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DEMO-14-1017Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217122 Scheduled Inspection Date: August 04, 2014 Inspector: Rodriguez, Jorge Owner: ESCALONA, CRISTINA CRUZ Job Address: 10616 NW 2 Avenue Miami Shores, FL 33150 - Project: <NONE> Permit Number: DEMO -5-14-1017 Permit Type: Demolition Inspection Type: Final Work Classification: Building Phone Number Parcel Number 1121360020060 Contractor: APOLO BUILDERS INC Phone: (954)445-5046 Building Department Comments INTERIOR DEMO INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-212636. No access, no one d home Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 01, 2014 For Inspections please call: (305)762-4949 Page 17 of 19 BUILDING PERMIT APPLICATION 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 BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL E]PUBLICWORKS JOB ADDRESS: 1061 114) 02 id fie MAY 1 014 BY- Double Y FBC 2MC) Master Permit Ne.!Dd —12' Sub Permit No. ❑ REVISION ❑ EXTENSION efiENEWAL ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:_l/ — A 13600,261960 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): 49 J:: n S Ldu C—Jc 4/ G��, - Phone#: !lj �-J- % SAV/ Address �� j �_^ Crc���" �� City: C,— / 1-4 A Tenant/Lessee Name: Email: State: / A10, Zip: CONTRACTOR: Company Name: AJ,� vi' Phone#: �r5/ (A Address: o ct I �i✓ City: /— 40 1440A, State: 11-L Zip: Qualifier Name: L o40 Phone#: State Certification or Registration M _CGC - /S-/ 07 y0*11y Certificate of Competency #: DESIGNER: Architect/Engineer: A11-4 Phone#: w J Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: &rn a Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR Double Fee $ Bond $ TOTAL FEE NOW DUE $ / 7 • 3 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 Signature - 0 INNER ignatureOWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of Me.1ti , 20 by n day of 20 , by (. rr�� ►�., Co�� �jr��7 . who is personally known to �Std� 041741"0 ___,who is personally known to me or who has produced as me or who has produced 56A identification and who did take an oath. NOTARY PUBLIC: Print: 1A3J it Waa[ Seal: ,�• "4a E APA1'",.1RIU • ., Hary ° ' S'.ire of Florida txpues May 27# MI ('"117:7 APPROVED BY 1 (Revised02/24/2014) identification and who did take an oath. NOTARY PUBLIC: ..I11 rrrr. l? ' Sign: Print: Seal: ///(111111�00\\ Plans Examiner Structural Review 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 FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH.YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. U COPY OF QUALIFIER'S STATE LIC CARD B V COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCECERTIFICATE 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 CQMPETENCY.OF QUALIFIER B. COPY OF MIAMI DADE COONTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: BUSINESS NAME: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 .: _COLETE CONTRAG ,�'S INFORMA MPTION t- IU/ BUSINESS ADDRESS: �0 y / tILF ly 4ve CITY 0-nhl4j /4srl STATE ZIP CODE�,�� BUSINESS PHONE: () FAX NUMBER CELL PHONE QUALIFIER'S S�(l ) �I�/3 =��1� QUALIFIER'S NAME: 'moi%o QUALIFIER'S LIC NUMBER: 4f6c is�ay�y E-MAIL ADDRESS (IF APPLICABLE): fa (Jd e %�U;��PJ. L Created on 3119109 BY MLDV I RV 3126109 MLDV ., �Ut_:`' 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 . 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 @0 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: C—f'S'°T, Aida 6, v 4 moi T Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this 81� day of ByJ (SEAL) Tvae of COM 1* mast Contractor Print Name: Signature: State of Florida ) County of Miami -Dade) Sworn to and subscribed beol����►� �► �� day of o`�®'.. •J9 By As"*-) \1 (SEAL) = �\ ro01�d Type of Identification Ddu' , Jan ,i ..• S� ``\,`� ''��►►1111►11►S 0`�� APOLBUI-01 TTOWER CERTIFICATE OF LIABILITY INSURANCE DATE5/116120146/2014 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 policy(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 Chris ImbsARB Charles L. Crane Agency 748 N US Hwy One Tequesta, FL 33489 CONTACT NAME: Tina Tower PHONE 561) 746-4514 F No; (561) 746-6566 E-MAIL DRESS: ttower@craneagency.com INSURER(S) AFFORDING COVERAGE NAIC 9 INSURERA:Ataln Speciality Insurance Co. 17159 INSURED INSURER W:.. INSURER c : Apolo Builders Inc. INSURER.D: 3041 NE 14th AV Oakland Park, FL 33334 INSURER E:. INSURER F: CIP193379 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. IUCYEXP LTR TYPE OF INSURANCE ADOLSUBRr AUTHORIZED REPRESENTATIVE POLICY NUMBER EFF M LIMITS GENERAL LIABILITYEACH 300,000 OCCURRENCE $DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A X COMMERCIAL GENERAL LIABILITY CIP193379 3/612014. 