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EL-13-2111un5� Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical FBC 20 SEP 17 2013 Permit No4_/ l3 _ 2111, Master Permit No. )-S Z JOB ADDRESS: 1301 JiF_ 103 . ,T City: Miami Shores County: Miami Dade zip: S3)39 Folio/Parcel#: Is the Building Historically Designated: Yes NO is Flood Zone: yn OWNER: Name (Fee Simple Titleholder): 8=11SO 17t n@tZ u HA AM 1+64 Phone#: JOS-137XI" 316 Address: 1'501 PIE JOS SfiYL City: MIM )tbDgz State: t( Zip: 3313S Tenant/Lessee NamePhone#: Email: (IjVU? P t-jtTrn(flL CDfn CONTRACTOR: Company Name: Q) f; Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Certificate of Competency #: Phone#: Value of Work for this Permit: $ FFU( A Square/Linear Footage of Work: (el Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: LL� 166aW12 =LIRIZ IMTW Tr=961 Submittal Fee $ Permit Fee $ / -5_0 -' ZP P CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ 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 C Application is hereby made fo 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 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 ✓/G'/ // Signature Owner or Agent Contractor The fo of inst umfnt was aVknowledged efore t is The foregoing instrument was acknowledged before me this day of( 0 I3 by day of , 20 _, by , who ii sonall3 (c� n to me or who has produced ho is personally known to me or who has produced / S\0 jb As identification and who did take an 04040 as identification and who did take an oath. NOT IV PUBLIC: ) \o --as Ida 1 P�)17i 1 date, o 2 f '\ I J015 ' Gt;v geP 3, �,' cx4ilPs ag�0 Sign: —11J tt� tt 12 PISS X„ ;tl mm' Print: NOTARY PUBLIC: Sign: Print: My Commission Expires: My Commission Expires: APPROVED BY ' % ,*??Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk Miami Shores Village BuildingDepartment 10050 N.E.2nd. Avenue Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: �� 1 % DATE: -(0116113 ADDRESS: Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor, I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercialbuilding at a cost of $25;000.00 or less (The new form states 75,000): The building -must be for your own use and occupancy. It may not be built for sale or lease. -If you sell or lease a building you' have built yourself within'ont year atter the construction is calm` plete the law will presume that°you built for -sale or lease, which is'a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with -holdings tax and provide workers' compensation for that employee, all as`prescrbed by law. Your construction must comply with all applicable laws,' ordinances, buildings codes and zoning regulations. Please read and Initial each paragraph. 1. 1 understand that state law requires construction to be done by a licensed contractor and have,appiied for an owner -builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initia C. 2. 1 understand that building permits are not required to be signed by a property owner unless he or she Is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit.1 understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed In his, or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial_ 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building the costs do not exceed $75,000. The building or residence must ti for my use or occupancy. If may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exemption. Initial 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial li A , 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by taw and by county or municipal ordinance. Initial �, 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain anowner-builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner-builderr may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employesWhile working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work.beirg done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiringthe withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. i understand that my failure to follow these may subject to serious financial risk. A- InitiaL U, 11 I agreethat, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner -builders as well as employers. l also understand that the Construction must comply with all applicable laws, ordinances, building codes, , and zoning regulations. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htto:/Mww.mvfloddelicense.comldborinro%ilbrindex.html Initial 4. 