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RC-15-96 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-240368 Permit Number: RC-1-15-96 Scheduled Inspection Date: July 31, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: MARTINEZ, WILSON Work Classification: Alteration Job Address:9022 NE 8 Avenue 3S Miami Shores, FL Phone Number (786)260-4966 Parcel Number 1132060420590 Project: <NONE> Contractor: STONE SERVICES GROUP, INC. Phone: (305)970-9651 Building Department Comments PARTIAL REMODELING TWO BATHROOMS Infractio Passed Comments INSPECTOR COMMENTS False INSURANCE CANCELLATION NOTICE RECEIVED 3/2/15 NEED TO PROVIDE LIABILITY INSURANCE JF 04/01/2015 LIABILITY INSURANCE RECEIVED Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 30, 2015 For Inspections please call: (305)762-4949 Page 19 of 19 Miami I)aclr Co FOUNDATION OPPORTUNITY--DRi.-EVERYTHING Wilson Martinez,MS Donor Relations 300 NE 2nd Avenue,Room 1437 Miami,Florida 33132 Office:305-237-3801 /Fax:305-237-7501 Email:wmartinl@mdc.edu I am MDC 104 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239577 Permit Number: PL-1-15-97 Scheduled Inspection Date:July 28, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: MARTINEZ,WILSON Work Classification: Addition/Alteration Job Address:9022 NE 8 Avenue 3S Miami Shores, FL Phone Number (786)260-4966 Parcel Number 1132060420590 Project: <NONE> Contractor: EDWARD ROJAS PLUMBING CORP Phone: (305)944-6788 Building Department Comments INSTALL TOILET AND WATER HEATER Infractio Passed Comments INSPECTOR COMMENTS False ase Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-233536, P-TRAPS FOR EEILAVATORY SHALL NOT BE CORRUGATED Failed C� Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 27,2015 For Inspections please call: (305)762-4949 Page 29 of 44 To: Page 2 of 2 2015-04-01 14:37:41 (GMT) 19542120145 From: Odalys Hurtado C"I? CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/01/2015 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies mazy require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of Such endorsement(s). PRODUCER - A. rvnrnE: Odalys Hurtado Oasis Insurance Services a/GNty (954)923.-7_334 . ........... ..... �a/cop (954)923-7336 2028. Harrison St Suite 20`1-2 E MAIL ADDRE Sy:, OkhUrtado fZ yal'iUU.CUm INSURERIS I AFFORDING COVERAGE NAIC A Hollywood FL 33020 INSURER A: GRANADA INSURANCE COMPANY INSURED .. ..___ ......__....... __._.. .... -......... INSURER B' STONE SERVICES GROUPING wsuRER r 164658 NE 27 AVE rNsuRErr l> INSURER E: - ................. ......... .--.... _......... _... NORI H MIAMI BEACH FL 33160 T INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE Lt$TEt7 BELOW HAVE. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI"riON 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.. A DUL SUBI't P(}LFCY EF"F POLICY`EXP LTR TYPE OF INSURANCE IN�5 U WV Ste, fytr_ f3. T-3 ICY NUMF3ER fMM/DDfYYYY) IMM/DD/YYYYT LIMITS } COMMERCIAL GENERAL LIAMUTY cnr.N r.ccuRRLN L s 500.000.00 DtiFn CL 7GC3 ...RENT _ ......... ..... _....... ....... CLAIMSdv`.ADE OGUJI. F'ftEP�luF;q(E';&av_urrenct+).. ........... ......_...... .. ... ... MED'XP(Any niw I or%091 S S.QgQ A X 0185FI-0,0014, . 03!25/201.5;03/25/2016 PERSONAL,&ADV INJURY 500.000,00 .r,LA(,;REGti"Itlitail r FS=Lra caEJVL.R L +eGl.�r>ATr_ $ 1:.000.000.0ix0 POLICY T" 1 FROIDUC TJ-COMPIOPAGC, £ ,000.000.00 J ...._ ....... ... .AUTOPhOBILE 1_IABII,ITV r r')tJ I�.!cL5itJ SLI LIMIT N!,i;TiJ BOU Y INJURY Pet person) r ...,.... ..._.... AUTOS AUTOS BODILY IN VURY,t rrt Acoident)I a J ........, HE .iJTO7 ._.._ . rPROPERTY DAA{E a ode^t)... -........... �... ....... _._. `S --'---- i UMBRELLA LiA€3 - ..... - .. Of.'i:UR tAt.,H OCI.:I)RRP NC:E $ EXCESS ilA 6 ..... __.. CLAIMS-MADE! AP,GREGATE S OLD RFTENTiONS w ...- WORKERS COMPENSATION PCR ;'J N ;AND EM PLOYERS'UABtUTY Y:N 4'TATiiTG.,,. .FFj,,,, _ F ,4riY PRO RiErUR P t :IV E!t xt -;::is : 1t..,IL,- E';.:..E C NT ...... ... - _ r "tNrA EXi F✓tF'I`ION El -(Mandatary in NN) E L rJJ$E E,C EMPLOYEE S )f yos..doscdbe ,ndor .. .......__ .- ......... . .. .._._._... _....-..._ '.DES_..R.:I IION-Or OPEQ.ATiDNS uelcv� 'E.1-DISEASE_PillvY LIMIT u - DESCRIPTION OF OPERATIONS;E OCA.TfONS!VEHICLES fAUORD 101.Additional PRonrnrks S.rfiedu(e,may bo attacne(I ifmo -Pace is required) - ADD CITY OF MIAMI SHORES AS ADDITIONAI..INSURANCE C;�ENERAL CO.NTR.AC"f(,!(-,=NSE#C(�C061794 CERTIFICATE HOLDER_ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF MIAMI SHORESACCORDANCE WITH THE POLICY PROVISIOW. 