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PL-15-394Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233248 Permit Number: PL -2-15-394 Scheduled Inspection Date: June 03, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: LUNA, LUISA FERNANDA Work Classification: Sprinkler System Job Address: 10090 N MIAMI Avenue Miami Shores, FL 33150-1216 Phone Number (305)757-3133 Parcel Number 1131010210090 Project: <NONE> Contractor: AT FIRST IRRIGATION INC Phone: (786)925-8837 tsuna toomments INSTALL NEW IRRIGATION SYSTEM (3) ZINE -------- INSPECTOR COMMENTS False nspector Comments Passed FqCREATED AS REINSPECTION FOR INSP-231541. CREATED AS REINSPECTION FOR INSP-228801. Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 02, 2016 For Inspections please call: (305)762-4949 Page 6 of 28 BUILDING Miami Shores Village j�� REC97 " "` Building Department FES®t5 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 745-2204 Fac (305) 756-8972 BY INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBCC`OI() Master Permit No.:p—� 05_ 3 PERMIT APPLICATION Sub Permit No. [:]BUILDING [ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING [ MECHANICAL [PUBLIC WORKS [:]CHANGE OF [] CANCELLATION [:] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 10090 NORTH MIAMI AVE. City Miami Shores County Miami Dade Zip: FoRo/Parcel#; Is the Building Hlstorka8y Designated: Yes NO X Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): LUISA FERNANDA LUNA Phone#: 305 213 3133 Address- 10090 NORTH MIAMI AVE. City. MIAMI SHORES State: FLA zip: 33150 Tenant/Lessee Name: Phone#: Email: LUNAMOON7556@GMAIL.COM CONTRACTOR: Company Name: P \N' 4; � % Phone#: Address: \ City: Stade: ' Zip: 7�,` A -2i SI Qualifier Name:`-®� o"� a Phone#: State Certification or Registration #: Certificate of Competency #: Vim: . � DESIGNER: Architect/Engineer: Phone#: Address: City: ____State: Zip: Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration [Near ❑ Repair/Replace ❑ 1emolition of Work -Z,014,T, Specify color of color thm tile. Submittal Fee $y�Permit Fee $ #Wsd J4 ti CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Train(ng/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (RevhedQ2/24/2M4) ` Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address city Zip 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 budding permit with an estimated value exceeding $25w, 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 r1 Signat Signature g g X�� O1IINER or AGENT CO CTOR The fore��^^g��oing instrument was acknowledged before me this The for ing in ment was a wl ged before me this 2-0 day of a 20 ) 5 . by 12® � 20 15 . by moo` ► . who is personally known to �° l� , who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an EQONZALEz �O0µ"'4�`'�' °,9@ .��o MY OEW ION 29 NOTARY PUBLIC: * * 14fYk0NMISSDNOTARY PUBLIC: * '` EXPIRES: September 16, X18 EXPIRES: September 18,7!018 '�, oma°` Bonded Tluu Budget Woary+ Ser" (�,� '/�oF �.°P•O BarhledTien Nab' Se�vlces Sign-' � � ii���'L.rt.9°,��g � Sign: Print: h I �'1 Print: E �. Seal: Seal: APPROVED BY = L� Plans Examiner Zoning Structural Review Clerk (Rewsed02/24/2m4) (r1C,2B Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 13P000346 -`` AT FIRST IRRIGATION INC D.B.A.: ?CKSONJACOB a certified under the provisions of Chapter 10 of Miami-Dade County Municipal Contractor's Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY CC NO: 13P000346 BUSINESS NAME/LOCATION RECEIPT NO. AT FIRST IRRIGATION INC 1140 NE 191 ST #25 MIAMI, FL 33179 7462489 EXPIRES SEPTEMBER 309 2015 Pursuant to County Code Sec 10-24 OWNER TYPE OF BUSINESS AT FIRST IRRIGATION INC SPECIALTY PLUMBING CONTRACTOR PAYMENT RECEIVED C/O JACOB JACKSON BY TAX COLLECTOR 37.50 02/23/2015 0226-15-003236 Restricted to City of Miami Shores sFor more information, visit Wyminlamidedeamytiagcollector 013098 Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY 7167755 FL B T BUSINESS NAME/LOCATION AT FIRST IRRIGATION INC 1140 NE 191 ST #25 MIAMI FL 33179 OWNER AT FIRST IRRIGATION INC Worker(s) 1 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2015 