11. I am aware of, and consent to; an owner -builder building permit applied for in my name and understands that I am the party legally and financially. responsible for the proposed construction activity at the following address: Inihai , e 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial (, Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. it also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this day of k"111—,2013 - V Produced there License or x 4J - - OWNER who was personally known to me or who has CLAUDIA V. CUBILLOS Notary Public - State of Florida My Comm Expires Sep 23, 2015 Commission # EE 128810 Bonded Through National Notary Assn. t« -N, r •+ rn '25.00' 0 25.00" i cto C*J,Ch -. Ctl� r 'V 28,75' 0 PJ 0 ILL V 0 I 4.50' 1 V . Miarni Shores Village �Q -.PPROVE_BY - DATE V► `D-74"�4 -I I � 71 �; `� -N, V 0 I 4.50' 1 V . Miarni Shores Village �Q -.PPROVE_BY - DATE V► `D-74"�4 -I I � 71 �; `� INSTALLATION OF UNDERGROUND LIGHTS F DRIVEWAY LOCATED AT 1301 NE 103RD. ST Cable depth The soil type is sandy and easy to dig feeder) cable can be used. For that reason a direct -bury OF -B (underground Tools & Materials 1- Southwire 250 ft. 14-2 OF -B W/G Cable Used in applications that include outside lamp posts,pumps and other loads. OF -B has a heat capacity of 90* C and is rated at 600 volts. UL Listed and • Used indoors for wet or corrosive locations • Used outdoors for direct burial • Resistant to sunlight, moisture and fungus Grry • MFG Part # : 13054255 �'r ► Cwt?<._f!�'�.� G�Jf�i�l:�- ��'t?�:.,. ��a�J � - A total of 20 (twenty) 3W LED Warm White In -ground lights will us fo this project. -10 of them will be connected to electrical timer box "A" located at the left side of the house and 10 will be connected to electrical timer box "B" located at the right side of the house. - To prevent any damage to the wire that will run from the driveway cables to the electrical timer boxes a PVC tube will be used on that part of the installation. Specifications: Shell Material: Stainless steel & Die-casting Aluminum Input Voltage: AC 110-240V Power Consumption: 3 x 1W Protection grade: IP65 Light Color: Warm White Size: 90 x 113 MM (H*D) Hole Size: 138 MM Approved: CE & SAA & RoHS Waterproof and dust proof Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-199350 Scheduled Inspection Date: November 19, 2013 Inspector: Devaney, Michael Owner: ALFONSO DE ANDA & LINA M AMSHTA, Al C1'1A1CA nC Aklr%A 2_ 1 IMA 11A ARROUTA Job Address: 1301 NE 103 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: HOME OWNER tsuuaing Department comments INSTALL LED IN GROUND SPOTLIGHTS FOR THE DRIVEWAY Permit Number: EL -9-13-2111 Permit Type: Electrical - Residential Inspection Type: Final Work Classification. New Phone Number (305)987-8588 Parcel Number 1132050300100 INSPECTOR COMMENTS False Inspector Comments Passed 21 Failed���—�9j/ Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 18, 2013 For Inspections please call: (305)762-4949 Page 10 of 31 Miami shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: 9tADING JOB ADDRESS: 71P-FCETVEff6 2013 �"— -- B 1 C 2010 Permit No.( �- g�- 2 �" Master Permit No. ROOFING City: Miami Shores County: Miami Dade Zip: --33139 Folio/Parcelk Is the Building Historically Designated: Yes NO is Flood Zone: 16 OWNER: Name (Fee Simple Titleholder):f-01110 X 0A- L1HAAMRTA Phone#: 36=90- I %3f(zj Address: 1301 HC. 103 ST YY1M) f11& City: State: TL_ Zip: 'N39 Tenant/Lessee Name: Phonek ^---- Email: Q AfluTA-oyn CONTRACTOR::_ Company Name: �_@ Srb? lC%V (oJ 6 L IJ C Phone#: 79(o 'Zoll 13 5q Address: wC4 3 N V-, 3 City: 'p t GC k State: —ft— Zip: 3'3 (� Z Qualifier Name: Q c7 % Q c -o S Phonek State Certification or Registration #: C Certificate of Competency #: -IF-7231 SO 0 Contact Phone# 2a(9 2-010( L35 --L_Email Address: l O S v� r c.i a to 0 _ Coe" DESIGNER: Architect/Engineer: Phonek 1 Value of Work for this Permit: $J , 0 D 0 . G D Square/Linear Footage of Work: e 400 s'v-- Type of Work: ❑Addition t ❑Alteration New ❑Repair/Replace ❑Demolition Description of Work: 10l _ t ✓N Cg ✓Z VAC &t Pta c n C6 c - 'q C� h f owc . Color thru tile: Submittal Fee $ n Permit Fee $ CCF $ -60 CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ �? 40 0_Bond $ Notary $ rJ • n� Training/Education Fee $ -F 20 � 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 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 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 Au &AA Signature Owner or Agent Contractor The fore of g instrument as acknowledged be re me this The fo oin instrument was ckn ledg or me this day of 20 �by Yr aky of 20 by who is p onally known to me or who has produced w o is p rs Hall known to me or who has produced As identification and who did take an oath. s�dentification and who did take an oath. NOTAR PUBLIC: N TARY PUBLIC%- . -U)v Sign: ,��5 a Sign:dmf - nda Print: Lp°)L>.51a�3,2�d5 Print: purmc_ScaS��?S.20� S M Commis n Ex itfe1288 s� C,.nsn x. , * E Assn• Y P �, r °ir,n goo # EG Notary PS My Commissi miss,00 ` . �a1 No<a�y APPROVED BY Plans Examiner /G Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) 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. "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 Au &AA Signature Owner or Agent Contractor The fore of g instrument as acknowledged be re me this The fo oin instrument was ckn ledg or me this