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EL-14-2019Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-219769 Scheduled Inspection Date: January 08, 2015 Inspector: Devaney, Michael Owner: MARTINEZ, SANTIAGO Job Address: 285 NE 95 Street Miami Shores, FL 33138 - Project: <NONE> Permit Number: EL -9-14-2019 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Pool - Private Phone Number (773)793-0782 Parcel Number 1132060133960 Contractor: IBEX TECH CORPORATION Phone: (786)242-4930 tiunaing uepanment comments POOL LIGHT REPLACEMENT INSPECTOR COMMENTS False Inspector Comments Passed' r � Failed Correction ❑ Needed �' l Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. January 07, 2015 For Inspections please call: (305)762-4949 Page 7 of 34 w(m BUILDING PERMIT APPLICATION Miami Shores Village Building Department SEP 17 2014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 _ Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2016 Master Permit No. Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Miami Dade Zip: 3 1 3 8- Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: 7 -0 792- �ame (Fee Simple Titleholder):_ S 1 !:fAO i mir-{ kyw' 2 Phone#: 'i13 . ✓� Address: K N� "I5f4 S+o" City: MtaAm l Skore's State: ��' Zip: 3 r3 0 enant/Lessee Name:pp ]] Phone#: mail: �� I LIQ Z. @ 9ol d -Oct, , b,mvvL -/-1`c. 77 3 _ 41-2,i� = 7 603 Company Name: ZT-3q\�_ �Zi-� CA�:NL•"Q Phone#: ::y Address: V2 3 S S SN -0 I GT 'S- F7& G City: lti� State:' 1 Zip: Qualifier Name:�?��2>D�. 1Z. 17Ey-� Phone#: wogs — 7:48-1528 State Certification or Registration #: 1300 Z.1 �;A& Certificate of Competency #: DESIGNER: Architect/Engineer: Address Phone#: _City: State: :$ sc)uare "Mm ❑ Addition Alteration ❑ New+ ❑ Repair/Replace Specify color of color thru tile: ❑ Demolition Submittal Fee $ Permit Fee $ CCF $ y " COO CO/CC $ (7 Scanning Fee $ _� Radon Fee $ 'D- �d `� DBPR $ Notary $ Qj r Technology Fee $ Q Training/Education Fee $ G Double Fee $ .V Structural Reviews $ Bond $ Q' TOTAL FEE NOW DUE $ 1 '� /� •_ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Application is hereby made to obtain a permit to do the work and instal commenced prior to the issuance of a permit and that all work will construction in this jurisdiction. I understand that a separate permit Zip Zip lations as indicated. I certify that no work or installation has be performed to meet the standards of all laws regulating 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. Signature` —_ OWNER or AGENT The foregoing instrument was acknowledged before me this "day of _ ct u 20 by Tz:i2/ Li, who is personally known to me or who has produced J_'(): P 600 705 q S 010 Das identification and who did take an oath. NOTARY PUBLIC: Sign: Print: M�L�11tNIL Signature CONTRACTOR The foregoing instrument was acknowledged before me this 2fl , day of "k d S r 20 j 't' by lam, who is Rersonally knowfn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: . . Print: M 1 ey[,O , U_J, ,� A Seal- ,,.•... Seal:"" MICHEL LLERENA MICHEL LLERENA ;°' �. z : `2.e Notary Public - State of Florida '; : ��;' Notary Public -State of Florida 9o; My Comm. Expires Sep. 8.2017 ''F oma:` My Comm. Expires Sep. 8.2017 '•; oc F ° Commission # FF 51963 4,;; ; Commission # FF 51963 �O /y APPROVED BY a. Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) f Z.01 CAO-rtc- t 6jL- to POWER OF ATTORNEY FOR PROPERTY S;. ST PAGE Know all men by these present, that I Santiago Martinez (Grantor) having a fee simple interest in the property located at 285 NE 95th Street Miami Shores, desiring to execute a SPECIAL POWER OF ATTORNEY, hereby appoint my cousin, Eric Periu, of 285 NE 95th Street, Miami Shores FL, as my Attorney -in -Fact to act as follows, GRANTING unto said full power to Execute any and all Permit Applications with the Village of Miami Shores for the property, commonly known as 285 NE 95' Street Miami Shores FL. All acts done by means of this power shall be done in my name, and all instruments and documents executed by my Attorney -in Fact hereunder shall contain my name, followed by that of Eric Periu and the description "Attorney -in -Fact", excepting however any situation where