7446379 Must be displayed at place of business Pursuant to County Code Chapter 8A - ArL 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY PLUMBING CONTRACTOR PAYMENT RECEIVED 13P000346 BY TAX COLLECTOR $75.00 09/29/2014 CREDITCARD-14-042260 This Local Business Tax Receipt only confirms payment of the local Business Tax The Receipt is not a license, Permit. at a certification of the holder's qualifications, to do business. Holder must comply witll any governmental or nangovarnmeMgI regulatory laws and requirements which apply to the business. The -RECEIPT ND. above must be displayed on all commercial vehicles -8dfaml-Dade Code Sec 88-276. Formorainformation, visitWWmiamidadeaav =U, CERTIFICATE OF LIABILITY INSURANCE DA 220/2o15rn 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 Wells Faro Insurance g Liberty Mutual Insurance PO Box 188065 Fairfield, OH 45018 CONTACT NAME: PHONE 800-962-7132 FAC No : 800-845-3666 E-MAIL ADDRESS: CLServiceCenter(§)Ube Mutual.com INSURERS AFFORDING COVERAGE NAIC $ INSURER A: First National Insurance Co of America 24724 INSURED At First Irrigation Inc. DBA AFI Lighting Solutions PO Box 60TO01 North Miami Beach FL 33160 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 23535128 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 ADDL SUBR POLICY NUMBER POLICY EFF PMLIR EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑✓ OCCUR 25CC36186020 7/10/2014 7/10/2015 EACH OCCURRENCE $ 1,000,000 DA AGE TO RENTED PREMISES(Ea occurrence) $ 200,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: ✓ JEOT- 7 LOC POLICY 7C OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED ✓ HIRED AUTOS ✓ AUTOS 25CC36186020 7/10/2014 7/10/2015 Eaaccden SINGLE LIMIT $ 1 000 000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident) UMBRELLA LIAR EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE — OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 1 OTH- STATUTE ER E.L.EACHACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached M more space Is required) Re: 13P000346 rCQTICIf-ATF' 14111 nER CANCELLATION Miami Shores Village Building Departartment 10050 NE 2nd Ave SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE Maggie McCall © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERT NO.: 23535128 CLIENT CODE: 3501508962 Maggie McCall 2/20/2015 11:20:00 AM (PST) Page 1 of 1 Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 sation 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 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.. Therefore, You may be Personally liable for the worker compensation iniuries of any Gerson 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. 1 Owner Signature: State of Flo County of Miami -Dade The foregoing was acknowledge before me this day of , 20 �S By Q=i CPX 1NltIAN who is pe ovally known to me or has produced �IG►Ct Cl t.KS4_ as identification. Notary: SEAL: Co of Mi -Dade The fore o - as acknowledge before me this �3 day By �CfJ CT I(i6'1 who i ersonally known to me or has produced AI(tuty-= LCeA-w- as identification. Notary: SEAL: MY COMMISSION # FF 073975 - ono^"" n w " EXPIRES: March 29, 2018•� MY COMMISSION 9 FF 073975 Bonded Thru Notary Puma Undenwbrs _* EXPIRES: March 29, 2018 Bonded 1WU Notary PuMlo Undewhers Arlenis Silvera From: At first Irrigation <atfirstirrigationinc@gmail.com> Sent: Monday, February 23, 2015 3:25 PM To: Arlenis Silvera Subject: Workers Compensation Letter Head 2-23-15 State of Florida County of Miami -Dade County To: City of Miami Shores Village This is to confirm in writing that I Jacob Jackson the sole owner of At First Irrigation Inc, Workers' Compensation Construction Industry Exemption effective 7/11/2013 and to expire on 7/11/15. In order to apply to workers compensation insurance exemption affidavit.. Kind Regards, Jacob k r � � tFirst Irrigation " Where Quality Meets Service " Licensed & Insured C.I.C-13P000346 (786) 925-8837 (305) 749-616o www.atfirstirrigation.com Notary Public State of Florida Sindia Alvarez ` MY Commleelm FF 1W§O til orr►de Expires 09103/2018