day of 20 �by Yr aky of 20 by who is p onally known to me or who has produced w o is p rs Hall known to me or who has produced As identification and who did take an oath. s�dentification and who did take an oath. NOTAR PUBLIC: N TARY PUBLIC%- . -U)v Sign: ,��5 a Sign:dmf - nda Print: Lp°)L>.51a�3,2�d5 Print: purmc_ScaS��?S.20� S M Commis n Ex itfe1288 s� C,.nsn x. , * E Assn• Y P �, r °ir,n goo # EG Notary PS My Commissi miss,00 ` . �a1 No<a�y APPROVED BY Plans Examiner /G Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) r � ' Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY Whereas, (owner) L, l N A p" As W FQ hereinafter referred to as the owner of the following described property (address): I3 ©I 10 3 5� 14ta7ry7; S�dfrs Legal Description Lot Folio # 11 3% 6-10.3 ja /o 0 Requests permission to install (describe work): Block Subdivision 0 C ri Within the public right of way of (address) A) e _/03 S t dw IN CONSIDERATION of the approval of this permit by the Village, the owner agrees as follows: 1 To maintain and repair, when necessary, the above-mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or Dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way 3. The Owner does hereby agree to remove or relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligations has been canceled by an affidavit filed in the Public Records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEDGE on this day of 45�/- , 201 3 If "A(h (Owner's Signature ) �PU� gra eQIts, 10 c�YP�b� xp`�es �ti12�a psso G `ra nR o� \ `syjr5r1'Ffs' 2 of: 09/16/2013 M N 14:10 FAX 305 441 6443 FIRST CLASS INSURANCE MA 2001/001 96'' CERTIFICATE OF LIABILITY INSURANCE DATE (MMtDDlYYYf) 1 THIS CERTIFICAAT 1S ISSUED ASA 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 CE tTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTAT OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the c rtiftcate holder is an ADDITIONAL INSURED, the pollcy((es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltl a of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the coMflcate holder in 11 u of such endorsement(s). PRODUCER — " CONTACT_.. -_-- First Class Insurance Market NAME: PHONE o ExtY (305)441-29q7 1 �„'° No). (305)441-6443 ' 4101 NW 8th Street M It. fcitncoaol c�ttt ----. Miami, F! 33126 - -- ------ Phone (305)441-2i 97 Fax (305)441-6443 _ INSURER(S) AFFORDING COVERAGE NAIC W INSURER A : ATLANTIC CASUALTY INS COMPANY AUTOMOBILE LIABIL INSURED - -- IN-RER B 19�1 MBW D SINGLE LIMIT ONE STOP PAVING AVING INC ANY AUTO ❑ AUTOS ❑_ AUTOS ❑ HIRED AUTOS U AUTOS�� C ED_ INst RERC: 1463 NE 173 STREET INSURER D: BODILY INJURY (Per acaidelft w$ M MIAMI, FL 33162 INSURER E: ❑ UMBRELLA UA ❑ OCCUR ❑ EXCESS LIAR • El CLAIMS -MADE. INSURER P: - _ - �— THIS IS TO CERTIFY HAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIT STANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CC NDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L R TYPE OF NSURANCE y ADD I SUBR _ POLICY NUMBER MMPOfD Y EFF wt EXP 07/17/2014 LIMITS A GENERAL LIABILITY n% COMMERCIAL GI WERAL LIABILITY ❑ ❑ cLAIMs- E © OCCUR ❑ ❑ GENL AGGREGATE L MIT APPLIES PEP.PRODUCTS El POLICY 1:1 P - 11 LOC L0390032338 07/17/2013 EACH OCCURRENCE 1,000,000.00 DAMAGE TO RENTED REMISES (Es gmmmW $ 100,000.00 MED EXP one parson $ 5,000.00 PERSONAL & ADV INJURY $ 100, 000.00 GENERAL AGGREGATE $ 2,000,000.00 _ -COMP/OPAGG $ 2,000,000.00 _ $ AUTOMOBILE LIABIL MBW D SINGLE LIMIT ANY AUTO ❑ AUTOS ❑_ AUTOS ❑ HIRED AUTOS U AUTOS�� C ED_ BODILY INJURY (Per person)ALL $ BODILY INJURY (Per acaidelft w$ M P OPER AMAGE $ ❑ UMBRELLA UA ❑ OCCUR ❑ EXCESS LIAR • El CLAIMS -MADE. _ - �— - EACH OCCURRENCE $ _ AGGREGATE $ — WORKERS COMPEM AND EMPLOYERS' LUBILITY ANY PROPRIETOR/P OFFICERMIEMBER (Mandatary in NH) Vyyeess describe under DESRIPTION OF OPE ATION YIN CUTIVE CL 29 ❑ RATIONS below N / A ❑ V1lC STATU- ❑ OTH- IMITS" — E.L EACH ACCIDENT $ - — E.L. DISEASE - EA EMPLOYE •$ E.L. DISEASE - POLICY LIMITI $ I I - - -T --- . NS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space to required) - DESCRIPTION OF OPERATit CERTIFICATE HOLD - - CANCELLATION «~ — MIAMI S 10050 NE ORES VILLAGE BUILDING DEPARTMENT 2 AVE BOVE DESCRIBED POLICIES BE SHOULD [RATION ON ATOF THEE THEREOF, NOTICE WILL E DELIVERED IN CANCELLED BEFORE A O E WITH THE POLICY PROVISIONS. MIAMI Sh 30575688 ORES. FL 33138 2 __ . __._.. _...------._--__-.•- v AU O D REPR ENTATIVE ACORD _1 v -inaa-ZUT U At UKU cvRPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PERMIT # CONTRACTOR: \4 I Luk- ctpr SUBMITTAL DATE: 3 -�?