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MC-15-1197Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-235042 Permit Number: MC -5-15-1197 Scheduled Inspection Date: May 26, 2015 Inspector: Perez, JanPierre Owner: ONDARTS, SEBASTIAN Job Address: 726 NE 92 Street 5-L Miami Shores, FL Project: <NONE> Contractor: COOLING AMERICA Building Department Comments Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060440430 Phone: (786)715-0662 REPLACE 1 WALL AC UNIT IN LIVING DINING ROOM Infractio Passed comments INSPECTOR COMMENTS False v� 12-4lis Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid May 22, 2016 For Inspections please call: (305)762-4949 Page 23 of 42 Owner Information Address Phone Cell SEBASTIAN ONDARTS 726 NE 92 Street Miami Shores FL 33138- 726 NE 92 Street Miami Shores FL 33138- Contractor(s) Phone Cell Phone COOLING AMERICA (786)715-0662 REPLACE 1 WALL AC UNIT IN LIVING DI mal Info: fication: Residential ved: In Review Denied: nine: 1 Fees Due Amount CCF $0.60 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.20 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 Date Approved:: In Review Type of Work: Valuation: $ 200.00 Total Sq Feet: 0 Pay Date Pay Type Amt Paid Amt Due Invoice # MC -5-15-55634 05/22/2015 Cash $ 58.60 $ 50.00 05/20/2015 Cash $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate at all wp be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-named contracto to do thSwork ated. oy May 22, 2015 Authorized Signature: Owner / Applicant / Contractor / Building Department Copy OWNER: Name (Fee Simple Titleholder): Sebastian Ondarts Phone#:S q ,34 9 4 4 e q1 Address: S 4 Al 14 LL—J A-ev 4)/,Lb 15-!1' 6 City: 19'r ' bL State: RQC-7�10 VS At 2 C S Zip: Tenant/Lessee Name: Peter Hoefler Phone#: 786-201-3951 Email: peterhofler@hotmail.com CONTRACTOR: Company Name: A"1 Ac.i irk rpt 614 ee-3 ., %L, A'J1r-"k-4Phone#: � S'�P �-5 e'� � Address: City: �,��!/%GLA�?t��� State: FL Zip: Qualifier Name: 7LPbv P,4,40, J/9 Phone#; 41 4-e State Certification or Registration #: ) Certificate of Competency #: - DESIGNER: Architect/Engineer: Address: City: Value of Work for -this Permit: $ 0" �4 o Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition 6 _ Description of Work: 0✓S' r -s < L h'fC �` �) '—_� 2 i Specify color of color thru tile: p Submittal Fee $ , Permit Fee $ �� " CCF $ COAC $ a Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE $ 5 . � .a 0 Miami Shores Village g v� MAY 19 2015 Buildln De artment 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 n BUILDING Master Permit No. f�l C'� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑ PLUMBINGECHANICAL Om F-1PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 726 NE 92 St #51- 5LCity: City:Miami Shores County: Miami Dade Zip: 3 1 Folio/Parcel#: f 3 Z - O.% ` C " Dr O Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Sebastian Ondarts Phone#:S q ,34 9 4 4 e q1 Address: S 4 Al 14 LL—J A-ev 4)/,Lb 15-!1' 6 City: 19'r ' bL State: RQC-7�10 VS At 2 C S Zip: Tenant/Lessee Name: Peter Hoefler Phone#: 786-201-3951 Email: peterhofler@hotmail.com CONTRACTOR: Company Name: A"1 Ac.i irk rpt 614 ee-3 ., %L, A'J1r-"k-4Phone#: � S'�P �-5 e'� � Address: City: �,��!/%GLA�?t��� State: FL Zip: Qualifier Name: 7LPbv P,4,40, J/9 Phone#; 41 4-e State Certification or Registration #: ) Certificate of Competency #: - DESIGNER: Architect/Engineer: Address: City: Value of Work for -this Permit: $ 0" �4 o Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition 6 _ Description of Work: 0✓S' r -s < L h'fC �` �) '—_� 2 i Specify color of color thru tile: p Submittal Fee $ , Permit Fee $ �� " CCF $ COAC $ a Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) Double Fee $ Bond $ TOTAL FEE NOW DUE $ 5 . Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) None Mortgage Lender's Address N/A city N/A State N/A Zip Zip NIA 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 IMPROVEMEN�SITO YO-Uf( PROPMTV.