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DS-14-1884Miami Shores Village Building Department AUG 27 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (30S) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 BY. FBC 20 LA3 BUILDING Master Permit NOD Is 114 i & PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL 7PUBLICWORKS ❑ CHANGE OF F -1 -CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 0000 ` i&-DVNP� B I vd City: Miami Shores County: Miami Dade Zip: 331 6 Folio/Parcel#: 11- 29-3 1- 0145' 06).Q Is the Building Historically Designated: Yes NO Occupancy Type: toad: Construction Type: y , Flood Zone: BFE: FFE: ,,�/ OWNER: Name (Fee Simple Titleholder):HI �I.�YlI s f o r V 1 10 �6 Phone#: L305) -7 q 5 -P-9- 6T Address: '10050 cNE 2Y1C'� � AV City: IA -&M, ), bo r State: I, dam-- Zip: Tenant/Lessee Name: ��� I691_ ,i CoUlu, � "y1a+ l) JLC Phone#: LWY \ 17q 5 -0 6 Z) Email: U6zzi a, ynI, ishoru 1 r- &am CONTRACTOR: Company Name:JES Cons-hUCtlOdi SV,- 2tgm$jtvic Phone#: -3.05-316.4462 Address: i Z3 $S S W 12 9 C'U Irl It 8 city: 1,1i a Inn t - Dade State: `F ( O r id a zip: 33186 Qualifier Name: 6 OY67 e E- 5 U Q Y ('-4: Phone#: 186 . S 8 +- 4244 State Certification or Registration #: C C7 C Certificate of Competency #: DESIGNER: Architect/Engineer: c ut'l ndo- Phone#:6 ;oq7- 9915' Address: 1075 93 r City 0 Ur ISIMItate: Zip: value of Work for this Permit: $ ki ,� 2 7 n � uar /Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ® New ❑ Repair/Replace ❑ Demolition Specify co1Qr of color thru tile: .t -•k'G tee. 9�i •�:w "q,: Submittal Fee $ Permit Fee $ �M1CO CCF $ Scanning Fee $ , V l� Radon Fee $ C A DBPR $ e� Nblary$ ; Technology Fee $ ' Training/Education Fee $ " ® Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ � I H P3 (Revised02/24/2014) t G 4 Q,� i 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 cencement must be posted at the job site . for the first inspection which occurs seven (7) days after the building permit is issued.W the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. f 1 r SignaturSignatu 101YU0IdA 159Ti[Ci: ►i7 The foregoing instrument was acknowledged before me this The foreg -instrument was acknowledged before / : me this d day of A 4 A 20 � `� by `� �+h ,day of � ��? � �� 20 14 , by -Alik'W30 ��12 , who is personally known to Jcg�°- , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: -ffej 1i.�(��✓i�2 — �f � Seal: as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: 66i'02ki � sz nbvia er Print: Seal r`R:"�N'•y TERESA NUNEZ-APONTE A A Notary Public . State of Florida Canuildsalon 08835 Plans Examiner Structural Review (Revised02/24/2014) a V-1toV1dc- I' P& &Notary Public State of Florida Abigail Santander d My Commission EE028731 Qfai Expires 09/22/2014 as i L2-1 _l Zoning Clerk SUAREZ, JORGE ERNESTO J E S CONSTRUCTION SYSTEMS INC 12385 SW 129TH CT, UNIT 8 MIAMI FL 33186 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.myftoridalicense.com. There you can find more information about our divisions and the rVulations that Impact you, subscribe to department newsletters a team more about the Departmenfs Initiatives. Our mission at the Department lei License Efficiently, Regulate Fairly. We consta strive to serve you better so that you can serve your custorners.1hank you for doing business In Florida, and congratulations on your new licensel DETACH HERE '7ZICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY ISSUED: 07/16/2014 DISPLAY AS REQUIRED BY LAW ISEQ 0 L1407160001600 Date CERTIFICATE OF LIABILITY INSURANCE 4/8/2014 Producer: Lion Insurance Company This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. 