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DS-14-1306Miami 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 ❑PLUMBING [:]MECHANICAL PUBLIC WORKS JOB ADDRESS: 'S N �� I -1-"CF1TVT JUN 19 2014 FBC 21i011 16 Master Permit No. a 5 1 `4 -1 Sub Permit No. ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores Countv: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): A6 -k n a Address: City: 7x"O Tenant/Lessee Name: Email: CONTRACTOR: Company Name: td� Address: / Z 1 4; / b0"t*""'t State: ho City: L!� 60 State: Qualifier Name: i Phone#: State Certification or Registration M./—Certificate of Competency #: _ DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ / .-0 'y n ay Square/Linear Footage of Work: 0 Type of Work: ❑ Addition Alteration ❑ New Repair/Replace El Demolition Description of Work: e— 44-.1 )5 dL4 Ver (yam Specify color of color thru tile:, Submittal Fee $ Scanning Fee $ Technology Fee $_ Structural Reviews $ (Revised02/24/2014) Permit Fee $ Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ iii f 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. f Signatur-L"� OWNER or A NT The foregoing instrument was acknowledged before me this 7,,//day of f 20 by �rl.et eO t"241is personally known to me or who has produced as identification and who did take an oath. :My Comm F,piies May 30. 2015 ( n" .; d J 79436 Assn. Signature CO CTOR The foregoing instrument was acknowledged before me this 7 day of Gvx-�_ 20 by who is personally known to mor who has produced as identification and who did take an oath. Print: Seal: My Comm. Expires May 30, 2015 Commission # EE 79436 Bonded Through National Notary Assn. APPROVED BYPlans Examiner ` d Zoning Structural Review Clerk (Revised02/24/2014) Detail by Entity Name Florida Profit Corporation TRUST MORTGAGE LENDING CORP Filing Information Document Number FEI/EIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date Principal Address 8200 NW 52ND TERRACE STE 100 DORAL, FL 33166 Changed: 05/29/2014 Mailing Address 8200 NW 52ND TERRACE STE 100 DORAL, FL 33166 Changed: 05/29/2014 CALAS Group 2000 Ponce de Leon Blvd 6th FL Coral Gables, FL 33134 Name Changed: 01/25/2013 Address Changed: 01/25/2013 Officer/Director Detail Name & Address Title PD. P04000096919 412142273 06/25/2004 FL ACTIVE AMENDMENT 09/27/2013 NONE Page 1 of 2 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetaillEntityName/domp-... 6/19/2014 Detail by Entity Name GONZALEZ, LEANDRO 8600 NW 53RD TERR. SUITE 103 MIAMI, FL 33166 Report Year Filed Date 2012 02/22/2012 2013 01/25/2013 2014 01/10/2014 �.=NFMMTI Page 2 of 2 01/10/2014 -- ANNUAL REPORT I View image in PDF format 09/27/2013 Amendment View image in PDF format 01/25/2013 ANNUAL REPORT View image in PDF format----] 02/22/2012 ANNUAL REPORT View image in PDF form—at 02/17/2011 --ANNUAL REPORT View image in PDF format 03/15/2010 ANNUAL REPORT View image in PDF format 05/04/2009 ANNUAL REPORT View image in PDF format---] 01/14/2008 --ANNUAL REPORT View image in PDF format 04/20/2007 — ANNUAL REPORT View image in PDF format 04/10/2006 ANNUAL REPORT View image in PDF format 1 1/18/2005 Name Chane F View image in PDF format 09/29/2005 REINSTATEMENT View image in PDF format 08/10/2004 Amendment View image in PDF format 06/25/2004 Domestic Profit F—View image in PDF format Copyriaht OL and Privacy Policies State of Florida, Department of State http:llsearch.sunbiz.orgllnquirylCorporationSearchISearchResultDetaillEntityNarneldomp-... 6/19/2014 a CERTIFICATE OF LIABILITY INSURANCE 06; 7/20°"YY"' 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 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 PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 14620 CONTACT Paychex Insurance Agency Inc PHONE FAX (AIC, NO. EXT): 877-266-6850 AIC, No): 585-389-7426 E-MAILmr A OR Certs@paychex.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: ILLINOIS NATIONAL INSURANCE COMPANY 23817 Paychex Business Solutions, Inc. Walter L Lista Inc INSURER B: INSURER C: 911 PANORAMA TRAIL SOUTH ROCHESTER, NY 14625-0397 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. NSR TR TYPE OF INSURANCE ADD UBR POLICY NUMBER f �p EFF POLICY EXP (MM1DDMnrYi LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADEE=OCCUR DAMAGE TO RENTEDPREMISES (Fa oactirrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ kEl1LAGGREGATE LIMIT APPLIES PER: POLICY O PROJECT= Loc PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ AOU SCHEDULED AUTOS AUTOS HIRED AUTOS A%0%WNED BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ UMBRELLA UA13 OCCUR EACH OCCURRENCE $ EXCESS uAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERfEJECUTNE OFFICER/MEMBER EXCLUDED? YIN 011732318 06/01/2014 06/01/2015 WC STATU- OTH- X1 T E.L. EACH ACCIDENT $ 1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000.00 E.L. DISEASE -POLICY LIMIT $ 1,000,000.00 (Mandatory in NH) NN If yes, describe under N/A X DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Worker's Compensation coverage is provided to only those employees leased to, but not subcontractors of the named insured. Waiver of Subrogation granted in favor of the certificate holder. GENERAL CONTRACTOR LICENSE NUMBER: CGCO22774 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 10050 NE 2ND AVE DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY MIAMI SHORES, FL 33138 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RVL)e _ N.E. 93rd STREET 75' TOTAL RNV 20' ASPHALT PAVEMENT Lp23' PARKWAY ASPHALT t � M M N90000'00"E 115.25'(M)(P) 5' CONC. SDWK a a C-1 FND. NAIL . a:•,.a .. . — t 0.2V— 20' oil—v ro co I ( I' eek A=98058'19" STEPS TILE Tan=2926' • onv I I•r♦ H N u U QLn ` N ONE STORY (fes ¢ o C N RESIDENCE # 578 e 32.00' 23.80' CC Q . 91 CONC . ° TILE _ N.E. 93rd STREET 75' TOTAL RNV 20' ASPHALT PAVEMENT Lp23' PARKWAY ASPHALT t � M M N90000'00"E 115.25'(M)(P) 5' CONC. SDWK a a C-1 FND. NAIL . a:•,.a .. . — t 0.2V— 20' co N �� I li� L=43.18' L=43.18' R=25.00' c M 1 DR SAX A=98058'19" STEPS TILE Tan=2926' 12.50' 1 H N u U QLn ` N ONE STORY (fes ¢ o C N RESIDENCE # 578 32.00' 23.80' CC Q . 12.50' STEPS° CONC . ° TILE Z0 OW WN CONC. L�A- M O m2 F SLAB 6VR M D P.T FND. DA 15' ALLEY -J S90°00'00"W 11.5' ASPHALT PAVEMENT -- co Q I /TT W Z H N u U o POOL c N N N CC Q C7 CONC . LU , Z0 OW WN CONC. L�A- M O m2 F SLAB 6VR D 15' ALLEY -J S90°00'00"W 11.5' ASPHALT PAVEMENT -- co Q I /TT W H N x O o N ca oil ^'Z N 35.00,