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RC-13-1792 (2)BUILDING PERMIT APPLICATION Miami Shores Village BuildingDepartment �CEK p APR � 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ���' j� FBC 20 Master Permit No. .-- Sub Permit No. UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION ❑RENEWAL F—IPLUMBING ❑ MECHANICAL ❑PUBLICWORKS [:]CHANGE CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS JOB ADDRESS: City: pp Miami Shores County: County: Miami Dade Zip: �O Folio/Parcel#: _I i,�'y`�7� �D Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: �l , Flood Zone: BFE: FFE:,,j OWNER: Name (Fee Simple Titleholder):A�(rP-LU tet/ /V 'Phone#: 0�"eRgQO1 —I/wl ArMracc• 1 f)0::�-n kklre— 1 / !. 0 U K/ City: State: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Address: City: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engine Address:gc- LCv ` ?t er: e W of Competency #: E10M,M 01, WI Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Scanning Fee $ Permit Fee $ CCF $ CO/CC $ Radon Fee $ DBPR $ 'Bond Notary $ Training/Education fee $ 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 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 postedd 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. / A Signature Signatui OvAer or Alent Contractor The foregoing instrum@nt as acknowledged before a this this day of 20%, by who 's personally known a or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: c Print: a n c— mi6l6f"Ffi*G tM of FlorM Diane Schwartz MY Commission EE 195926 R EXPIMS 08!08!2018 APPROVED BY The foregoinS instrument w s ack owI dged before me l day o 201 by wh personally kn o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: ` Print: Tr%oi WYK�yii Diane Schmrtz ¢ P' MY CommiSSlon EE 196926 Evros OSM/2016 Plans Examiner Structural Review (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) CP/zo/ Zoning Clerk PAINTING AND SERVICES UNLIMITED DIAMOND REMODELERS 9024 Dickens Ave.. Surfside, FL 33154 Dade: Tel. (305) 865-9005 - Fax. (305) 865-0934 JEFFREY DIAMOND L,ic: CC#94BS00437 Insured LASORSA ENTERPRIZES INC. CGC 03149 April 22, 2014 Dear Miami Shores Building Official, I am requesting extensions for the following permit numbers: Building permit RC -8-13-1792 Mechanical permit MC -8-13-1948 Plumbing permit PL -8-13-1793 Electrical permit EL -8-13-1794. The owner of the home had a baby and we had to stop all work until the baby was big enough to go to daycare and the owner was able to go back to work. We would like to extend these permits for four more months to complete the work. Thank you for your help in this matter. Sincerely, J Diamon t Arlenis Silvera From: Lana Curzon <lanalabrousse@gmail.com> Sent: Thursday, May 01, 2014 3:59 PM To: Arlenis Silvera; Ismael Naranjo Cc: DiamondJef@aol.com; Curzon, Andrew; andrewjcurzon Subject: Permit #: RC13-1792 Mr. Naranjo, We received your building critique for the permit extension at 10050 NE 12 Avenue, and understand your