-o I ADDRE��- o - NAME:L- RESUBMITAL DATES: PROJECT TYPE: ' I 1t' 6 FIRE STRUCTURAL IMPACT FEES ELECTRICAL HRSIDERM PLUMBING NOC MECHANICAL Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 5092135 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ONE STOP PAVING INC RENEWAL SEPTEMBER 30 1463 NE 173 ST 539886 y 2014 " NORTH MIAMI BEACH, FL 33162 Must be displayed at place of business Pursuant to County Code Chapter 9A — Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED ONE STOP PAVING INC 196 SPECIALTY ENGINEERING BY TAX COLLECTOR CONTRACT 45.00 08/22/2013 Worker(s) 1 E231500 022413-000861 This Local Business Tax Receipt only confirms payment of the Local Business Tau. The Receipt is not a license. permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles — Miami—Dade Coda Sec 882n. MwMFaADE MMFor more information, visit www miamidade gayffaxcollector Municipal Contractor's Tax Receipt Miami Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY CC NO: E231500 BUSINESS NAME/LOCATION ONE STOP PAVING INC 1463 NE 173 ST NORTH MIAMI BEACH, FL 33162 OWNER ONE STOP PAVING INC MC RECEIPT NO. EXPIRES E SINE" SEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Chapter BA — Art. 9 & 10 TYPE OF BUSINESS SPECIALTY ENGINEERING CONTRACTOR For more information, visit www_miamidede gmA collentar PAYMENT RECEIVED BY TAX COLLECTOR 225.00 08/22/2013 0224-13-000861 $TA;TE'OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET .� TALLAHASSEE FL 32399-0783 ACOSTA, CARLOS M ONE STOP PAVING INC 1463 NE 173 ST NORTH MIAMI BEACH FL 3162 ' 8 Congratulations! With this license you become one of the nearly one million STATE OF F:owoa AUS Z- 24 3 5:9 DgPgg . OF ,BIISII�SB 3 Floridians licensed by the Department of Business and Professional Regulation. PROFE3SI011iAL ;RTsGIILATION. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. CGC157.3719 07/26 f Z2 128018437 Every day we work to improve the way we do business in order to serve you better.; For information about our services, please log onto www.myfloridalicense.com. CERTIFIED GENSRi',L CONTRACTOR There you can find more information about our divisions and the regulations that ACOSTA CARLOS M Impact you, subscribe to department newsletters and loam more about the OIJB STCSP. �PA'ti'11�G �C Department's initiatives. Our mission at the Department Is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! : I$ CBRTIFI1 ma8er the grovisi.ame of ca 489 8s: *W#a" date$ A1UG :31-,.. 20.1.4 I L -12672601D90 DETACH HERE .• LICBNSN NBR 07/26/20121128018437 CGC1$13719 The GENERAL CONTRACTOR Named below IS CERTIFIED." Under the provisions of Chapter. 489 ---FS. Expiration date: AUG 31, 2 01 ACOSTA, CARLOS..M. ONE STOP PAVING INC 1463 NE 173RD ST NORTH MIAMI BEACH RICK SCOTT GOVERNOR FL 33162-1350 KEN LAWSON SECRETARY DISPLAY AS REQUIRED BY LAW I ;vp JEFF ATWATE:R STATE OF FLORIDA CHEF FINAMCfAI.CFwt3ER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION 12-26-2012 * * 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: 03/03/2013 PERSON: ACOSTA FEIN: 020688821 BUSINESS NAME AND ADDRESS: ONE STOP PAVING INC 1483 NE 173 ST NORTH MIAMI BEACH FL 33182 SCOPES OF BUSINESS OR TRADE: 1— STREET OR ROAD CONSTRUCTION: P 3— LICENSED GENERAL CONTRACTOR EXPIRATION DATE 03/03/2015 CARLOS M 2— CONCRETE OR CEMENT WORK — FLOO IMPORTANT: Pursuant to Chapter 440 . 06114), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ender 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 440.06113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at ,say 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 say time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 ft-tt- W. 08-20-2012 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: 08/20/2012 PERSON: ALVAREZ FEIN: 203013508 BUSINESS NAME AND ADDRESS: VILLA CLARA CONCRETE FINISH INC 6841 SW 129 AVE APT 8 MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: 1- CONCRETE OR CEMENT WORK EXPIRATION DATE: 08/20/2014 --" JULIO IMPORTANT. Pursuant to Chapter 440 . 05(141 F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ander tbis section may not recover benefits or compensation Umder this chapter. Pursuant to Chapter 440.05(12), 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 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at say time after the filing of the notice or the issuance of the certificate, the person named an the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shell revoke a certificate at say time for failure of the person named on the certificate to most the requirements of this section. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 kunoo eMilEMIN JO 0610084010s�tggAad a4iopun pM= sl Z3HVA"IV 01-Ine samvs 00�➢1 t-0�1�01�13IM31403 VWV-13 THA 69LOOS1390 11.3dW03 :10 31VOI-ALL833 SS3NIsne CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE IMLL BE DELIVERED IN 10450 NE 2nd Ave ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENT ACORD 25 (2010/08) QF C 1NO-2010 ACORD CORPORATION. All nights reserved. The ACORD name and logo are registered marks of ACORD _ _�..,.,. .. ... .: k, ,.... .. ..:..,: ,..... .h.,--, ....... .. .�... 