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BPP-14-1653Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-216907 Permit Number: BPP -7-14-1653 Scheduled Inspection Date: November 19, 2014 Inspector: Rodriguez, Jorge Owner: GONZALEZ, MARIO Job Address: 9811 NW 1 Avenue Miami Shores, FL 33150 - Project: <NONE> Contractor: TROPICAL OASIS POOL & SPA INC 5uiiaing Department comments Permit Type: Pools/Whirlpools/Hot Tubs Inspection Type: Final Work Classification: Addition/Alteration POOL RESURFACING USING DIAMOND BRITE REMOVE Infractio REPLACE COPING AND TILE MOVE POOL EQUIPMENT 7 INSPECTOR COMMENTS FT FROM CURRENT LOCATION Phone Number (786)236-0135 Parcel Number 1131010330080 False Phone: (305)798-3304 November 18, 2014 For Inspections please call: (305)762-4949 Page 8 of 41 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 18, 2014 For Inspections please call: (305)762-4949 Page 8 of 41 BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC Miami Shores Village =7C1VFE_:D 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 FBC 20D® Master Permit No. m? &- a"5_-:3 Sub Permit No. ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL F-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple, Titleholder): ' `dV_1 ® 6 CGGl� Phone#:��� Address: City: zK1 99 zrl�z> State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: (-Dp 1 (q) C� 1S c7� Phone#: 3U5 % (G t? — 33 0 y Address: _� Z� 1..� t f S a V --k City: M I G M i Qualifier Name: SC State Certification or Registration #: DESIGNER: Architect/Engineer: I-,::- I Zip: e#: Certificate of Competency #: Address: I City: State: Value of Work for this Permit: $ _600000 Square/Linear Fa of Work: Type of Work: ❑ Addition d Alteration ❑ New Repair/Replace Description of Work: ( Oc) 1 V ieSy r trP D hu t t (c) P► h (n 4, I -P e Zip: ❑ Demolition tC" NI0v Specify color of color thru tile: Submittal Fee $ 570.0Permit Fee $_ CCF $ CO/CC $ Scanning Fee $ 5 e OD Radon Fee $ DBPR $ Notary $ Technology Fee $ Q_. L47 fo Training/Education Fee $ 0 Double Fee $ Structural Reviews $ Bond $ t4 I -0-0 TOTAL FEE NOW DUE $ (Revised02/24/2014) 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 Zi 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 charaed. Signature —J OWNER or AGENT The foregoing instrument was acknowledged before me this a day of � , 20 1 il` by r..wa:s&s, �c ro , who is personally known to Signature CONT CTOR The foregoing instrument was acknowledged before me this day of /w 20 f q by �( Za P" " 1 ��A , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PU LIC: NOTARY PLI I Sign: Sign: L•. d'°t'' YIH®SQ/AIVY MARTINEZ Print: �_°' := ISSION # EE080681 Print: i4 kk MY COMMISSION 0 EE68088' %� ., i ^ EXPIRES April 04, 2015 Seal: �:'a. 44�• . r__.,_ — Seal: M:,V EXPIRES April 04, 2015 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) This instrument prepared by: his Valle, Esq. Isis Valle, P.A. 3625 NW 82 Avenue, Suite 401 Miami, Florida 33166 =P4 2014RC0513694 9k 29238 Ps 4999; Ups) RECORDED 07/22/2014 12:05:25 DEED DOC TAX 1pfod.1.1,00 I-IAR11EY RUVIPIP CLERK. OF COURT iIAMI-DACE COUNTYP FLORIDA LAST PAGE Parcel Identification No. 01-3101-033-0080 THIS QUIT-CLAIMMxD,executed this2-) day of cltt1 ,2014,by9811NW1Ave Corp, a Florida corporation, whose post office address is 7901 H spanola Avenue, Unit 1007, North Bay Village, Florida 33141, first party, to Mario Gonzalez, 111, a single man, whose post office address is 9811 NW l Avenue, Miami Shores, Florida 33150, second party: WITNESSETH, that the said first party, for and in consideration of the sum of Ten and No/100 Dollars ($10.00) in hand paid by the said second party, the receipt whereof is hereby acknowledged, does hereby remise, release and quit -claim unto the said second party forever, all the right, title, interest, claim and demand which the said first party has in and to the following described lot, piece or parcel of land, situate, lying and being in Miami -Dade County, Florida, to -wit: Lots 12 and 13, Block 128, MIAMI SHORES SECTION SIX, according to the Plat thereof, as recorded in Plat Book 10, at Page 39, of the Public Records of Miami -Dade County, Florida. SUBJECT TO covenants, restrictions, easements of record and taxes for the current year as well as that certain Mortgage and Security Agreement dated May 22, 2014 and recorded June 4, 2014, in Official Records Book 29177, Page 1259, in the Public Records of Miami -Dade County, Florida. TO HAVE AND TO HOLD the same together with all the singular the appurtenances thereunto belonging or in anyway appertaining, and all the estate, right, title, interest, lien equity and claim whatsoever of the said party, either in law or equity, to the only proper use, benefit and behoof of the said second party forever. IN WITNESS WHEREOF, the said first party has signed and sealed these presents the day and year first above written. Signed sealed and delivered in the presence of Print Nance: a12 /Print Name:'�_araRtl%.�.�i_r:� �1f1�i�ccx 9811 NW 1 Ave Corpa Flo corporation"•�....