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RC-15-1159 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239835 Permit Number: RC-5-15-1159 Scheduled Inspection Date: July 24, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: QUINONEZ, FRANCISCO Work Classification: Alteration Job Address: 188 NW 104 Street Miami Shores, FL 33150- Phone Number Parcel Number 1121360131500 Project: <NONE> Contractor: IBERICA CONTRACTORS USA CORP Phone: (786)200-0423 Building Department Comments BATHROOM RENOVATION 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 23,2015 For Inspections please call: (305)762-4949 Page 31 of 39 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239595 Permit Number: PL-7-15-1696 Scheduled Inspection Date: July 23, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: QUINONEZ, FRANCISCO Work Classification: Addition/Alteration Job Address: 188 NW 104 Street Miami Shores, FL 33150- Phone Number Parcel Number 1121360131500 Project: <NONE> Contractor: ALDAN PLUMBING INC Phone: (305)829-3031 Building Department Comments LEGALIZATION OF BATHROOM Infractio Passed Comments INSPECTOR COMMENTS False nspector Comments Passed n1� Failed �/� Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 22,2015 For Inspections please call: (305)762-4949 Page 29 of 39 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 I I I Inspection Number: INSP-239240 Permit Number: EL-5-15-1264 Scheduled Inspection Date: July 17, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: QUINONEZ, FRANCISCO Work Classification: Alteration Job Address: 188 NW 104 Street Miami Shores, FL 33150- Phone Number Parcel Number 1121360131500 Project: <NONE> Contractor: B.L.F ELECTRICAL INC Phone: (786)380-2509 Building Department Comments SMOKE DETECTORS SYSTEM INSTALLATION AND Infractio Passed Comments BATHROOM REMODEL INSPECTOR COMMENTS False Inspector Comments Passed Failed IV Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 16, 2015 For Inspections please call: (305)762-4949 Page 21 of 35 ::'Per�rtit -5 `SCORES Miami Shores Village Permit ryypeMon. 10050 N.E.2nd Avenue NW £ Work,CIAS atsion Alteratl�tl Miami Shores,FL 33138-0000 permlt&atus.APPA 311ED fiver" �� Phone: (305)795-2204 0„ y W- t e.71 61201 i Expiration: 01/12/2016 Project Address Parcel Number Applicant 188 N 1104 Street 1121360131500 FRANCISCO QUINONEZ Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell FRANCISCO QUINONEZ 188 NW 104 ST MIAMI SHORES FL 33150-1240 Contractor(s) Phone Cell PhoneI Valuation: $ 3,000.00 IBERICA CONTRACTORS USA CORP (786)200-0423 Total Sq Feet: 60 Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved: : In Review Final PE Certification Date Denied: Window Door Attachment Type of Construction: BATHROOM RENOVATION Occupancy:Single Family Framing Stories: Exterior: Insulation Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Electrical Certificate Date: Additional Info: Review Electrical Review Building Bond Return : Classification:Residential Review Planning Fees Due Amount Pay Date Pay Type LPaidue Review Plumbing CCF $1.80 Review Plumbing DBPR Fee Invoice# RC-5-15-55584Review Structural $2.00 07/16/2015 Credit Card DCA Fee $2.00 Review Mechanical Education Surcharge $0.60 05/15/2015 Credit Card Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 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-n med contractor to do the work stated. �J July 16, 2015 Authorized Signature:Owner / Applican gent Date Building Department Copy July 16, 2015 1 % Miami Shores Village ,. P� Building De MAY 15 2 g artment p 015 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 i , Tel: (305)795-2204 Fax: (305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No P-C-1S — � I�� PERMIT APPLICATION sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP Q 1 CONTRACTOR DRAWINGS JOB ADDRESS: g0 'l OL/ S 1 City: Miami Shores County: Miami Dade Zip: 332S0 — 1240 folio/Parcel#: 1 1'21 MO — 0 1` 4-Soy Is the Building Historically Designated:Yes NO Occupancy Type: Load: r Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): �F:LLINGSw 6• ax'6IQ0Nt' Phone#: 786_ 200 -0923 Address: A S N G k4 S4 l ' City: MI AlM( S'A402E'S State: `�'Le�12.( 0A Zip: 33TSy — 1'Z "I o Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name:.T3-E'21 C4- (OAR'24CTOa S VSA- app. Phone#: 3c�S" LA96 ' 9G 03 Address: 5(-//VIe- 106 f-�- City: Mj,4jt4 S'li-I �(?t"� state: Zip: 3313� Qualifier Name: J4yiEt2 1 D ti25-,�- G(YU 2?ALe-2 Phone#: WS Y% CIS-0 3 State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ��/� Square/Linear Footage of Work: 6o fV�f Type of Work: E] Addition LJ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: � 1RU01"I 2tNOy��c.�a� SMOkr `t- C?Z�YL ILL Description Specify color of color thru tile: Submittal Fee$ L�� Permit Fee$ ((1 �� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �� L.JC) (Revised02/24/2014) � r 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be oppr ved and a reinspection fee will be charged. Signat Signature OWNER or AGENT CONTRA TOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 0 S day of 120 1 by IS day of r', , 20 1 by ��►�51Cy ooi"o M1Z,who is personally known to 1(�� 14 f—,who is personally known to me or who has produced ��— �`�1'-S as me or who has produced D2--ay'�'-4— as identification and who did take an,0% identification and who did take an oath. NOTARY PUBLIC: ����s NOTARY PUBLIC: Sign: _ Sign: Print: ,.'