concerns about an infant residing on the premises. I ask that you please grant the request to extend the permit. The infant will not be residing in the home during the construction process. We look forward to receiving a response from you in a timely manner. Regards, Lana Curzon AC_ORD. CERTIFICATE ®F LIABILITY INSURANCE PRODUCER (954) 966-9993 Gulfstream Insurance Agency, Inc. THIS CERTIFICATE R ISSUED A8 A ONLY AND CONFERS NO RIGHTS 5833 Johnson, Street HQLDER THIS CERTIFICATE DOES INSURED Lasorsa Enterprises, Inc, 2071 SW 70th Avenue Bay G-19 DATE (MMIDOIYYYy) FL 33317- INsuRERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD )NDICATED. 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 D HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGAR GATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD'L TYPE OFINSURANCEPOUCYEFTIVE POLICYEXPIRAf10N POLICY NUMBER MIDDATE MIW/DD A DATE MD GENERAL LIABILITY • CFP0000507 02 LIMITS a1/27/2Oi4 01/27/2013 EACHOCCU $ 1,OOO,aoO X COMMERCIAL GENERAL LIABILITY MqG RREM E CLAIMS MADE ® AA MISEsT Ee rren S 100, 000 .• OCCUR / / ------------ ANY AUTO ! ! ! ! I'L AGGREGATE LIMITAPPUES PER: POLICY CT LOC OMOBU.E LL481UTY ! ! ! ! RETENnON $ ! ! ANY AUTO ALLOWNEDAUTOS ! ! ! ! SCHEDULED AUTOS HIRED AUTOS NDN -OWNED AUTOS SPECIAL PROVISIONS (GARAGE LIABILITY ANY AUTO ! ! ! ! EXGESSfIIMBRELLA LIABILITY OCCUR ED CLAIMS MADE DEDUCTIBLE ! ! ! ! RETENnON $ WORXERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERWEMBER EXCLUDED? It yea, de$Wba under SPECIAL PROVISIONS OTHER DESCRIPTION OF OPERAnONSILOCAnONBNEHICLESIEXCLUSIONS ADDED BY�ENDORSEMENTISPECIAL PROVISIONS -cra i irw,a i c r (305) 756-8972 Miami Shores village Building Dept. 10050 NS 2nd. Avenue FL 33138- 5,000 1,000,000 2, 000,0oo 2.,000,000 COMBINED SINGLE LIMIT (Es acdderd) $ BODILY INJURY (Per person) $ BODILY INJURY $ (Per accldent) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - Fll ACCIDENT $ OTHER THAN EACC $ AUTOONLY: __ _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT. FAILURE TO DO SO SHALL IMPOSE NO O AnOM OR LIABILITY OF ANY KIND UPON THE IN IRE R ITS AG OR R NT AUTHORIZED REPRE E CORD 25 (2009/08) IS025 (oios).o6 0ACORD CORPORATION 1988 Page 102 I 09-16-2008 10:07 FROM-GULFSTEN INSURANCE +9549623263 T-726 P-002 F-109 ACOM, CERTIFICATE OF LIABILITY INSURANCE oDONW�ONHC ONLY ANNF�OROMM UPON THE Gulfatream Tzaurauce Agency, Inc. HOLDER THOS C4StnFICATE DOES NOT ANEW i 5833 Johnsen Street ALTER THE COVERAGE AFFO BY THE POUCI�S INSURERS AFFORDING COVERAGE Hollywood FL 33021 INSURED ��ANorth Pointe Insurance Co Diamonds 6 Co Enterprises Unlimited. Inc Mm 6; dba Painting 9 Svcs Unlimited INSURER^ 9024 Dickens Avenue I 111M D: Surfside FL 33154- iNsursER t�ntt�ae�Ex - - DA'M OR THE POLICIES OF INSURANCE US= BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY FERIUD INWG.A I — Hw i vw 1 ^M.,Y�u.aa AIN REQUIR>METIT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V NCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POUCIES