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RC-13-699�seu,�3 I 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: BUILDING Permit No. Master Permit NO C'1 e3 —(619 ROOFING JOB ADDRESS: 9510 nw 1 st ave City: Miami Shores County: Miami Dade gip: 33150 Folio/Parcel#: 11-3101-024-4260 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): Goldie Baker Phone#: 786-566-1119 9510 NW 1st ave City: Miami State: fl Tenant/Lessee Name: Phone#: Email: 33150 CONTRACTOR: Company Name: Laumar Roofing Systems LLC Phone#: 954-321-8335 Address: 501 sw 21 terrace #1 City: Fort Lauderdale State: FI Zip: 33312 Qualifier Name: Jose E Baez Jr Phone#: 954-321-8335 State Certification or Registration #: CGC1515362 Certificate of Competency #: 180-8252 Contact Phone#: 954-321-8335 Email Address: jbaezjr@laumarroofing.com DESIGNER: Architect/Engineer: Phone#: O® b Value of Work for this Permit: Square/Linear Footage of Work: (:7) Type of Work: ❑Addition ❑Alteration ❑New *epair/Replace ❑Demolition Description of Work: Renovate bathrooms, kitchen remodel(replace cabinets), extsr Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ d� Bonding Company's Name (if applicable) N/A Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A Mortgage Lender's Address City State 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 forst inspection which occurs seven (7) days after the building permit is issued the absence of such posted notice, the inspection will not be approved and a reinspection fee ill be charged. JSignature Signature O or Agent Ltj Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this -TA day of t,5 , 20�, by day of , 20, by l who is personally known to me o has pr uced who is personally known to me or wh as prod c iww- 111 Cm,.. 'L�- As identification and who did take an oath. L,)Qrd &r— as identification and who did take an oath. NOTARY PUBLIC: Sign: <<PS Print: •�� rp�••., My Commission Expires: (U0�// jr/.i'' u lest' Aflas�COMgISSION #fE 146065 9 ' a'EXPIRES; NOV. 14 2015 t.., •nnua•� WMV.A.AR0NNOTARyAom NOTARY PUBLIC: N. , ME , MI/M Print: ���t�Y�A••'•Y'llies.w Arias— My Commission Expires: ION # EE 146065s 'EXPIRES: NOV. 14, 2015 niaua WWWAARONNOTARyxam APPROVED BY Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10nM9)(Revised 3/15/09) OFN.'201302OW4 BOOK 26536 PAGE 3795 DATE:03M912013 09:5213 AM DEED DOC 1,500.00 HARVEY RUMN, CLERK OF COURT, MWOADE CTY TM JNSTRUh9W PREPARED BY AND RETURN TO: JIM "IMAGO INDEPENDENT TME OF FORT LAUDERDALE, INC. 4331 N. FEDERAL HWY., SUITE 101 FT. LALZERDALt FL 33308 Our File NO -1 9I91 -92S1 FaMW Idwillmd0ft (Polio) Number. 11-3101-0244VM Documentoxy Stamps in the amount Of $1,3M00 have been paid herem WAR" DEED THIS WARRAWY DEED, made the Sh day Of Mwd2013 by MISOL LDC, a Nuida IAnW Liability CamPW- whose POU Offlee address Is: 9737 NW 41 Sr 0106, DORAL, FL 33178 herein called the OreatDr, to GIORDANO PROPEM HOLDING, INC, a Fimids, P"t Corporation whose post ofr= address Is. 1225 RATrERAS LANE HOLLYWOOD. 1x1.33019. hmquafter called the Graeam rW&rew used k"M At term *0raJ1t0r' Wd 'Gnmtte' include aft the parties to MU bmnownt and the heim legat F4—MWM and 4WS)w Qfbafivi$" and the —mm -d agstpts 0f_jp_*jkqu) W I T N E S S B T JL- That the Grantor, for and in consideration of the sum ofTEN AM 00,100'5 ($10,00) Dollats and Other valuable c0mideratmM receipt whereof is hereby acknowledged, hereby grats, bargaim sells. WkM remises, releases, conveys and confirms onto the Ofawen all that cefftm land situate to MIAMI -RADE County, Sim of I%rida, viz.: Lot 5 and the North 112 Of Lot 6. Block 5, BONMAR PARK, a subdivision according to the P10 titeive recorded at PW Book 17, Pop 11, of the Public R*coi* of Mlenti-DA& CouW, Fl"Ift Subject to easementa, reshidions and reserve&= at reewd and Was for the year 2013 and thereafter. T*GSTHM with all the t1ma"001% h"Wit2ftmW and Wwftanws thereto belonging or in anywise TO HAVE AND TO HOIA the same in fee simple forever. AND, the C"artor hereby c0vWWft with said Onfitee that the Grantor is lawfidly seized of said lend in fee simple,, that the Grantor has good tight and lawful eniberity to sell and