0.50' N00008106"w ' 122°22'( R&M — 4CA °V 11 �.a' ��: 28.75' m cn_ N ® -� >s 20.80' X IM n ::t:: :25.01W:. m :s::_® 42. PERS` Mi APPRO D A ZONING DEPT I 72.80' z M s® �zo M M. 7.50' rn� BLDG OF -PT i � ALL FEDERAL DEC 0 3 01� � SUBJECT ior_.c,n,I, . rlcEwir-I ___A CBS�CONCREiEBLOCKSTRUCTURE.CLF MAIN (NKFENCEPL=PROPE ��J ArJrJ �E�lII�'iIOII` - RT Y LINE, DUE=DRAINAGE UTILITY EASEM ENT, IP=IRONPIF E• F=FOUND. AIC -AIR CONDITIONER PAD, PIC -PROPERTY CORNER. 044-DRUAM HOLE, WF=MODEN FENCE, RES=RESIDENCE, cL-CLEAR, RB=REBAR, UE-u'nLITY EASEMENT. CONIC=CON�,Nr, VdA =DRAINAGE EASEMENT CIL-CENTER LINE, O=DIAMTER, TYP=TYPICiJ- M=MEASURED. R=RECORDED. ENC E C '2P R• ASH NfD=NAIL 8 DISC. S=SET. FEE -FINISH FLOOR ELEVATION, VALID UNLESS EMBOSSED WITH O/S=OFFSET PIP=POV�RPOLE, O ERH METER SURVEVOR'S SEAL w0ODFENCEaAL o SED: TION BASED ON LOC. # 3250 S. B-62 ELV: 8.74 t 'TYPE OF SURVEY: BOUNDAR-f SURVEY ,SURVEYOR'S NOTES: 1) 5U CQ NION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF AFL I A ! E S Y/ AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFES S1 1L ! 4) LEGAL DESCRIPTION PROVIDED BY CLIENT 5) UNDERGROUND ENC ROA E „ OCAT 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM OF 182. IP OF NCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN ON THIS SUR YT HA Y BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. .91) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IFANY, AFFECTING THIS PROPERTY. BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB (,A PAGE I"? N.E. 13th AVENUE z SAM, ♦L♦♦♦� j w I ir_�rr BLDG OF -PT i � ALL FEDERAL DEC 0 3 01� � SUBJECT ior_.c,n,I, . rlcEwir-I ___A CBS�CONCREiEBLOCKSTRUCTURE.CLF MAIN (NKFENCEPL=PROPE ��J ArJrJ �E�lII�'iIOII` - RT Y LINE, DUE=DRAINAGE UTILITY EASEM ENT, IP=IRONPIF E• F=FOUND. AIC -AIR CONDITIONER PAD, PIC -PROPERTY CORNER. 044-DRUAM HOLE, WF=MODEN FENCE, RES=RESIDENCE, cL-CLEAR, RB=REBAR, UE-u'nLITY EASEMENT. CONIC=CON�,Nr, VdA =DRAINAGE EASEMENT CIL-CENTER LINE, O=DIAMTER, TYP=TYPICiJ- M=MEASURED. R=RECORDED. ENC E C '2P R• ASH NfD=NAIL 8 DISC. S=SET. FEE -FINISH FLOOR ELEVATION, VALID UNLESS EMBOSSED WITH O/S=OFFSET PIP=POV�RPOLE, O ERH METER SURVEVOR'S SEAL w0ODFENCEaAL o SED: TION BASED ON LOC. # 3250 S. B-62 ELV: 8.74 t 'TYPE OF SURVEY: BOUNDAR-f SURVEY ,SURVEYOR'S NOTES: 1) 5U CQ NION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE AND RAISED SEAL OF AFL I A ! E S Y/ AND MAPPER. 3) THE SURVEY DEPICTED HERE IS NOT COVERED BY PROFES S1 1L ! 4) LEGAL DESCRIPTION PROVIDED BY CLIENT 5) UNDERGROUND ENC ROA E „ OCAT 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM OF 182. IP OF NCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL RESTRICTIONS NOT SHOWN ON THIS SUR YT HA Y BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. .91) CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING INFORMATION. 10) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IFANY, AFFECTING THIS PROPERTY. BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUE OF SAID PB (,A PAGE I"? N.E. 13th AVENUE z w CERTIFIED T0: ALFONSO DE ANDA, 1301 N.E. 103RD ST., MIAMI SHORES, FL. 33138., PAUL Jo SARDON, P.A., FIRST AMERICAN TITLE INSURANCE COMPANY, REGIONS BANK, ITS SUCCESSORS AND/OR ASSIGNS, ATIMA. LEGAL DESCRIPTION: LOT I BLOCK 6 OF REPLAT OF TRACT "B", MIAMI SHORES BAY PARR ESTATES SUBDIVISION ACCORDING TO -THE PLAT THEREOF AS RECORDED IN PLAT BOOK b3 AT PAGE 17 OF THE PUBLIC. RECORDS_ MIAMI DADE COUNTY, FLORIDA I HEREBY CERTIFY That the survey represented thereon meets the minimum technical requirements adopted by the STATE OF FLORIDA Board of Land Surveyors pursuant to Section 472.027 Florida Statutes. There are no encroachments, overlaps, easements appearing on the plat or visible easements other than as shown hereon. ADIS•N. NUNEZ REGISTERED LAND SURVEYOR STATE OF FLORIDA #5924 BLANGO SURVEYORS ING. Engineers . Land Surveyors • Planners . LB # 0007059 555 NORTH SHORE DRIVE MIAMI BEACH, FL 33141 . (306) 865-1200 Email: blah' cosurveyorslncoyahoo.com Fax: (305) 865-7 0306 4/18/11 h-= 120652 11-342 04 r F.I.P. 1f2' q (NC; 10.) c aai /r PLATUMTS OC E `r .� • •-;'�•; gid' '.. • W a '� ice, I�wq�e�, y p•� f 3.5 �.� POOL PUMP im ®sr ~ ®� ® Z _I � r 3- ON PL .. E `r .� • •-;'�•; gid' '.. • W a '� ice, I�wq�e�, y p•� alsj 1,9- S�-6s BUILDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 PERMIT APPLICATION Permit Type: BUILDING FBC 20 Permit No. C)s 1,;4 -- Master Permit No. ROOFING JOB ADDRESS: 1301 HE 103 Sly City: Miami Shores County: Miami Dade Zip: s 3131,,' Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): `{Sb 91 PirI-A 1U M AMSUIA _rhonea: 3U UVE— 16 5 �� Address: � .DI fll~. 