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BPP-15-363 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-228511 Permit Number: BPP-2-15-363 Scheduled Inspection Date: July 02, 2015 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: SARMIENTO JTRS, MARIA Work Classification: New Job Address: 1059 NE 98 Street Miami Shores, FL 33138-2505 Phone Number (786)333-2300 Parcel Number 1132050180230 Project: <NONE> Contractor: ELITE WATERWORKS INC Phone: (786)326-6730 Building Department Comments NEW SWIMMING POOL Infractio Passed Comments 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 01, 2015 For Inspections please call: (305)762-4949 Page 12 of 47 J Miami Shores Village ' V I� Building Department } Le � � �`1°s' �I p 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 !D BUILDING Master Permit No.,pP /, 36 3 PER IT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL F-]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP 9 A/ q CONTRACTOR DRAWINGS p1/ JOB ADDRESS: ID�/ F /� rjT City: Miami Shores County: Miami Dade Zip: 3 313— Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: �LConstruction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): ylf"W :YAR/1 Ina Phone#: Address: /1,F 97:2/ City: l'l//�/�`�fiOPl�5 State: F` Zip: 3 3 !3 Tenant/Lessee Name: Phone#: Email: ` CONTRACTOR:Company Name: L�T9 4l1�rOOA(/O��S //VG Phone#: 7Opy 3oZo/:O"7Z e5)D Address: 0 7 ®z --'2W/ 31 !jr r C City: Rztf1fyr State: / Zip: �. Qualifier Name: / /M C jF/-6 1-�"ez/s"$- Phone#: 7jv State Certification or Registration#: 2�z �57r09� Certificate of Competency#: m VS 010U.9 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 0 New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ 570.62C) Permit Fee$ CCF$ CO/CC$ w Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$[✓ W TOTAL FEE NOW DUE$ (Revised02/24/2014) ` 49,(-4 , 5 v \ 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 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t absence f uch posted notice, the inspection will not be approved and a reinspection fee will be charged. atu Sig n r nature e ��, �`�'�- y ` Si g OWNER or AGENT CO RACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 byla day of FX31/0-$i y 20 1, by 0 w o' personally known o who i nay Hawn 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 oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: 1 L DOMINGUEZ MISSION#EE192618 Seal: 9'a. � ��� Seal: EXPIRES FXMIMS•may 15,20t 5 � �� App 25.2016 kidW Thru Nfty Public wwww hm cam APPROVED BY Plans Examiner 1 Zoning AVICV ��\� Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 va 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 MEJIA, MARCELO ELITE WATERWORKS& FLOORING 13701 SW 31 ST ST MIAMI FL 33175 Congratulations! 'nth this license you become one of the nearly _, one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses range = DEPARTMENT OF BUSINESS AND from architects to yacht brokers,from boxers to barbeque restaurants, PROFESSIONAL REGULATION and they keep Florida's economy strong. RP252555092 ISSUED: 05/07/2013 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 REG COMMERICAL POOL/SPA CONTR www.myfloridalicense.com. There you can find more Information MEJIA, MARCELO about our divisions and the regulations that impact you,subscribe ELITE WATERWORKS&FLOORING to department newsletters and learn more about the Department's (INDIVIDUAL MUST MEET ALL LOCAL initiatives. LICENSING REQUIREMENTS PRIOR Our mission at the Department is: License Efficiently, Regulate Fairly. TO CONTRACTING IN ANY AREA) We constantly strive to serve you better so that you can serve your HAS REGISTERED under the provisions of Ch.489 FS. customers. Thank you for doing business in Florida, Expiration date:AUG 31,2015 L1305070000692 and congratulations on your new license! The Department of State is leading the commemoration of Florida's 500th anniversary in 2013. IV For more information, please go to www.VivaFlorida.org. VIVA FIU810A DETACH HERE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ti RP252555092 The COMMERCIAL POOL/SPA CONTRACTOR � `1 Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2015 (INDIVIDUAL MUST MEETALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) MEJIA, MARCELO ELITE WATERWORKS& FLOORING 13701 SW 31ST ST MIAMI FL 33175 VIVA FLORIDA RICK SCOTT ISSUED: 05/07/2013 SEQ# L1305070000692 KEN LAWSON GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY CTQB Construction Trades Qualifvinq Board BUSINESS CERTIFICATE OF COMPETENCY 06BS00439 ELITE WATERWORKS INC Q.B.A.:ELITE WATERWORKS&FLOORING MEJIA M RCELO Is certified under the provisions of Chapter 10 of Miami-Dade County - `_ QUALIFYING TRADE/S) 0020 FLOORING 0055 SWIMMING POOL Juliana H.Salas p.E Secretary othe Board f Lr� N�L� Miami-Dade C .