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DEMO-14-2210Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 U0 Inspection Number: INSP-222956 Permit Number: DEMO -10-14-2210 Scheduled Inspection Date: December 11, 2014 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: ATASH, KARIM & METIS CORINA Job Address: 1195 NE 100 Street Miami Shores, FL Project: <NONE> Contractor: JJ ELECTRICAL OF DORAL LL isunaing uepartment comments DEMO AS PER PLANS Passed Failed Correction Needed Re -Inspection Fee D 0 R No Additional Inspections can be scheduled until re -inspection fee is paid. Work Classification: Electric Phone Number (305)790-5551 Parcel Number 1132050190360 Phone: (305)305-1620 INSPECTOR COMMENTS False Inspector Comments CREATED AS REINSPECTION FOR INSP-222561. CREATED AS REINSPECTION FOR INSP-221246. Remove all service to building and set a temporary for construction service after obtaining a permit for it. 5 nov.20' 14 Same as above. December 10, 2014 For Inspections please call: (305)762-4949 Page 10 of 22 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BUILDING PERMIT APPLICATION ❑BUILDING ELECTRIC ❑ ROOFING FBC 20 /® Master Permit No.aqW11vSq_7 Sub Permit Nolb & - 2210 ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 11 95 '41'o-- /(go - 5 —/R z C / City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: OWNER: Name (Fee Simple Flood Zone: BFE: NO FFE: _ Address:I & e-_ 59 r_T R K i City: �� syi T S O' state: Zip: 3 I V Tenant/Lessee Name: Phone#: 3s�a (P— 15 SS 1 Email:i M ^,� S f �'M0911 . C'iq� CONTRACTOR: Company Name: �/ • f - Of- &�N26eL_ Phone#: ?06- ^ 30�9— 16 Zt�D Address: --Itwo.55— City: State: �G Zip: 3 Qualifier Name: �ls.�2 1---A- 174.) 4.) � , Phone#: .'�05' 36=ps^162c Statkertii 1ication or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: c'/— Square/Linear Footage of Work: �® Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Demolition Description of Work: ^ erN1 0 _rf 0-45, S TR , Specify color of color thru tile: Submittal Fee $ Permit Fee $ /O Scanning Fee $ Technology Fee Structural Reviews $, (ReAsed02/24/2014) Radon Fee $ Training/Education Fee $ CCF $_ DBPR $ CO/CC $ Notary Double Fee $ Bond $ 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 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 broch X re will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencem nt must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the abs nce of uch osted notice, the inspection will not be approved and a roirfspection fee will be charged. Signature _a_� _Z ;' Signature OWNER or AGENT OR The foregoing instrument was acknowledged before me this �(7 day of Ve( 20 14 _ by //� i�2 1'Q '1lCly), who is personally known to me or who has produced J::�-i'5>r>(1C& Kllgio as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: The foregoing instrument was acknowledged before'' tme this day of 0�0)-QP—i 20 `7 r by 3OW 1e.1' 30"D , who is personally known to me or who has produced Ve( l q V-0ao r) as identification and who did take an oath. NOTARY PUBLIC: Print: 0 Seal: : ' ': TALIA LARA n, NATAl�1,� '� MY COMMISSION # EE124530 Seal: ?.. ,, COMMISSION # E�� 530 EXPIRES September 30, 2015 AN,P.Wer- P EXPIRES September 30, 2015 (A07 398-0i59 Flaidallo�ysenice.com ao7)9se-oas3 F�ofWeNoteryBervice.com N��k�k�k�k�k�k�k�k�k�k�kNt�k�k�k�k�k�k�k�k+k�ksk�k�k�k�k�k�k�k�k*�k�k�k�k�k#4�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k�k#�k�k�k�kS�k�k�k�k�k�k�k APPROVED BY G�'/G/ Plans Examiner Structural Review (Revised02/24/2014) Zoning Clerk 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: 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; The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 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 CONTENTS. I Owner Print Name: Signature: State of Florida ) County of Miami -Dade ) Sworn to and,su scribed before me this 06 day of (X�{ OI , 20_[�L_. By K GI( \ (y) (SEAL) MY COMMISSION # EE124530 EXPIRES September 30, 2015 Print Name: AND UNDERSTAND ITS State of Florida ) o County of Miami -Dade ) Sworn to ansubscribed before me this day of t O , 20 14 By lal)t@f rlu( 0 of o Miami Shores Village Building Department 10050 N.E.2nd Aveawe Miami Owm, Florida 33138 Tel: (305) 785.2284 Fwc (305) 750.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE' IFC :1OR HAS A MIAMI OADE COUNTY CERTIFICATE OF COMPETENCY. A. OF CERTIFICE OF COMPETENCY OF QUALIFIER- // B. OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI nAnE COUNTY W NICIPAL / CANTRACTOR S TAX RECEIPT. o.COPY aF LIABILITY WSYJRACE• ECOFYOFWORKERS COMPENSATION INSURANCE` (Wo*es C EXEMPTION mst bw NOTIM TO OWNER Aflid) Cen5ftde Hokler MATY SHORES VILLAGE BLDG DEPT 10050 NE2NDAVE NAMI MM, FL 33115 Cwdf d0 =d epedfy ft descd0m of wconbaftfieet 1 mmnber. •uuuu ....................... ...............•...•....ao..........•a....... . • ■■uuu BHSfNESSNAfuE ' 35 .E=.Z�cpcav-- qF- 5012&7 u Bus9IESsaDDf2Ess:�� py IC�°if�` CRYl -4-41$ STATEZIP -- BUSINESS PHONE FAX NUMBER L_) CELL PHONE (_) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: .... Miami Shores Village Building Department 10050 N.E 2nd Avenue O mi Shmm, Florida 33136 Tel: (305) 795.2204 FWL (30Mi 756 8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: - AL ONTRACTOR: A COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE' D. COPY OF WORKERS COMPENSATION INSURANCE' (Workers CmWensdm EXEMPTION must Dawe NOTICE TO OWNER AIN&M IF CONTRACTOR HAS A MM DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE' E. COPY OF WORKERS COMPENSATION INSURANCE' (Workers Caron EXEMPTION must Imre NOTICE TO OWNER AMwM 'YOUR INSURANCE COMPANY MUST ISSUE ACERTIFICATE AS FOLL(I : Cerate Homes. MIAMI SHORES VILLAGE BLDG DEPr 1IM50 ME 2ND AVE MIAMI SHORES, FL M36 Cel must syecffy Ore desaWon oro or mm dw- ........................................................................................... BUSINESS NAME: BUSINESS ADDRESS: CELL PHONE (� QUALIFIER'S LIC NUMBER' FAX NUMBER (_� QUALIFIER'S NAME: STATE ZV ACiO ' CERTIFICATE OF LIABILITY INSURANCE °am ..._ _. 04=2014 FRanucm TWS CER11FICATE IS ISSM ASA CHATTER OF INFORWTWN PREMIER FARMERS AGENCY MANUEL ACEVEoO 7859 NW 50TH MEET ONLY AND CONFERS NO RIGs'rTs UPON THE CERTIFICATE HOLDER. THS CFRTiFICATE DOM Wr AL16M, EXnM � ALTER THE COVERAGE AFFORDED eY THE POUCIES BELOW. PRODUM-CMVMPAW S MIAMI, FL 33166 PHONE:305-599-1349 FAX205-599-1359 INSURERS AFFOWNG SAGE NM# u jt ENDL"MALCE AMERICAN SPECIALTY 9M CO. JJ ELECTRIC OF DORAL, LLC 7865 NW 109 PL DORAL, FL 33178 vauffin s: amumma E f !!