10050 Northeast 2nd Avenue auritonlzentatonc:S¢.Nrnrtve ODALYS HURTAC)O U �f�..,•� Miami Shotes FL 33138 y,K`rLL rl)1988-2614. ACORD.CORPORATION.Ail rights reserved. ACORD 26(2D14101) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE 2/28/2015 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION KEY KNOWLEDGE INSURANCE, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9101-C S. W. 19TH. PLACE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR FORT LAUDERDALE, FL. 33324 qb ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (954)382-5259 COMPANIES AFFORDING COVERAGE COMPANY ARCH SPECIALTY INSURANCE CO. A INSURED COMPANY SERVICES GROUP, INC. g TEGUI COMPANY 1 AVENUE C CH, FL 33160 COMPANY D COVERAGES AV AV THIS IS TO CERTIFY-THAMIEPOI OF I URANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTAMDjlqG. I NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS UCH I SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co LTR TYPE OF INSURANCE CY NU POLICY EFFECTIVE POLICY EXPIRATION DATE(MAKIDDIM DATE(MM/DD/YY) LIMITS GENERAL LIABILITY BODILY INJURY OCC $No Coverage COMPREHENSIVE FORM Ar-L0018.4 10/15/2016 01/30/2015 BODILYINJURYAGG $NO Coverage UNDERGROUND PREMISES/OPERATIONS PROPERTY DAMAC3E OCC $No Coverage EXPLOSION&COLLAPSE HA7ARD PROPERTYDAMAOEAGG $NO Coverage PRODUCTSICOMPLETED OPER Bt&PD COMBINED OCC $NO Coverage CONTRACTUAL INDEPBI&PD COMBINED AGG $NO Coverage DENT CONTRACTORS PERSONAL INJURYAGG $NO Coverage BRROADOAD FORM PROPERTY DAMAGE PERSONAL INJURY AUTOMOBILE LIABILITY ANYAUTO N/A DILY INJURY gp7p Coverage ALL OWNED AUTOS(Privaw Pagg) at person) g AL OWNED AUTOS BODILY INJURY (Other than Priva(e Passengeo (Per sccidcn() $No Coverage HIRED AUTOS NON-0WNEDAUTOS PROPERTY DAMAGE $NO Coverage GARAGE LIABILITY BODILY INJURY& PROPERTY DAMAGE $No Coverage COMBINED EXCESS LIABILITY UMBRELLA FORM N/A EACH OCCURRENCE $No Coverage AGGREGATE $NO Coverage OTNER THAN UMBRELLA FORM $NO Coverage WORKERS COMPENSATION AND WO$TATA- 0TH EMPLOYERS'LIABILITY (L16 IT THE PROPRIETOR/ EL EACH ACCIDENT $No Coverage PARC"SJD(ECU7IVE INCL N/A EL DISEASE•POLICY LIMIT $NO Coverage OFFICERS ARE EXCL g OTR EL DISEASE-EA EMPLOYEE $NO Coverage DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Please be notified that this Policy is not longer in effect due to non payment premiun CERTIFICATE HOLDER CANCELLATION Miami shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING, COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FAILURE YO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY ►(IND UPON THE COMPANY ITS AGENTS OR REPREBENTgTMEB, AUTHORIZED REPRESENTATME MARIA A RYALS, AGT y?s' ?,R:•... ..ry._. .�. ACORD 25-N(1/95) ®ACORD CORPORATION 1988 'roduced using Forms Bova Plus software.www.pomuBMS.COM;Impressive Publishing 800-208.1077 Policy Number; Date Entered: 8/12/2004 ACORo CERTIFICATE OF LIABILITY INSURANCE D r 1/14/lg/2015 15 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 pollcy(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 certlflcato holder in lieu of such endorsemant(s)_ PRODUCER NA T KEY KNOWLEDGE INSURANCE, INC. 9101-C S. W. 19TH. PLACE PHONE (954)382-5259 (959 Noe A/C NII:(954)382-0080 E ale@ko krowled oins.com PORT LAUDERDALE, FL. 33324 n RESS:�yY g INSURER(S)AFFORDING COVERAGE NAIC f INSURERA:ARCA SPECIALTY INSURANCE CO. INSUreF,D STONE SERVICES GROUP, INC. INSURER 8: MR CARLOS REATEGUI INSURER C: 16468 NE 2 7TH AVENUE INSURER D: NORTH MIAMI BEACH, FL 33160 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. IN5R MAIL SUER POLICY EFF POL LTR TYPE OF INSURANCE IVSD wv POLICY NUMBER MM/001yyyY MM D LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 CLAIM8-MADE OCCUR ACLOO1841500 0/15/2014 /30/2015 PAMAGEa a ooeurrencc 1$100,000 MED EXP Any one Person) $10,000 PERSONAL A ADV INJURY s 1 000,000 GEN'LAGGRE=GATE LIMIT APPLIES PER: pENERALAOGflEOATE $2,000,000 POLICY PRO- JECT F LOC PRooucTs-coMP/op Aoo 132,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINCLE LIMB s Ee accident ANY AUTO N/A BODILY INJURY(Per person) E ALL OWNED 8CHEDULED AUTOS AUTOS 80DILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PRO DAMAGE AUTOS Per accident 8 9 UMeRE{rOPZRATIONSbolow OCCUR EACH OCCURRENCE= S EXCESS CLAIMS-MADE N/A AGGREGATE g DED TION S WORKERS COION S AND EMPLOYEITY STg7 ERH ANY PROPRIETEWEXECUTNE YIN B OFFiCER/MEMpe07 N/A E ',MTION E,l EACH ACCIDENT S (Mandatory In H ycs tleaCllbe E.L.DISEASE.EA EMPLOYEE S DES�RtPTION TIONS below E.L,DISEASE,POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additlonal Remarks Schedule,may be attached M mare apace is required) GENERAL CONTRACTOR/ KITCHEN CABINETS AND COUNTER TOP REPLACE PLEASE BE ADVISED TATS INSURANCE POLICY HAS BERN CANCELED DUE TO NOW PAYMENT OF PREMIUM , EFECTIVE CANOE CERTIFICATE HOLDER CANCELLATION MIAla SHORES vIT.Y.Ar_r BUILDING DEPARTbRNT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 6950 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN baAM SHOnS, FL 33038 ACCORDANCE WITH THE POLICY PROVISION& 305-756-8972 AUTHORIZED REPRESENTATIVE Maria A, RyaZa,Agt- 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD °roducsd using Farms Boas Plus soft�q.www.F0m100wxorrr Im"salve Publishing 800-208-1977 ABCO PREMIUM FINANCE, LLC P.O.Box 141029,Coral Gables.FL 33114 Tel:(305)461-2555 Fax:(866)598.3210 INSURED STONE SERVICES GROUP,INC. . CARLOS REATEGUI 36468 NE 27TH AVENUE NORTH MIAMI BF,ACH,FL 33260 STANDARD CANCELLATION NOTICE NOTICE OF'CANCELLATION (AVIS.O.DE.'CANCELACION) - 0849565-7 249663 TBA 31,220.30 0/130/2015 1,111 iiiiij!I You are hereby notified that the policy described above is cancelled for non-payment of an installment in accordance with .the conditions and terms of the premium finance agreement which incorporates, a power of attorney. This cancellation- is effective one day after the above captioned date, at the hour indicated in the policy as the effective time. The Florida Insurance Code part XV of Cha ter627, recognizes this as a valid notice of cancellation and provides that the insurer shall promptly return the unpaid balance due under the finance contract, up to the gross amount available upon cancellation of the policy, to the premium finance company and. arty remaining 'unearned premium to the agent or the insured, or both, for the benefit of the insured or insureds. If the policy or any statute requires the insurer to give notice to a mortgagee, governmental, agency, or other third party before the policy can be cancelled, the 'insurer shall, give the prescribed notice in behalf of itself or the insured to any governmental agency, mortgagee, or other third party on or before the second business day after the day it receives. the notice 'of cancellation from the premium finance company and shall determine the effective date--of- cancellation taking into,-co-nside-ration -the number of-.days. notice. required to complete. the cancellation. IF THE ABOVE CAPTIONED INSURANCE CONTRACT PROVIDES MOTOR VEHICLE LIABILITY INSURANCE REQUIRED BY THE FINANCIAL RESPONSIBILITY LAW, PROOF OF FINANCIAL RESPONSIBILITY IS REQUIRED TO BE MAINTAINED CONTINUOUSLY FOR A PERIOD CSF THREE (3) YEARS, PURSUANT TO CHAPTER 324, FLORIDA STATUTES ANDIHE OPERATION OF A VEHICLE WITHOUT SUCH FINANCIAL RESPONSIBILITY IS UNLAWFUL. ABCO PREMIUM FINANCE,LLC RISK PLACEMENT SVCS,INC 08061 C/O;ARCH INSURANCE CO KEY KNOWLEDGE INSURANCE** 2400 E COMMERCIAL BLVD 0728 9101 SW.19 PLACE#C FT LAUDERDALErPL 33308 FT LAUDERDALE,FL 33324 INSURANCE COMPANY AGENT COPY PRODUCER 130M 015 Miami Shores Village - �� ry 1 Building Department JAN 15 015 ` f 10050 N.E.2nd Avenue, Miami Shores, Florida33138 :—e Tel:(305)795-2204 Fax: (305)756-897L2 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 [C) BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. VUILDIN ` ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL G ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR*. DRAWINGS 4/JOB ADDRESS: �a 2 ,�/ ! h `� s City:m lAAI Miami Shores Countv: f Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: /C� OWNER: Name(Fee Simple Titleholder): Wlzro i7 �GT� i'!r 2 Phone#: �1 6 7` /�C� Address: 795;A /Uee-- CC 19'>7 �ei7 Lxo- City: �L 6/moi, J h State: �I Zip: 3313 Tenant/Lessee Name: Phone#: Email: �- CONTRACTOR:Company Name: rr'-j t Phone#: 3o4- Sr30 Address: 64 fJ,.z City: State: L Zip: .3-d,,4 0 Qualifier Name: Phone#: State Certification or Registration#: C_ ri> c v e j'7 9 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: 9 00 Square/Linear Footage of Work: Type of Work: ❑ Addition�—❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �Q �' l c s jy0O 3 el 6 "77�i z, Zxljq coo.