Convey said lend, and hereby warrants the title to said land and Will defend the am against the lawful did" Of 811 PetWfts whomsoever and that said land is fift of all twumbfintm "OW taxes fiftm4-sdxsquem to Dwamber 31,201.2. IN Wrf?WM VMMF, the said Grantor has MW ad sealed these presents the day and year fast above Written. Signed, seated and dtilvand in die pmence Of. r....... RLOS A. Mallow Of MISOL, Liability Company Witness #11hintedvame Ell STATE OF FLORIDA COUNTY OF MIAM-DADS The ibrego'"g kftmnt was acknowledged be= me this Sth day of Match, 2013, by CARLOS A. BALZAN, as Wrof WLimited LLC.. 8 Flo" miled Liability ComPRAY Who is personally known to am or has produced -r% A W 1491111ftAdOn and 0 did 53 did not false an auk SE" A Printed i\�Omey "Nm, My commission expires: Pile Na. &*V6& Electronic Articles of Incorporation For GIORDANO PROPERTY HOLDING, INC. P13000001809 FILED January 07, 2013 Sec. Of State vherring The undersigned incorporator, for the purpose of forming a Florida profit corporation, hereby adopts the following Articles of Incorporation: Article I The name of the corporation is: GIORDANO PROPERTY HOLDING, INC. Article II The principal place of business address: 1225 HATTERAS LANE HOLLYWOOD, FL. US 33019 The mailing address of the corporation is: 1225 HATTERAS LANE HOLLYWOOD, FL. US 33019 Article III The purpose for which this corporation is organized is: ANY AND ALL LAWFUL BUSINESS. Article IV The number of shares the corporation is authorized to issue is: 100,000 Article V The name and Florida street address of the registered agent is: CRAIG M. DORNE, PA 3132 PONCE DE LEON BLVD CORAL GABLES, FL. 33134 I certify that I am familiar with and accept the responsibilities of registered agent. Registered Agent Signature: CRAIG M. DORNE P13000001809 FILED Article VI January 07, 2013 The name and address of the incorporator is: vhernngf State JOHN GIORDANO 1225 HATTERAS LANE HOLLYWOOD, FL 33019 Electronic Signature of Incorporator: JOHN GIORDANO I am the incorporator submitting these Articles of Incorporation and affirm that the facts stated herein are true. I am aware that false information submitted in a document to the Department of State constitutes a third degree felony as provided for in s.817.155, F.S. I understand the requirement to file an annual report between January 1 st and May 1 st in the calendar year following formation of this corporation and every year thereafter to maintain "active" status. Article VII The initial officers) and/or director(s) of the corporation is/are: Title: D, P JOHN GIORDANO 1225 HATTERAS LANE HOLLYWOOD, FL. 33019 US Title: D, V MICHELLE GIORDANO 1225 HATTERAS LANE HOLLYWOOD, FL. 33019 US Article VIII The effective date for this corporation shall be: 01/01/2013 CFN 2011.3RO30511.11.3 NOTICE OF COMMENCEMENT OR EIS 29588 Ps 3417; QP9 ) A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION RECORDED 04/18/2013 10 0 51 a 12 � + URT 1 MIAMIHARVEY �:UltiC CLEI�'N� OF CDA f1SAl`iI-GAGE CDUIdTtg FLORIDA PERMIT NO. TAX FOLIO NO.11-3101-024-0260 LAST PAGE STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Legal description of property and street / address: Bonmar Park PB 17-11 Lot 5 & N1/2 of lot 6 blk 5 lot size 73.500 X 113 or 9774-0516 or C9774-0516087700 9510 NW 1st ave, Miami, it 33150 2. Description of improvement: Bathroom & kitchen remodel plus exterior paint 3. Owner(s) name and address: cl° 9510 NW 1st ave, Miami, 0 33150 Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: Laumar Roofing Systems LLC STATE OF, FLORIDA, COUNTY OF DADE 501 SW 21 terrace #1, Fort Lauderdale, fl 33312 5. Surety: (Payment bond required by owner from contractor, if Name and Address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes, Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) _ _ fjSignatureOf Owner Print Owner's Na/me aoh6flogyaro Prepared by Swom to and subscribed before me this day of , 20. Address: Notary Public: ®�St® ��a °°a�rv+,r.s Yuliesy Arias �,a�� B 3�3/�,� Print Notary's Name: V 14F A . MCOMMISSIOn#EE14Ei065 My commission expires: ] : EXPIRES: NOV 14, 2015 V VI A' AARONNOTARYc m 