� Y retains all property rights herein M"miamidade.Dov/economy ount � Feb 18 15 04:16p Elite Waterworks Inc. (305)5530300 p.1 010331 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY 5799581 . \ LBT -) BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ELITE WATERWORKS&FLOORING RENEWAL SEPTEMBER 30, 2015 13701 SW 31 ST 6047278 Must be displayed at place of business MIAMI FL 33175 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS ELITE WATERWORKS INC 196 SPECIALTY BUILDING CONTRACTOR PAYMENT RECEIVED O6BS00439 BY TAX COLLECTOR Worker(s) 1 $75.00 07/17/2014 CHECK21-14-023709 This Local Business Tax Receipt only conlirms payment of the Local Business Tax.The Receipt is not a license, permit or a certification of the holders qualifications.to do business. Halder must camplywith any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sac Ila-276. For more Information,visit www miamidade.govltaxcollector ;Report Viewer Page 1 of 1 E • cos at A'�, JEFF ATWATER CHEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION aa 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: 2/28/2014 EXPIRATION DATE: 2128/2016 PERSON: MEJIA MARCELO FEIN: 753186839 BUSINESS NAME AND ADDRESS: ELITE WATERWORKS INC ELITE WATERWORKS&FLOORING 13701 SW 31 ST ST MIAMI FL 33175 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR "D r Puna ardto Chapter 440.0S(14),F-&.an offer of a corporation winoelects exemption tram tNs�flag a ceNAcsts of election under thissection may recover banalAs ar aongene®on urger flit cnepter.Pursuant b CMpOar 440.05(12),F.S_, of election to be exempt..appy oay w0h ted scope of Me brrsness or trade fisted on tire notice of ebction M be exempt Pursuant to ChaptK 440.05(13L F.S.,Notice of electionto be exempt aed cord0atn of election m be exempt shag be subjeot to—cation d,at arty tens alter Me5Bnp of tha notice or Ne erauance of Ne certlhate.tlro person named on the notice or araaate no loWr meet&the requirements of this section far issuance of a cedlMoe.The department shalt revoke a ardficete at any tame for facture of the person named on the eerli ate to me the requirements of this sermon DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)4I3-1609 t D https:llapps8.fldfs.com/crTeportviewer/reportV iewer.aspx?data=kdvpg-mc9D7Q3 gH6TER6e... 1/3/2014 A`oRr�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYl7 05/21/14 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 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). CONTACT PRODUCER NAME: Florida Barkers Insurance a NE • (305)225-1243 FAX Nol: (305)225 5053 817 SW 122 Ave. ENL jorgeluis@eoridabankersinsurance.com Miami,FL 33184 INSURER(S) AFFORDING COVERAGE NAIC# Phone (305)225-1243 Fax (305)225-5053 INSURER A: SOUTHER CROSS-TAMPA INSURED INSURER B: Elite Waterworks Inc DBA Elite Waterworks and Flooring INSURER C: 13701 sw 31 st INSURER 0: miami,fl 33175 (786)326-6730 INSURER E: 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. IN RI TYPE OF INSURANCE A UB POLICY NUMBER MBVOLICY EFF MPMI�1 EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 1 ODD © COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ ❑ ❑ CLAIMS-MADE © OCCUR GL4016357MED EXP(Any one person $ 5,000.00 A © 1000 05/18/2014 05/18/2015 PERSONAL&ADV INJURY $ 1,000,000.00 © 1000 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 ElPOLICY ❑ PROECT ❑ LOC $ AUTOMOBILE LIABILITY COMBINED INSINGLE LIMIT KED ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ AAUUTNOSWNED PROPERTY DAMAGE $ Per accident ❑ UMBRELLA UAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS UAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ TH- WORKERS COMPENSATION ❑ WC Y LIMI El OER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ V yes describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarim Schedule,H more space Is required) *—POOLS CONSTRUCTION AND REPAIR BELOW GROUND** "**'Miami Shores Village as listed as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave Miami Shores Village,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD Elite Waterworks inc. �" + ►`"'"`" 13701 SW 31st ST -�.. -•'"° Miami, FL 33175 Ph: (786) 3266730 'vv' r Fax:(305) 5530300 Date: 