-n.1 /t675,c4'r'e" 0,:7/-"p Specify color of color thru tile: Submittal Fee$ Permit Fee$ (H'� ��(�- U" CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �=5 (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 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 occur seven (7) days after the building permit is issued.. In the absence of such posted notice, the inspection will not be approv and reinspection fee will be charged. Signature Signatur WNE rAGENT CONTRACTOR Th oregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this �L_day of J ti 20 1 byday of }s-rw 20 15 by moo who is personally known to C14rC (I"3 rf(-A-1 z 41 1 who is personally known to me or who has produced J' v I as me or who has produced I i2) as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: vvvv �-, Z4" Sign: Sign: Print: _ `�'` v J!'� `'' - Print: �Ir Seal: _ �;r �j�, = Seal: C- mfr a,r _ APPROVED BY ' �-� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) M . � STATE OF F=LORIDA 9.. DEPAR.TMENT'OF'B:USNESS AND . :: PROFE S S I 0 NA�:'AZ E,G U LA CG.006.1794- TI'DIV. gla. SUl ':, '08/28%2014. t' CERTIFI'EDCENt1 .: Nfl . .,,.:. ;. BEAT .. „ . EGUr, CAAL&AL-�e-JAN -00',: STONE'SERVOul its IS, rERTIFII-p- u.n;der the"ptov'fsibiis df Ch;469"'F'S':' Expiration date ; AUG.31;201' L1408280042845 AC�® Policy Number. Date Entered: 6/12/2004 CERTIFICATE OF LIABILITY INSURANCE DATE(MMID0WW) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ni's HOLDER 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 requlre an endorsement. A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsomen s). PRODUCER TACY KEY KNOWLEDGE INSURANC , INC. NAM 1iE: 9101-C S. W. 19TH. PLACE PHONE .(954)382-5259 FAx U-MAIL ac No:(954)382-0080 FORT LAUDERDALE, FL. 33324 ADDREss n'=Yaia@k eyknowledgeins.com INSURER S AFFORDINO COVERAGE NAIC It INSURED $TONE $$RVICES GROUP, TNC, INSURERA:ARC3 SPECIALTY INSURANCE CO. INSURER B: 1!R CARLOS REATEGUI 16468 NE 27TH A�r7� INSURER C; NORTH MIAt1IINSURER D: SACH, E'I. 33160 INSURER E COVERAGES INSURER F! 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. ILTR TYPE OF WSURANCI_ NSD POLICY NUMBER MMIC POLIC P A COMMERCIAL GENERAL LIABILITY MlYYTY LIMITS CLAMS MADE ®pCCUR EACH OCCURRENCE $1,000,000 AGLOO1841500 0/15/2014 0/152015 PREAR T E9 occurD $100,000 MED EXP(Any one person) $10,000 GENT AGGREGATE LIMIT APPLIES PER: PERSONAL BADV INJURY $1,()00,000 POLICY p& FILOC GENIZAALAGGREGATR S2,000,000 0714ER; PRODUCTS-COMP/OP AGO $210 Or OOO AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT AMY AUTO N/A Ea accidenALL $ AUT WN ED SCHEDULED BODILY INJURY(per Damon) S AUTOS HIRED AUTOS NON-OWNED BODILY INJURY(PeraCottlenl) $ PerOacclC DAMAGE $ UMBRELLA LIAR OCCUR $ EXCESS LIAR CLAIMS-MADE N/A EACH OCCURRENCE $ DED RETENTON3 AGGREGATE S WORKERS COMPENSATION $ AND EMPLOYERS'L1Uii-jr y PER B ANY PROPRIETOR/PARTNER/BXECUTIVE YIN STA TE E T OFFlCER/MEM6EREXCLUDED? ❑N/A E)MbaiOi.7 S.L.EACH ACCIDENT (ManCatoty in NM) $ ffes tl IONunder $ D�SGtRIPTPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATK)NS I LOCATIONS t VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached N more space is required) GENERAL CONTRACTOR/ KITCHEN CABINETS AND COUNTER TOP REPLACE CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLA= BUILDIIQG DEBARTI-MNT SHOULD ANY OF THE ABOVE pE$GRIBED POLICIES BE CANCELLED BEFORE F6950 NE 2ND AVE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NMANI SHORES, FL 33038 ACCORDANCE WITH THE POLICY PROVISIONS. 30$-756-8972 AUTHOR{ZPDREPRESENTATIVE s Maria A. Ryala,AgY. / il 'Zt�"�' ".. �� •" 0 1988-2.014 ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD ORD CORPORATION. All rights reserved. Iroduced ushg Fanna Boss Plus softwar&www.FamaBoas.co,rr Impressive Publishing 800.208-1977 Page 1 of 1 ' L 1�1 10096 9 FFCHE-F L 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 Thia cel1160S that the indlvldual listed 11eI0W has elected to be exempt horrf Florida 1Narkers'Compenaatlon law. EFFECTIVE DATE: 10115/2014 EXPIRATION DATE. 10/1412010 PERSON: REATEGUI CARLOS A FEIN: 650942862 BUSINESS NAME AND ADDRESS: STONE SERVICES GROUP INC 16488 NE 27TH AVE N MIAMI BEACH FL 3318D SCOPES OF 13USINESS OR TRADE; CONCRETE CONSTRUCTION NOC Pumuaette CPnPtWyq,0tt•t.P.B.,fneMe•.of�caae.lbn+hM alaee•••mPlhn tram thr ahapfere w•mfRe•MYmnnpemt i wr"amaovp�at beleMna"fgefueWrn�e++e^frMornVfupaawaeenin,.m,eg.tr Mtnl•aae�be.qwvb aPunun"imroroCfbc,Mn MPhr 1<t.q apter nweoertlAee.tuM.•ptpdqb,wpM�rleY o lloa and � 'me"' an "Pe" on the Werk. nbnger m••ta"eM !o1401 1.14bMogcutwrocn qurth lime 49uenei Of.numate.T.II—- qW the C460kni* "P"rtmant(hall Www.a OFS-F2.Dna252 CMFICATE OF ElECTiON TO SE EXEMFt REMSEDOT-ty Ou Ea710N57(AGO)413-180@ https;//apps8.fldfs.com/erreportviewer./reportV iewer.aspx?data=kdvpginc9.D7Q3 gH6T'11R... 10/21/2014 >l Aged- • -• / �'P,f vr� e�l�gw Pad 740 �el7ele1 Nrleo I C�� ."