local practice differs from the procedure set forth herein, in that event local practice may be followed. This SPECIAL POWER OF ATTORNEY shall be valid and may be relied upon by any third practices until such time as any written revocation is provided by Grantor. Signed Santiago Manez [GRANTOR]; The undersigned witness certifies that Santiago Martinez [GRANTOR], known to me to be the same person whose name is subscribed as principal to the foregoing power of attorney, appeared before me and the notary public and acknowledged signing and delivering the instrument as the free and voluntary act of the principal, for the uses and purposes therein set forth. I believe him to be of sound mind and memory. Dated: August 27, 2014 �9 r [SEAL] Notary Public 'OFFICIAL SEAL" Maureen A. Moran Notary Pubk, State of Illinois My Commission Expires June 16 X15 F FLORIDA, COUNTY OF DADE HEREBY CERTIFY that this ,s a true copy of the "!Qlnal filed ,n this office on day of J _ 1 'IAIESS my hand d Olhc+a! Seal. } VE VIN, C F,c.(, c, ut d cou fy Duns c. Miami Shores Village Building Department CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. --2X—COPY OF QUALIFIER'S STATE LICENCES B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE* 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 D. X COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) IF CONTRACTOR HAS A MIAMI 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 Compensation EXEMPTION must have NOTICE TO OWNER Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33136 Certificate must specify the description of operations or contractor license number. rwrrrrwrrrrrrwrrrrrarrrarrrrrwrrrrwwrwrrrwrwrraarrrraararrrwarwrrwrraaraaraaararwwwawawwrw� BUSINESS NAME: Ibex Tech Corporation BUSINESS ADDRESS: 12355 SW 129 CT Ste 3 CITY M I a I" Yi I STATE FL ZIP 33186 BUSINESS PHONE: 7c 86) 2424930 FAX NUMBER Ll -848-371-0441 CELL PHONE ( 305) 8752598 _ QUALIFIER'S NAME: Eduardo K. Perez QUALIFIER'S LIC NUMBER: EC13002186 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD k EC73 ISS ISSUED: 08117=14 DISPLAY AS REQUIRED BY LAW SEO N L1408170003M Ibex Tech Corporation CERTIFICATE OF LIABILITY INSURANCE �.vvr-rcwl�rti 8DATE(MMA) 4D/"'"' 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 FINANCIAL AFFAIRS CORPORATION 1405 SW 107th Ave #201C Miami, FL 33174 A037643 W.CT MIRIAM CABEZA PHONE (305)221-4911 v x:(305)d35 -MAIL me eza inancia a airs.us INSU S AFFORDING COVERAGE -SCOTTSDALE INSURANCE COMPANY INSURED IBEX TECH CORPORATION 12355 SW 129 CT, SUITE 3 MIAMI, FL 33186 305-525-0777 INSURERB: MAPFRE INSURANCE COMPANY BRIDGEFIELD CASUALTY INSURANCE COMPANY INSURER D : F - I :d �NSUREU fl -w I IMIr-'A I � NII IAAQCU- MMII0J^kt kII IIAMCM. 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 BYPAID CLAIMS. CTR TYPE OF INSURANCEPOLICY EFF POLICY EXPLIMITS LIMITS X COMMERCIAL GENERAL UABILITY CLAIMS -MADE ® OCCUR EACH OCCURRENCE 11000,000 pp $ 100 ,050 MEDEXP An one n $ 5,000 A CPS2068141 08/16/14 8/16/15 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG s 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ r r ow BODILY INJURY (Per person) $ ANYAUTO ALL OWNED iDULEDBAUTOSCHEDULED X � NON -OWNED HIRED AUTOS AUTOS CA1201618 05/19/14D5/19/15 BODILY INJURY (Per accident) $ M $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE $ C WORKERS COMPENSATIONR AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIEXECUIlVE Y OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If describe under N/A 196-15947 08/05/1408/05/15 O X I STA LITE TK E.L. EACH ACCIDENT 1 OT' -000 $ E.L. DISEASE - EA EMPLOYEE $ 100,000 Y LIMIT 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ELECTRICAL CONTRACTOR ADDITIONAL INSURED CLAUSE AND WAIVER OF TRANSFER OF RIGHTS APPLIES TO CERTIFICATE HOLDERS IF REQUIRED BY WRITTEN CONTRACT PER TERMS AND CONDITIONS OF ENDORSEMENTS CG2033; CG2404 AND GLS295S VEHICLE : 2004 DCX SPRINTER 25004X2 VIN #WD2PD144245705931 PG/ MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2014/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITti.!lJJ,9Q1-LrY PROVISIONS. ©1988-2014 ACORD CORPORATION. All dahts reserved. The ACORD name and logo are registered marks of ACORD