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ACT-15-1181 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-234962 Permit Number: ACT-5-15-1181 Scheduled Inspection Date: July 22, 2015 Permit Type: Awnings/Canopies/Tents Inspector: Rodriguez,Jorge Inspection Type: Final Owner: GONZALEZ,ALAIN Work Classification: Miscellaneous Job Address:389 NE 99 Street Miami Shores, FL 33138- Phone Number 7861277-9756 Parcel Number 1132060135540 Project: <NONE> Contractor: AWNING UNIVERSAL INC Phone: (305)757-5080 Building Department Comments RECOVER EXISTING AWNINGS Infractio Passed Comments TO REPLACE ACT15-664 INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 21,2015 For Inspections please call: (305)762-4949 Page 11 of 34 A-77 yry, a s 7�t P8!C1Tlt; ? � �sHO1S i, Miami Shores Village ffl #t# jl AwningsC� i oplenta 10050 N.E.2nd Avenue NE ... ..,., Miscellanea Miami Shores,FL 33138-0000 APPROVED Phone: (305)795-2204 fi Expiration: 11/24/2015 Project Address Parcel Number Applicant ,- 389 NE 99 Street 1132060135540 Miami Shores, FL 33138- Block: Lot: ALAIN GONZALEZ Owner Information Address Phone Cell ALAIN GONZALEZ 389 NE 99 Street 786/277-9756 Miami Shores FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 4,000.00 AWNING UNIVERSAL INC (305)757-5080 Total Sq Feet: 0 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final Date Denied: Review Building Type of Work:RECOVER EXISTING AWNINGS Additional Info: Classification:Residential Color Approved: In Review: In Review Code Comments: : Code Approved: : In Review Code Denied: Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# ACT-5-15-55613 DBPR Fee $2.00 DCA Fee $2.00 05/28/2015 Credit Card $ 133.40 $0.00 Education Surcharge $0.80 Permit Fee $120.00 Scanning Fee $3.00 Technology Fee $3.20 Total: $133.40 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING,MECHANICAL,WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the fore in information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futher a ori=tanamed contractor to do the work stated. May 28, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy May 28, 2015 1 Miami Shores Village Building Department , �- 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 INSPECTION'S PHONE NUMBER: (305)762.4949 FBC 20 (0 BUILDING Permit No. PERMIT APPLICATION Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): ���a, ) 6�DD0­7 Z Phone#: Address: '��c1 t.� �icl S'-Z-� City: —State:--/—.I Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: I 1 Toc- Phone#:(36)iso`�Mo Address: �J V3 L) S City: - J1r l C1 Cn'I State: Zip: .,�9 Qualifier Name: �EN�j p t Phone#: (cf \ t . State Certification or Re�g�istr�atio�nj#: " g S �`t� _Certificate of Competency#: Contact Phone#:��i V J 1 83C=l tq SN, Email Address: CA U01 I VC 1rS2 I 6(AJYI 10 \ 'n 000,C yy) . DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit:$ 40a c7 Square/Linear Footage of Work: Type of Work: ❑Addition ❑Alteration ❑New Wl epair/Replace ❑Demolition Description of Work: kr(A f �- 70 �c—r- (S Color thru tile: Submittal Fee$ Permit Fee$ ' n CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ Ig I ��� ` ' Q� TOTAL FEE NOW DUE$ JAL o t�PB o,p VCW (. �w eVA4 �4v ee � sl41,r I Bonding Company's Name(if applicable) Bonding Company's Address City State Zip 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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature N t Owner or Agent / Contractor �I The foregoing instrume was acknowledged before me this /Vik The fore g instru nt was acknowledged before me this- i day of Z"q'20 by G day of M 20 by �1.