10,S fl City: Miami 1=95 State: f( Zip: 13� Tenant/Lessee Name: Phone#: Email: Ll fl A M ft& r (611 CONTRACTOR: Company Name: Vlha. WrA d (rZT -i i N I Phone#: 36�—R Q `%E S:D Address: C `i1SSW _ j 21 `) *VL City: ry� I (AM 0 State: TL Zip: 331 Qualifier Name: .Sft% OULIQ 6t V6CLf_L Phone#: 3K_ 36+ So State Certification or Registration #: Certificate of Competency #: K- B S QQ 20 Contact Phone#: _ 3K 30+8 ®, � Email Address: DESIGNER: Architect/Engineer. Phone#: Value of Work for this Permit: $ 5.111D Square/Linear Footage of Work: Z. 1W S,1+T Type of Work: OAddition OAlteration ONew ®Repair/Replace ODemolition Description of Work: uA= A5MALT 1T MC ff W9 VDM � 0 611 Q Color thru tyle: Submittal Fee $15 Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ 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. "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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature__A ON& Signature Owner or Agent 'V`ct Contractor The foregoing instrument was acknowledged before me this 4J �l day of , 20� by ,�--M %A- ,, who is personally known tome or who has produced 'Pu ID As identification and who did take an oath. P< NOTARY Sign: Print: My Commission Expires: APPROVED BY The foregoing instrument was acknowledged before me this -3 day of UZ Q— , 20 Q by�LU 0 ��17 Q who is personally known to me or who has produced as identification and who did take an oath. e,0toes®Pi1g11i�f /����,r. ZZI y RIri k�,Ytk4e9toF�ItsF,Y7ka27k&d:&�Y9t�4: k9e8t9t4:Ft:FaY Plans Examiner Structural Review NOTARY PUBLIC: Sign: ✓ •• ,. Print: eel My Commission Expires: FF�®!/ (Revised 5J20 8ev-' P12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) a- 7�-Xw Off, Clerk t,ltyP� itT It LrM30 r"M�; 1��� 1 N c 7 o g i Uvt AMA-)S/uPLOn, wmvn tr wv (D'ViLf") WE XYZ `Tt+6-d i<S �bYL ��DuIZ l-�—ll° i �� 1�fi1C Ya3t? l��p �C.J ►�-�c� �'�—. j�s� `� �S )o, // 0 ef /�p I `�'� ' CERTIFICATE OF LIABILITY INSURANCE 11I30/'i2 THS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS No RIMS UpON THE CERTWICATE kms. Yr�S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMiENI:k EXTEND OR ALTER THE COVERAGE AFFOMW BY THE PI CIES BELOW. YIBS CERTMATE OF fNSLqWlCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TME IS$UWG )r REFR£SENTATIVE OR PROMICK AND THE CERTIFICATE HOLDER. WPORTANr: It the coWlicate holder Is an ADDITIONAL RMMED, ft PolicXt S) must be endoived. U SURROGATON IS wavED, v+b1d to j the terms and eondtlobs of the pobcy, certain policies VISYwire are A statement on this eertliic does not"Idw rights to thef cert a holder in Hsu of such mWoasernentls} FROVUCER CONTACT GRETELL GONZALE'Z USA mal Insurance Cw#USA istsUranoe Agency Co PHONE(3p) „ Extl-Nok 5841 S.W. 137th Ave. raven -- Milami, FL 331$3 MMfljR S COVERA S NAILg Phone 386,;3M Fax {305) 388' MrNSURER A : FATE NATIONAL INSURANCE CG ANY INStRED I INSURER B.' Vile Clara Concrete Inc INSURER C: f 6644 SW 429 Ave Apt 8 INSURER D Miami, FL 33183 € 8048059 ; INSURER E INSURER F, ti,vvz;r%#vw iw %or-wII R+A'tC tIllyl m: REVVIR3AtARMARER! i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUEO TO THE INSUREDNAMED ASM F4iR THE POLICY PERIOD I INDICATED. moTWITHSTANDING ANY IEOIPRBIENT, TERM OR CONDIT04OF ANY =4TRACT OR OTHER D00AMENT WITH RESPECT TO W" THIS CER'I'W=TE M KY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLMS DESCRIED Hsi IS SUBJECT TOALL THE TERMS, EMMONS AND CONDITIONS OF SUCH POLICIES, LATS SHOW14 M AY HA E, BEEN REDUCED BY PAID TYPE OF INSURANCE POLICY NUNISM, 4ANSM M GIfAfl& A + OMER" UMU71 � :k coMMERCIAL GENsm t.1ABILtrY C -AIMS-MAIX W OCCUR I 167 ! N{ ' ! N 1 wEAG1i j+j i i 1 i � 10f08l2092 4 h ; ( 110103=3 CKd IJ E $ 1#� OQO,i� (� tat s umBmcril r s 1M.40O m0 . . MED 84P� (Any � 6, .00 _ PERSONAL S ADV tAidilRY j $ IIDD=.00 GENERAL AGGREGATE $ j GEIWL AQGREGATE LIMIT APPLIES PER: Ii] t W POLICY Loc, ..1dIR9,OG@.00 s 4 AWOMOBILE LIABILITY AW AUTO NED SCHEDULED A FOS Y HIRED AUTOS AUTOS E j f � j t j � StfVC;LE i thdlT } LY INJURY (Par person) $ 3 S=Y fN3kM IFet $ #. S $ } U6ABRELIALIAB f7OCCURt [3 EXCESS LIAR J CLAfMS-MADE i ' E EACH OCCURRENCE $ I AGGREGATE S ow 11 Rh"iEN11G# k ffi i WORKERSOOMPENSATM AND tiMOYERS'L1A$4M Yfu! AW PROPRIETORIAA RfID(ECUTWE EXOLUAF.D? under L _ _�I RErPTION OF OPERATIONS tretory {N f A j I vNC STATtf C1TH, SRM Lt6AiTS EL EACH AO=SNT $ EL DISEASE -EA EMKOYE S ._ E.L -POI ICY LIMIT TM OF OPERATMS I LGCATIONSf VEN#CLES ~AWWIOI,AWMMReamrksSchedu*IfMWeSVMISMqUW40M T� I I I Miami Shares Vile 10050 NE 2nd Ave Miami Shares, FL 33138 Q 1111118-20" AC(= CORPORATION. AA rfghts resevveCL ACRD 25 (24101") QF The ACORCI narna and kgo, are ireStstered nmrks *fACORD, i#IlU1 i4 A0k UNTO 8tt1 i.At'WpNE TAX it- WT 2U13 FIRST-CLASS TAlf ion E Mta41 t> 1tiFs Ci1HliV'ltf+ S AT�3{71= i OfI1t3A U.S. POSTAGE #moi �Wl.' t AGt,.l� ' E3tPl tE St T S8� 03,PAID PAlD 1st LbC9Et I USt B =�DIo-t.#41fEib 0 PI.AO6 StRIE S MIAMI, FL MtAiVll, Ri .381FiT 1 G!