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RC-15-122Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232938 Permit Number: RC -1-15-122 'Scheduled Inspection Date: April 21, 2015 Inspector: Rodriguez, Jorge Owner: LLC, CID 1050 Job Address: 1050 NE 91 Terrace Miami Shores, FL Project: <NONE> Permit Type: Residential Construction Inspection Type: Final Building Work Classification: Alteration Phone Number (305)586-6050 Parcel Number 1132050010340 Contractor: GON GAR CORP Phone: (786)258-1213 tsuiming uepartment comments FLOOR INSTALLATION ON FIRST FLOOR. REMOVING Infractio Passed Comments OLD TILE AND INSTALLING WOOD. I INSPECTOR COMMENTS False 1/22/2015 - See Code enforcement. Work commence without permits. April 20, 2015 For Inspections please call: (305)762-4949 Page 48 of 56 Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. April 20, 2015 For Inspections please call: (305)762-4949 Page 48 of 56 BUILDING PERMIT APPLICATION Miami Shores Village Building Department JAN 20 2015 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 20 Master Permit No. C-- 15-- 2� Bond` -- Sub Permit No. `'(BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [-]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1050 N. E. 91 TER Cly: Miami Shores County Miami Dade Zia• Folio/Parcel#:11-3205-001-0340 Is the Building Historically Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: X BFE: FFE: OWNER: Name (Fee Simple Titleholder): CID 1050 LLC Phone#: 305-586-6050 Address: 10 NW 2 STREET City: MIAMI State: FLORIDA zip: 33128 Tenant/Lessee Name: Phone#: Email: MPORT075QGMAIL.COM CONTRACTOR: Company Name: E ms_ , v�- Phone#: W4ii V 12 L Address: Z GI :�: cs) -:SQL City UJD� State: Zip. s Qualifier Name: ® 4 i/ l -L t LA Phone#: State Certification or Registration #: Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Q MO&RcZA bsC� k A S — DC,,,Jfvf4Wj il'UUM s �\ X (9 �•�y �i:'� Specify color of color thru Submittal Fee $ Permit Fee $GL—�,CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ (Revisedo2/24/2014) 1MC41 N S S4 Bond $ ` TOTAL FEE NOW DUE $ 1 38. 5 6 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 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 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 ee will be charged. Signature Signature ER or AGENT CONTRACTOR The /foregoing instrument was acknowledged before me this day of V LGA 20 � by ✓✓— L C o personally know to me or who has produced identification and who did take an oath. NOTARY PUBLIC: W as The foregoing instrum t was acknowledged before me this Z� day of 20 15 , by G%2fio is personally known to me or who has produced as Identification and who did take an oath. NOTARY PUBLIC: Sign: r` Sign:_ w Print: Print: Seal: Coglm,lE Jul $bf817 Seal - ha 00 0 lF y D47,; a�a APPROVED BY 5 Cy_ Plans Examiner (Revised02/24/2014) Structural Review Nowy Pubuc - State My Comm. Expires Jul Commission #F FF a Zoning Clerk GARCIA, ALBERTO GON GAR CORP 2201 SW 5 PL FORT LAUDERDALE FL 33312 Congratulationsl 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 STATE OF FLORIDA from architects to yacht brokers, from boxers to barbeque restaurants,DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. +� PROFESSIOkkIAL R DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1504678 The GENERAL CONTRACTOR ❑ ❑ ISSUED: 07/24/2014 niRp1 AY AR R;=01 IIPI=n RV I AW qFn a 11AMIAMM'"o E=GULA1'�ON Every day are work to improve the wray we do business in order to CGC1504678 ISSUED: 07/24/2014 serve you better. For information about our services, please log onto www.myfloridalloonse.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newslettersand learn more about the Department's CERTIFIED GENERAL CONTRACTOR GARCtA, ALBE12'O initiatives. G ON GAR CORP Our mission at the Department is: Ucense 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! IS CERTIFIED under the provisions of Ch.488 FS. E pUstkm date : AUG 31, sols L146724MO1239 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1504678 The GENERAL CONTRACTOR ❑ ❑ ISSUED: 07/24/2014 niRp1 AY AR R;=01 IIPI=n RV I AW qFn a 11AMIAMM'"o • B OWA RiD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER `I, 2014 THROUGH SEPTEMBER 3o,2011.5 DBA. GON GAR CORP Receipt $x:180-7391 Business Name: Business Type: GENERAL CONTRACTOR (GENERAL CONTRACTOR) Owner Name: ALBERTO GARCIA Business Opened:12/21/2006 Business Location: 2201 SW 5 PL Sitafe/County/Cert/Reg:CGC1504678 FT LAUDERDALE Exemption Code: Business phone: 786-258-1213 Rooms Seats Employees Machines Professionals 2 For Vending Business only Number n¢ fl11ar_hinac• Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT DUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: ALBERTO GARCIA 2201 