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. X COPY OF QUALIFIER'S STATE LIC CARD B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. -XCOPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. X COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY 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: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: Laumar Roofing Systems LLC BUSINESS ADDRESS: 501 SW 21 terrace #1 CITY Fort Lauderdale STATE FL ZIP CODE 33312 BUSINESS PHONE:9( 54 ) 321-8335 FAX NUMBER9( 54 l 321-8308 CELL PHONE () QUALIFIER'S NAME: Jose Baez Jr QUALIFIER'S LIC NUMBER: CGC1515362 E-MAIL ADDRESS (IF APPLICABLE): Jbaezjr@laumarroofing.com Created on 3119109 BY MLDV I RV 3126109 MLDV BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-9895 — 954-831-4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA: Receipt#:180-8252 ` ere tJamA, LAUMAR ROOFING SYSTEMS L.L.C. ,�.._�.,.,,__,GENERAL CONTRACTOR Owner Name: JQSE zuGEN O BAE9 ,7R Business Location: $01 SW 21 TER BAY 1 FT LAUDERDAt�E Business Phone: Business Opened:o5/08/2oos tAWC0untY1C61WR8q:CGC1515362 Exemption Coda:. Rooms seats Employees machNRe,s Professionals 10 For Vending Business only Number M M�r.4cinran� ti....ae:.e. r.,.,,.. Tax Amount Transfer Pae NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 0.00 10.00 1 0.00 30.00 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: JOSE EUGENI,O BAEZ JR 501 5W 21 TER BAY 1 FORT LAUDERDALE, FL 333:12 2012 .2013 Receipt OIC -11-00012181 Paid 0/1a/201a 30.60 W W%0%1i#! W%W% ■ same AN 4. A %W 111�w.�twwA JEFF ATWATER CHIEF FINANCIAL OFFICER * * 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: 7/16/2012 PERSON: BAEZ FEIN: 272548912 BUSINESS NAME AND ADDRESS: LAUMAR ROOFING SYSTEMS LLC 800 SW 21 TERRACE FORT LAUDERDALE FL SCOPES OF BUSINESS OR TRADE: EXPIRATION DATE: 7/16/2014 JOSE 33312 ROOFING - ALL KINDS CONSTRUCTION OR AND DRIVER ERECTION PERMA 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 under this section may not recover benefits or compensation under 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 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. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 ACfI632-1 'STIATk.-0F,, FLORIPA!, W nRY''Llc 0 IQ, NESS A .aplmmmil iFLORJD&I- STATf NAL ftSs Am Pkla S -sl N*g.,m VCT;,,0N;,IlqD.VSTRY�-1, DATE BATCH NUMBEI "Aw: 10 -thider: the0 --, i ia of, ]1��.irati-on .,4ate: 2014'';M' � A �P L 0.,,- 17607 i3 Cit''N LOX ,AHATCHRE P.L, 4 IftINOR PISP 0 $EON L12083002412 SE 112083002597 i XM LAWOON m LAUMROO-02 MATERAT .4Cc>RL'7° �- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 4/1/2013 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 Insurance Office of America, Inc. P.O. Box 162207 Altamonte Springs, FL 32716-2207 CONTACT NAME: PHONE 800 243-6899 FAX Arc No. No): (407) 788-7933 ADDRESS: INSURER(S) AFFORDING COVERAGE MAIC # 10/14/2012 INSURER A: Starr Indemnity & Liability Company 38318 7EACHOCCURRENCE $ 1,000,000 INSURED INSURER B: INSURER C: Laumar Roofing Systems, LLC INSURER 0: P.O. Box 347 Fort Lauderdale, FL 33302 INSURER E: INSURER F: AUTOMOBILE COVERAGES CERTIFICATE NUMBER: RwminN NLIMRF:R- 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. ILTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER MLICDEFF M/D POLICY MEXP D LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABILITY CLAIMS -MADE ❑X OCCUR SIPG-GL00005-02 10/14/2012 _ 10/14/2013 7EACHOCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX-1PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITYEa ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS eB�INEDdSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY Per accident) $ PROPERTY DAMAGE $ PER ACCIDE UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDEDI F (Mandatory in NH) l yes, describe under DESCRIPTION OF OPERATIONS below NIA I WC STATU- OTH- T Y LIMIT ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) GERTIFIGATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village AUTHORIZED REPRESENTATIVE Building Department 10050 N.E.2nd Avenue - Miami Shores Florida 33138 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD