2014 EACH OCCURRENCE $ 1,000,000.00 ARgRE PREMISES oc�a nDence $ 100,000•00 MED EXP (Anyone person $ 5,000.00 PERSONAL BADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ JECTPRO- ❑ LOC PRODUCTS -COMPIOPAGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ AAOWNED ❑ SSCHHEEDULED ❑ HIRED AUTOS ❑ A°r� NED ❑ ❑ C011 NED SIF dard)INGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ P OPERTY AMAGE $ er accident $ ❑ UMBRELLA LIAB ❑ OCCUR ❑ EXCESS UAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS• LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTVE OFRCER/MEMBER EXCLUDED? (Mandatory in NH) El H yey�s describe under DESCRIPTION OF OPERATIONS below NIA ❑ WC STATU- ❑ O1N- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addidorml Remarks Setwdule, If more apace Is requires Assault & Battery Included In Policy. Certificate of Insurance is addificnal insured to Certficate Holder. License Number EC#13006034 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 N.E. 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2010/05) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE ©1818-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-8314000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA:VERSTEC ELECTRIC INC Business Name: Owner Name: FELIPE STECCO/QUAL Business Location:4020 SW 108 TER DAVIE Business Phone: 9 5 4 - 2 14 - 7 9 5 2 Receipt #:181-2999 /ALARMS/CONTRACTOR Business Type:"",'(MASTER ELECTRICIAN CONTRACTOR) Business Opened:05/01/2006 State/County/Cert/Reg:9 8 - CME -17 9 8 -R Exemption Code: Rooms Seats Employees Machines Professionals 1 For Vending Business Only Number of Machines: Vendina Tvna: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: VERSTEC ELECTRIC INC Receipt #03B-13-00000079 4020 SW 108 TER Paid 10/01/2013 27.00 DAVIE, FL 33328 09/30/2013 Effective Date 2013 -2014 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA.VERSTEC ELECTRIC INC Business Name: Owner Name: FELIPE STECCO/QUAL Business Location: 4020 SW 108 TER DAVIE Business Phone: 954-214-7952 Rooms Seats Employees 1 Receipt #: 181-2999 Business Type: ELECTRICAL/ALARMS/ CONTRACTOR (MASTER ELECTRICIAN CONTRACTOR) Business Opened: 05/01/2006 State/County/Cert/Reg: 98 - CME -17 9 8 -R Exemption Code: Machines Professionals Number of Machines: VendingType: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.001 0.001 0.001 0.001 0.001 27.00 Receipt #03B-13-00000079 Paid 10/01/2013 27.00 09/30/2013 Effective Date Miami shores V Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation InsuranceExemption 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 . f: 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 anyRerson 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 Contractor Print Name: Print Name: '�� I Q -Q,) Signature: Signature: State of Flori State of Florida) County of 1Vliami-Dade) County of Miami -Dade) Sworn ib 4nd scribed before Sworn Sworn t and scribed before me s day off. . , 20_ l day of , 20 By QI )MESA . C 67 LOURDES A. CHANG cowss10N # FF094767 MY CONIbIISSION # FF094767 EXPIRES: J=09, 2018 I I WO EXPIRES: Juie09, 2018 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 LA_ W_ CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the individual listed below has dtected to be exempt from Florida Workers' Compensation Iew. EFFECTIVE DATE: $/31/2013 PERSON: STECCO FELIPE FEIN: 300116049 BUSINESS NAME AND ADDRESS: VERSTEC ELECTRIC INCORPORATED 4020 SW_ 108 TERR DAVIE FL 33328 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING WITHIN BUIL EXPIRATION DATE: 8/31/2015 Pursuant to Chapter 440.05(1141. F.S., an officer of a rorporatien who alerts exemption from thischapter by fl"a caerrdflcate of etedion.undergde eectlonmay lot tecover benefits orcorapensadon dei dqs ehapter. Purant to Cher 440.05(12). F.S., Cerates election to bs exempt.. apply only within the scgpe of the to ss Or trade Gated on the n dto of eledlon to be exempt. Pursuant to Chapter 440.05(15), F.S.. Notices of eted on to be ezdnpt and tariificates of election to be exempt shall be subject to revocetiOn if, at any tkns alter qui filing of the notice or the Issuance of the Vie, the perm awned on dte rhe of certificate no Longer MOM the reciukemarns of this sedan far Isauartce of a certificate. the deparimepi dual rovoka a eta at any *m for failure of the parson mmned onthe cettdicate to meet the MgUirements of this sedian. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EX134PT REVISED 07-12 QUESTIONS? (8$0)413-11309 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218377 Scheduled Inspection Date: August 29, 2014 Inspector: Devaney, Michael Owner: GONZALEZ, RICARDO Job Address: 150 NW 101 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -6-14-1354 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1131010230210 Contractor: VERSTEC ELECTRIC INC Phone: (954)214-7952 Isunamg uepartment comments KITCHEN AND 1 BATHROOM REMODEL INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-218204. Add 1 receptacle to end of new counter. Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 28, 2014 For Inspections please call: (305)762-4949 Page 21 of 27