�._ By: io G 'res er ry or €IAL- I11Lk AD ?01.11 ---._-...... AJ 7 Ali STATE OF FLORIDA ) COUNTY OF MIAMI -DADS Ss: t CAS l a_ fta I The foregoing instrument was acknowledged before me this 21 day of < rt , 2014, Mario Gon�acIl, I'resident of 9$11 NW 1 Ave Corp, a Florida corporation, who nue produced_ , l r . 6t1,+f� 11 OU) c/- and who did take an oath. NOTARY PUBLIC, STATE OF FLORIDA Serial Number: % NotaryPubiks Slat00f F10 da CommissionExpires- 5 Isis vane y, . -y,� E y camm�aion 6E098205 era zPB®sis CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 04BS00474 ICAL OASIS POOL & SPA INC. D.B.A.: PUIG WI Is certified under the provisions of Chapter 10 of Miami -Dade County Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY CC NO: 048SO0474 BUSINESS NAME/LOCATION TROPICAL OASIS POOL& SPA INC 7920 SW 145 AVE MIAMI, FL 33183 MC RECEIPT NO. EXPIRES NEW BUSINESS SEPTEMBER 30, 2014 7440999 Must be displayed at place of business Pursuant to County Code Chapter 8A -Art. 9 & 10 OWNER TYPE OF BUSINESS TROPICAL OASIS POOL& SPA INC SPECIALTY BUILDING CONTRACTOR ® For more information, visit www.miamidade.povltaxcollector PAYMENT RECEIVED BY TAX COLLECTOR 175.00 11/14/2013 0223-14-001022 h3Q7b 01-00 J,19 001407 odt'�cy CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 07/29/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policypes) 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 Yes Insurance Agencies, Inc. 9507 Bird Road Miami, FL 33165 Phone (305) 225-5757 Fax (305) 223-8158 CONTACT Madeline Estrada E: PHONE : (305) 225-5757 a No): (305) 223-8158 E-MAIL madeline@yesins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Granada Insurance Company INSURED TROPICAL OASIS POOL AND SPA 7920 SW 145 Ave Miami, FL 33183 (305) 798-3304 INSURER B: INSURER C: INSURER 0: INSURER E: INSURER F: L1wvenAUr_b GCIiIIFICATE NUMBER: REVISION Nt1MRFR- 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. I�TIR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF POLICY / EXP UMITS A GENERAL LIABILITY © COMMERCIAL GENERAL LIABILITY ❑ F]CLAIMS-MADEQ OCCUR F]PERSONAL 0185FL00008962 05/05/2014 05/05/2015 EACH OCCURRENCE $ 1,000,000.00 PA13E TO RENTED REM SES Ea occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 &ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ PRO- ❑ LOC PRODUCTS - COMP/OP AGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OW NED SCHEDULED ❑ AUTOS ❑ AUTOS NON -OWNED ❑ HIRED AUTOS ❑ AUTOS ❑ ❑ Ea MrBIIN�DtSINGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY Per accident) ( ) $ PROPERTY DAMAGE Per accident $ $ ❑ UMBRELLA LIAR ❑ OCCUR ❑ EXCESS LIAR ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NLIM ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) ❑ If yes, describe under DESCRIPTION OF OPERATIONS below N / A ❑ WC STATU- ❑ OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) Plastering or Stucco Work CERTIFICATE HOLDER CANCELLATION Miami Shores Village Dept. 10050 NE 2 Ave Miami Shores, FL 33138 ACORD 25 (2010/05) OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Madeline Estrada ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 3/6/2013 PERSON: PUIG FEIN: 200938130 BUSINESS NAME AND ADDRESS: TROPICAL OASIS POOL & SPA INC 7920 SW 145 AVE MIAMI EXPIRATION DATE: 3/6/2015 WILSON FL 33183 SCOPES OF BUSINESS OR TRADE: CONCRETE SWIMMING POOL CONSTRUCTION NOC CONSTRUCTION -NOT 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 ff, 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 � •f Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner —Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. tPrint Name: Signature: V a /40�- (2g - State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this -3 0 day of t,( �,20j_q_. By Yu S`AN/ MARTINEZ ARTINEZ M' '= MY COMMISSION # (SEAL) ,', EXPIRES April 04, 2015 Type of Ide dallotary$ervice.cOm Print Name: M15,0,1 IIo Signature: State of Florida) County of Miami -Dade ) Sworn to and subscribed before me this 'S C� day of `5:� 1 , 20 1 J ( — EZ BY 1::yHOSVANY MART -IN n,,,M AGFn80881 EXPIRES AptU 04, 2015 PIL OASIS �,,. POOL & SPA d 1'uipical oasis Pool & spy 7920 S.W 145 Ave. Miami FI, 33183 305-798-3304 tropicaloasispool@yahoo.com www.tropicaloasispool.com Bill To: Vanessa Castro 9811 Nw 1 Ave Miami Shores Description Pool resurfacing requires all grinding and etching. Removal of all air pockets and dump debris. Aad washes and bond kote application . Replace drain cover. Diamond Brite standard colors, Pool coping and waterline file installation labor only. Home owner will provide all materials Relocating pool equipment and installing a new 12 volt light and transformer with new wet niche. All labor and materials included. Safety fence to comply with pool barrier Lnvoice No Date: F c -E -ms: Due Date: 88 Jul 19, 2014 NET 0 Jul 19, 2014 Quantity Rate Amount 1.00 $2,000.00 $2,000.00 1.00 $1,000.00 $1,000.00 1.00 $2,000.00 $2,000.00 1.00 $1,050.00 $1,050.00 indica'las non-iaxal-le i'tenn ........................ ................. ................................................. I..... ........... .......... 0 L! 0'a I $6,050.00 Tax x L (0,00'N) $0.00 'total $6,060.00 Paid $0.00 Balance Due $6,060.00 112