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EL-14-1198-i Vii d I W Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-224424 Permit Number: EL -6-14-1198 Scheduled Inspection Date: December 04, 2014 Inspector: Devaney, Michael Owner: BECERRA, EDUARDO Job Address: 839 NE 97 Street Project: Contractor: Miami Shores, FL 33138 - <NONE> ELECTRICAL MASTERS INC Building Department Comments NEW POOL SPA Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number (786)390-3312 Parcel Number 1132060142610 Phone: 305-265-7996 mtractio Passea comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. December 03, 2014 For Inspections please call: (305)762-4949 Page 44 of 46 Miami Shores Village JUN 0 8 2 14 Building Department A� 10050 N.E.2nd Avenue Miami Shores Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 a FBC 20 BUILDING PERMIT APPLICATION Permit Type: Electrical Permit No. I H 1 � 9 Master Permit No.w PIki — 9c� JOB ADDRESS: R 3 9 Ill G q-) 'St City: Miami Shores County: Miami Dade Zip: 33 138 Folio/Parcel#: I I - 3a o(.- OIq--2/ la Is the Building Historically Designated: Yes NO >` Flood Zone: OWNER: Name (Fee Simple Titleholder): y�rdr� <L!.-3e�1� Phone#: Address: $ 39 r{) E 91 Sf City: ni`'r_%'wi S koreS State: cFe- Zip: 33 13 S Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �� %e l ��s �S /�vc Phone#: 7k6 3 S2 k2 Address: yej d _S . e!/ / f City: .(va oy w// State: "i, c ew Zip: "3 3 /'V'/ Qualifier Name: D Sy a l/I //;d1-1 <y¢/e2 Phone#: - G - 3 F-,> fr 2 g 5 - State State Certification or Registration #: •�"r/h !!",;? 05-7 Certificate of Competency #: Contact Phone#: Email Address: ©S5/e na ,�//�� di�• ®� DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ /100 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ANew ORepair/Replace ❑Demolition Description of Work: 'oe Lri Submittal Fee $ Permit Fee $ �?®® °fie Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ 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 Zip City State 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 copv 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 Owner or Agent The foregoing instrument was acknowledged before me this ZZ day of , 20 4, by-�� who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: ..��•""'w,, Luz Helen isg®n / Sign: I Print: .�•� � •� EXPIRES. MAY 19, 2017 FvM-0 My Commission Expires: Signature Contractor The foregoing instrument was acknowledged before me this ZZ -- day of , 20 a, by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: gon .� Q Sign: � ' Print: '�•"EXPIRES: MAY 19,2017 Ipll . 1.COPf! My Commission Expires: APPROVED BY < �� e Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(R.,evised 07,10/07)(Revised 06/10/2009)(Revised 3/15/09) RODRIGUEZ, OSVALDO ELECTRICAL MASTERS INC 8M4I 14TH ST KI FL 33144 -r Congratulations! With this license you become one of the nearly one minion Floridians licensed by the Department of Business and Professbnai 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 i dbrmation about our services, please log onto warw.myfioridaiicense.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! i L (850) 487-1395 FLOMA AC# 6-3 3 5 6 4 7 =NT 'OF BUSINESS _AMD F 2 127009317 E R 0 0 3057 , 'A= LOCAL LISr. , S PRIOR TO N'rRAGT ----AM AREA) 8Aa STzmM under tte .provisions at t%489 sa8ira"ti date,Atiti 32T 2014 L12090402106 T ------'^' ---_'- 6335641 STATE OF FLORIDA DBFAR.C1�L "CNTP'�RSITION HOARD SEQ#1,12.090402106 Q9 0'1,2., . -UM 0 i3�31:� :'; 1$R00130.5��+ h� ;,�� ` �, IR... file ELECTRICAL COW.r,RjL=1Z � Named below HAS REGISTERED r ViIder the provi's oaa 09''. Expiration date: AUG 31., 2O1 IM (INDIVIDUAL ;MUSTS .MLR]E3T L R> S 'MOR TOCpRA RODZ °IL�TCf�� ECT'RICA , MIAMI FL 2 B AZir FL 3 313 �. L&IiIrSON RX. C1 SCOTT`4' SECRRTARY GOVERNOR DISPLAY AS REQUIRED BY LAW E Municipal Contractor's Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: 97E000003 M C BUSINESS NAMEII.00ATION RECEIPT NO. EXPIRES ELECTRICAL MASTERS INC NEW BUSINESS SEPTEMBER 30 2014 8400 SW 14 ST 7436805 MIAMI, FL 33144 Must be displayed at place of business Pursuant to County Code Chapter 