�`� : _ 0 �Q ��. Print: Seal: �'����� ,,���`�` Seal: °���� .•��O\: TATE APPROVED BY 16- Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE W*LORIDA PROAR OF BUSINESS AWY COC1522673,` _ ULATION c .10/16/2014 CERTIFIED ; IBERICA Co IS CERTIFIED under tho provJ4ions OfCh.4$p FS,; ftk*ndt XUG31.2DI8 L141660000107 AC# 779615 SIGNATURE Lia ° u ess.Tit Reve, Mimi-Dadeiunty,State of Florida, THIS IS NOT A BILL—DO NOT PAY 1177090 "UBIND$S:NANlEJWCL4TND[d RB[:EIPTl�lti 16Ei21CA CONTRACTORS USA NEW BUSINESS � �MO CORP SPTE 30,,X015; 54.NE 106 ST 7456995 mkh$ tq d�yoplaca of busim" MIAMLSHORES,Fl. 33138 P�ieuamoCoun�ytode L7lapter tiA-Art 9 6[70 OWNER SEC.TYPE OF BUSINESS PAYMENTAECEiVED IBERICA CONTRACTORS USA CORP 196 GENERAL BUILDING BY TAx cotiECTOR C/O PERE7,JAVIER CONTRACTOR YVotker(s) 1 CWlSM73 45.00 10/22/2014 0226-15-000290 This Local Busiosss Tax beeipt only coafrax psymratoi the local BMMM Tax.The Receipt is sofa licenk pomK ora corli6cadoa a►W holders quNiUcadm a do Iasisess.Holder must ecslNly wuh any peeasseml or soogorpfsslMW roBaMMry hews asd rpuirsomems which apply to tha bosh m The lIMMI NO.ab000aysst be dbplaypd on all commedal eshlal=t Wb i=Dada We Sae le-2m. Farmers miermssioN tdtftWWWAia I AC Rte'® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/15/2015 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(ies) 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Alejandro Moreno Best Rate-Insurance Exchange Of America (PA ,N Ext: (866)616-0065 aC No). (305)403-0801 8600 NW 17th Street E-MAIL briar@instantr1 uotesdirect.com ADDRESS: _ INSURER(S)AFFORDING COVERAGE _ N_AIC N Miami FL 33126 INSURER A: PREFERRED CONTRACTOR'S ASSOC INSURED ------------- - — --- -- --- INSURER 13_ IBERICA CONTRACTORS USA CORP INSURER C: 54 NE 106 STRET INSURER O: INSURER E: Miami FL 33138 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. INSR ADDL SU -�POLICY EFF POLICY EXP LTR TYPE OF INSURANCE VER POLICY NUMBER MM'DD,YYYY MM DD/YYYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED P— REMISES(Ea occurrence S 50,000 ! MED-EXP(Any one person) S 5 000 A PCIC5026-PCA533981 12/15/2014 12/15/2015 PERSONAL a ADV INJURY $ 1,000,000 ! GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 1,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG S 1,000,000 PRO- OTHER: AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ 1Ea acc dentj__-_ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per accident` IS UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB HCLAIMS-MADE AGGREGATE _ 5 DED RETENTION$ I� S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUT� ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A EL EACH ACCIDENT S (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ ___ If yes,describe under -- _-- - DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CGC1522673 JAVIER PEREZ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES BLDG DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES,FL 33138 { ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERI/ICES 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 Flarida Workers'Compensation law. EFFECTIVE DATE: 2/12/2015 EXPIRATION DATE: 2/11/2017 PERSON: ALFONSOGONZALEZ ABEL FEIN: 471833137 BUSINESS NAME AND ADDRESS: IBERICA CONTRACTORS USA CORP 184ONW 16TH ST MIAMI FL 33125 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 410.115(14).F.S..an ofioe of a corporation who elects exemption from this chapter by film)a ate of election under this section may not recover beneft or compensation under this chapter.Pursuant to chapter 440.05(12).F.S.,Carttilcates of election to be exempt..apply eniy within the scope of the business or trade fisted on the notice of election to be exempt Ptssuard to Chapter 440.05(13),F.S..Nolloes of election to be exempt and cerlWcates of election to be exempt she)be subject to revocation if,at any time alter the Hing of the notice or the Issuance of Nue certiNcate. the person rennet on the notice or certificate no longer meets the requirements of oft section for Issuance of a certificate.The department shalt revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)113-1608 JEFF ATWATER MEF FWANCIAL 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: 10/24/2014 EXPIRATION DATE: 10/23/2016 PERSON: PEREZGONZALEZ JAVIER FEIN: 471833137 BUSINESS NAME AND ADDRESS: IBERICA CONTRACTORS USA CORP 54NE 106ST MIAMI SHORES FL 33138 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.D5(141 FS.,an officer of a corporation who erects wtemption from this chapter by fi6g a certificate of election under this section may not recover benefits or sensation under Oils chapter.Pursuant to Chapter 440.05(12).F.S..Certificates of election to be exempt..appy 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 lf,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 reorements of Oft section for issuance of a cedificate.The department shelf revoke a DFS-F2-DWC•252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 100Q*e.4MP-f/�e- r C exQwl�ti�� $' ' aC�D . 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