2-18-2015 State of Florida County of Miami-Dade Before me this day personally appeared Marcelo Mejia who,being duly sworn, deposes and says: That he carries a workers Compensation exemption and that any subcontractors working on the job at 1059 NE 98 Street in Miami Shores will carry their own workers compensation policies or exemptions. Sworn to a subscribed before me this l I day of r-5,151yA?iX 20 l5 B Y Personally known / Or produced Identification Type of identification produced MA A INGUEZ SION 6 E 192618 ES !AI 3a"Ilan com P - t,t stamp of notary 1 SNoR 2 Gr logo ,,,,;� Miami shores Village Building Department OR1DA 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.. _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. Owner Contrac Signature:NkN"� Signature: State of Florida State of Flo ida County of Miami-Dade f f — County of Miami-Dade The fore oing was acknowledge before me this �-t 3 The foregoing was acknowledge before me this �0 day of . ,20day of ,�20By Bywho i ersonally known me or has produced who i ersonally known to s produced as identification. asdentifiratin •' ' L OMINGUEZ Notary: Notary: EE192618 SEAL: Akgi r ': DARRYt S.FU, SEAL: E$Apra 25,2016 .:liMY COMMISSION N EE 2fr. u qtr 906-01 hooded Thru Notary Publk Underwrrt . FPeen/f f{ �}"' 6-3 ORE., Miami SMiami Shores Village µ ,; �? do irk 10 q 050 N.E.2nd Avenue NE ` Miami Shores, FL 33138-0000 `tea Phone: (305)795-2204 OVED"' eNlE®IM ,. _ ,;, " �tonroA rIExpiration: Project Address Parcel Number Applicant 1059 NE 98 Street 1132050180230 Miami Shores, FL 33138-2505 Block: Lot: MARIA SARMIENTO JTRS Owner Information Address Phone Cell MARIA SARMIENTO JTRS 1059 NE 98 Street � (786)333-2300 MIAMI SHORES FL 33138- 1059 NE 98 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 25,000.00 ELITE WATERWORKS INC (786)326-6730 Total Sq Feet: 424 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Fence Date Denied: Final Type of Work:Swimming Pool Occupancy: Private Pool Deck Additional Info:NEW SWIMMING POOL Bond Return : Wall Steel Classification:Residential Scanning:4 Review Electrical Review Planning Review Building Review Building Review Plumbing Review Plumbing Review Structural Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $15.00 Invoice# BPP-2-15-54534 CO/CC Fee $50.00 04/09/2015 Check#:5090 $984.50 $50.00 DBPR Fee $11.25 DCA Fee $11.25 02/19/2015 Credit Card $50.00 $0.00 Education Surcharge $5.00 Permit Fee $750.00 Plan Review Fee(Engineer) $160.00 Scanning Fee $12.00 Technology Fee $20.00 Total: $1,034.50 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: G that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction an Pu !more,I authorize the above-named contractor to do the work stated. ,. April 09, 2015 Authd Signature:Owner / Applicant / Contractor / Agent Date Buildin Department Copy April 09, 2015 1 ,SHot FEB 19 2015 r Miami Shores Village Building Department �ZOR10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL,SPA AND HOT TUB SAFETY ACT • .(W ) ckknowle��that as new wimming pool, spa or hot tub will be constructed or installed at . I% Miami Shores, FL, and hereby .Virm that one of the following methods will be used to meet the requirements of Chapter 515, • �" Florida Statues and the Florida Building Code R4101.17. . 'P.lease lrfitiahthe method(s)to be used: ..... .. . .. .. • .;... •The pool will be equipped with an approved safety pool cover that comp lies with ASTM ••••; F1 46- T.1SGbmit Manufacturer's Specifications). •, fir`"•A continuous,one-piece(child)barrier meeting the requirements of Florida Building Code • •• H4117.J.Mwill protect the pool perimeter.The plans shall show the fence location and method of •.•• :attachment,including one end that shall not be removable without the aid of tools. (Submit Manufacturer's S;70q ons). A combination of non-dwelling walls and fences(screen enclosure,child fence, masonry fence walls,chain link or wood fence,etc.)will protect t he pool perimeter.The plans must specify t he type and loca�tiion, of all non dwelling walls. Florida Building Code, R4101.17.1 U�_ 'Any combination of protection which incorporates dwelling walls with openings directly into the pool perimeter and all windows and doors will be equipped with exit alarms complying with Florida Building Code R4101.17.1.9(Submit Manufacturer's Specifications). Any combination of protection which incorporates dwelling walls with openings directly Into the pool perimeter and all doors will be equipped