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EL-14-1655Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222653 Scheduled Inspection Date: November 17, 2014 Inspector: Devaney, Michael Owner: GONZALEZ, MARIO Job Address: 9811 NW 1 Avenue Miami Shores, FL 33150 - Project: <NONE> Contractor: MB ELECTRIC SERVICE CORP suiuding Department comments IM Permit Number: EL -7-14-1655 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number (786)236-0135 Parcel Number 1131010330080 Phone: (786)325-3383 RELOCATE POOL EQUIPMENT APPROX 7 FT FROM Infractio Passed Comments CURRENT LOCATION I INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-216922. Check bonding and lz� grounding. Add 120 volt G. F. I. protected receptacle within 6 to 20 feet of waters edge. Failed 40� llf�_ Correction24:'p /G/ Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. November 14, 2014 For Inspections please call: (305)762-4949 Page 18 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 LINE PHONE NUMBER: (30S) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC ❑ ROOFING FBC 209® Master Permit No. cff Sub Permit No._4�Lz ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: I I C' V -e- Folio/Parcel#: Is the B- d n�oricalH Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): Address: �� /�&u % City: /; � 5�,5 _Z42-i4e2 X3150 Designated: Yes NO_ BFE: FFE: State: Zip: �53/5 b Tenant/Lessee Name: Phone#: Email: -p - CONTRACTOR: Company Name: 1 •. �12c ►,. �[ �r✓ica° ��Yr Phone#:( 3 15-- 3 3 9D Address: 3 1 S-1— ff LJ ) of f I City: TL • Zip: 33 U 5 - Qualifier Name: ) V re(- E. �4uxzxsz.. Phone#: State Certification or Registration #: Certificate of Competency #: /;z e 000 J401 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ V Square/Linear Footage of Work: Type of Work: ❑ Addition El Alteration 1:1 New Repair/Replace Description of Work: r" 10`� 0 0 c 1 M Zip: ❑ Demolition 1-®y'", Specify color of color thru tile: Submittal Fee $ t Permit Fee $ 3V,#P `eAP CCF $ 0 CO/CC $ Scanning Fee $ Radon Fee $ 4 > DBPR $ Notary $ Technology Fee $ 9C) Training/Education Fee $ G , f--)® Double Fee $ Structural Reviews $ (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ ®'t Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved,and a reinspection fee will be charged. Signature Y�� Signature OWNER or AGENT CO RACTOR The foregoing instrument was acknowledged before me this day of 20 by a.uW-S0, s Yom° who is personally known to me or who has produced identificatiorfhnd who did take an oath. [iI.71fl137 Sign: 1 Print: I2�- . YHOSYANY MARTINEZ Seal: MY COMMISSION # EEOSM81 EXPIRES April 04, 2015 The foregoing instrument /was acknowledged before me this day of ��(y ,20 i'l by s e- C- �. Pu -r. ( , who is personally known to as me or who has produced identification and who did take an oath. NOTARY Sign: Print: 40< < Seal: `= MY COMMISSION # EE080681 EXPIRES Aprii 04, 2015 53 as L407199. ' FforideNotamySeMee.00m APPROVED BY Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk It Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 PERMIT APPLICATION SEP 19 2014 FBC 20 Master Permit No — Sub Permit No. E�-- ❑BUILDING XELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-] PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: W 331 Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): AA610 o VM, 5 e le d'hone#: Address: C/ /� w , A V'(_ City: I -A i cvm V '-f State: Zip: '?,3)5 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: NA 'D Ele C,-�_l G 45�r_ ry i r Q Co 6 Phone#: 'I &o '3ZS 3 3 j33 Address: S City: 01M \ CXP/i S ate• �L Zip: air C. Qualifier Name: �S? `� p�'�rt7 i�tvAW-2-- Phone#: State Certification or Registration M Certificate of Competency #:1210C)D0 `ICS DESIGNER: Architect/Engineer: Phone#: Address: City: State: Value of Work for this Permit: $ go i) Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration JgNew ❑ Repair/Replace Description of Work: ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Feet _ _✓ ! CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews (Revised02/24/2014) DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE 03 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved nd a reinspection fee will be charged. Signature Signature ' OWNER or AGENT CONTRACTOR The foregoing instrument wasacknowledgedbefore me this day of � , ack 20� by �-Lerfe&who is personally known to me or who has produced as The foregoing instrument was acknowledged before me this day of & 0 20 , t c . by re who is personally known to me or who has produced C1 Q - 1-3 f---? 