PL-15-1476 (2) Miami Shores Village =BY:Building Department10050 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 /0
BUILDING Master Permit No��
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
®PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I DRO C)17
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder):,LDn)ai 0-P- I P_Sli�ad e S CQ,- Phone#: 12!j zc)6
Address:
City: State: Zip:
Tenant/Lessee Name: Phone#:
Email: T /'
CONTRACTOR:Company Name: S �J y" t `7 P 1 6 AJ / Phone#: Q _C L-j 6
Address: -3 0 0- 3
City: h/t r 6,I""t r State: zip: 3 3 �—
Qualifier Name: / ' V- �u 'tf0
C"'r 1 Q r-, `G-!A- Phone#0 -- �= �Z((7
State Certification or Registration M CSD 0 � _Certificate of Competency M
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit:$_ i tf� < Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration 2SNew ❑ /Re lace
Re air
P p ❑ Demolition
Description of Work: �I c Y S y e"A- cit---,
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ ��l�' x y CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
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 on 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
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 /S by day of 20 by
r,
who is personally known to ono is personally known to
me or who has produced T as me or who has produced_T�� as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Si n
Pudic St of Florida
Print: Notary Print:
Joan
Seal: MY Commission FF 082753 Seal: 00 ft- Notary Public State of Florida
aw Ezprres01r1212018 Joanna M Feliciano
d' My Commission FF 082753
OF
Exp ires 01/12/2018
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
14
Local Business Tax Receipt
Miami-Dade County, State of Florida
-THIS IS NOT ABILL-DO NOT PAY LBT)
6989884
BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES
S A J IRRIGATION INC RENEWAL SEPTEMBER S 2015
13003 SW 195 ST 7265515
MIAMI, FL 33177 Must be displayed at place of business
Pursuant to County Code
Chapter 8A-Art.9&10
OWNER SEC.TYPE OF BUSINESS
PAYMENTS A J IRRIGATION INC 196 SPECIALTY PLUMBING BY TAX C LLECTOR
CONTRACTOR 86.25 11/18/2014
Worker(s) 1 12P000188 0246-15-300792
This Local Business Tax Receipt only confirms payment rf the Local Business Tax.The Receipt is nut a license,
permit,or a certification of the holder's qualifications,to do business.Holder must comply with any governmental
or nongovernmental logulatory laws and requirements which apply to the business.
JID The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Code Sec Ra-276.
MOM
kD
For more information,visit www.miamidtule.govAaxcollector
CTQB
Construction Trades Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
' ` 12P000188
" N S AJ IRRIGATION INC
_D.B.A.:
4VMANCA ARTURO
Is certified under the provisions of Chapter 10 of Miami-Dade County
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: 5/8/2014 EXPIRATION DATE: 5/7/2016
PERSON: SALAMANCA ARTURO
FEIN: 454493970
BUSINESS NAME AND ADDRESS:
S A J IRRIGATION INC
13003 SW 195 ST
MIAMI FL 33177
SCOPES OF BUSINESS OR TRADE:
LANDSCAPE GARDENING AUTOMATIC SPRINKLER IRRIGATION OR
&DRIVERS INSTALLATI DRAINAGE SYSTEM
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
- -- - .._ .. .-•- --.._�.. ......i,.,....,,.,ah...rho���nv
3
S
' ,
Pp �'4�"�� �`�y �`
cgQa
OWNERTYPIf*"'rol!$INESS PAYMENT RECEIVED
S A J IRRIGATION INC SPECIAL 1 PLUMBING C®AI7127�CTf��
' .. 13Y TAX COLLECTOR
s r' 175.00 :06/08A*5'-
,,r -.0229-15-006621
Th
1 teCeipI is not*ldin the following Municipalities:Aventura,Doral,Hialeah,Key Biscayne,
Mlaml Cfardan3,Miami Lakes,Palinetto Bay,Pinecrest,Sunny I;les Beach,lliniilft of Cutler bay.
MIAMI For more information,VisRwww.miamidade,g�r[ylxwllector
QUALIFYING TRADE(S)
0003 LAWN SPRINKLER
Secreta Dancer P.E.
Secretary of the awr9
www.mlamidade.aov/developrrar�t
♦SNORE Lr
gain ,,,,,�, Miami shores Village
Building Department
�IORIpA 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: i:::i±
Owner
State of Florida
County of Miami-Dade -6-
The foregoing was acknowledge before me this U day of t/'�"L- 20 l
Byy���� �U S � who is personally to me or ha roduced
as identification.
Notary: e •. ��''%��
.may . .•.. v•. . b
SEAL:
S.A.J Irrigation Inc.
Date: June 15, 2015
State of
County of
Before me this day personally appeared who, being_duly sworn.
deposes and says.
That he or she will be the only person working on the project located at:/1)'-yv 4r— 1(tS
Sworn to(or affirmed)and subscribeb before me da of_)r�.?� 20 by )9/lA41d
;� II
Personally know.