DESCRION HEREIN IS SUBJECT TO ALL THE TERMS. D(CLUSIONS AND CONDRIONS OF SUCH POLICIES. AGGREGATE LIMO SHOWN MAY HAVE BERN REDUCED BY PAID CLAM. _ FOLM 6FEEnYELTR pOLIC1f EL49RAT�N IBp1xq s 300,000 flRECAe1Af3l W8raI9 S 100,000 A QDN1RaLLUUMM R C Rm4ERWALI.IABIL37Y l d.AS MWE ® octan 3094114796 ' ` 09/28/2008 09/28/2009 5, 000 Ay 6 300,000 GENERAL $ 6b0, 000 PROM CM-COI�IDP ASS S 600,000 c�neae+eD sINt31 E LmGT / / / 000 AMMMTE L9MRAPl� PEF t R POLICY cr Loc LIAORMY1 AWAITO ALJ. QVWW AUTOS SCHMMAUTOS NpN / / / / tEB s BODt1.Y RWJRY (FWP—1 s SOMLY NJURY¢ PROPERMCAMAGS ovuNEDaUTOS (Pe►am+q a t3ARAfiELIA6(LIiY AUTO OILY-rA CM fi s OTWRTNAN EAACC S AUTOCIMM AGO s ANYAUTO / / / / UT / � s ❑ s occuR CLaaMs MADEcA _ s DlaoucrreLe / 1 / / s s fc. EACH ACCENT s 7 BOFFICEWMEMMOCCLUDW RETEMN s "ALS swY rtac�rrae � axs. ra►rrlM�t � E7teCY7'NE elm it 4n1 s' _.... ' 83042710 _ 08/10/2009 - - 08/10/2010:-*--. DISEASE -CA s Mow eLD>SeASE- s 1W.000 olttee DESC.taPTlowl 4F OPSRA�1gS0�'►�(�II810#IB AODM in �'��� .Additional IADAd6 CBunty Building t Zoning Painting and Specialty Contractor WMiamn Island Condo Assoc. Building 4000 Williams island Blvd. Waimai, Fl. 33180 RD2"(7" M 8020 iee'tGw MOULD ANY OF TIS ANOW OWPOM POEM BE CAM== DMM TM EMAIM DATE THOMP TSD: MUM POLL Elm% K in YAR 30 DAY$ WFMjW OMMM 7W =ffMTE I1DL= KAMM 10 "13 I.DFT. Mft FAH.M TO DO 30 SHALL NO O6L(6ATM OR LMB1UTIY OF ANY IDND UPON THE I M06% AG@ITf OLi A Aarleo>� , 10ACORDCORPORATION 7885 Knee -1 ni 2 F4ECTRONIC LASER FOMMS. INC, - paw -we I y tiuc UbleS,e MMIHUMY LM5UKbH For dey we YOU, WAM s ir Our at to strweta Thera fordoh, A C #7.175 -7722-01 .Z ATE OF FLORIDA PAR%== OF BUSIMsS AM PROFESSIONAL REGULATION Womtom 40 NCyjtTjjOjMW- WMY T LXCMSMG BOARD (850) 487-1395 STREE LLAMLSSEN FL 32399-0783 INC YL 33432 s fiats V0WM ydu becesm am afthe ready one n9loon 60 VsPWftnWd d &mkms wW RdbsgkrW !%ugumum- OF Busxmss MM. $010MAL REGULATION bmker� ftm' M. 15,75. S, I" Wkwism ren" *am wd*=% to yacht P -POMP 0, I ftm d8ur3rft, arid they keep Rockla's 4 e=uxllystrong- 031 iiie': 06/08/12 216420i72 11"PWO the Way We cb business an WdW W MW you better. MVkesures. *M ba GrIto WWWA.1 I' 11! 11 11, 11 khdk:ej&ecm zT- C0N`M=R to regulav= got GWWWrt n"Wetters OW fewn mors Iuc WWknwd bc MOM Ercbr* Reguleft Fs* We ;sib you am W" yawassimnem -4 AMMMMMMA =d— the Vzovisime o--.- ki FkrWe, and cOngOMM00fis on Your rtew Mcer" I .Ch.489 FS 0 31, 2014 T.22b4800909 , DETACH HEM- - STATE OF FLORIDA ON SECIftue6escogog CRUT3MINMISHIDUNTRYPR21M T 01- I VO/V 2U;L4- 4 'tl, CTOR 42.0872 1522,034407 71he QMIERAL Named below I CZRTjjv:CgD P� Under the pr isiOus Of Cha- ter 489 FS. e AUG Expiration da e: AUG 33., 20r4. o--RSA LA—SORSA; ANTmoNr U—a "A 3'3 SW 12 ST RISES -INC Chi IL P -ATO FL 33432 a • Rug 06 13 05140p RNTH0MY LRSORSR 561-368-5244 p.l Afti .TEFF A TWAUR '6 CHIEF F110111CIAL STATE OF FLORA DEPARTARM OF F00ACIAL SERVICES ONISION OF WORKERS' 4EMA7= 'CEFnVWATlE OF ELECT= TO BE EXEMPT FROM