PL-15-1110 Miami Shores Village rtl
10050 N.E.2nd Avenue NE ` tffl11 r
fix
.... � a
-. - Miami Shores, FL 33138-0000 `
Win
Phone: (305)795-2204 " ui
F�6R1DA ` 4.
,,W-5, Expiration: 12/23/2015
f ter. t1
Project Address Parcel Number Applicant
1111 NE 91 Terrace 1132050010120 W
POLYMATHIC PROPERTIES INC
Miami Shores, FL 33138- Block: Lot:
,_OwnOwner Information Address Phone Cell
Ps
er
PROPERTIES INC 1111 NE 91 Street (707)451-8111
MIAMI SHORES FL 33138-
707 ALDRIDGE Road
VACAVIL CA 95688-
Contractor(s) Phone Cell Phone Valuation: $ 780.00
GMP CONTRACTORS (786)443-3548
Total Sq Feet: 150
Type of Work:INSTALL NEW KITCHEN SINK REMOVE EXI Available Inspections:
Type of Piping:
Inspection Type:
Additional Info:
Top Out
Bond Return: Final
Classification:Residential Scanning: 1 Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBPR Fee Invoice# PL-5-15-55510
$2.25 05/12/2015 Credit Card $50.00 $ 109.10
DCA Fee $2.25
Education Surcharge $0.20 06/26/2015 Credit Card $ 109.10 $0.00
Permit Fee $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
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,PL BING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAV I ert4 that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and z FuSltermore, I authorize the above-named contractor to do the work stated.
June 26, 2015
Auth ' ecl Signature:Owner / Applicant / Contractor / Agent Date
Building Department Copy
June 26,2015 1
IVlldl 1 II JI IUf CJ V IIId6C
Building Department 2 0,5
MAY 1
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949 !�
FBC201O
BUILDING Master Permit No.'R-c Is ( L�
PERMIT APPLICATION Sub Permit No. �LI S-- 111 v
;F-JBUILDIN ❑ ELECTRIC ROOFING ❑ REVISION F-1EXTENSION [:]RENEWALUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: // // A-Z6- 9/ /E/2Az4CE BI-0��12/4- -_43/-36
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):PLY/_/.f7/�/C Rfxc� D-Te-S Z'aG. Phone#:707-4S/-
Address: 7 07 ,,�Ltor
City: \1/LLE State:4ALIF01-1A. M zip: 956''-6
Tenant/Lessee Name: Phone#:
Email: i _I
CONTRACTOR:Company Name: �M.Q e0 A.){ ZLG` el h Phone#: '7G
Address:: 13 5 c)0 5 tL) 25 o .5
City:TB 6,jps jP i c{ State:—F— t', Zip: .3.3a c(Z
Qualifier Name: /S4czc at 64119 t i,_C. Phone#:
State Certification or Registration#: C F l X12 4'S Z 2 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: City: State: Zip:
b eo >
Value of Work for this Permit:$ 719 ,z X Square/Linear Footage of Work: / 0
Type of Work: ❑ Addition ❑ Alteration ❑ New /Z Repair/Replace El Demolition
Description of Work: I,ys 7*L L 6AE 141 �Li�Gf f�� S/0*!K - ZZ P-WO✓E mal/�77,[,lC
Specify color of color thru tile:
Submittal Fee$ �` 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 S _ -�
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 19' 20 7-C by day of 20 �,by
.S 446,1&2) ,who is personally known to r e-6t C < talc I�ty c 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 oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: C' / Sign: C'�
Print: '4''4'. 4Print:
Seal: ? :"'•. � MIRUMA.LORENTE Seal: 1MC�nooc�t�RAan�oe
* * W COMMISSION#EE 169621 tea'PF 410M
EXPIRES:March 26,2016 SWM DW NOWYPudb
th wAbrs
0
A�r9rFOF rBMM T%uge Notry samm
I
############################t############################################################################### III
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Coll
ISAAC
s eawanra any seUrlwrwcw�gWna by hm
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
CABALLEIRO, ISAAC
GMP CONTRACTORS
13500 SW 250TH#924733
HOMESTEAD FL 33092
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
Every day we work to improve the way we do business in order to CFC 1428225 ISSUED: 07/20/2014
serve you better. For information about our services,please log onto
www.myfloridalicense.com. There you can find more information CERTIFIED PLUMBING CONTRACTOR
about our divisions and the regulations that impact you, subscribe CABALLEIRO, ISAAC
to department newsletters and learn more about the Department's GMP CONTRACTORS
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! Expratmn date AUG 31.2016 11407200001539
DETACH HERE
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD ;,.
CFC1428225
The PLUMBING CONTRACTOR ;.t
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2016
0 •0
CABALLEIRO, ISAAC ;
GMP CONTRACTORS
13500 SW 250TH#924733
HOMESTEAD FL 33092
002045 -- --- --- ___�_ --- -- - - ------- -
Local Business Tax Receipt
Miami-Dade County, State of Florida
-THIS IS NOTA BILL - DO NOT PAY
6640412
13USINESS NAME/LOCATION
GMP CONTRACTORS RECEIPT NO. EXPIRES
691911
OPERATING IN RADE COUNTY 8ENEWAL 9111 ja SEPTEMBER 30, 2015
Must be displayed at place of business
Pursuant to County Code
Chapter 8A-Art9&10
OWNER
CABALLEIRO CORP SEC.TYPE OF 13USINESS
196 PLUMBING CONTRACTOR PAYMENT RECEIVED
Worker(s) CFC1428225 BY TAX COLLECTOR
$75.00 09/17/2014
This Local Business Tax Receipt only confirmscal CHECK21-14-069853
or imul ora certification of the holder s qualificatiDrrse to do business. Holder mast Receipt
or nongovernmental regulatory laws aad re ui is not a license,
The RECEIPT N0.above must be displayed 9 roments which apply to the business. Ph with 80Y governmental
P yed on all commercial vehicles-Miami-Bade Code Sec 68-276.