Or produced Identification.V '
Type of Identification. FL92-
tP �4y_ Notary Pudic State Florida
F Joanna M Felioano
My COmmisalon FF 082753
OF EXPiroa 01/12/2018
Print,Type or Stamp Name Of Notary
1
JUN-19-2015 13:26 From:3052472999 Pa9e:1/1
CERTIFICATE OF LIABILITY INSURANCE DATE 61191IYYYY)
�06/19/t 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: If the certificate holder Is an ADDITIONAL INSURED,the pollry(las)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 cortlficate does not confer rights to the
eertlflcate holder In Ileu of such andor'se_ment(s). _
CONTA
PRODUCER NP40g- ANTHONY HAZARD
PHONE: F0`x 05 247-2999
A. Hazard Insurance Agency O,.Ext); (305)247-4004 ., arc No):,. 3
(_ )
1008 NW 1stAve. ADDR[ss CELIA@HAZARDINSURE.COM
Homestead,FL 33030 INSURERfS)AFFORDING COVERAGE NAIC V
Phone (305)247-4004 Fax (305)247-29_99 INSURER A: UNITED SPECIALTY INSURANCE CO
INSURED INSURER 5: .. .. ..
S.A.J. IRRIGATION INC INSURERC:
13003 SW 195 Street INSURER o=
MIAMI,FL 33177• (766)237-6210 Ir+suReR[_:
_ IN5UR0_P
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE:LISTED BELOW HAVE BEEN ISSUEn 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 DESURISED HEREIN IS,SUBJECT TO ALL THE TGRmS,
EXCLUSIONS AND CONDI I IONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE GeEN REDUCED BY PAID CLAIMS.
POLICY E
LTR TYPE OF INSURANCE ADDUBR wVp POLICY NUMBER (MMIDOlYYYY) (MM/DD/YYYFF POLICY EXP Y) _ _
GENERAL LIABILITY EACH UCCU
INSR RRENCF -, S 1,000,000.00
DAMAGE q L RENTED LIMITS 100,000.00
COMMERCIAL GENERAL EDIBILITY _PRkfY1l&S(.EB,OCc'urrerxel a _
U ❑ CLAIMS-MADE Q OCCURDCG0008600 MED EXP(Any 2 person) i 5,000.00
A El 08/01/2014 08/01/2015 -
PEKSUNAL&ADV INJURY S 1,000,000.00
❑ GENERALAGGREGAI'[ s 2,000,000.00
GEN'L AGGREGI—XATS1 E LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG S 1,000,000-00
U POLICY I PIrrTRO ❑ LOC 9 _
AUTOMOBILE LIABILITY _ — - - - ccasci ED�1 E OMIT s '
ANY AUTO BODILY INJURY(Per person) S
U ALL OWNEr) SCHEDULED 80p11,Y INJURY(Prr accident S
AUTOS U AUTOS
❑
IIIRCDAUTOS NON-OWNED PR01tKYDAMAOE g❑ AUTOS (Per afrr erd) _
171 F71 $_ ...
UMBRFI.I.A LIAR
U U OCCUR EACH OCCURRENCE $„
❑ EXCESS LIAR ❑(;l AIM;•MADE AGGREGATE
U DED ❑ Kt I o-noN s.
WORKERS COMPENSATION ^ WC STATU- OTH-
I_l ❑E
, AND EMPLOYERS'LIABILITY Y/N TORY LIMITS R '
ANY PROPRIL IORIPARTNER/EXECU'I IVE C.L.FACH WrIDENT $
OFFI(;r:R/MEMBER EXCLUDCD? NIA -- -
(Mandatory In NH) E.L.DISC-AAF EA EMPLOYE S _
eya s,describe unde( -
DESCRIPTIUN OF OPERATIONS below E I. DISEASE-POI ICY LIMIT R _
DESCRIPTION OF OPERATIONS)LOCATIONS/VEHICLES (Attach ACORD 101,Additional Hemarks Schedule,H more apace Is required)
PLUMBING CONTRACTOR-License#12P000188
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Mlami Shores Village Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
10050 N.E.2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores,Florida 33138 AUTHORVGO REPRESENTATIVE
I ANTHONY HAZARD
®1988.2010 ACORD CORPORATION_ All rights reserved.
ACORD 25(2010105)OF The ACORD name and logo are registered marks of ACORD
PL- - -
SgoaF$y Miami Shores Village P1717ItT F!U
g �Bq Residential
10050 N.E.2nd Avenue NE
' INc�tfcGlassr atto r . r S stent
Miami Shores, FL 33138-0000
iw� mjf`�attts APPROVED
Phone: (305)795 2204 �\ ,
/201 Expiration: 12/16/2015
Project Address Parcel Number Applicant
1080 N E 105 Street 1122320280090
Miami Shores, FL 33138- Block: Lot: VERONIQUE LESTRADE SFARA
Owner Information Address Phone Cell
VERONIQUE LESTRADE SFARA 1080 NE 105 Street (305)799-2006
MIAMI SHORES FL 33138-2106
Contractor(s) Phone Cell Phone Valuation: $ 4,850.00
S A J IRRIGATION INC (786)237-6210 , Total Sq Feet: 00
Type of Work:LAWN SPRINKLER SYSTEM Available Inspections:
Type of Piping: Inspection Type:
Additional Info:
Final
Bond Return : Underground Sprinkler
Classification:Residential Scanning:3 Review Plumbing
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $3.00
Invoice# PL-6-15-55988
DBPR Fee $2.25 06/19/2015 Cash $ 126.50 $50.00
DCA Fee $2.25
Education Surcharge $1.00 06/16/2015 Credit Card $50.00 $0.00
Notary Fee $5.00
Permit Fee $150.00
Scanning Fee $9.00
Technology Fee $4.00
Total: $176.50
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: 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. Futhermore, I authorize the above-named co to do the work stated.
June 19, 2015
Authorized Signature:Owner / Applicant / Con ra r / Agent Date
Building Department Copy
June 19,2015 1