FLORIDA WORKERS' t;OMPIPWATM LAW • • COW WWTION NDUSTRY Ems' M This o ddles that fndWAW Isted bit has a to be exempt from Fbrkb Workers' Compensalon law DATE W! M13 EXPIRATION DATE: 5/2312015 •LASORSA ANTHONY FESIS 59182&M MAtAIIE ADDREINCSS: BMF ' i.A SA ENTER�,RI SES ' 383 8 V TREEi BOCA RATON FL 33432 OF IRJS�ESB OR TRADE: UCL du Id Utf: 1'/8 HN 1 HUMP LH'ULIKUH bbl -368-5244 P.2 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 1115 S. Andrews Ave., Rm. A-'100. FL Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBA: Receipt #1c-MnWA 73 xMIt (RWIDWitIAL 8"Iness Name: Business ENTERPRIsss AJC Business Type: ) If Owner Name: ANTRWY LASORSA Business Opened:05/01/1982 Business On:2071 SW 70 AVE 019 State/C*Unty/Cort/Reg:C(3C032497 DAVXE Exemption Code: Basin Pitone:954-474-5537 I Rooms Seats Employees OieCbirtee plaft slonals 6 §;;h—M—S onv Number attVlaebines: Vending T Tax Trensfa Fee NSF Fee 1:Penalty PRO Yeem CoLLectlon Cwt Told raid 27.00 0.000.0DI 0.00 0.00 27.00 !I THIS RECEIPT NIUSTBE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS :1 I THS 81! OWWS A TAX RECEIPT This tax is levied for the privilege of doing business within RrOward Cotm[y and Is nwrreguiatory in nature. You must most all County andror Munic$oafty Planning WHEN VALIDATED and zoning mqulrements. This Susinass Tax Reoelpt must be tramerred when the business is sold, business name has dlar W or you have moved the business Iocalon. This receipt does not kdcate that the business Is legal ar ttlat 11 it is in compliance with State or local lamas and regulations. Ariailing Address: ANTHONY LASORSA Receipt #O1C-12-00011176 383 SW12 ST Raid 07/03/2018 27.00 BOCA WON, M 33432 07/01/2013 Effective nate I .k 2013 -2014 f tarn/!:1/LU!`t/ lUf+ UU•JO Im �n�+ j •• ��•, ��•1-ao� m a' AL ol%r- tor—m i irnoik1 r— yr Lfpeiia® 4 v iova mmNioc; o4H5f2014 1:o b°RolDIJt R :i,t3b�) 161SU18(iC9 and FinancialTvICe8, Inc.FER 6175 NW 153 ST STE 100 Mlaml Lakes. Fl 33014 PH: (305) 512-9721 FAX' (306) 5129889 POLNiY pfJrOI THIS CE93'fiFICATE IS ISSUED AS ¢NLY AND CONS NO RIO NO1.DEFL Tom CERlil`!CA'HEE AMM THE COVERAGE A MATTER OF UVOWATION S IPPON 1NE CE IVICATE NOT AMEND, MCIEND OR &!Y THE POI,cIES 68: =. BNSU43ERS AK*RM i COVERAW NAIL 8 urvuRED AYOUNG PLUMBING CORP, 740 NW 91 AVE PEMBROKE PINES, FL 33024 ALUADI YO u1L(36N137hl.LTABILRV aAn UMM © OCCUR seT4T.�Rec+aTE LB+BTAT'RJr� T'ER: POLICYrlPROJECT IAC MMA: ASCENoXirrC0NW=kLrMRAf4CE 04A=14Q4/06M15 I • C: ew vm s NSLAERD LAGGRwlAm i MBUMR e WSNlD ABOVE FOR THE PDLICYF2M INDICATED. NOTWITHSTANONG TME POLICIES OF URANCB LISTED BELOW HAVE BEEN ISSUED TO THE ENSURED ANY REQUIREMENT, TERM OR CONOMON OF ANY CONTRACT Oit OTHER DOCUMBirr TTM RESPECT TD wwcH THE3 TE MAYBE ISSUED OR MAY KXMI4. THE EM9URANCEAFFORDED BY THE POLICIES DESCRMM HEREg4IS. WTO AI.I. THE TFJM. M=10164- M3 AND CONOiTI OF SUCH POLICIES. AIWREpATE LWIS SHOWN MAY HAVE 1� REDUCCxOBY PAD CLA(— i TYPE OF POLNiY pfJrOI rA ALUADI YO u1L(36N137hl.LTABILRV aAn UMM © OCCUR seT4T.