For more information,visit>Ij/�►w,miamidAda b
r
DATE(%4MfDDfYYYY)
ACQM,- CERTIFICATE OF LIABILITY INSURANCE 05/08/2015
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
JAL INSURANCE SERVICES INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
141 E.Conirnercial Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fort Lauderdale,R-33334
(954)958-0878 INSURERS AFFORDING COVERAGE NAIC#
TrSURED Cabalieirc's Corp INSURER A: Maxurn Indemnit/Company
GIVIP Contractor'S INSURER 8;
13500 Sw 250 St INSURER 0:
Homestead FL 33092 INSURER D:
(786)443-3548 INSURER E-
COVERAGES
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.THEWSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
Aw mm— POLICY EFFECTIVE POLICY EXPIRATION
LTR MR0 TYPE QF IN URANCE POLICY NUMBER DATF(MM? aATEi4M2=1 LIMITS
GENERAL LIAR)LITY
EACH OCCURRENCE $ 1,1300,0100
X COM*RCVJ-GENERAL LIABILMY DAI4AGE W REN I ED
PREMISES Ea orrurence $ 100,000
CLAIIASMADE
L.!Lli O(XAJR MED EXP(Myonefenqw) $ 5,000
A BDG0071475-01 02/01/2015 02/01/2016 PERSONAL&ADVINJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GFN`I AGGREGA`rF LIMIT APPLIES PER PROoticTs-Cwpiop AGO $2oo(),000
PRCTO .........
X I POLICY r JEI LOC
_AIJTOMOBILE LIABILITY COMBINEn SINGIE LIMIT
ANYALITC1 (Eniawdent)
ALLOWNEDAUTOS pHODILYINJURY
SCHEDLA-EO AUTOS I (Per parson}
HIRED AUTOS
BODILY INJURY
NON-OWNEDAUT09
PROPERTY DAMAGE
(Parivident)
GARAGE UAGLn-Y
AUTOONLY-EA ACCIDENT I$
ANYAUTO EA AOC
OTHERTHAN
AUTOONLY:
AGO
EXCESSA)MBRELL)k LIABILITY EACH OCCURRENCE t'
-A OCCUR CLAWSMADE
AGGREGATE is
Is
DEDUCTIBLE J$
RhTLNIION .__A is
VVORKERSCOMPIENSATIONANDI-:R'
EMPLOYFIRS'LIABILITY
AW F I EACH ACCIDENT I$
EXCLUDLO?
E,L.DISEASZ.��LALIMAPLOYL
LOYL
Llt"AL PROVISIONS below E.L�01 POL"
'Y IIAIT
OTHER
I DESCRIPTIONOP C)PFRXfIONS II,CGATK)wiivEHic;tr-,sfFX.CI,USlGN'4AfX-)nBY,=.NnOR,3EMENTiSPE--LALPROVISIONS
Plumbing Contractor,Lic#CFC 1428225
CERTIFICATE HOLDER CANCELLATION
Miami Shores Village SlIOULD ANY OF THE AP3OVE EOVE DESCRIBED POLICIES HE CANCE[A-F0 BEFORE THE.
Building Deparment DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR.TO MAIL30 DAYS WRITTEN
10050 NE 2nd Avenue,Miami Shores,FL 33138 NOTICE 10 THE ICATE HOLDER NAMED 10 THE LEFT,BUT FAILURE TO 00 SO SHALL
Fax(305)756-8972 IIWOSLORLIGA110N OR^RIL3Y Qf�ANY KIM[)UPON THE INSURER.ITS AGENTS OR
RFpRPsF-riwq.n I
AUTHORIZE
ACORD25(2001108) �'F OACORD CORPORATION 1988
WE
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: 5/1/2015 EXPIRATION DATE: 4/30/2017
PERSON: CABALLEIRO ISAAC
FEIN: 711003637
BUSINESS NAME AND ADDRESS:
CABALLEIRO'S CORP
GMP CONTRACTORS
13500 SW 250 ST
HOMESTEAD FL 33092
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL LICENSED PLUMBING HEATING,VENTILATION,
CONTRACTOR CONTRACTOR AIR-COND
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 of 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 certificate at
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
GMP CONTRACTOR'S
13500 SW 250 ST MIAMI FL 33092
LICENCE# CFC 1428225
PHONE : 786-399-0821
Date : 04/23/2015d
State of 1/4 k.!.c.`.......
County of
Before me this day personally appeared.15. ,4.G.. .4461, GAo, being duly sworn,
deposes and says:
That he or she will be the only person working on the project located ST
I-P,41vl Fl-c72-11P4 3-3/3 F
Sworn to (or affirmed)and subscribed me this.73. day of... ............ .20.1�,by
Personally know...... r�....
OR Produced Identification.................
Type of identification Produced..................
�r,�rooc��u a
WCOW N N•W41"
W ^WW ,Nm
�011d1d lbn NdM Pdit
Print,Type or Stamp Name of Notary
1
,SNORES
�,,,, ,,,,, Miami shores V
Building Department
�LORlDA 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.
f: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•
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge before me this day of�� / ,20 f
By IQCe e 0, f`�RZ)f lr Cy who is personally known to me or has produced
as identification.
Notary
1 90 CE8AR RAMOi
SEAL: I FF at00
Auou�s r2DIY