`-(F-IOU 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 $250, 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 a absence of such posted notice, the inspection will not be approved atW a reinspection fee will be charged. /f Signature Signature `R or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this 001, day of �/LGl-� , 20 r S , by who is personally known to me or who has produced * SS 2,0 4T as identification and who did take an oath. NOTARY PUBLIC: &.e—' Sign: Print: —r Irk &AAA& S . /L4,1 — —'L Seal: APPROVED BY (Revised02/24/2014) THOMAS S MARX MY COMMISSION #FF1 mn EXPIRES Jun® 15, 2018 7-Lil The foregoing instrument was acknowledged before me this day of 0� , 20 0 . by who is personally known to me or who has produced t=om as identification and who did take an oath. NOTARY PUBLIC: Sign: Print' Seal: ans Examiner Structural Review ******************************* Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PADILLA MARTIN, JULIO COOLING AMERICA 1831 BUCHANAN ST HOLLYWOOD FL 33020 Cbngratuiations! "With this license you become orte-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 toimprove the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.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! DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND •_ PROFESSIONAL REGULATION CAC1817050 ISSUED: 06/11/2014 CERTIFIED AIR COND CONTR PADILLA MARTIN, JULIO COOLING AMERICA IS CERTIFIED under the provisions of Ch.489 FS. Expira8on date : AUC -SI -2016 L14'5',10=745 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING R0ARn CAC1817050 rk rI A00 O AID / 1-%ILIM -r ^,k-- -_ ,.- _ -IN IN vvAwi I IViYIIYV VVIV 1 rx^t., I UM Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 PADILLA MARTIN, JULIO COOLING AMERICA 1831 BUCHANAN ST HOLLYWOOD . FL 33020 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL -DO NOT PAY 6997200 LBT BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES COOLING AMERICA RENEWAL SEPTEMBER 30, 2015 DOING BUS IN DADE CO 7272727 MIAMI, FL 33000 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED MACIVER ENTERPRISES -196 GENERAL MECHANICAL BY TAX COLLECTOR CONTRACTOR 75.00 07/21/2014 Worker(s) 1 CAC1817050 0221-14-0046551 This Local Business Tax Receipt only confirms payment of the Local Business Tex. The Receipt is note license, permit, ora certification of tbe holder's qualifications, to do business. Holder must comply with anygovernmental or nongovernmental regulatory maws and requirements which apply to tits business. The RECEIPT N0. above mast be displayed on ell commercial vehicles- Mimnl-Dade Code Sec 8a 276. MIAW® For more infomtation,visit www demidadeamftudectar i- rom :.l I menez ins. 305 264 5382 05/19/2015 08:30 #921 P.001/001 _ CERTIFICATE OF LIABILITY I DATE(MM/DD/YYYY) _ _ _ _ _ __ _ INSURANCE i_ __, _ I 05/19/15 THIS CERTIFICATE IS ATE DOES NOT AFF ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON WE CERTIFICATE HOLDER THIS HE POLICIES BELOW. CERTIFITH S CERTIFICATE OF INSURANCE DOES A OT CONSTITUTE A CONTRACT BETWEEN THE IISSSUING INSURER(S)GE AFFORDED BY TAUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: N the certiflcata holder is an ADDITIONAL INSURED, the Pollcy(ies) must be endorsed. IfSUBROGAT)ON 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 endorsament(s). _ --- _ -- fPRODUCER -.N--T Jimenez & Co., Inc. 8000 Coral Way Miami, FL 33155 Phone (305)284-9900 — Fax305 264-5382 INSURED - _�-------- MACIVER ENTERPRISES LLC DBA COOLING AMERICA COOLING AMERI 1831 Buchanan St NAME:_ PHONE �_&p,- d).—(305) 264-9900— 305 2. _ . (� Nvk_.__. ) 64-5382 �- JUIIO Iimenezandconipanycom — tNSURER(S) AFFORDING COVERAGE i —_ — —._�MC q .--t CYPRESS PROPERTY & CASUALTY INSURANCE '. Hollywood. FL 33020786-715-0662 --------..._.-.... _--- ---...