�Rec+aTE LB+BTAT'RJr� T'ER: POLICYrlPROJECT IAC GL 0000016219 04A=14Q4/06M15 I • k oa ®� a loom ew vm s Fi3CidRt mAOY mUureY i +.�9 LAGGRwlAm i PVJM=.CW§WPAW a mnuu BB.E LuaBILITY ANY AUTO ALLOWNEDAUM �iEDUtffiAU'IC3S KHMAUTOS MN.OWMDALCM i d QOpaYpvA?N4Y s tt��Fen�n yupw i : @ARAM LLABUTYO0WY-eAACCa)M AMIAWO i O FAA= a aEMES4 EUAUA80" accure =wow= E MENTM a EAhH0=We4lM a a s a a �Ya�uAee�L r°N'um ANrE.L. OFFICeTtR�+IaSREKCWDED? SPECUILPOef EMNA=tDW a �. .EaewtaT� s a PLUMBING RESIDENTIALAND COMMERCIAL I CERTIFICATE HOLDER CANCEU ATIO N 1 CITY OF MIAMI SHORES WLIAGE elm" w1mam otircommm acAmomueoeuDReT mwM a m 10050 NE 2Nb AVE D1iTE T1l�F fl� ffi! BIER YY TD KAM go Df&t lb6TTl�1 MIAMI SNORES FL 33138 W110E TO THS CERaIURCATB *l0LDM TO 1fM LEFT, BUT TO 00 so GWAL MMOBtto,►Trouwa IIINDyPbNr1 rTe urBox OACORO STATE OF FLORIDA. DEPART- WNT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRIA LICENSING BOARD (850)-487-1395 �Vffi 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HERNANDEZ, JUAN C A YOUNG PLUMBING CORP 740 NW 91ST AVE PEMBROKE PINES FL 33024 A Congratulationsi With this license you become one of the nearly one miction 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 inbrmation about our services, please log onto www.myftddaRconse.com. There you can find more information about our divisiaaas and there 111- orft that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License, Efficiently, Regulate Fairly. We constantly strive to. -serve you better so-thatyou-can-serve your customers. Thank you for doing business- In Florida, and congratulations on your new Ilcensel The Department of State -is -leading the commemoration of Florida's 500th anniversary in 2013. For more information, please go to wuwv.VivaFlorida.org. VIVA fINA DETACH" HERE STATE OF FLORIDA DEFARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER M;1;tvT*- I Sri Named below HAS REGISTERED. Under the provisions. of Chapter 439 FS. Expiraftwdate: - AUG 31, 2015 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO COW111AGTING IN ANY AREA) HERNANDEZ; JUAN -C AYOUNG PLUMBING CORP 740 NW 91ST.AVE PEMBROKE PINES FL 33024 RUCK SCOTT ISSUED: 09/1003 SEQ # L13E}9IOM147G KEN I_AVYISM GOVERNOR DISPLAY AS REQUIRED BY LAW • SECRETARY Local Business Tax Receipt Miami—Dade County, State of Florida THEISNOTA IML- DONOTPAY 4122669 A YOUNG PLUMW4G CORP DOING BUS IN DADE CO MMM FL 33000 'ECEM""M EXPIRES RENEWAL 30—SOP-14 430520.7 Must be &W&Ve8 at p1m of Pmt to County Code Chapter SA -Art. 9 & 10 Mual Contractor's Tax Receipt ZT-Dade County, State of Florida -TH1SiS NOTA BILL -DO NOTPAY CC NO: 98P000228 BUS1iNESs NAMElLOCATIOl11 A YOUNG PLUMBING cORP DOING BUS IN DADE OD MIAMI, RL 33000 MC RECEIPT NO. EXPIRES AMIW llf"s SEPTEMBER 30, 2014 Must be displayed at place of business Pursuant to County Code Sec 10-24 OWNER TYKE OF BUSINESS A YOUNG PLUMBING CARP PLUMBING CONTRACTOR Restricted to City of Mkrrd Beach Cags�Ft'e b>Naa►aHoa,vls& PAVWENT RECEIVED