� who is n known�etif-Zation o has produced who is ersona ly own to me or who has produced and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: L/ Sign: Print: Iry �C . r 04 67-02-,r l2-,!^ Print: 17 My Commission Exp My ommissio xpire "wo MoarrPut�licJESSE WALTERSMY0�'E�sN"21.2017 Notary Public-State of Florida /FF 072474 My Comm.Expires Sep 23,2016 APPROVED BY �'Z�77"" Tiansiffkaminer Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) SNORINC.193 ES G t Miami Shores Village OS,�$ Building Department FLRIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 756.8972 11­� IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. `./ COPY OF QUALIFIER'S STATE LICENCES B. V/ COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. �/ COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CO7-COPY CTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. OF CERTIFICATE OF COMPETENCY OF QUALIFIER " � n� J�o - B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. � OPY OF LIABILITY INSURACE* E. & COPY OF WORKERS COMPENSATION INSURANCE (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME:AA W 1 (14 s Lki'1 i V P'i BUSINESS ADDRESS:AA (�q ,StYU+ CITY Iq I0 rn I STATE I ZIP BUSINESS PHONE: ( ( )�rj ]— � � � FAX NUMBER( ) CELL PHONE )31 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: ♦SNoREJJAC.19 s Li J- Miami shores Village Building Department rE 04 OR1Dp' 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 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: U Owner AWMK%Wft"public•SUN of Awids State of Florida s t, MM Com•ENOM Nov 21.2017 COMASion r FF 072474 County of Miami-Dade The foregoing was acknowledge before me this day of 1201-57 By *� IC/l h Zo JP Z _ who is ersonally know mye or has produced as identification. Notary. • ' JENIVFER MAW= � � "JYoEasy( BasNecAfFFMiiva SEAL: av"My Cvrmm rs�rieesM�ov281.2;009 � .•'' Cu,rmrsss(w##FFF072A7A4 AWNINGS IVERSL, INC. 3292 NW 41 Street Miami, FL 33142 Tel: 305-7.57-508 Email. auniv'er ala%Avnin s a oo,cor May 15, 2015 State of: FLORIDA County of : MIAMI-DADE Before me this day personally appeared Yenv!Carias who, being duly sworn, deposes and says: That he or she will be the only person working in the project located at: 389 N.E. 99"' Street. tianni Sh.._._._aores FLj3138, Sworn to (or affirmed) and subscribed before rye this 15`Fday of IVi015, by Yo_ ri ,arias. Personally known Or produced Identification Fype of Identification Produced � R�8i1i�d.t0 E X Public.state ida Expitt 21,2447 �., a aCtit►114810#fP 4172474 i __. a _.— �ri t, Type or Stamp Name of Notary � ^ CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY #rr. 14BS00453 WNINGS UNIVERSAL INC 9AZAS RODRIGUEZ YENY LI LIBETH Is certified under the provisions of Chapter 10 of Miami-Dade County QUALIFYING TRADE/S1 0008 CANVAS AWNING JL*ana H.Sa4a P.E. Semv � /� ®�� Seaetary of the BoarE glib ra4eis al n s I+eiein- www.ftvam dmd*.goWeco nmy Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY 7177412 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES AWNINGS UNIVERSAL INC NEW BUSINESS SEPTEMBER 30, 2015 3292 NW 41 ST 7457431 MIAMI, FL 33142 Must be displayed at place of business Pursuant to County Code Chapter BA—Art,9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED AWNINGS UNIVERSAL INC: 196 SPECIALTY BUILDING BY TAX COLLECTOR CIO YENY L CARIAS PRES CONTRACTOR 75.00 10/29/2014 Worker(s) 1 148500453 0224-15-000354 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt Is not a license, permit,or a certification of the holder's qualifica lions,to do business.Holder must comply with anygovernmenial or nongovernmental regulatory laws and regjiremenis which apply to the business. The RECEIPT N0,above must be displayed on all commercial vehicles—hiiami-Bade Code Sec Ba-276. HIAMufg4DE For moro lnfoimation,vlsil%nw/mfamidade.uovltaxcoilecior Y MuniCiPal' Contractor s Tax Receipt Miami-DadisrCioTasty, SOtatePo Florida CC NO! 148500453 RECEIPT No. EXPIRES 2015 aw INESNINGS uNAMEI OC*"rION SEPTEMBOMR 30+ 3292 NW 41 ST 746665U coca pursuant to County MIAMI,FL 33142 Sec 10-24 TYPE OF BUSINESS PAYMENT RECEIVED SPECIALTY�,,��.