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EL-14-1279Miami Shores Village JUN 18 2014 Building Department; 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. E� ✓`% /� PERMIT APPLICATION Master Permit No.& FBC 20 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Gonzalez Reid Phone#: 305-933-0683 .,,-----290 NE 95 Street City: Miami Shores Tenant/Lessee Name: Email; JOBADDRESS: 290 NE 95 Street City: Folio/Parcel#: State: Fl uni Shores y County: �r�l7 " i Is the Building Historically Designated: Yes NO V Flood Zone: CONTRACTOR: Company Name: L S Curtis inc Phone#: Address: 20341 NE 30 Ave #108 City.. Aventura State: FL Qualifier Name: Lewis S Curtis Phone#: EC0003175 State Certification or Registration #: Certificate of Competency #: Contact Phone#: 786-486-1961 Email Address: aasteve@aol.com DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $_I 0 0 0 . 0 0 Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: Kitchen appliance 33138 33138 786-486-1961 33180 786-486-1961 ❑Alteration ❑New ❑Repair/Replace ❑Demolition counter top receptacles, lights, switches and Submittal Fee $ Permit Fee $ X_i_02,0 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I `1 �t.- It ` 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 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 a r the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee wa le charged. e Signature Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this _16 day of . , 201H, by L I je l , ;; ��e . who is personally known to me or who has produced . 5-3 3 6 19 As identification and who did take an oath. NOTARY PUBLIC: The foregoing instrument was acknowledged before me this2nd day of June 2014 , by Lewis Curtis w Personally known to r who has produced as identification and who did take an oath. NOTARY Sign: ( Sign: rid® Print: ` ASSANDRA a NEs stem of doable M FeQele+►o MY COMMISSION S EE219418 My Commis My Commi es: EXPIRES July 28, 2016 ' My Gomrttlalon FF 0®2793 , APPROVED BY �1 Plans Examiner Zoning Structural Review Clerk (Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) L3 LOOLi[Mll to] *9 N *1611 Miami shores V BuildingDepartment 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tei: (305) 795.2204 Fax: (305) 756.8972 ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■■eeeeeseeeeeseeeeeeeeeeeeeeseeeeeeeeeeeesoeaeeeeeeeeese■■eeeeeseeeeeeeeeeee■e■®�eereeeeere COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: L S Curtis Inc BUSINESS ADDRESS: 20341 NE 30 Ave 108 STATE FL ZIP CODE 33180 CITY Aventura BUSINESSPHONE: 3( 05 )892-0115 FAX NUMBER3( 05 )932-1009 CELL PHONE 7( 86 ) 486-1961 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: EC0003175 E-MAIL ADDRESS (IF APPLICABLE): Created on 3M 9109 BY MLDV 1 RV 3126109 MLDV aasteve@aol.com Lewis Curtis DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 NORTH MONROE-STREET TALLAHASSEE FL 32399-0783 CURTIS, LEWIS STEVEN L. S. CURTIS INC 20341 NE 30TH AVE AFT 108 AVEVTURA FL 33180 Congratulationst 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.myfloridalicelise.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, (850) 487-1395 STATE OF FLOMA AC # 6133936 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ECO003175 05118112 118186995 CERTIFIED ELECTRICAL CONTRACTOR CURTIS, LEWIS' St,T' L.S. CURTIS INC Out mission at the Department is: License Efficiently. Regulate Fairly, We constantly strive to serve you better so that you can serve your customers. I IS CERTIFIED under the provisiono ®z C4.489 Ps Thank you for doing business in Florida, and congratulations on your new license! t' uxpirtion date, AUG 31, 2014 L120SIB00884 DETACH HERE v 1_6A K lqpgd,� 7 AC#6133936 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ#L12051800884 SATCHNUMSERLICENSE NBR 05/ 8/20121118186.995 IECO003175 The ELECTRICAL CONTRACTOR RICK SCOTT KEN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW AC40RVrCERTIFICATE OF LIABILITY INSURANCE DATE (/20/1YYYY) 111/20/13 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 cert ficate 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 Insurance Industries CONTACT STACY PARKS ME: PNGNEjAjcN, • (305)891-2808 Fvc Na; (305)891-6367 -MAIL stacy@insuranceindustriesinc.com 953 N.E. 125th St. _ _ INSURERS AFFORDING COVERAGE NAIC # N. Miami, FL 33161 INSURERA: SCOTTSDALE INSURANCE CO Phone (305)891-2808 Fax (305)891-6367 INSURED INSURER B: INSURER C: LS CURTIS INC. INSURERD:_-- 20341 NE 30 Ave #108-6 INSURER E: AVENTURA, FL 33180- (305) 892-W 15 .---- AUTOMOBILE LlpglllTy ❑ ANY AUTO ❑ AAL OWNED r-7SCHEDULEDBODILY ❑ HIRED AUTOS UTOS L❑J AAUUTOO S NED ❑ 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. INSR LTR TYPE OF INSURANCE ADD UB POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A GENERAL LIABILITY u COMMERCIAL GENERAL LIABILITY r-1 F1CLAIMS-MADEQ OCCUR ❑ Y CPS188037 11118/2013 11118!2014 EACH OCCURRENCE $ 1,000,000.00 GE TO RENTED PREM SES Ea occurrence) $ 100,000.00 MED EXP (Any one person $ 5,000.00 PERSONAL 8 ADV tVJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEWL AGGREGATE LIMIT APPLIES PER: ❑ POLICY ❑ jEa ❑ LOC PRODUCTS - COMPIOP AGG $ 1,000,000.00 -- $ -------.. .