SW 5 PL FORT LAUDERDALE, FL 33312 Receipt: #05A-13-0-0010841 Paid 09/08/2014 27.00 A ®_ CERTIFICATE OF LIABILITY INSURANCE °" 1/12015 THIS CERTIFICATE IS ISSUED AS A MATTER OF gdFORMATiON 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. RIIPORTANT: If the certificate bottler Is an ADDITIONAL INSURED, the poHcypes) must be endorsed. R SUBROGATION IS WAIVED, subject to tre terms and conditions of lire policy, certain policies may require an endorsement. A statement on ids certi8ceta does not confer rights to the certificate holder In lieu of such M&reemangs PRODUCER ULA111. MARTA M ALONSO Florida Bankers Insurance 7275 SW $ Street Miami, FL 33144PRODUCER PHONE 256-6483- FM 262-0678 ffitt (305)ADD marta@fl0 -Oom GL -0504010824-1 Phone (305)266-6493 Fax 0262-0679MISURER�AFFORDING COVERAGE wuCo Dretm® [NSURER A : FEDERAL NATIONAL INSURANCE COMPANY GONGAR CORP. INSURER B : INFINITY INSURANCE COMP. _ USURER C: 2201 SW 5 PL IN"Er D: FT LAUDERDALE, FL 33312 USURER E: (VA) 577-8815 AUTOMOBILE UABILITY ❑ ALL ANY WN ❑ AUTOS SCHEDULED HF_EDULED AUTOS © SC ❑ HIRED AUTOS ❑ MON-OWNEDAUTOS ❑ N RISDRER 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. NSH LTR TYPE OF Q+�URANCE A eM WVD POLICY NUMBER POLICY EFF Lam A GE'1ERAIRAL LUIBIUITY Q COMMERCIAL ERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE © OCCUR F1- Y N GL -0504010824-1 0/15/2014 06/15P2415 EACH OCCURRENCE $ 1,000,000.00 PREMISES Ea p=mw=1 $ 100,000.00 MED EXP (Any one) $ 5,0w.00 PERSONAL & ADV IW1RY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,001,000.00 GEML AGGREGATE LIMIT APPLIES PER: 0_ POLICY ❑� L1 Loc PRODUCTS - COMPVOP AGG $ 2,000,000.00 $ AUTOMOBILE UABILITY ❑ ALL ANY WN ❑ AUTOS SCHEDULED HF_EDULED AUTOS © SC ❑ HIRED AUTOS ❑ MON-OWNEDAUTOS ❑ N --- 509800012351-001 08/15/2014 08/15/2015 COMBINED SINGLE LIMIT $ (Ea aaddeM BODILY INJURY (Per perm) $ 25,000.00 BODILY INJURY (Per acddarl) $ 501000,00 __ (Per decd wMDAMAGE $ 25,004.00 $ $ ❑ UMBRELLA LIAB ❑ OCCUR -- ❑ EXCESS LIAR ❑ CLAIWMWE — EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE REr@ mN s $ $ WORKERSCOMPENSATION AND EMPLOYERS' LABILITY Y/14 ANY PROPRIETORlPARTNEWDtECUTIVE OFRCERfMEMBER DCCLUDED? I my M Wo DESCRIP OF OPO ERATIONS blow %U GrH- WST E.L. EACH ACCIDENT $ EJ_ DISEASE - FA EMPLOYE $ FJ DISEASE - POLICY umrT I $ DESCRPTWN OF OPERATIONS I LOCATIONS! VEIaCLES (Attach ACORD 101. Additional Ronaft Sdwdaie, N mom Is required) CERTIFIED GENERAL CONTRACTOR LIC # CGC 1504678 CERTIFICATE HOLDER CANCELLATION ®19W2W9 ACORD CORPORATION. All ftft reserved. ACORD 25 (21XIO/W) OF The ACORD creme arm logo are mgbared marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT MIAMINE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2ND AVENUE ACCORDANCE WITH THE POLICY PROVISIONS` Miami shores, Florida 33138 AUTHOR� REPR�E+Ii`AT11iE - "- �•AI•,.« - _r 117187. bmp ®19W2W9 ACORD CORPORATION. All ftft reserved. ACORD 25 (21XIO/W) OF The ACORD creme arm logo are mgbared marks of ACORD a • . urvtatum ur vvumi%r- z uumt r-m,-jAIFum ,* * 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: 1/26/2015 EXPIRATION DATE: 1/25/2017 PERSON: GARCIA ALBERTO FEIN: 270021977 BUSINESS NAME AND ADDRESS: GON GAR CORP 2201 SW 5TH PL FORT LAUDERDALE FL 33312 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL LICENSED PLUMBING LICENSED ROOFING CONTRACTOR CONTRACTOR CONTRACTOR 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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (650)413-1609 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 . f: 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 and acknowledges that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.. Therefore, You may be Personally liable for the worker compensation iniuries 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 Na Signatur State of County of Miami -Dade) Sworn to and subscribed before me this Owner Contractor Print Name: State of Flon`da ) County of Miami -Dade) Sworn to and subscribed before me this day of .20 1 r GON GAR CORP GENERAL CONTRACTORS 2201 SW 5 Place - Fort Lauderdale, FL 33312 02.20.2015 State of Florida County of Miami Dade a Before me this day personally appeared ��� CDPWCAA who, being duly sworn, deposes and says: I, Alberto Garcia the Qualifier for GON GAR. CORP, certify that I will be the only Person performing work at the property located at: 1050 NE 91" Terrace, Miami Shores, FL 33138 Sworn to (o affirmed) and subscribed before me this day of�U,10442015, by Personally know OR Produced Identification Type of Identification Produced Print, Type V r ` 11 ""ft •flame of Fulda .' r fl10" JW 25, 1T ,,a 1gOp +t FF 0398 <wr 1 ,( ��jjpp 't ,(�r� �W v�.e��' �!. is }aA�a'1 -',€da �PM��y�►��"�.n� ttte ti^` ;aha;. :�` ¢�q �� Sep$