3WO16 CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 300,000 $ X POLICY PRO- JECT LOC AUTOMOBILE LIABILITY EaMeoddd �tSINGLE Lg1AlT $ BODILY INJURY (Per person) $ ANY AUTO ;pjSU;,:: , ;. BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ PER ACCIDENT) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? F (Mandatory in NH) N/A STATU- ETH - E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ If yes describe under DESGcRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, U more apace Is negrdred) MASONRY - RESIDENTIAL ONLY "THE FOLLOWING LICENSE INFORMATION WAS PROVIDED TO US AND REQUESTED SHOWN ON THIS CERTIFICATE BY THE NAMED INSURED ON THE ABOVE MENTIONED INSURANCE POLICY. THE INSURANCE COMPANY, CARRIER, BROKER, AGENCY NOR AGENT WARRANTY ANY INFORMATION ABOUT THIS LICENSE # CGC 1512484 " reortotrrwre I.tni n=o CAMPPI I ATIAM ACORD 25 (2010/05) ©1988-2010 AGGRO GURPURA I IUN. All rlgnis reserves. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MIAMI SHORES, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 AGGRO GURPURA I IUN. All rlgnis reserves. The ACORD name and logo are registered marks of ACORD `AA: #14 i -333 d la LA . .... .. jw-6. ,4ZEW W- S-P AS A -ARF -60Y. 01-22-2013 JEFF ATWATER STATE OF FLORIDA CW9F FINANCIAL OFFICER DEPARTMENT OF FINANCIAL, SERVICES I DIVISION OF WORKEt!i COMPENSATION CERTIFICATE OF ELECTION" TO BE EXEMP"i FROIiA FLORIDA .WORKER$' COMPENSATION LAW'* "iCONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 01/22/2013 PERSON: APOLINARIO I=E1N: 592522898 BUSINESS NAME AND ADDRESS: APOLO BUILDERS INC 3041 NE 14 AVENUE OAKLAND PARK FL 33334 SCOPES OF BUSINESS OR TRADE: T- 110ENSED GENERAL CONTRACTOR T MPURTANT: Pursuant to Chapter -W �05i14X Fs., as aN" ofcorp Ufa hex section may not recover benefits or compensation ander this Chapter. Pursuant to Chapter 440.05(12).• 6.S,, scope of the business or trade tinted an the notice of election to be exempt. Porsoeat to ,Chapter 44Q.6-5 election to be exempt shall be subject to revocation It, at .any time after the- .111114. of the notice at the certificate no longer meets the requirements of this section for issuance of a certificate. The department named on the certificate to meet the requirements of this sectloa.. )WC -252 CERTIFICATE OF ELECTION TO BE, EXEMPT REVISED 01-11 =.I ay. fttlgg iirt er ioaEe of -fo dton ander this election :to 10:exempt... apply only within the $, fiotfces of election to be exempt and Certificates of Co of fbeeortllfkft1116 parson named on the notice or revoke a certificate at any time for failure of the person QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FU!TUR,E REFERENCE DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY Aft CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS* COMPENSATION LAW EFFECTIVE: 01/22/2013 EXPIRATION DATE: 01/22/2015 PERSON: BURT E APOLINARIO FEIN: 592522898 BUSINESS NAME AND ADDRESS: APOLO BUILDERS INC 3041 NE 14 AVENUE OAKLAND PARK, FL 33334 'SCOPE OF BUSINESS OR TRADE: 1- LICENSED GENERAL CONTRACTOR IMPORTANT F 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 L under this section may not recover benefits or compensation under this D chapter. H Pursuanuto Chapter 440.05112), F.S., Certificates of election to be exempt._ apply only within the scope of the business or trade listed on R,�ii Amo1i�4f4,;i4 :lip . E Pursuant to• Chapter 440.0511.31;; F.S., Notices of election to be exempt and certificaattes of electiowlo-'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. N -C-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 1 to ' BROWARD COUNTY LOCAL BUSINESS TAX; RECEIPT 115 S..Andrews Ave.,.Rm. A-100, Ft. Lauderdale, FL 33301-1895,— 954-831-4000 :DSPTEIERVALID OCTOB-R -1,2 I 30, 2014 DBA: Re##'GENERAL CONTRACTOR (CERTI Business Name: 180-5909 APOLO BUILDERS INC Business T Yie:GENERAL CONTRACTOR) Owner Name: BURT E APOLIMM110/QUAL Business ORe0ad- Q/01/1.994 Business Location: 3041 NE 14 .AV} rCaCi!5.L2484 OAKLAND PAS. Ez tl' ode: Business Phone: x e Professionals Rooms a , saw�as`ki�Al3xNn y v = �'� S p^ k " � Number of Machines: +�� � ve tiini Tylia: Tax Amount Transfer F AN Collection Cost T Paid i 27.00 0.0 k x"WbbT 0.00 27.00 I THIS RECEIPT MUST BE:PQSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tak is Levied for the ,privilege of doing business within Broward County and is non -regulatory In naturs. You rust meet all Courdy-and/or Municipality planning t and zoning requirements. This Business Tax- Receipt must be transferred when WHEN VALIDATED the business is sold, business . name has changed or you have moved the business location. This receipt dies not indicate that the business is legal or that f #'is In, complian e;Wlit► Stata or local Iii td uiatio�ts: Mailing Address: APOLO BUILDERS INC Regeipt #04A-12-00014832 3041 NE 14 AVE Paid 09/25/2013 27.00 OAKLAND PARK, FL 33334:' 2013 .2014