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EL-15-1264 A tMit Ivd EL-45 `SgOREs Miami Shores Village Parmit Type 'Elt ctricai �� d ltial cn 10050 N.E.2nd Avenue NW er afka, i*Oftafib Alteration:' Miami Shores, FL 33138 0000 " term sttrsCi`VLF Phone: (305)795-2204 isseu7/16/20'1 + Expiration: 01/1212016 Project Address Parcel Number Applicant -Street ._._ _.. ..._ .. __._._..,,_,..____..�.,.... __..._,,....-�.,........ _... _. 188 NW 104 Street 11213601315� 00 L!Lia2�iShores, FL 33150- Block: Lot: FRANCISCO QUINONEZ Owner Information Address Phone Cell FRANCISCO QUINONEZ 188 NW 104 ST MIAMI SHORES FL 33150-1240 Contractor(s) Phone Cell Phone Valuation: $ 1,200.00 B.L.F ELECTRICAL INC (786)380-2509 - - I Total Sq Feet. 00 Type of Work:SMOKE DETECTORS SYSTEM INSTALLATIO Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# EL-5-15-55722 DBPR Fee $225 07/16/2015 Credit Card $ 116.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 05/27/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 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 informatipn is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-na ed con or to the work stated. July 16, 2015 Authorized Signature:Owner / Applicant / ontract r /I Agent Date Building Department Copy July 16, 2015 1 Miami Shores Villagei D Building Department71:4v 72015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20140 BUILDING Master Permit No.& /`5:— //4-(? PERMIT APPLICATION Sub Permit NQLZ7-1 /,S" 2bZ-71 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL ❑PLUMBING ❑ MECHANICAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: AI W 104 S4 City: Miami Shores County: Miami Dade Zip: S3� 3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): T9AA)C1.SW QW'L10 U--G Phone#: ?po ro 200 0`'( Z_­1 Address: 4Sg A)LJ 4 uY T/1 City: N I AtMV 94&,.e-J State: Tenant/Lessee Name: Phone#: Email: ) CONTRACTOR:Company Name:_ L L�� �— -`'�— Phone#: 76�,_3 F-30-2-5 tom( Address: 7-5 C) W ST 33 City: ; `17 J State: �� Zip: 3301 Z Qualifier Name: V /��%�i'� 2_AuA-)�,4— Phone#: 501 State Certification or Registration#: 454--l-1300 548S 8 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1,20o Square/Linear Footage of Work: Type of work: ❑ Addition ❑ nnAlteratiion 0 New ❑ Repair/Replace 1 ID Demolition Description of Work: St,,olal. G�2.+G k1J�_ S7S7e(� !w4n- /�s t'Ln, �/,4 mol., eeu or b,�L Specify color of color thru tile: Submittal Fee$ . ��nn Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ .4 0 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 the absence of such posted notice, the inspection will not be approved and einspection fee will be charged. Signature Signature OWNER or AGENT C TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 by 1 20 day of M� ,20 J�Z-, by personally known to �`�% 2-�A13 ,who is personally known to me or who has produced as me or who has produced_ )=l. DeI MT- ( MPa3C as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PB IC: Sign: Sign: n : rich Print: Notary Seal: � � Joanna M Feliciano Seal: My commission FF 082753 X4 Exp,r��01112l201B "M CA111111111"LL FlorM com"sin aif 113169 APPROVED BY `j'�(�y Plans Examiner Zoning Structural Review Clerk ,nA 1-w, ORE' y Miami shores Village @� y` Building Department 0,;R 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. �✓ COPY OF QUALIFIER'S STATE LICENCES B. ✓ 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 CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY 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: 13L FBUSINESS ADDRESS:ADDRESS: l x.50 W Y-'(- s� � CITY �� STATE ) K ZIP MO12- BUSINESS PHONE: (�� 1 360-2-5 01 FAX NUMBERV/4NP-u/-(3 0s ) 62-K-1&03 . CELL PHONE(9t� ) &c90- 2-501 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 " 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LABRADA, VLADIMIR A B.L.F ELECTRIC. INC 1750 WEST 46TH STREET APT 337 HIALEAH FL 33012 Congratulations! With this license you become one of the nearly - - - - ---- — one million Floridians licensed by the Department of Business and __ Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION r.. Every day we work to improve the way we do business in order to EC13004858 ISSUED: 08/07/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe LABRADA,VLADIMIR A to department newsletters and learn more about the Department's B.L.F ELECTRIC. INC 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, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date : AUG 31,2016 1-1408070002116 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION � c` ST1t ELECTRICAL CONTRACTORS LICENSING BOARD EC13004858 ! r The ELECTRICAL CONTRACTOR Named below IS CERTIFIED t4 f� WE Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ❑ LABRADA, VLADIMIR A • •• �❑ B.L.F ELECTRIC. INC r 1750 WEST 46TH STREET APT 337 HIALEAH FL 33012 ISSUED: 08/07/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408070002116 007987 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS NOTA BILL - DO NOT PAY LBT 6253082 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES BLF ELECTRIC INC RENEWAL SEPTEMBER 30, 2015 1750 W 46 ST 337 6517644 Must be displayed at place of business HIALEAH FL 33012 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS BLF ELECTRIC INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED EC13004858 BY TAX COLLECTOR Worker(s) 1 $45.00 07/24/2014 CREDITCARD-14-029661 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, s permit,or a certification of the holder's qualifications,to do business. Holder must comply with 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 Sec Ba-276. For more information,visit www.miamidade.aovhaxcollector i STATE PLEASE CUT OUT THE CARD BELOW AND RETAIN F DEPARTMENT OF FINANCIAL SERVICES FOR FUTURE REFERENCE DIVISION OF WORKERS'COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA IMPORTANT 0 Pursuant a Chapter 440.05(141, F.S., an officer of a corporation who WORKERS'COMPENSATION LAW elects exemption from this EFFECTIVE: 03/27 2014 +•.,, �" under this section from chapter by filing a certificate of election PERSON: EXPIRATION DATE chapter. y not recover benefits or compensation under this VLADIMIR A LABRADA 03�26/2016 FEIN: 261720283 H Pursuant to Chapter 440.05(12), F.S., BUSINESS exemptic apply only Certificates of election to be NAME AND ADDRESS: R the notice of election within i be the scop, of the business or trade listed on BLF ELECTRIC INC 1750 W qe ST qpT-337 E Pursuant to Chapter 440.05(13), F. S., FL asolz and certificates of election to be exempt shall be subject to S•. Notices of election to be exempt if, at any time after the filing of the notice or the issuance re the certificate, the revocation SCOPE person named on the notice or certificate no longer meets OF BUSINESS OR the requirements of this section for issuance of a I- ELECTRICAL WIRING WITHIN BUIL department shall revoke a certificate at any time for failure certificate. the 2- LICENSED ELECTRICAL CONTRACTOR person named on the certificate to meet the requiror faients rethe section. of this CUT HERE QUESTIONS? (850) 413-160g i * Carry bottom portion on the lob, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION 70 BE EXEMPT REVISED 01-11 i I '� "� CERTIFICATE OF LIABILITY INSURANCE DATE 05/22DIYYYY) � NCE 05/22/15 THIS CERTIFICATE IS ISSUED ASA 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. - --.— -..-----t------- — -- -----------__-- ----- _ ----- ----------- ---- , — - IMPORTANT: if-the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. H SUBROGATION IS WAIVEDI- ,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 JULIO JIMENEZ NAME: _ Jimenez 8 Co.,Inc. P�HCON o,Ext): (305)264-9900 (A/C,No): (30.5)264-5382 8000 Coral Way ADDRESS. julio@jlmenezendcompany.com Miami,FL 33155 INSURER(S)AFFORDING COVERAGE NAIC 0 Phone (305)264-9900 Fax (305)264-5382 INSURER A: GRANADA INSURANCE COMPANY 09730 INSURED INSURER B: PROGRESSIVE EXPRESS INS COMPANY 02962 BLF ELECTRIC INC INSURER C 1750 W 46 ST #337 INSURER D: HIALEAH,FL 33012 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. INTRR TYPE OF INSURANCE INSR SWVD POLICY NUMBER POLICY EFF POLICY EXP — LIMITS (MMIDD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES a occurrence) $ 100,000.00 A CLAIMS-MADE \/l OCCUR 0185FL00031139 MED EXP(Any one person) $ 5,000.00 l.N 11/09/2014 11/09!2015 PERSONAL&ADV INJURY $ 1,000,000.00 r_1 GENERAL AGGREGATE s 2,000,000.00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 r-� -- PRO- i POLICY --J JEGT -I LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 300,000.00 (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 02043045-2 BODILY INJURY(Per ) $ B AUTOS , AUTOS 02/02/2015 02/02/2016 > accident HIREDRUTOS _I NON-OWNED PROPERTY DAMAGE $.� AUTOS (Per accident) $ -� UMBRELLA UAB i OCCUR EACH OCCURRENCE $ j EXCESS LIAR -;CLAIMS-MADE AGGREGATE $ .... DED L_: RETENTION$ $ _ WORKERS COMPENSATION rWC STATU- r-OTH- AND EMPLOYERS'IJABILITY y/N '_: TORY LIMITS —.I ER ANY PROPRIETOR/PARTNERJEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE$ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) —ELECTRICAL WORK"' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISf6S7----, 10050 NE 2 AVE MIAMI SHORES VILLAGE,FL 33138 AUTHORIZEDREPRESENT TTVE FAX:305-756-8972 © 8-201 AO' CORD CO PORATION. All rights reserved. ACORD 25(2010/05)OF _T e ACORD nameand-rogo are registered marks of ACORD BLF ELECTRIC INC 1750 W 46st #337 Hialeah, FI 33012 Date: 05/21/2015 State of: Florida County of Dade Before me this day personally appeared _\A(Ac mir 016"")A who, being duly sworn, deposes and says: That he will be the only person working on the project located at 188nw 104st in Miami Shores, Florida. Sworn to and subscribed before me this 21 day of May 2015, Personally Know / Or produced Identification r Type of identification produced F\'Yf,L 4Poai 4PAF ic, —1c=� Print,Type or Stamp Name of Notary � 4 "M Cru NOW V*k-State o1 Florida My Comm.Enim Oct 80 2016 Commission IR 113169 5t10RFs G logo Miami shores Village Building Department ORiDp' 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 BELO YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. c""` Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of maw 20/s� B —}-lq_yli si S CC U I�j aA who is personally known to me or has produced as identification. Notary: SEAL: r oe�, Notary Public state of Florida ' `F Joanna M Feliciano My commission FF 082753 Expire.011 0111212018