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MC-14-981Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-212422 Permit Number: MC -5-14-981 Scheduled Inspection Date: December 10, 2014 Permit Type: Mechanical - Residential Inspector: Perez, JanPlerre Inspection Type: Final Owner: , Work Classification: A/C Replacement Job Address: 96 NW 92 Street Miami Shores, FL 33150 - Phone Number Parcel Number 1131010160070 Project: <NONE> Contractor: CAMACHO MECHANICAL CONTRACTOR LLC Phone: (305)696-5456 Building Department Comments REPLACE AC UNIT 3.5 TON Infractio Passed 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 09, 2014 For Inspections please call: (305)762-4949 Page 4 of 43 s Miami Shores Village _ 1 ° Building Department MAY 142014 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 BY INSPECTION LINE PHONE NUMBER: (305) 762-4949 -~ �u FBC 20P BUILDING Master Permit No. PERMIT AP LTCATION Permit No. 14L /L/^ BUILDING 0 ELECTRIC Ej ROOFING . EVISION Ej EXTENSION RENEWAL PLUMBINGME L � PUBLICWORKS E] CHANGE CONTRACTOR CANCELLATION SHOP DRAWINGS JOB ADDRESS: �96A S�2 City: Miami Shores County: Miami Dade Zip: za'�vg; D Folio/Parcel#: l/B JQ/D1 &0V 7 (2 Is the Building Historically Designated: Yes NO .14T Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder):/4t2�� !�®� � � it Phone#: ao'!5' %72 —45-a.915( Address: S-1(45 4F42 22— City: State: 2R19M / Zip: -7>W2 -- or Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: nk\m 94'Lq'-. Mo A � ice" -,a[ cb Phone#:�_bcml 615 `14 Address: % G 9,=S0 is" 1 M C, _t City: V-� th, k State: L, Zip: Qualifier Name: L w. --. C!. A: l,Vacsk� Phone#:��05��(®�s�5a State Certification or Registration #:C Ka 12 Aq!l 2 re Certificate of Competency M _ DESIGNER: Architect/Engineer: 4f-ef l��r� �� Phone#: Value of Work for this Permit: $ Sqi Type of Work: ❑ Addition ❑ Alteration ❑ New Description of Work: Submittal: Fee $ Scanning Fee $ State: Zip: Footage of Work: Repair/Replace ❑ Demolition Permit Fee$ CCF $ CO/CC $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ 3 l 4 • �� 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 t 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 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. n Signature " -S Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this 9 The foregoing instrument was acknowledged before me this /® day of ° g20;by hominy®Utr E}.S1'e2yof #7411 .20,bylQGh who is pers ly kn n to me or who has produced dA '-who is petsonally known to me or who has producedqd&V4 + # e_ PrtS e 1 uPRS As identification and who did take an oath. ° as identification and who did take an oath. NOTARY PUBLI NOTARY PUBLIC: Sig Sign: _ Print: Pring `�;' Y p y au�up LUIS ALFONSO M Commission Ex ii'eOn" °�= PAY GQtir>PAt ;31f�N # EC(1 1288 M Commission E i aY PVB•. EXPIRES November 11, 2016 Notary Public - State of Florida f�9re3 aox+ « .ae My Comm. Expires Apr 25, 2016 Commission # EE 174735 APPROVED BY Plans Examiner Zoning Structural Review Clerk Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012) )(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) ry—I M.—Py MEZZO Miami shores V11age Building Department 10050 N. E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR /ARCHITECT Kermit N. iQ-i H2.2216 dkees Name (Fee Simple Title Holder Phone Ownees Address: City: -LAI State : _ s Zip Code: 3-�� .lob Address (Of where work Is ging done): Wk ✓Q - Citlr: Miami Shores State: _Florida Zip Code::22aQ0 Contractors Company Name: A Phone #: aO - 969 -45bf Address: & 2.y -S'V 117 C�- City: _ d -w-('61 1L.1 ® State:d L___l,- Zip Code:_22� Qualifier's Name: _ l! a2 Lic. Number: Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: Ni 1 hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the lama Shores harmless for all legal Involymeet. Signature Signature of rtietorAgOnt W*RftorAn Nw The foregoing instrument was aknowledged before me The foregoing Instrument was aknowledged before m this day of y1A 1 .20/tL,by s AM�cl�,gs°�¢�v' this day of �Q , 20liby �y i S UV�o Is personally known to me or who has produced who Is personally known to me or who has produced aseiprderi�flcetion. 10Vd0L X11* as indentfficallon. Notary. Puc atary Pu EDt;ARDO MARTINEZ Sign: E. NERMANDEZ; ; ° L Notary Public - State of Florida NO N Rett Ign: 1 M Comm. Expires Mar 23, 2015 Seel: Iffy corm. b*ft 4Mt A q#1# �; °�%�,og��;"•` Commission # EE 76843 COMWOM 0 FF 61411 STATE OF FLORIDA DEPARTMENT OR BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH.MONROE STREET TALLAHASSEE FL 32399-0783 CAMACHO, LUIS GA24ACHO MECHANICAL CONTRACTOR LLC 1030 SW 117TH COURT UNIT #D-12 MIAMI FL 33184-2537 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.myfloridalicense.com. 1 There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments 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 licensel _._......... ____,..