---- AUTOMOBILE LlpglllTy ❑ ANY AUTO ❑ AAL OWNED r-7SCHEDULEDBODILY ❑ HIRED AUTOS UTOS L❑J AAUUTOO S NED ❑ -- SINGLE LIMIT COMBINED Ea ccident a BODILY INJURY (Per person) $ INJURY (Per accident $ Pera den DAMAGE $ $ ❑ UMBRELLA UAB ❑ OCCUR ❑ EXCESS LIAB ❑ CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ Ej DED ElRETENTION $ _ $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOMPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) El If yess describe under DESCRIPTION OF OPERATIONS below N I A STATU-ITS 1:1OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) ELECTRICIAN CERTIFICATE HOLDER IS ALSO ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2 AVE MIAMI SHORES, FL. 33138 ACORD 25 (2010105) QF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. O 1988-2010 ACORD CORPORATION. All rlgntS reserveO. The ACORD name and logo are registered marks of ACORD NPP CERTIFICATE OF LIABILITY INSURANCE R054 DATE(MM/DD/YYYY) 4/24/2014 THIS CERTIFICATEIS 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(ies) must be endorsed. If SUBROGATIONIS 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 endorsement(s). PRODUCER AUTOMATIC DATA PROCESSING INS AGCY CONTACT NAME: PRONE Fax (ac, No, Ext):(Arc. No): 250717 P: F: ADDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAME! SAN ANTONIO TX 78265 INSURER A: Twin City Fire Ins Co INSURED INSURER B. INSURER C: CLAIMS -MADE OCCUR L. S. CURTIS INC. INSURER D: 20341 NE 30TH AVE APT 108 INSURER E: AVENTURA FL 33180 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. INSR TYPE OF INSURANCE ADDL SUBR HYD POLICYNUMBER PO� EFF POUCYEXPLIN LlAIITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENI. AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY a JE Q [_1 LOC PRODUCTS -COMP/OP AGG g OTHER AUTOMOBILE LIABlLI1 LIABILITY SINGLE LIMB $ (Ea accident) BODILY INJURY (Per person) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per aoadem) PROPERTY DAMAGE (Per accident) $ NON -OWNED HIRED AUTO AUTOS UMBRELLA LUIS OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAR CLAIMS -MADE DED RETENTION S WORHERSCOALPENSAT/ON AND EMPLOYERV IJ"ILM X PER ATH - STATUTE E _ E.L. EACH ACCIDENT 11,000,000 ANY PROPRIETOMPARTNERS(ECUTIVE YIN A OFFICER/MEMBER EXCLUDED? (AandatoryInMR El N/A 76 WEG TR9959 05/01/2014 05/01/2015 E.L.pisEASE-EA EMPLOYEE 11,000,000 If yes, describe under [DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT 11,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Those usual to the Insured's Operations. rs:o,nmrATF unl nF:p CANCELLATION V 7bGtI-LU'14 A[;UKU I:VKrVKA l IVty. can ngF" reserveu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Miami Shores Village g BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORZED REPRESENTA TIVE Building Department 10050 N.E. 2nd Ave. Miami Shores, FL 33138 V 7bGtI-LU'14 A[;UKU I:VKrVKA l IVty. can ngF" reserveu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ORDER FORe FL SS1-U 2014 Space Saver -1 All -On -One Florida and Federal Labor Law Poster $9.95 LAM Please laminate the poster(s) I'm ordering for an additional $10.00 each $10,00 Moreno, Owner/Manager SYM Investments Inc ❑ Check Enclosed Check #: Check Amount: $ ❑ Bili My Company Subtotal: SYM 325 NE 126th St ❑ VISA ❑ MC ❑ AMEX ❑ Discover North Miami, FL 33161-4609 Ftp. Date Shipping & Processing: $5.95 acct # m m Mo. Yr. TOTAL Name: Signature Required: Please emer your phone number for proper issuance of your Call for Information $17,000 Certificate of Compliance. Email Address: Fax: on Spanish posters Personnel Concepts P.O. Box 3353, San Dimas, CA 91773-7353 0 600/333-3795 • Fax 600/760-1190 • www.pemonnekmmpte.com Detach and return in envelope provided. _ PIN#: P063776958 J7e4694=14061 _........................................................................................................................................................................... Ref. No,: P23980 ALER You Must Post Revised Florida • Federal Notices Company Information (Please correct out-of-date Information. Use enclosed envelope.) Company: SYM Investments Inc Owner/Manager. Mauricio Moreno Address: 325 NE 126th St City, State, Zip: North Miami, FL 33161-4609 Phone: Description: General Compliance For. State of Florida I Florida Notices Included: If any of these notices are not posted/current or are damaged/defaced, then order your 2014 SSI. FL Minimum Wage (Effective 1/1/2014) FL Unemployment Compensation FL Workers' Compensation Notice FL Discrimination FL Child Labor Law Failure to comply with posting regulations can lead to fines up to $17,000 (29 USC Sec. 666 0)) & (29 USC Sec. 2005). Return this forth In the enclosed envelope to bring your business into compliance, lFederal Notices Included: I If any of these notices are not posted/current or are damaged/defaced, then order your 2014 SS below. Employee Polygraph Protection Notice (REVISED 1/2012) OSHA 3165 'It's the Law" Notice (REVISED 3/2012) Equal Employment Opportunity Is the Law Notice (NEW GINA REGULATIONS EFFECTIVE 1/2011) IRS Notice 797 (REVISED 12/2013) IRS Notice of Wdhholding/Eamed Income Credit (REVISED 12/2013) Federal Minimum Wage (RELEASED 1/24/20D9) USERRA Rights and Benefits Notice (REVISED 11/08) Family and Medical Leave Act -- for employers of 50 or more employees (REVISED 2/2013) U.S.C.I.S. Discrimination Notice Employee "Right to Know" Notice Emergency Numbers Payday Notice