�-1�1r��-�r l.%1 �s C.�c�+J�: a.J�.�—C7V'�Z '��--►(L- ��tµltiJtrury�� E I t SNiOR�s ..,. Miami shores Village Building Department �ORtDp' 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 acknowledges 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 wor ers compensa ion insurance coverage rom 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 /7 Contractor Print Name: W,40,171 /V 'n Print Name: Signature: Signature• State of Florida) State of Florida) County of Miami-Dade) Count of Miami-Dade Y ) I �uiu�ru�rr�i Sworn to and subscribed before me this \\`4 �Bllfv S,� Sworn to and subscribed before me this l�` �,rl@n;''�%,, day of N 20 1��,` i.xp'�.12By By� day of ps t_--) ,2 (2 oo 6 .� y , (SEAL) r'41 gsi /fG' (SEAL) Type of Identification produced < '. ip Type of Identification produced S ` LQR\,\,, ORID� ��`�� Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-233534 Permit Number: EL-12-14-2723 Scheduled Inspection Date: June 25, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: MARTINEZ,WILSON Work Classification: Alteration Job Address:9022 NE 8 Avenue 3S Miami Shores, FL Phone Number (786)260-4966 Parcel Number 1132060420590 Project: <NONE> Contractor: CARIBE ELECTRICAL CONTRACTOR INC Phone: 786-412-0067 Building Department Comments 26 FIXTURES, 1 RANGE, REFRIGERATOR, MICROWAVE Infractio Passed Comments AND 5 RECEPTACLES. INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-233480. Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. June 24,2015 For Inspections please call: (305)762-4949 Page 10 of 40 Miami Shores Village Building Department DEC 12 0 4 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 BUILDING Master Permit No. t:_L `l —Z77 2 S PERMIT APPLICATION Sub Permit No. ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �y 4 ut 3-5 (� City: Miami Shores County: Miami Dade zip: 3 3 Z 3 d Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: v/ ^7 FFE: OWNER: Name(Fee Simple Titleholder): /SCS 'C�d�� '�� Phone#: o Address: Z L A-"� A e,,-e � J � s 3City: � 313 Tenant/Lessee Name: L Phone#: � Email: '.In -77/'J _ ' �h o 4/ / C-a h7 i CONTRACTOR:Company Name: �' � �^�`c '� Phone#: Address: City: State: Qualifier Name: /L� �' .�Z4*'_°)'V .-9' Phone#: State Certification or Registration#: �=G— /' 005 '/ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: ` 1C� City: State: Zip: Value of Work for this Permit:$ �c� 0L� ySquare/Linear Footage of Work: Type of Work: El Addition LJ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: �-- J,(/-e Specify color of color#hru 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$LcqS (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 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 of a einspection fee will be charged. Signature Signature O NER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before /m�a this day of �G�ir/O 20 2 by day of 20 --1 by who i personally known o wh is personally own to me or who has produced as me or who has produced G1 as identification and who did take an oath. identification and who did a an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Ct ��- Sign: —' r. .` 1Notary Public-State of Florida Print: I L° Print: •oer xprres u 9,2015 Seal: NORVELL A.S. HOLYFIELD Seal: Commission#EE 82521 `. Notary Public-State of Florida '""��"`" Bonded Through National Notary Assn. My Comm. Expires Jan 21, 2017 Commission #EE 851490 APPROVED BY „ /� �/3'J�' Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) �► �° CERTIFICATE ; DATS(MWD01YM) O LIABILITY INSURANCE ,a128114 THIS C>=RTI^F)CAT#z IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FLIGHTS UPON THE CERTIFICATE HOLDER,_THIS I ! CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,-EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES t BELOW. THIS CERTIFICATI~OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED k --REPRESENTATIVE OR PRODUCER,AND THE CERTII=ICAT>_HOLDER. i1NPORTAN r: if the certificate holder Is an ADDITIONAL INSURED;iia pollcy(iea)M"Ut be endorsed. If SUBROGATION IS WAIVER,SLip)eat to the terms and e00idit10415 of the Policy,CCr(Ain polides may require an endorsamor t, A statement on this ceft cw*does not oontor Hghts to the _owtIftceoe bolder in lieu of such endorssmantis). PRCOUC i Amp- First Class)nsurance Market ! PHONE t (305)441-2997 305)441 fyd43 4101 NW 9th Street ;; e� ,r4,..._ i ADLZRESS_ mcC�eol com Miami, FL 33126 ......,., ,.