______ __... DETACH HERE DEP; WAT i3F f AEPARTMW FRdPTB t�+1C2249971" :�BRTIi�`�Eil�. CANACAd" ' r C 110. 1�` aCZRTInED'°t�aae� t3ie STATE. OF FLORIDA Cf'@iW'I�.��A4;�1]ZtQ:T14'QF'QQ ��741'11Y 'CFDALf�,�L"�'filRiT'A t--..^�4'�P�T1 w.r�wo.. rsw.w lb.+h wr7 .wirvvi :- Lc t�IBTNLI�S A1�i �GtIi;AT20DT #803'449 RACTQit CT�� LL [�t B t► ------SE L12.09 -x200172 I REN LAWSON SECRETARY' '� CERTIFICATE OF LIABILITY INSURANCE DA�JM 05/12/�14 Yn 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 WANED, 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 endomement(s). PRODUCER Acceptance Insurance Services 6887 S.W. 40th St. COME:NTT Rene E. Samayoa NAAC PHONE , (305)740-0515 1 Fi4lC No, (305)740-0518 -Mall rene@acceptanceinsserAces.com INSU S AFFORDING COVERAGE NAIL e Miami, FL 33155 INSURER A: Accident Insurance Company 11573 Phone (305)740-0515 Fax (305)740-0518 INSURED INSURER 0: INSURER C: Camacho Mechanical Contractor, LLC INSURER D : 1030 SW 117 Ct INSURER E: Miami, FL 33184 (305) 965-4568 AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS F-1 HIRED AUTOS ❑ AUTOSWNED ❑ ❑ 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD UB POLICY NUMBER POLICY EFF M POLICY EXP MMIDD LIMITS A GENERAL LIABILITY 0 COMMERCIAL GENERAL LIABILITY OCCUR ❑ ❑ CLAIMS -MADE [:]N F] N CPP0009120-00 07/03/2013 07/03/2014 EACH OCCURRENCE $ 1,000,000.00 GE TO RENTED PRESES Ea occurrence $ 100,000'00 MED EXP (Any one person)t $ 5,000.00 PERSONAL &ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLE$ PER: 0POLICY E]PRO- ❑LOC PRODUCTS -COMPIOPAGG $ 1,000,000.00 $ AUTOMOBILE LIABILITY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑ AUTOS F-1 HIRED AUTOS ❑ AUTOSWNED ❑ ❑ INGLE LIMIT BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (PaOPEJ rd) MAGE $ $ ❑ UMBRELLA LIAR OCCUR ❑ EXCESS UA13 ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ ❑ DED ❑ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LUU31UTY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yyes describe under DESGcRIPTiON OF OPERATIONS below N I A ❑ WC STATU ❑ OTH- ER _LIM EL EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 111, Additional Remarks Schedule, K more space is required) Air conditioning installation, service and repair CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) QF The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shone Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE �-- Miami Shores FL 33138 305-756-8972 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) QF The ACORD name and logo are registered marks of ACORD 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 aperiod 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 uemwffly liable for the worker compensation injuries of any person 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. Print Name: ✓ i► a State of Florida ) County of Miami -Dade ) Sworn to ans bscribed day of By before me this 41— ,20_N_. )TARY PLOLIC•&TATE OF FLORIDA ViN!an Santana Contractor Print Name:_�jZ/� Signature: State o Florida ) County of Miami -Dade) Sworn to and subscribed before me this y day of , 20 -PL -L. NOTARY PUBLIC -STATE OF FLORIDA B Vivian Santana (S,) Expires: �ULX 12, 2014 (SEAL) '••11.„.,.••' Expires: 3ULY 12, 2414 11 Type of Identification p Tvne of Identifiratnn nr nrt ” * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/15/2013 EXPIRATION DATE: 8/15/2015 PERSON: CAMACHO LUIS FEIN: 264593668 BUSINESS NAME AND ADDRESS: CAMACHO MECHANICAL CON 1030 SW 117 CT UNIT D-12 MIAMI FL 33184 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt Pursuant to Chapter 440.05(13), 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 certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 UNITED STATES POSTAL SERVICE 'First -Class Mail Postage & Fees Paid USPS l Permit No. G-10 • Sender`: Please print your name, address, and ZIIP+4 in this box • pr 0 ed y 00115 v lion 7- chi C°r� F�, ea /i4y o Jan 13,'2014 Re: 96 NW 92 ST Miami Springs, FL 33150 Raul Olivera Lic: CMC1249922 1117 SW 141 AVE Miami, FL 33184 We, Property Consultant Group, Corp, are writing to inform you that we will no longer be having you as Mechanical Contractor for the repairs/remodel of our above referenced property. As per current building code policy/procedure, your reception of this letter shall initiate what is the 10 day period necessary to have you removed as current qualifier. Carlos Cienfuegos Property Consultant Group, Corp 9415 SW 72 ST Miami, FL 33173