1 Holiday, FL 34691 (727) 938-5562 Insurers Affording Coverage MAIC # Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer A: Lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer c: Insurer D: Insurer E: Coverages 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. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance I Policy Number Date Date (MM/DD/YY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence Commercial General Liability Damage to rented premises (E4 Claims Made 11 Occur occurrence) g Med Exp Personal Adv Injury General aggregate limit applies per: Policy ❑Project ❑ LOC General Aggregate Products - Comp/Op Agg UTOMOBILE LIABILITY Combined Single Lirrt (EA Accident) Any Auto Bodily Injury All Owned Autos (Per Person) Scheduled Autos Bodily Injury Hired Autos Non -Owned Autos (Per Accident) Property Damage (Per Accident) EXCESS/UMBRELLA LIABILITY Each occurrence Aggregate Occur 0 Claims Made Deductible A Workers Compensation and WC 71949 01/01/2014 01/01/2015 X WC Statu- OTH- Employers' Liability tory Limits ER E.L. Each Accident $1,000,000 Any proprietor/partner/executive officer/member E.L. Disease - Ea Employee $1.000,000 excluded? NO if Yes, describe under special provisions below. E.L. Disease - Policy Limits $1,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/LocationsNehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 31-66-155 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": J.E.S. Construction Systems, Inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s), while working in: FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: ISSUE 04-08-14 (TLD) Benin Date 12/9/2013 CERTIFICATE HOLDER CANCELLATION Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to MIAMI SHORES BLDG DEPARTMENT do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. 10050 NE 2 AVE MIAMI SHORE, FI 33188!" 0 CERTIFICATE OF LIABILITY INSURANCE DA si26/14 PRODUCER Florida Bankers Insurance 7278 SW 8 Street MIAMI SHORES BUILDING DEPARTMENT THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33144 THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # Phone (305)266-6493 Fax (305)262-0679 INSURED JES CONSTRUCTION SYSTEMS INC ' 1171MAmp INSURERA: FEDERATED NATIONAL INSURANCE INSURER: BB: 12385 SW 129 COURT UNIT # 8 INSURER MIAMI, FL 33186 INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 OF MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INS RD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE N�YUDD POLICY EXPIRATION DATE =R LIMA GENERAL LIABILITY EACH OCCURRENCE 1,000,000.00 ❑� COMMERCIAL GENERAL LIABILITY GL -0504010820-01 06/14/14 06/14/15 DAMAGE TO PREMISES Ea ocaurence 100,000.00 MED EXP (Any one person) 5,000.00 ❑ ❑ CLAIMS MADE Q OCCUR A ❑ ❑ PERSONAL 8 ADV INJURY 1,000,000.00 ❑ GENERAL AGGREGATE 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG 2,000,000.00 Q POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO (Ea accident) ❑ ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON OWNED AUTOS BODILY INJURY (Per person) BODILY INJURY (Per accident) ❑ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE ❑ OCCUR ❑ CLAIMS MADE AGGREGATE ❑ ❑ DEDUCTIBLE ❑ RETENTION $ WORKERS COMPENSATION AND❑ EMPLOYERS' LIABILITY WC STATU- ❑ OTH- LIMITS ER E.L. EACH ACCIDENT ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/ MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CGC 1512762 CERTIFICATE HOLDER CANCELLATION j%L,urcu Aa tcuumuol wr © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES BUILDING DEPARTMENT 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 40050 NE 2 AVE THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES, FL. 33138 