�...______....._._.._� INSUR RA(S FORGNo COVORAOe MAIC i! Phone (305)4b1-2997 Fax X305 441 64A3 INSU--•—'---ATLAnt71C CASUIIIY INSURANCE COMPANY -- I INSURER B- PROGRESSIVE F-XORESS INSURANCE COMPANY CARIBI=ELECTRICAL CONTRACTORS INC I iNSUc- .TECHNOLOGY INSURANCi^COMPANY ' 261 W27STREETIN€URI �Rp, HIALEAH,FL 33050 }�} INUVRERE: �.-.__.•__��_ _._._..__ INSURER P: - ^^-^^--'•,-^,____._.,.,, � --J CERTIFICATE NUMF31wR: _ REVISION NUMBER: I rMIS IS TO CERTIFY THAT THE POLICIES(5 INSURANCE LISTED$SLOW HAVE BEEN ISSUI t?TO W INSURED NA.MEDASOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CIwRTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUOJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CWM$, �lNSR' "-•-- – ---•--' iADDL:BUAR —' ;J,ZR n7YP&OF INSURANCE �IFLyR NA/Df POLICY NUMBER ; POLICY EFP POL�y 4ENEkALLIABILrrY ____— ._..,. -, (XMIODNYM ftlMUtl@/ LIAMTS – j I EACH {IRR $ 1,000,000100 ® COMMERMAL GENERAL LIABILITY + I ; I �EI� ctJUM3-MADEFY'-- I ; , PREAIISEs(EeOtturrenca) S ��i0oa.oa .... A I OCCUR I I L039003246 MED w6,000.00 07115/2015 PERSONAL&ADV INJURY f; T,000,000.OQ i I GeNERAL AGGRLMA�AUG 2.000 000.00 , i GEN'LAGGREGATR(.16QTAPPLIES POR. ! ? ` POLICY ❑ P I P�OAUCTS-COMPlO2,000,000,00 I I_ }' IE�C4r ❑ LOC - { AUTOMOBILE LIABILITY 1 1 ��NEO 61NGLE LIMfT 1 ;Q i A ALL OWNED �ry BCHEwLEDB gUTO$ t ` i 35-1 BODILY INJURY 1022511 giTS 03/26/2014 03/26/2015{'�BOrHLY INJURY(Peramid crn($ HIRMDAUTOS AUTOS i ! l .'. : j UMEFRELL.ALWB C r OCCUR j i EACH OCCURRENCE $ ; I EXCESS LJ A 13 ❑Cl.a6NSMADE-{ ' � l '""""""" E. RETENTI NS_ AG6REt3ATE i 3 t----' �DED _ , "^'—•----.__. I WORiamsCOMPENSATtON `1 ; AND EMPLOYE:MW LIABS,ITY Y l N + 1 ANY PROPRIE,T'OR/PARYNER/EXECUT'N, C I OFFICER/MEM8ERRXCL(1DC;D? „N!A TWC3430922 I 1 E.L EACH ACCIDENT ; s 1!)00,000 00 i I IrMyee baNH) 1 10/25/2014 10/25/2015 E DESL`ftt+'TroN CSF OP£RAnONb below I I 1 I L,D�!8A8Lr-EA EMPLOYEt S 1,000.000.00 l E.L,DISEASE-pOtiCYLIMIT 5 1,D00,ODO.DD I , I I 1 Dfi6CRwnoN OF OPMATIONS I LOCATIONS vr;HICLEs(Af�ai a.,.. >wAC4t20181,Rtld3tlon6lRemarksSche4u1e,7moreepACAistogDired) ELECTRICAL CONTRACTOR T _ r i i ! _ I CERTIFICATE HOLDER CI CANCELLATION_.._ j ty of MiSmi Shores Village: I - — —^-- - - --- -- 10050 NE.2nd Ave SHOULD ANY OF THE ABOVE DIESCRiBeD pOLICII5$SE CANCELLED 13EFORE E EXPIRATION DATE THEREOF,NOTICE VALL BE DELIVERED IN Miaml Shores, X133138 1 A R1ANCEWITH THEPOLICYPROVISIONS, i ORIx D REPRESENTATIVE j i i ACORD 23(2010/05)OF 988-2010 ACORD CORPORATION. All rights reserved. The ACORD name.and 1090 are registered marks of ACORD 12112/2014 15:18 3059814478 KIM & LOWMAN, LLP PAGE 01/02 / CNN; 20140839590 BOOK 29420 PAGE 273 DATE12/08/2014 0106-13 Piv1 DEED DOC 624.00 HARVEY RUVIN,CLERK OF COURT. MIA-DADE CTY Erepe Y and retu.m W: Marci M.Lowman ;Partner Kim&Lowman,LLP 8620 NE 2 Avenue Miami,FL 33138 305-9814477 File Number: 14-Martine-3548 Will Call No.: __!Space Above This Line For Recording Data]. Warranty Deed This Warranty Deed made this 26th day of November, 2014 between Capitslinter, LLC,a Florida limited liability company whose post office address is 660 Curtiswood Drive, Key Biscayne, FL 331.49, grantor, and Wilson Martinez and Eliezer Bastidas Betancourt, a married couple under the laws of Minnesota, as Joint Tenants with Right of Survivorship whose post office address is 2619 SW 5 Street,Miami,FL 33135,grantee: (Whenever used herein the tents "grantor" and "grantee" include all the pnr ics to this instrument and the heirs, legal representatives,and nssiens of individuals,and the successors and assigns nfcorporaiions,trusts and trdstees) Witnesseth, that said grantor, for and in consideration of the sunt of TEN AND NCI/too DOLLARS ($10.00)and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described land, situate,lying and being in Miami-Dade County, Florida to-wit: Unit No. 3-S, MIAMI SHORES CONDOMINIUM, according to the Declaration of Condominium thereof,as recorded in Official Records Book 8414, Page 676, of the public Records of Miami-Dade County,Florida,as amended and restated. Parcel Identification Number: 11-3206-042-0590 Also known as 9022 NE 8th Avenue,Apt.3S,Miami Shores,FL 33138 Subject to taxes for 2014 and subsequent years; covenants, conditions,restrictions,easerncnts, reservations and limitations of record,if any. Together with all the tenements,hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and