3-11 -1-Qs identification and who did take an oath. identification nd who did take an oath. NOTARY PUBLI : NOTARY U I Sign: 4C Sign: Print: Print: +: YH0SvAEL NY MARTIN ""' *: MY COMMIS �,�o YHOS ;,;' Seal: :1':= MY COM # EE Seal: d:{C EXP APrI104, 2015 IBES April 04.2015 �"'' `!!?; `" Fiona AOtaryservic--- � ESP erviee,w. (4 07) 398-0153 plofid'NotMS (407) 398-0153 APPROVED BY ��'/L /leC rr Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) o STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MUNOZ, JUSEF P M.B. ELECTRIC SERVICE CORP 3955 NW 195 ST MIAMI GARDENS FL 33055 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. 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. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the 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! DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND -' PROFESSIONAL REGULATION ER13014793 ISSUED: 06/16/2014 REG ELECTRICAL CONTRACTOR MUNOZ, JUSEF P M.B. ELECTRIC. SERVICE CORP (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) HAS REGISTERED under the provisions of Ch.489 FS. Expkatkn date : AUG 31, 2016 L140616=1276 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD LICENSE NUMBER The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 (INDIVIDUAL MUST MEETALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) MUNOZ, JUSEF P M.B. ELECTRIC SERVICE CORP 3955 NW 195 ST MIAMI GARDENS FL 33055 ISSUED: 06/16/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1406160001276 .v..-- -- -- --pmos "10 k-anaS 3'd J°pue0 SWr4o 1103dS Wbdld 3813 b000 w8vly WlEmne 2000 -lVoI810313 1,000 (S)3a`dal CJNIAArivflo CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETEI 12E000401 M B ELECTRIC SERVICE CORP D.B.A.: MUZ JUSEF P Is certifiedgunder ,,the provisions of Chapter 10 of Miami -Dade County . I - 09/22/14 08:53AX AHSA/MTC 3055988003 p.01 A *APE�(MM7DONYYYI �AY ` Rbe CERTIFICATE OF LIABILITY INSURANCE 09/22114 _ ................................................................._......._.........,........_........_...�.,......__...... —..:....,__............. _...,,.; ;+ THIS CLciZTIFICAi R tS ISSUED AS A MATTER ORMATION ONLY AND CONFERS NO R[4HT3 UPON CMS CIWRTtPICATE HOLDER. TNtS i CERTIFICATE DOES NOT AFFIRMATIVELY OR NE43ATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 's BELOW. 1:H13 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ImmKTANT: x the terms and conditions of the policy, certain policies may require an endorsermnt. A atatemont on this certificate does not confer rights to the eertiflcate holder in lieu at such endorsement(s)- --------................_..__......�-,......._._._._......,........__....._........ .................__....... ......... ._-.......__._...__............•...................._..... ........... ............ «« _ ...._: PRODUCER ; CEACI.._.............. MAYRA �'AC£NDA West Sunset Insurance Agency IMM Sunset Drive, Sufte #470 Miami, FL 33173 INSURED M.B. ELECTRIC SERVICE, CORP 3955 N.W. 195 Street MIAMI GARDENS, FL 33105-5 305 GRANADA INSURANCE COMPANY i INSURER 8! .............•..-••---._..._ INSURERE .._ . .................... —,,.................. ........ _..... NUMBER: THIS L`i TO Cf?RT1PY TrtA r PI t£ PfiLtCkG3 OI i[,fSLIt�ANGE L13TBC> SLOW HAVE CCN 155UED Tib TME ft�iSURED N£i3 A90V9 Fi}R 1 NI:POLICY PE3�14G INDICATED, NOTWITHSTANDING ANY REOUIR£MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RrSPECT TO WHICH THIS i 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 9Y PAID CLAIMS, 635_.. TYPE Op INSURANCE .. i . . ........................... _ ....,.....,—.....