BY TAX COLLECTOR 77.65 08/29/2013 0229-13-000937 -7 y Nf'i Y .TEFF AT WATER STATE OR FLORIDA cHPEF FiNAe cAL OFA DEPARTMENT OF FINANC AL SERVICES DIVISION OF WORKERS' COMPENSATIOP CEIMFICA E OF ELECTION TO d EXEMPT FROM fLO,RMA VIORKER-1 CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida EFFECTIVE DATE 11101/2013 PERSON: HERNANDEZ FEIN: 650883903 BUSINESS NAME AND ADDRESS: A YOUNG PLUMBING CORP 740 N.W. 91 AVE PEMBROKE PINES FL 33024 SCOPES OF BUSINESS OR TRADE: 1- LICENSED PLIMING CONTRACTOR EXPIRATION DATE: 11101/2015 JUAN C 11-07-2013 COMPENSATION LAW * * Compensation law. RAMTAIR Pursuant to Chapter 440 . 05(14) F.S., an officer of a corporation who efts exetap0001 from this chapter by filing a certificate of election soder this section may not recover benefits or compensation under this chapter. Parana to Chapter 440.05(12), f.S., Certificates of election to be exempt... apply only WOMB the scope of the business or trade hated on the notice of election to be exempL Pursuant to Chapter 440,05(13), F.S., Notices of el"11011 to be exempt aad certificates• of election to be exempt shall be subject to revocation if, at any time after the filing of the notice W the issaw" of the rcertifieate, the person rammed on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department Asti revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section., QUESTIONS? (850) 413-16( OWC-252 CERT*=TE OF BMnON TO BE EXEMPT REVISED 01-11 ------- i PLEASE CUT OUT THE CARD BELOW AND RETAIN FO.R FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FUMMIAE SERVICES DIVISION OF WORKERS' COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTIOUTQBEEXEMPT FROM FLORIDA VIIORiiERV COMPENSATION LAW '` EFFECTIVE 11/01/2013 EXPIRATION DATE: 11/01/2015 PERSON: JUAN C HERNANDEZ FEIN: 6601193903_ BUSINESS NAME AND ADDRESS: A YOUNG PLUMBING CORP 740 N.W. 91 AVE PEMBROKE PINES. FL 33024 SCOPE OF BUSINESS OR TRADE I- LICENSED 'PLUMBING CONTRACTOR f IMPORTANT F Pursuant to Chapter 44(L05041, F.S., an officer of a. corporation who O elects exemption from this chapter by filing a certificate of election `- under ;this section May not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.0502}, F.S., Certificates of election to be H exempt_ apply only within the Scope of the business or trade listed on E the notice of election to be exempt R E Pursuant to Chapter 440.0503), 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 tmrtificam The deportment shall revoke aj certificate at any time for failure of the person named on the certificate to most the requirements of this section. QUESTIONS? (850) 413-1609 Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 CTC *m TraftsWJ;pQt W"V Board y IRM CERnFrPME OF COMPETENCY YOUNG PLUMBING CORP RA- 3 EGfwvr CERTIFICATE OF LIABILITY INSURANCE I °",M(wvbwfr ' TIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTiFiCATE HOLDER TWA 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMIORTANT: itthe CetR$Ceia holder is ADD TIONAL tNBURED, the poricy(feaj must bs endasrei. U SUBROGATION IS WAIVED, subject to the term and conditions of the poft, cartel" policies map regWre an andoraemerIL A stotentaft On this certHtcate des Nei carrier rwft to the holder In Ren of such erWoratmert e . S Insurance Marke tg IncI O Box 551287 FL Lauderdale FL 333551267 gMiami 100501V.Ed Aveiaae PROW d90fl t cagg g525St _ 13 114 _.