chat said land is free of all encumbrances,except matters of record and taxes accruing subsequent to December 31,2013. In Witness Wbereof,grantor has hereunto set grantor's hand and seal the day and year first above written. DoubleTimee 12/12/2014 15:18 3059814478 KIM & LOWMAN, LLP PAGE 02/02 rFN: 20140839590 BOOK 29420 PAGE 274 Signed,scaled and delivered in our presence: Capitalintcr,LLC, lig - eiity company By: Witness N i ./� WTI WM y� Pat.rtce CC , 5ole Managing Member r Witness Name: ^ '�vlo� State of Florida County of Miami-Dade The foregoing instrument was acknowledged before me this 26th day3fQlovember,2014 by Patrice Scernana of Capitalinter, LLC, a Florida limited liability company, on behalf of said firm. tit.hc (_j is personally known or [Xj has produced a d4we4&Jiea;W as identification. • `r [Notary Sea]) Notary PuUlic '� ^^� eey aY#%4r. MARDI LOWMAN MY COMMISSION 1 R 034616 Printed Name: EXPIRES:July 9,2017 q +,po.,� �'' Bo�dadlnroBv�Jg�INodryServlc� My Commission Expires: Hlarin/1ly Deed•Page 2 DoubleTEmem Miami Shores Village JAN 15 2015 Building Department 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 BUILDING / '� Master Permit No. PERMIT APPLICATION Sub Permit No.? L,I<S —cl ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP h ) CONTRACTOR DRAWINGS JOB ADDRESS: !70 Z Z /V a _q 7�6 p� d 3 -fes City: Miami Shores County: Miami Dade Zip: / b' Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Wi/SCn daikkeZ Phone#j /(o 2(,, o / ( 6 / p Address: qy a,� 12L � fI rYrenuL1_ Ani:, s v City: /�iam) J 6 of-eo State: J Zip: 3-1 Tenant/Lessee Name: Phone#: i Email: CONTRACTOR:Company Name: &211&a)Z - Phone#: q44.6 4.6 ).?k- Address: .GGAddress: a D n k I / f c'S , City: IC State: �'' I * Zip: 13 j Gf` Qualifier Name: "I r Phote. 4-4– 6 7 �� State Certification or Registration#: 1104 / 4-3l Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: / City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration / ❑ New Repair/Replace ❑ Demolition Description of Work: L � Specify color of color thru tile: Submittal Fee$� Permit Fee$ �d ' CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 1 2 1 -S (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 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 s ven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approvONERdAGENT a einspection fee will be charged. Signature Signature O CONT ACTOR The foregging instrument was acknowledged before me this The foregoing instrument was acknowledged before me this _day of 20 7J by day of .-20 � L 2 /D by WI I�Son Akd?llne2 , is persona y now o 9-wccwho is personally knn—own o me or who has produced as me or who has produc identification and who did take an oath. identification and who did take NOTARY PUBLIC: NOTARY PU I _ Sign. Sign. 11 "R2 MAIDELIN ARTINEZ Print: A44a Print: NORVELL A. OLYFIELD :• My Comm.Expires Jul 29,2015 Seal: Seal: Commission#EE 82521 Notery Public-State of Florida °• My Comm. Expires Jan 21,2017 '•��"'��, Bonded Through National Notary Assn. Commission #EE 851490 Bond Throu h National NoEat Assn. APPROVED BY �Ii/S '/5 Plans Examiner Zoning M n / Structural� 'Z/R7eview`� Clerk (Revised02/24/2014) 1//T 7 L 3 S� 2 2 6 8 / RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CFC049431 The PLUMBING CONTRACTOR Named below IS CERTIFIED Igo Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ROJAS, EDWARDO -R ' EDWARD ROJAS PLUMBI "CORP 880 NE 111TH ST BISCAYNE PAM ' +L-13161 ISSUED: 08/052014 DISPLAY AS REQUIRED BY LAW SEQ# L1408050001639 Local Business Tax Receipt —h mri-Dade County,'State of-M6rPda --__--- TMSIS NOTA BILL—DO NOTPAy WJMMBE NAMAMMATION RECEIPT N(X EXPIRES EDWARD RQJAS PLUMING CGRP RENEWAL -SEPTEMBER,30,40.15 880 NE 111 ST"'"" 2371250 MtM be disPle"d at oft of waolness. BMfiGAYNE PARC,FL 33181 Pursuant 10 Coutrby Code C4VW SA-A+t 9&1Q , OWNER Mr-TYPE OP BUBWE88 EDWARD ROJAS PLUMBING CORP 198 PLUMBING PAYMENT RECEIVED CONTRACTOR By TAX COLLECTOR Worker(s) 1 CFC049431 46.00 07/182014 0224-14-006140 This local BUsiusss Tax Receipt only confirms paydot of the local Business Tax.The Receipt is not a license, permit,or a cerdfiaadon of the hobbies qualificadous,to do business.Holder mutt comply with may governmsalal or nongovermmeatai regulatory Ism and requireataats which apply to the business, The RECEIPT NP.above meet be displayed ea aH commereid vehicles-Milmi-pada Inde Bao 8a-276. Forma bdormstion vish Report Viewer