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ff' ' 1171MAmp j%L,urcu Aa tcuumuol wr © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) QF Terra Tech Consultants, Inc. • Environmental Consultants ♦ Foundations ♦ Geotechnical Testing ♦ Inspections ♦ Construction Materials Testing ♦ Structures Location: FIELD DENSITY REPORTS Client: Bas I.I, Inc. Date: 1 09/17/14 Address: 13727 SW 152nd Street, Suite # 115, Miami, Florida - 33177 Order No.: 14-2604 Project: 10000 Biscayne Blvd., Miami Shores, Florida Contractor: Bas II, Inc. Description: Tan To Brown Silica Sand With Rock Fragments. Location: Maintenance Area , Sub -Grade, N.E. Comer Lab # D-34051 Location: Maintenance Area, Sub -Grade, S.E. Comer Lab # D-34052 Location: Maintenance Area, Sub -Grade, S.W. Comer Lab # D-34053 Location: Maintenance Area, Sub -Grade, N.W. Comer Lab # D-34054 117.4 118.0 116.9 117.2 Test Results of Field Densities ASTM method: D-2922-81 Description of Test Area I Maintenance Area, Sub -Grade Densities At 10000 Biscayne Blvd., Miami Shores, Florida Lab No. D-34051 D-34052 D-34053 D-34054 Test No. 1 2 3 4 Depth in inches 12" 12" 12" 12" Field Density lbs/Cft. 117.4 118.0 116.9 117.2 Mositure Contents % 10.2 10.9 9.8 10.0 Maximum Density % in the field 99.0 99.5 98.6 98.8 Reg. Compaction by jobspecs 95% 95% 95% 95% 100 % Max. Density Proctor 118.6 118.6 118.6 118.6 Proctor No. P-2615 P-2615 P-2615 P-2615 Optimum Moisture % 18.9 Remarks I All The Above Tests Comply With Job Specifications Checked By I R.E.D.S. I Report By I A.M. FLORIDA REGISTRATION No. 39228 Respectfully Submitted BY, Terra Tech Consultants, Inc. Rafael E. Droz-Seda, P.E. Date: of/wAY As a mutual protection to clients, the public and ourselves, all reports are submitted as the confidential property of clients, and authorization for publication of statements, conclusions or extracts from or regarding our reports is reserved pending our written approval. Terra Tech Consultants, Inc. ♦Environmental Consultants ♦ Foundations ♦ Geotechnical Testing ♦ Inspections ♦ Construction Materials Testing ♦ Structures Location: FIELD DENSITY REPORTS Client: Bas I.I, Inc. Date: 09/18/14 Address: 13727 SW 152nd Street, Suite # 115, Miami, Florida - 33177 Order No.: 14-2604 Project: 10000 Biscayne Blvd., Miami Shores, Florida Contractor: Bas II, Inc. Description: Tan To Beige Lime Rock. Location: Maintenance Area , Base Course, N.E. Comer Lab # D-34055 Location: Maintenance Area, Base Course, S.E. Comer Lab # D-34056 Location: Maintenance Area, Base Course, S.W. Comer Lab # D-34057 Location: Maintenance Area, Base Course, N.W. Comer Lab # D-34058 129.6 130.0 129.3 129.8 Test Results of Field Densities ASTM method: D-2922-81 Description of Test Area I Maintenance Area, Base Course Densities At 10000 Biscayne Blvd., Miami Shores, Florida Lab No. D-34055 D-34056 D-34057 D-34058 Test No. 5 6 7 8 Depth in inches 12" 12" 12" 12" Field Density lbs/Cft. 129.6 130.0 129.3 129.8 Mositure Contents % 9.6 9.8 8.8 10.0 Maximum Density % in the field 99.7 100.0 99.5 99.8 Reg. Compaction by jobspecs 98% 98% 98% 98% 100 % Max. Density (Proctor) 130.0 130.0 130.0 130.0 Proctor No. P-2616 P-2616 P-2616 P-2616 Optimum Moisture % 17.8 Remarks All The Above Tests Comply With Job Specifications Checked By R.E.D.S. Re rt B A.M. Respectfully Submitted BY, Terra Tech Consultants, Inc. 01 Rafael E. Droz-Seda, P.E. FLORIDA REGISTRATION No. 39228 Date: a9'�/914- As a mutual protection to clients, the public and ourselves, all reports are submitted as the confidential property of clients, and authorization for publication of statements, conclusions or extracts from or regarding our reports Is reserved pending our written approval.