---...... _ 1 OENEtM LIABILITY CCWMERCIAL GENERAL LIABILITY I I -i I CLAIMS -MADE! It/' OCCUR Ai i ..:.................................................. WWI, AGGREGATE LIMIT APPLIES PER: AUTOMOBILE: LIABILITY ;•..' ANY AUTO ' ALL OVVNCO .8C.I- ROULEO AUTOS AUTOS i KRED AUTOS AAUTO$ �C UMBRELLA �u.�.i........ _......... .......... ` ... i- : DCCUR EXCESS LIAS '• ..i _ LJ: G1,AIMo-fdADL , a WORKERSCOMPENSATiON 1 AND t;MPLOYERS' LIADCUTY ANY PRQPRiS rOR1PARTt+�FR1EXECUTIVYIN: r N E C}FftC,.ER/MEI1tgER eJ(t;:Ll•Iti�„[�? (Mandatary In NN) It yam_ : MEO EXP 08124/2014: 08/2412015 ..... i CsE_NERAL AGORWATF, i • PRCMCTS . COMMOP 001-ALY INJURY (Per person) I S F3QDILY FNJURY {Psi BGctOo�)! S E.L. E.L. E.L. ......................Z ... .. ..................1........ 1 E ` ` i i I _ WWRIPTIORI OF OPERATIONS! LOCATIONS! VI=I6CLES (Aaac—fsACaRO 1111, Addttlonal Remdrks SCBedele, if more space IS regasrcd) ELECTRICAL CONTRACTOR i I ......... ..-........ _...... _.............. .:... ........................ _.................._......._.....M......_......__............_--_...................._. CERTIFICATE HOLDERCANCELLATION �..—._..........._._ _._.....__ --- ----—_....... ----.....—...._....--...._.... ._... .......-_........_...._.._..............._...---...................._....._..................... -- SHOULD ANY OF THE AGOVO DESCRIGED POLICIES 89 CANCIELLSO WORE MIAMI SHORES VILLAGE i THE EXPIRATION DATE THEREOF. NOTICE WILL Be 09LIVERED IN BUILDING DEPTACCORDANCE W" T144 CY PROVISIONS. .............._._.._._._............---........... ............. _._................ ... 10050N•E.2t lAV£NUE i AUTIIORIMOREPRESM4TA E MIAMI SHORES, FL. 3313E _—...�.....a,.....M.__ — ....,....—.....__....�.,..... _.......................... ..--....._� ........................... --- .......- - 01988 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010103) OF The ACORD name and logo are registered marks of ACORD ACCIDENT ._._. f100% JEFF e � 4 JEFF ATWATER `�°w0• CHEF 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: 911 012 01 4 EXPIRATION DATE: 9/9/2016 PERSON: MUNOZ JUSEF P FEIN: 208556856 BUSINESS NAME AND ADDRESS: M B ELECTRIC SERVICE CORP 3955 NW 195TH ST MIAMI GARDENS FL 33055 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR Pursuant to= 44005j14), F S . an offer of a Cotpotation who elects exemption from this Chapter by IiltnA a certificate of election under this section may rat reccser trenafds or mrrmansetxin urrtlerOsa Mapter. Puravantto Gheptar 440 05(12). F S., Certtfaates of n lo De exempt.. apply "wdMn the scope of the busmeas or hada Bated an me noboe of electon to be exempt Pursuant to Chapter 440.05(13). F.S., Notoes of election to be exempt and Carteiptea of election to be exempt shag be sub(eat to re mcalam d, at my litre after the bfmg at me ndtioe or the rssa mane at am camgcate, the person named on the rmir<e or c.tir.ate rm longer meets the requirements of this section fm aimumos of a CerNgcate. The departnumt shag reaake a certificate at any lime for fagum of the person -Mad on the CerMiwte to met the tequiremems of thlo section DFS•F2-DwC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)4131809 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 . f1. The officer ownsipt 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 listedaas 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 anyperson 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. Print Name: �_ �✓ State of Florida) County of Miami -Dade ) Sworn to and subscribed before me this '3–_5 day of , 20 1 � . MY COMMISSION # EEutsu (SEAL) .PtQFS April 04, 2015 Contractor Print Name: Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed before me this 01— ) day of f4p T7 , 20 f q . B F - �,NY Mpg RT N y ,. s$i IP11 MY COMMISSI N 04, 2015 fNFAT) U/RLII. �Ya►RES P of