with a self-latching device with positive mechanical latching/locking installed a min.54"above the threshold. If this option is selected,submit plans showing all types and location of all perimeter protection.The plans must also show the location and type of all openings,and the hardware type for each location. (Submit Manufacturer's Specifications). In accordance with the Code,the pool may not be filled with water without compliance with the Private Swimming Pool Safety Requirements,and upon expiration of the permit,the pool shall be presumed to be un fe.I understand that not having one of the above installed will constitute a violation of ha r 515,F. .,an d will be considered as committing a misdemeanor of the second degree,p le a pr Ided in Section 775.082 or Section 775.083 L.Thisormmust be signed by the agent e e contractor. CONT CTOR'S I ATURE AND DATE OWNER'S MSIGN�ATRE AND DATE / tiff- L-w4 CONTRACTOR'S NAME P SE PRINT OW R'S NAME(PLEASE /INT MA OMINGUEZ NO -1 prp 25,2016 PUB I® s.Fox 9G&Ot N ►r Mfr COMMISSION M EE 089600 EXPIRES:May 15,2015 tj,' Bonded TFau Notary Pubk Underwriters f SNORES SINE Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 .. SWIMMING POOL OWNER'S CERTIFICATION :....: ... . • .Ratc - 5 . . •••••' 41JAN Shores Village ••••: 130ding &X401ng Department • 'Atfelition;.Biulding Official • . • ...... •....• •••• I certify that I am the legal owner of the property described as A121 - Y�vl lv i MvA n/,�-bcated at (09q ug- �� S W AA41 In accordance with Section 33-12(f), Code of Metropolitan Dade County, certify I rt fy that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting and approved barrier prior to final inspection and use of the pool (�— IJIJ' Legal Owner Note: This certification is to be submitted with a swimming pool permit application in duplicate. SHul I sell Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RESTRICTIVE COVENANT PROTECTIVE POOL ENCLOSURE ..KNOW ALL MEN BY THESE PRESENTS: .0000. .6. . VHEREA,,the undersigned_At/ f 7/�PIlJr�,�(/j#�fjD�//}/V/j /�Jpll�(/ /are the fee sees.. .....10 06 simple o* qs)o tthe following described property situated and being in Miami Shores Village,Florida: .:0 0.. ..t•4ddress: •./ 9 ��� �� l — sees. 00 0 . sees.. sees.. "••• Whereas,t;a, owner(s) 0 sees.. • . desire toyi%%%ld Lot(s)as a single building site,and the undersigned owner(s)do(es)hereby declare and agree as follows: 10.60.. 00 . sees '. •6 0 �. 0 That the property will not be used in vitiation Of any ordinances of Miami Shores Village or Miami-Dade 6 • . ..10. . County now in effect or hereinafter enacted. sees.. • •• 0 That the purpose of the covenant is to induce Miami Shores Village to issue a permit for a pool where the required enclosure is not on the subject 1 property where the pool is located. III. That if any of our adjoining neighbors remove any portion of their fence or wall,or if our/my property shall fail to meet code requirements for pool barriers,we,as owners will immediately install a protective enclosure to meet code requirements and will obtain a permit for such fence. IV. That,[/we,as owner(s)hold Miami Shores Village harmless for any negligence or injury that results from not having the enclosure. V. If enclosure belongs to said property,I agree to maintain&or replace said enclosure in the event that is damaged or removed by any case. NOW,THEREOF,for good and valuable consideration,the undersigned do(es)hereby declare that he/she will not convey or cause to be conveyed the title to the above property without requiring the successor in title to abide by all terms and conditions set forth herein. FURTHER,the undersigned declare(s)that this covenant is intended and shall constitute a restrictive covenant concerning the use,enjoyment and title to the above property and shall constitute a covenant running with the land and shall be binding upon the undersigned,his/her successors and assigns and may only be r eased by Miami Shores Village,or its successors,in accordance of said Village then in effect. OWNER SfGN&PRINT Ji���6 � � OWNER SING&PRINT ;U &A- --I Her Certify that this day personally appeared before and has produced ID # ' Das identification and he/she acknowledge that he/she executed the foregoing,freely and voluntarily, for purposes there in expressed. y SWORN TO AND SUBSCRIBED before me on this `day of YOy _ (Revised 05/2209 NOTA PUBLIC STATE OF 0 IDA DARRYL&Fox ;+= MY COMMISSION#EE 089600 EXPIRES:May 15,2015 . BMW Ttn Norm,Pubk code ,