Page 1 of 1 rte �• c �/1 �- �I 1 oopi JEFF ATWATER STATE OF FLORIDA - CHIEF FINANCIAL OFFICER 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: 7/12/2013 EXPIRATION DATE: 7/12/2015 PERSON: ROJAS EDWARDO i ..FFIN7 45307R6,i1 BUSINESS NAME AND ADDRESS: EDWARD ROJAS PLUMBING CORP 800 NE 111 STREET BISCAYNE PARK FL 33161 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS Pursuant to Chapter 440 05(14),F an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefts or compensation under this chapter Pursuant to Chapter 440 05( F.S.Certificates of election to be exempt...apply only within the scope of the businof ess or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13).F.S..Notices b election to be exempt and certificates is election to be exempt shall be subject to revocation if,at any time atter the filing of the notice or the issuance of the cenificate,the person named ti the notice or certificate no longer meets the requirements of this section for issuance cf a certificate.The department shall revoke a certificate at any time for}allure of the person named on the certificate to meet the requirements of this section. i DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 j away ;( UJO rct I-v WLR l f�r�SO� allot,,/-ed- WUR'� on -I%I1 r, MAIDELIN MARTINEZ • «`�= Notary Public « -State of Florida •"=: My Comm.Expi P s Jul 29,2015 Com 'ssio EE 82521 Bonded T o h atio I Notary Assn. I ♦SNNcRFs Boom b,,,M Miami shores Village NT, �d Building Department ORNp' 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 acknowledges 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 Contractor i Print Name: ` /'tQ Print Name: Signature: Signature• State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Sworn to an subscribed before me this�� Sworn to and subscribed before me this day of `T 20Lf . day of �'L/ ,20 """" MAIDELIN MARTINEZ By � By .`avo�•.. r. Notary ublic- tate of Florida (SEyrig NORVW A._ (SE : :•_ My Comm.Expires Jul 29,2015 Typ o a¢�ti j / Type f &i r uce -; ; s My Comm. Expir Jan 21,2017 Commission#EE 1351490 e Bonded Through National Notary Assn. 0111512015 15:08 (FAX) P.0011001 CERTIFICATE OF LIABILITY INSURANCE F DATE01/150IYYYY) 01/15115 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 ORALTER 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 on ADDITIONAL INSURED,the pollcy(1Be)must be endorsed- If SUBROGATION IS WAtVED,subject to the terms end conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificats holder in lieu of such ondorsoment(s). PRODUCER LUCIA Estrella Accurate P" "E305 226-8727 „�N (305)226-8767 8300 West Flagler Suite 114 jMgev luclaestrellaCbellsouth,net Miami,FL 33144 INSURERS AFFORDING COVERAOB NAIC a Phone 305 226-8727 Fax (305)226-8767 INSURER A: Granada Insurance Co. INSURED INSURER 9: Edward Rojas Plumbing Corp 680 NE 111 St INSURER D BlScayne furl(,FL 33161- 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. 1 TYPE OF INSURANCE ADD UDR POLICY N MBER POLICY EFF POLICY BXP LIMITS GENERAL LIABILITY EACH OCCURRENCE 1 OOO 000.00 ® COMMERCIAL GENERAL LIABILITY PREMISES RENTED s 100,OO�.QO A ❑ © CLAIM8-NADF Q OCCUR Y 0185FLOD051045 06/06/2014 08/06/2015 MED EXP(Any one person)I 1 5,000.00 ❑ PERSONAL a ADV INJURY 6 1,000,000.00 ❑ GENERAL AGGREGATE 6 1,000,000.00 GEN'LAGGREGATELIMIT APPLIES PER_ PRODUCTS.COMPfOPAGG 6 1,000,000.00 ® POLICY EJ P ❑ LOC 6 AUTOMOBILE LIABILn'Y CEQ�MBI ED SINGLE LIMIT E e n El ANY AUTO BODILY INJURY(Par person) I ALL OWNED E:] AUTOS E:] SCHEDULED AUTOS BODILY INJURY(par accident: i ❑❑ HIREDAUTOS a NON-OWNED POPE TYnDAMgGE _ d 6 ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE 6 ❑ EXCESS LIAM ❑CLAIMS-MADE AGGREGATE S DEO 11 RETENTIONS = WDRKERS COMPENSATION YIN WC STATU. ❑QTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? ❑ N/A E.LEACH ACCIDENT 6 (Myaat de ry In NH) E.L.DISEASE-EA EMPLOYE 6 DE5�RIPTION OAF OPERATIONS below E.L.DISEASE-POLICY LIMIT 6 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attech ACORD 101,Additlonal Remarks Sohoduls,If more space Is required) CSCO49431 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE.DESCRIB.Pp POLICIES BE CANCELLED BEFORE City of Miami Shares Village THE EXPIRATION DATE THEREOF,NO WILL BE DELIVERED IN 10050 NE 2nd Ave ACCORDANCE WITH THE POLICY VIS ONS. Miami Shores,FL 33168 AUTHORIZED REPREDEN7Anv 305-756-8872 Lucia Estrella ACORD 25(2010105)QF ®9988- URD RPORATION. I rights reserved. The ACORD name and logo are registered marks of ACORD