#II+iTt~Ii#IA.y;l#E7 S Fi 113., PERMIT N0.231 583742-3 THIS IS P40T A BILL - DO NOT PAY RENEWAL SUUIYLI NACLARA CONCRETE FINISH INC CC #REONSOQ769 608631-8 6841 SW 129 AVE g 33183 UNIN DADE COUNTY OWNER VILLA1CLARA CONCRETE FINISH INC $l v4r§!k AtTY BUILDING CONTRACTOR WORKER/S ZONING LMT OR c ervtOF THE couNn OR Es: NOR DO NOT FORWARD GOES 3T EXEMPT TME' MOLOER FROM ANY OTHER REOUIR o3a UCEN.THIS IE BY LAW, THIS i3 NOT or% NOT A CER'S VILLA CLARA CONCRETE FINISH INC THE MOLDER'SpUALIFlCA- QU OF flQN$' JULIO ALVAREZ SANTOS FRES SW 129 AVE 8 PAYMENT RECEIVED 16841 MIAMI FL 33183 MIAMI-0ADE COUNTY TAX COLLECTOR- OLLECTOR: 08/17/201Z 08/�17/g2}0A�1ZT 0'00075.10 I33 }}Srif 3331{�fijVIli �I Fii331i�1j`r SEE OTHER SIDS omor 08-20-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCfaL 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: 08/20/2012 PERSON. ALVAREZ FEIN: 203013506 BUSINESS NAME AND ADDRESS: VILLA CLARA CONCRETE FINISH INC 6841 SW 128 AVE APT 8 MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: 1- CONCRETE OR CEMENT WORK EXPIRATION DATE: 08/20/2014 --' JULIO I se IMPORTANT. Pursuant to Chapter 440 . 05414►, F.S., an officer of a corporation who elects exemption from ibis 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 440.05113), F.S., Notices of election to be exempt Bad certificates at 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 an 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 forfeiture of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1608 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 WJ -POO-Ptl1W 10 0 E 18111e40 #a foto "KW aWiaoun Paidl3m-qI QUALIFYING TRADEIS) I RECEIVED 01/04/2012 14:18 From: 01/05/2012 02:22 #765 P.001/001 CERTIFICATE OF LIABILITY INSURANCE 01/04/12 PRODUCER Accurate THIS CERTIFICATE IS ISSUED AS A MATTER OF JiF6i6lAij614 8300 West Flagler Suite 114 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33144 _.,j4AL-X 11EI;kAG EDSY��EMLJC�l �SRE AMg9j.— _kAffl(llft� - - ILOWL__ Phone (305)226-8727 FaX (305)226-8767 INSURERS AFFORDING COVERAGE MAIC # INSURERA: WesteMWorld Insurance Company INSURED Isabela Concrete Finish Inc 6811 SW 129 Ave JN4YRER 1k.__ .......... jtjSURER.C. Apt 4 Miami, F1 33183 _INSPRERD: INSURER E COVERAGES INSURER F: THE 0066FEi OF WSURANCE LISTED HAVE BEEN `1iS`UED-TO THE INs`1U-'R—E&'N--A--M- ED 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 OFSUCH ._._fgqplES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR; ADM' TYPE OF INSURANCE POLICY NUMB .MR. IN ER POLICY EFFFCTfVE POLICY EXPIRATION DAT Y LIMITS GENERAL UABILITY EACH OCCURRENCE 1,000,000 COMMERCIAL GENERAL LIABILITY TY NPP1216873-03 f0_00TI'MY— 12122(11 12122112 4RPMS S Ey o%Vq; 100,000. El 7 CLAW MADE Sd OCCUR 'MED EXP (Any one person) 6,000 A W1 PERSONAL & ADV INJURY 1,0001000- ❑ GENERAL AGGREGATE 11000,000 GENLA AGGREGATE LIMIT APPLIES PEP: G PRODUCTS - COMPIOP AGG 1,000,000i .[3 POLICY OPROJEcT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO ❑ ALLOWNEDAUTOS BODILY INJURY F-1❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ BODILY INJURY NON OWNED AUTOS (Per accident) PROPERTY DAMAGE ------- ._(R!raccident) . GARAGE LIABILITY AUTO ONLY -EA ACCIDENT El ANY AUTO OTHER THAN AQ�; .EA AUTO ONLY: AGO EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE [I OCCUR 0 CLAIMS MADE AGGREGATE ❑ DEDUCTIBLE RETEN71ON WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TO 1J., ❑ OTH ER ANY PROPRIETOR I PARTNER/ EXECUTIVE i E.L. EACH ACCIDENT OFFICER I MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE V yes, descrIbe under SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT OTHER DESCRIPTION OF i Wckm6mii VEHICLES i kx6Luiioks X65E BY &56RsEM61f 1*-S-P—EC--tALPROVISIONS CERTIFICATEHOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED En BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DISPLAY..30- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON IN U , ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REP Lucia Estrella ACORDii(;i601id8)iaF @ACOR D CORPORATION 1888 r a s J 4 11/30/2012 FRI 16:00 FAX r MEN 11.:11:-►y.��s03-09-2012 JEFF ATWATER STATE OF FLORIDA CMEP PINANCIAL OFFICER DEPARTMENT .OF FINANCIAL •SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPEN ATION LAW '* COWTRUCTION INDUSTRY EXEMPTION This cdrtifies that the individual listed below has elected to be exempt from Florida Workers' Comp sation law: EFFECTIVE DATE: 03/09/2012 PERSON: OTANO FEIN: 45396117878 BUSINESS NAME AND ADDRESS: ISABELA CONCRETE FINiBH ZNC $811 SW 120 AVE 04 MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: 1•- CONCRETE WOIOC EXPIRATION DATE: 03/09/2014 GEASSEL 2- FINISHINQ 0 1003 D IMPORTANTe Pursuant to Chapter 400 . 