•. ,:. t. E:., . f„ ':�<`.� ��.�i Sr f ! f i. -t "i >' �•kizv -! • �� i •• irlf 1. 1 -• r ;, 1� f ,,..13r' '3't. ri" K+ r' rt< f KYI., r r -!'. ra<K ?„t�•. 'drt-+. , +. l:K Iia M6' i _ :1 h-sx4r f;' 3` ..i: I ,.:. i �, ,.ir �r :' t �• r ! - Imo; i �7.✓-tl:. KI i�'t �!'. - � •. �•ir.:. � {H • • t: •.. ^.I/ fxr-.� r i. ,. R ,. 0211312014 1 02113/2015 III Lm Z7Lr- • -a 5 fl�l BUSINESS CERTIFICATE OF COMPETENCY # 13EO00065 CERTIFICATE BOLI CANiEi1 70N SUMnUAMUFMMASMDESC3MMFGUCESIECANCEAMsIMPANTM MIAMI SHORES VILLAGE nMTffmW.VffiWMMMWwvALwuww7o=jL 30 rice BUIDING DEPARTMENT ToTm lmnnmK"mTolwuwr.wrmwmTovososmL 10050 NE 2nd AVE MIAMI SHORES, FL 33138 IMMUE-ACEVEM� �- maw n jmfim _ a ACORD CORPommoN 4 Wca. �ifmal �lf•�•! S Www.VY PAIAL6A�3li f 1.000,4�� PRODUM-CMVMPAW S 2.6DD.4�i1� 5 fl�l BUSINESS CERTIFICATE OF COMPETENCY # 13EO00065 CERTIFICATE BOLI CANiEi1 70N SUMnUAMUFMMASMDESC3MMFGUCESIECANCEAMsIMPANTM MIAMI SHORES VILLAGE nMTffmW.VffiWMMMWwvALwuww7o=jL 30 rice BUIDING DEPARTMENT ToTm lmnnmK"mTolwuwr.wrmwmTovososmL 10050 NE 2nd AVE MIAMI SHORES, FL 33138 IMMUE-ACEVEM� �- maw n jmfim _ a ACORD CORPommoN 4 CTQB ConsUuchon Trades QuaWYKV Board BUSINESS CERTIFICATE OF COMPETENCY 13EO00065 JJ ELECTRIC OF DORAL LLC D.B-A.: JU � ✓ J VIER A Ig Glf KW under the provrsw of Ctopter t O of Miami-Dade Gau�ty STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1355 1540 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 JURADO, JAVIER A JJ ELECTRIC OF DORAL LLC 7885 NW 109TH PL MIAMI FL 33178 Local Business Tax Receipt Miami—Dade County, State ®f' Florida -rens I A - DONOTPAY 7105588 .R s nocaaWH MM. 1) ELECMC OF DORAL LLC RENEWAL 780 NW 109 Pi 7383292 DORAL. FL 33178 LBT.,.., EXPIRES SEPTEMBER 30, 2®95 Must be displayed a2 pfam of businms PursLow CGUMY Code ci pWrOa-Art.9&W JEFF ATWATER CI*EF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERSCOMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual fisted below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 2/18/2013 PERSON: JURADO FEIN: 767076553 EXPIRATION DATE: 2/1812015 JAVIER A BUSINESS NAME AND ADDRESS: JJ ELECTRIC OF DORAL LLC 7865 NW 109 PL MIAMI FL 33178 SCOPES OF BUSINESS OR TRADE: ELECTRICAL WIRING CONTRACTOR -PROJECT ELECTRIC LIGHT OR WITHIN BUIL MANAGER, CO POWER LINE C Pursuant to Chapter 440.0.N14), F.S., an officer of a corporation Who elects exemption from this chapter by Whig a certilicate of election under this section may notmwwrbenOWormqmmaffonwWwtbdmpW Pumuent to Cha pal 440.05(12). F.S. Certificates ofelection to be exempt... apply only within rte scope of the business or trade listed on the notice of election to be exempt. Punatent to, Chaff 440.05(13), F.S., Notices of elation to be exempt acct carModes of election to be exempt shall be subject to reef if, at any time after the Bing of to notice or to mance of the certificate, the person named on the notice or certificate no longer meets the requhemmts of this section for issuance of a Abe. The department shati revoke a at arty time for taitureof to person named on to C01WK ate to meet the requirement of to setiom DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413.1609