____ �s+su>a�LeLARFORaaeCovEaaoe T a n+sa�Lotitia.Clt51n4&(�usidasFund INSIRWR: _ _ -. __.----- _ IRsuReo METRO -2 Metro Electric Service, InaC 21607 NE 3Avenue 8th Aventura FL 33160 !R- ®:._ _...._......__... �_._......_.__ _ ..�... R: (CCURREMM S1AE0.000 7HIS is TO CERTIFY THAT THE FO WS— OF INSURANCE LwrFu SEI.Ow HAVE BEEN ISSUED TO THE INSURED •�•w�AsovE FOR THE mjcy PERIOD INDICATED, NOTYIATHSTANOINO ANY REQUIREMME TERM OR CONDIRON OF ANY CONTRACT OR OTHER DOCUlSEbrr VM RESPECT TO WIQCH THRs CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED 6Y THE POLICIES DESCRIBED HEREIN IS SUBXCT TO ALL THE TERMS,. EXCLUSIONS AND C � NSA SUCH POLICIES. UMrrS SHOAL! MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE �WAINARCE_..— EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED EI ACCORDANCE VWTH THE POLICY PROVISO. gMiami 100501V.Ed Aveiaae 13 114 tdLOTe B ' eEkERIY.TY �-.--7 (CCURREMM S1AE0.000 COA4 _._ .----- . �neRSOaAL A ADVGEN!LLtRt'-, N a1 009 OOti _. ' aEntFRa.s�rrE sa; ou:i PRODUCTS-G4t�PK}P RtM9 S OOO.o� At CREQ4TE La0r MPLIES X A>rT uAenlrr AWAUTO p d' { t ' ! tj ? B06Y.Lt FNJIWY iP'OP� t 9 BO�6Y INJfIRY(PB+eN S KIM AUTO$AUTOS I p OMeREi1.A LdA9 _ CLAt516dd50E l I EAGHOOcLw EMNCE S � gQGAELiATE b WORKMCOMPENSATION A1@rSMOVE16'LIA1MAY YIN 'F'OAIPMTNEWEXECUTaE - 7088944t -GN<Y' U14b - l A .4 H- IX ._. I4 Y.L!!)tiT9_._,._ER ._ E.t. EACHRGCfD£NT pt 000 w0—..�.•• AM 6XCLU0e0i MIA ( `fFt rytA t'"$EA I eA bt000000 E.L ami' -SE . PO4"Uw. $7 000 000 I i t � Of*+2tA?fMIWG1r tYH=J2S{AtlaaflACOR0 t01.AQ SaireO:le.emaa epees iar Elechical Contractor looted at 16050 NE 2O Avemie, North Miami, FL 33181. NN "iIIYY�itilY AliV1[Y wim- r4A I tun. An ngms reservaq. ACORO 25 (20101") Tire ACORD d too. are registered markt of ACORD _..... _...... ......... ... _.__.. _.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE Shores VdIage EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED EI ACCORDANCE VWTH THE POLICY PROVISO. gMiami 100501V.Ed Aveiaae AunlpR rau Arae Nz Mimi Shores FL 33138 NN "iIIYY�itilY AliV1[Y wim- r4A I tun. An ngms reservaq. ACORO 25 (20101") Tire ACORD d too. are registered markt of ACORD _..... _...... ......... ... _.__.. _.. x gg���r��q,O 3iiJ GMABii 1505 610.1E A� �8NORTE -UMUM—A A. FL MLWTRIC KICK -4m 333a"l (350) 457- �1Alft r; �r.= + r r! : f i a rt '•.-ii 4 in +►�- '.r! n I tG PG a r: rnearly _ r: M i. r> rs << �; r -c.: s` d by to D.re T = � of s: -i- �. and : r :`-ss ■ t'.:6 1. r .,•i N �? _ � Our r. r es:, r, (_�s and !1 �-'1 �� \ �. range r:' 7. 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