- INsuRER is : —T— " r INSURER rCOVERAGES CERTIFICATE NUMBER: —THIS F : - ___ _ REVISION NUMBER: _ IS YO CERTIFY THAT THE POLICIES OF (N8URAlJCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POL1C1' 1�ERIOD ^' INDICATF�. NOTWITHSTANDING RNY 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. ADDL'SUBR� _..._ _----.._.. LTR TYPE OF INSURANCE IigR i I POLICY NUMBER POLICY EFF POLICY EXP I-- -'- —t —y �— - — - - -- _.. �(MM/Dp/YYYYMM�DD[YYY-jY j GENERAL LU161UTY -- © COMMERCIAL GENERAL LIABILITY LIMITS _ --- _ - i I �, EACH OCCURRENCE 100,000.00 i A : ❑ ElCLAIMS-MADE OCCUR GFL102179702 DAMAGE TO RENTED .$ 100,000.00 I I --- j ❑ _ MED Exi? (qne perste g 5A0 0 0.0 j 02/02/2015 1 02/02/2016 ' - _ PERSONAL 8 ADV INJURY $ 100,000.00 GEN'L AGGREGATE LIMIT APPLIES PER; I POLICY ❑ PRO- ❑ LOC I —� 1! GENERAL AGGREGATE $ 100,000.00 - f — ---- _ ---- j 7 I I PRODUCTS-COMP/OPAGG $ 100,000.00 �— ------ . _.-JEC.T_.._ _ ... F --•"- I AUTOMOBILE LUIHILny ' ❑ ANYAUTO TO�MBINED SINGLE LIMn'- ' ALL OWNEDSCHEDULED ` U AUTOS ❑ AUTOS ! ! BODILY INJURY (Per Person) t$- -- i ❑ NON—OWNED AUTOSE]AUTOS BODILY INJURY(per ccident) $HIRED — AMAGE ($ �❑ UMBRELLA UAB ❑ OCCUR rd� 1$ i ❑❑ EXCESS LIAR__ ❑ CLAIMS j I ! - - ---! LEACH OCCURRENCE -MADE DED n RETE ION �I AGGREGATE `WORKERSCOMPENSATION -...._._.—•----- AND EMPLOYERV LIABILITY Y I N! ANY PROPRIEfOR/PARTNER/EXECLrTryE OFFICER/MEMBER EXCLUDED? - ' - - — - WC STATU ❑OTB i - T�$Y. Li1411T�9__ -- �R ,• j -_-- I N / A (Mandatory In NH) i Hyye�sPT, describe under I -- I EL EACH ACCIDENT _ -._ I $ - M�- �_ --- DESCRIION OF OPERATIONS below f -)_.___ E L DISrAS i -- 1 - CA EMPLOYE;; $ � ^ POLICY LIMIT:.$ ++I iDESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace is required) * AIR CONDITIONING INSTALLATION, SERVICE OR REPAIR*** *LICENSE # CAC1817050*** CERTIFICATE HOLDER CANCEL -TION MIAMI SNORES VILLAGE BLDG DEPT SHOU AN O E OVE DESCRIBED POLICIES BE CANCELLED BEFORE ! 1 THE P1 i0 A !THEREOF, NOTICE WILL BE DELIVERED IN i 10050 NE 2 AVE f ACC DAN E ITH E POLICY PROVISIONS. MIAMI SHORES, FL 33138 - --•- - _ _- _ j SA � FAX:305-758-8972 AUTHO IZ D ENT - i ACORD 25 (2010/06) QF ®1 8-2010 ACORD CORPORATION. All rights reserved. ORD name and 1090 are registered marks of ACORD Report Viewer .. P 'IR -s =11 To ()-%- ' CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WOFMRS• COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This Certifies that the mclIvWual laded below tuts elected to be exempt from Florida Workers' Compensation IoW. EFFECTIVE DATE: 1/142014 EXPIRATION DATE: 11142016 PERSON: PADILLA JULIO SR FEIN: 270526941 BUSINESS NAME AND ADDRESS: MACIVER ENTERPRISES LLC COOLING AMERICA 1831 BUCHANA ST HOLLYWOOD FL. 33020 SCOPES OF BUSINESS OR TRADE: HEATING, VENTILATION, AIR-COND u� vas�+�du� me m meet uie::,in.� ��o� a cam. mem�rtncp elvg DFS-F2-DWca52 CERnFlcaTE OF ELECnoN To Be EXEMPT REMSIM 07-12 aUESnONS? (M)41a, M Page 1 of 1 I httns:l/anns8.fldfs.com/errenortviewer/renertVit-wer•a_enx?data=k(ivnoinrgT)70'lQHF'T P.R 6 1 /1 AI7m d 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 has acknowledge 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. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er State of Florida County of Miami -Dade The foregoing was acknowledge before me this 1 ( day of M ''4 % , 20 % 5 By'SP Rfl S i 4,40 0 A,/)Sr$(Z'TS who i personally kno to me or has produced Tb<S p /z -T as identification. A0 '� THOMAS S MRX Notary: ��:......., + 4• :X 72018 +;�A� ©CPIRES June SEAL: NzrUP,gerv�e.�m (40n 3=9"IW Maciver Enterprises DBA Cooling America CAC1817050 Date: S1 .2_ 0� ► S State of FL -v -Z- t k-> County of Y"" % A--- o—i �^s�— Before me this day personally appeared JU 1 dill.- -& who, being duly sworn, deposes and says: That he or she the w4rily person working on the project located at: � k qZ J o' F Sworn to (or affirmed) and subscribed me this day of 20 � 5 , by 01U_A Personally Know OR Produced Identification FL_ nro+vAtj Type of Identification Produced 031 y� ' �dtilg4l�� :a Print, Type or Stamp Name of �WeA i ..S\\�a\\`�� ////)III I I W\\\\``