8A -Art. 9 & 10 OWNER TYPE OF BUSINESS ELECTRICAL MASTERS INC ELECTRICAL CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR 200.00 09/05/2013 0222-13-001244 MIAM W For more information, visit www.miamidadegpvftaxcollector Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 3693075 BUSINESS NAME/LOCATION ELECTRICAL MASTERS INC 8400 SW 14 ST MIAMI, FL 33144 301 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2014 3857902 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED ELECTRICAL MASTERS INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR 75.00 09/05/2013 Worker(s) 3 97E000003 0222-13-001244 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. � The RECEIPT N0. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-278. M®D DEi For more information, visit �+�rw miamidade govftaxcoller�t ELECT -1 OPID• KH .4�oRvCERTIFICATE OF LIABILITY INSU CE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC D HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID 0410112014°'' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELY AMEND, EXTEND OR ALTER THE GE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BENTHE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER GENERAL LIAMUTY IMPORTANT: K the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be , 8 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on Cate does not Confer rights to the Certificate holder In Neu of such EACH OCCURRENCE $ 1►�r PRODUCER CONTACT NAME' Teresa FL Cann " . Agot [Sure Insurance Brokers 8700 W. Hagler St, Suite 270 PHONE 305-223-2533 FAX . 305.220-0765 Miami, FL 7 weEss .Corn TemaR Ca rmona. ASM CLAa� Q OCCUR tAVERWE NAS 8 INSURER A : Florida Citrus, `" nem(FUS) INSURED Seeftical Masters Inc. msuRER e : Travelers Cas CO 8400 SW 14TH Street Miami, FL 331" %j INSURER D: INSURER E INIKIRIS F• GENERAL AGGREGATE $ 2r�r �A0.CM73&-W-Av= dr 1 @ f: KE� BllMisr--K: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THENAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR O DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC D HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID TYPE OF INSURANCE mwL SURR Policy NUMBER POUCY OF POUCY am LIMITS NE 2 Ave GENERAL LIAMUTY Mail, Mia, FL 33138 Mmi ��► � ' EACH OCCURRENCE $ 1►�r B X COWERCIAL GENERAL UARRM 7A846384 10/09/2013 1M11fd01;±j"E- I RERrEff $ 100, MED EXP (Arty are pefs $ 5. 0001 CLAa� Q OCCUR &ADV PLIURY $ 1,000,04 BLANKET ADDITIONAL INSUREPER�NAL %j GENERAL AGGREGATE $ 2r�r R GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGO S 1, $ 17 PeRcoT LOC POLICY Is AUTOMOBILE LUUMM WA mcklem BODILY KI1RY (� Pte) $ ANY AUTO BODILY INAIRY (Per --MW) $ 01"ED �� LED f ALL OS PROP' HIRED AUTOS � �ED FY WGE $ $ UMBRELLA UABOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB HCLAIMS-MADE $ MIDRKERS COMlB+I8 TM t X TATU TH E.L. EACH NT A AND EMPLOYERV LIAB LITY ANY PROPRIETORIPARTNERIEXECUTIVE Y I N 1084 35 04101/2014 041NM1*0 E L DISEASE - EA EMPLOYE $ Ute, OFRCERIMEMSER EXCLUDED? D (may In NH) N f A M ELL DISEASE - POLICY LWT $ 1 r000r DESLRFPTION OF OPERATIONS below yy �i DESCRIPTION OF OPERATIONS i LOCAT l VBOMM ( ► ACORD M, A MW" ReMRft 8Nredule,"more spans B 1®ctrical ContractorI IN JA Ir iI M WIV. S.,,� CiTYM11 - SHOULD ANY OF THEDESCRIBED POUCIES BE CANCEILLED BEFORE THE EXPIRATION DATE , NOTICE WILL BE DELIVERED 01 ACCORDANCE WITH TrEE ParCr PROVISIONS. City Of Miami shores Fax:305-7868872 NE 2 Ave AUTHORIZED REPRESENTATIV Mail, Mia, FL 33138 Mmi ��► � W 711141-Z17u Ab!7RY %iv 'urw r lvn. Owl rsnw F%mu Inu ACORD 25 (201015) The ACORD name and logo are registered maw of ACORID z r 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. 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; 2. The officer is listed as 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. Owner Print Name: Signature: State of Florida ) County of Miami -Dade ) Sworn to and subscribed day of By_ (SEAL) Type of before me this , 20 fN#F MAY Contractor Print Name: 0 //G d -7 n* Ps e Z Signature: State of Florida ) County of Miami -Dade ) Sworn toan wubscribed ` day of Cu J Lo before me this 2 20 L