`G Cpti{1R,�CTOR BY TAX COLLECTOR OWNER 1 8.7 5 05/142015 AWN1NvS LJV,'-=RS,ALINC 02_}-15-005707 C/0�= ✓,�C-P,'r`.S FRES Restricted to City of Miami Shores ®� For mon iafoanation,visit„_5_�--- M Y DATE 0MMIDD{MMlDDlYYYY) ..�. CERTIFICATE OF LIABILITY INSURANCE 5 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: N the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. K 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 CONTACT VMA I BRITOS AN City Bird Rd.Insurance Agency PHONE (305),552-1758 FAx I=NoA/C,No (305)226-6418 8475 Bird Road LADDRESS allaitybirdroad@hotmail.com Miami,FL 33155 INSURERS AFFORDING COVERAGE NAIL# Phone (305)552-1758 Fax (305)226-6418 INSURERA: LLOYDS OF LONDON INSURED INSURER B: A Universal Awnings Inc./Awnings Universal Inc. INSURER 0: 3292 NW 41 Street INSURER D: Miami,FL 33142- (305)757-5080 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 001 REVISION NUMBER: 001 THIS 1S 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 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 UB POLICY EFF POLICY EJB LTR POLICY NUMBER MMA)DWOM (MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE s 500.000.00 © COMMERCIAL GENERAL LIABILfIY PREM SE TO RENTED $ 100 000.00 A ❑ ❑ CLAIMS-MADE © OCCUR Y 05/13/2015 05/13/2016 CIBFL0005616 MED EXP(Any one person $ 5,000.00 ❑ PERSONAL 8 ADV INJURY $ 500,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000.000.00 © POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINES SINGLE LIMB MB n ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED BODILY INJURY(Per axldent S AUTOS E] AUTOS ) ❑ HIRED AUTOS 1:1 AUTOS P OP 12dYAMAGE $ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE 5 ❑ EXCESS LIAB ❑SMS-MADE AGGREGATE S ❑ ED ❑ RETENTION $ WORKERS COMPENSATIONWC STATU- [:]&HAND EMPLOYERS LABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ Ifyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMTr S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space Is required) LICENSE#14BS00453 CERTIFICATE HOLDER 1S LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 N.E.2ND.AVE. ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FLORIDA.33138 AUTHORIZED REPRESENTATIVE %nVIAN BRITOS J 01988-2010 AFFORD CORPORARON, All rights reserved. ACORD 25(2010105)OF The ACIDRD name�nd logo are registered marks of ACORD `vJ 10/22/2014 Report Viewer ��4 bIIJF S a ��p3 ' ryi �r/rr JEFF ATWATER - CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION "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: 10/16/2014 EXPIRATION DATE: 10/15/2016 PERSON: CARIAS YENY L FEIN: 461953437 BUSINESS NAME AND ADDRESS: AWNINGS UNIVERSAL INC 3292 NW 41 ST MIAMI FL 33142 SCOPES OF BUSINESS OR TRADE: DOOR AND WINDOW INSTALLATION 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 a 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-OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413.1609 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6ePl KMZ%2fSz5bXKYfBxkrekeESoPVy1 v4NPOPN42XeirDR... 1/2 A-c.-T I Is- INA9 -k Cl :R=25.00' r•.r i A=90'15'49"(C - A=39.38'(C) L k M T=25.1 15'(C) - - `� rtf i t• PA �y®* MAR 2 7 2015 �1► i ALUMINUM iBY:_ iM GATE 0 n n�. b v n 10' ASPHALT n -Jn;, FND. 5 8" o ao 0 0 7V.07'� o 1.P. 0.13'(S) 25.�P) �• 20.15' O FND. 5/8" 35' 89. 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