06114), F.S., m officer of a corporation who elects 611001111190 froze this chapter by filing a oerilfloale of election ander taus aactioa may net recover benefits or Compensation under this cbapter. Pursuant to Miller 440.06112), F.S., Certificates of slectlo0 to ed 6)(0111111... apply only wlibla the scope at. the business or trade listed an lite itolle0 0( election 10 be exempt. Pursuant to Chapter 440.06(13), F.S.d Notices of election to be exempt and csnllloat9l of Olasllod 10 be eRCtOpt shaft be subject to revocation 11, at any time eller be filing Of In notice 011 the Issuance 01 (hp certlllcate, the person named on the notlCo Of certificate no longer meals the requirements of this ascllan for lumnace of a certillame. The department snail revoaa 6 eorcillcut et any rima for Mara like .the 11agr named on the ceniticate to meat the requlremools of MIS soctlon. VC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 QUESTIONS? (850) 4131609 11/30/2012 FR2 16-00 FAX X002 12-14-2011 JEFF ATWATER SPATE OF FLORIDA CHIEF FINANCIAL OFFMISK 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: 12/14/2011 PERSON: OTANO FEIN: 453967878 BUSINESS NAME AND ADDRESS: ISA09LA CONCRETE FINISH INC 8811 SW 12e AVE 04 MIAMI FL 33183 SCOPES OF BUSINESS OR TRADE: 1- CGNCRETE WORK EXPIRATION DATE: 12/13/2013 DAVID r IMPORTANT: Poromet to Chapter 440 . 069141, F.S., an officer of a corporation who efeas exemption fah this chapter by filing a carllfleafs of election ander this mutton may not recover benefits or compensation most (file chapter. Pursuant to Chapter 440.061121, F.S.. Certificates of elecllse to be exempl... apply only within the scope of the business sr Grade listed se the notice of election to be exempt. Purs114a( to Chapter 440.05113), F.S., Notice* of election to be exempt and cartiflselas of election ra be exampt shell be subject in revocation if, at any time after Ibv filing of the notice or this issuance of the cerlilfcels, ted person named an the notice or cenflicale no longer meele the requirements of this sectlo4 (or issuance of a cerin -cote. The department shall revoke a cerlffieste at any time for failure of Me Parma named on the cerllflo*6 to meal the requirements al this section. QUESTIONS? 050) 413-160! OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 INSPE,CiION RECORD, INSPECTION REI UESTS: (30$)762-4949 or Log on at https:llbldg.miamishoresvillage.com/cap REQUESTS ARE CCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY. Requestsmustb received by 3 pm for following day inspections. Drivewa s/Sidewal ks/S labs Parcel #:1132050300100 Owner's Nam : EVELYN UAN Owner's Phone: Job Address: 13(11 NF 103 Street Total Square Feet: 2400 Miami Shores„ FL 33138- Total Job Valuation: $ 5,900.00 Bond Numbe. Contractors Miami shores Village Phone 10050 N.E. 2nd Avenue VILLA CLARA Miami Shores, FL 33138-0000 (305)804-8059 Phone: (306)795-2204 Fax: (305)758-8972 0IR INSPECTION REI UESTS: (30$)762-4949 or Log on at https:llbldg.miamishoresvillage.com/cap REQUESTS ARE CCEPTED DURING 8:30AM - 3:30PM FOR THE FOLLOWING BUSINESS DAY. Requestsmustb received by 3 pm for following day inspections. Drivewa s/Sidewal ks/S labs Parcel #:1132050300100 Owner's Nam : EVELYN UAN Owner's Phone: Job Address: 13(11 NF 103 Street Total Square Feet: 2400 Miami Shores„ FL 33138- Total Job Valuation: $ 5,900.00 Bond Numbe. Contractors Phone Primary Contractor VILLA CLARA CONCRETE FINISH (305)804-8059 Yes WORK IS ALLOWED MONDAY THROUGH SATURDAY, 7:30AM - 6:0013M. NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS. BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING INSPECTIONS DONE ON FRIDAY. NO INSPECTI IN WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT�PLICANTS RESPONSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDINGOFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL WARNIIS G TO ! OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTE Ob THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMS MCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. STRUCTURAL INSPECTION ATE INSP Foundation Stemwall Slab Columns 1st Lift Columns 2nd Irft Tie Beam Truss/Rafters Roof Sheathing Bucks Windows/Doors Interior Framing Insulation Ceiling Grid Drywall Firewall Wire Lath Pool Steel Pool Deck Final Pool Final Fence Screen Enclosure Driveway Driveway Base Tin Ca Roof in Progress Mop in Progress Final Roof Shutters Attachment Final Shutters Rails and Guardrails ADA com liance FINAL DOCUMENTS Soil Bearing Cert Soil Treatment Cert Floor Elevation Survey Reinf Unit Mas Cert Insulation Certificate Spot Survey Final Survey Truss Certification STRUCTU COMMENTS BCTION RECORD ZONING INSPECTION 1 DATE I INSP Zoning Final ZONING COMMENTS ELECTRICAL INSPECTION DATE I INSP Tem ora Pole 30 Day Temporary Pool Bonding Pool Deck Bonding Pool Wet Niche Under round Footer Ground Slab Wall Rough Ceiling Rough Rough Tele hone Rough Telephone Final TV Rough TV Final Cable Rough Cable Final Intercom Rough Intercom Final Alarm Rough Alarm Final Fire Alarm Rough Fire Alarm Fina{ Service Work With ELECTRICAL COMMENTS PLUMBING INSPECTION I DATE INSP Rough Water Service 2nd Rough Top Out j Fire Sprinklers Septic Tank Sewer Hook-up Roof Drains Gas LP Tank Well TO Lawn Sprinklers Main Drain Pool Piping Backflow Preventor Interceptor Catch Basins Condensate Drains FINAL HRS Final PLUMBING COMMENTS MECHANICAL INSPECTION DATE INSP Underground Pipe Rough Ventilation Rough Hood Rough Pressure Test Final Hood j Final Ventilation � Final Pool Heater Final Vacuum FINAL MECHANICAL COMMENTS