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BPP-11-1245
Miami Shores e Villag ► I -- �MbPr Building Department �`� �- 1 �3 • F,rl(L -K— p1 10050 N.E.2nd Avenue,Miami Shores,Florida 3313E Tel: (305)795.2204 Fax:(305)756.8972 Y' _y_\ __ 041 j6rv_� BUILD Permit No._"� 1) PERMIT APPLICATION Master Permit No. FBC 2004 Permit Type(circle)6uilding ElectricalQQ Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder),��eOvEz/�r/E . 17X-E�C_ Phone#.79W-797 5-S_-7 7 Owner's Address /4116/ X116 /'4017 57 City /!/114r l/ j�~,Cr_S State GL Zip Tenant/Lessee Name Phone# Job Address(where the work is being done) IfI6/ eV67 110.7 ST. City Miami Shores Village County Miami-Dade Zipl3/9� FOLIO/PARCEL# //- -3-74-5-- 0a'`I-O/VO Is Building Historically Designated YES NO Contractor's Company Name Phone# Contractor's Address k4l ?�S'` /¢t•� , City Al/Alsw* State Zip .3 3/4/.R Qualifier Name .4/��k- .ESC�'i4. a Phone# �p State Certificate or Registration No. 4ff000'd /V.SG 4e S-/ Certificate of Competency No. Architect/Engineer's Name(if applicable)/AE�/L45:0w /FFtSC Phone Value of Work For this Permit$ J Square/Linear Footage Of Work: Type of Work: ❑Addition ❑Alteration ❑New ElRepair/Replace ❑Demolition Describe Work: /t/E 110,00e_//��o� t /01"e. Submittal Fee$ Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ DPBR$ Zoning$ Bond$ Code Enforcement$ Double Fee$ 0-C-17( Structural Review. Total Fee Now Due$ i-6-ZD 0 Is . See Reverse side-4 . .. ......... .._ _. 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS..and 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 a reinspection fee will be charged Signature ,d Signature wner or Agent Contractor The foregoing instrument was acknowledged before me this�N The foregoing instrument was acknowledged before me this--,//YW day of Tvt ,20 L,by yTL ex, day of 20 by who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 01 Sign:-V4 s Sign: Print: Print: My Commission Expires: My Commission Expires: GLORh4 P.ALFONSO i����•�,r�,+ici1'�` I�1'�`S`I #�E0466J4 . MY COMMISSION tt Et046674 EXPIRES December 06,2014 EXPIRES December 06.2014 APPLICATION APPRO ,1'•Asa F ke.¢on+ (a07)398.0153 Flodde servimmm Plans Examiner t ° Engineer do/1--/7 1,4e Zoning (Revised 02/08/06) PERMIT# CONTRACTOR: SUBMITTAL DATE: U 1 ADDRESS: l (0) NAME: RESUBMITAL DATES: PROJECT TYPE: refl 711314, ZONING FIRE STRUCTURAL IMPACT FEE - � ELECTRICAL HRS/DERM P PLUMBI G N MECHANIC AL BL G I Iltlll 111111111111111 IIlliVIII IIII!Illi ITU , GFN 201 1 RO584993 NOTICE OF COMMENCEMENT OR 8k 27810 Pa 3411► (Ips) A RECORDED COPY MUST'BE POSTED ON THE J08 SITE AT TIME Of FIRST INSPECTION RECORDED 08/31/2011 14:29:05 HARVEY RUVINr CLERK OF COURT PERMIT N0 L1 L4 TAX FOLIO NO.//3. 6t5 0/VO MIAMI-OA6E COUNTYr FLORIdA LAST PAGE STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real Property.and in accordance with Chapter 713,Florida Statutes,the following information is provided In this Notice of Commencement. 1.Legal description of property and streetladdress: L01' �� '' �' �� �'�= �� fs�, BL.Cr_,,k J /Yd!r /©_-7 5r. ; /"!7. +O.�s.•,tee-. -33 3 8 2.Description of improvement: AeC4e,, 3.Owner(s)name and address: 7G_—•e i4/(oi /fid Ida 57 , �'l�.���,s yd�ss �� . �✓3i3& Interest in property: Name and address of fee simple titleholder. ------------- 4.Contractor's name and address: 04�`'` 1pw A,-441 .3.5 Avim. ; /*/ 5.Surety:(Payment bond required by owner from contractor,If any) Name and address: Amount of bond$ 6.Lender's name and address: 7.Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1Xa)7.,Florida Statutes, Name and address: 8. In addition to himself,Owners designates the following person(s)to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement:(the expiration date is 1 year from the date of recording unless a different date is specified) Sig t re o wner Print Owner's Name Prepared by Swom to and subscribed before me this day of20 Address:44 "t Mw 35 Ova Notary Public +�►���✓ s.�.@ Print Notary's Name My commission expires: 123A1.52 PAGE 4 SM ;_"°*, GLORIA P.ALFONSO y •c MY COMMISSION#EE046674 EXPIRES Deo~06.2014 T ATE OF FLORIM GOUN 1'OF DARE ^G«� S Iy ��gyCrR °r-Ythatifvsisata9crpYof0aa co (407)3984l5a i arta dau cf F i, ,ria 0i�_____— ;:J Ij' v K 11( i7' udl. ICourtJ HARV- WV ta,CLERK,of crrcuit arxt tour By �D D.C. :r r STATE OF FLORIDA AUG I � 2011 PERMIT #: 13-SC-1363015 DEPARTMENT OF HEALTH D TE PAID 08/05/2011 r ONSITE SEWAGE TREATMENT AND DISPO4,AIr.SYSTEM APPLICATION FOR CONSTRUCTION PERM±'t' FEE PAID: 70.00 RECEIPT #:13-PID-1684832 APPLICATION FOR: [ ] New System [X1 Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment ( ] Temporary [ ] APPLICANT: .Jacqueline Butler AGENT: Blue Waters Pools TELEPHONE: 1 (305)634-0956 MAILING ADDRESS: 4811 NW 35 Ave Miami, FL 33142 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT 110 489.105(3) (m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. LOT: 19 BLOCK: 1 SUBDIVISION: PLATTED: 01/01/1955 PROPERTY ID #: 11-3205-024-0140 ZONING: I/M OR EQUIVALENT: ( Y ) N Q PROPERTY SIZE: 0.32 ACRES WATER SUPPLY: [ ]PRIVATE [ ]<=2000GPD (X]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y 1 N p DISTANCE TO SEWER: FT PROPERTY ADDRESS: 1461 NE 102 St Miami, FL 33138 DIRECTIONS TO PROPERTY: BUILDING INFORMATION: [X] RESIDENTIAL [ ] COMMERCIAL Type of No. of Building # Persons Total Design Flow Establishment Bedrooms Area Ft Served For This Unit 4 4000 8 500 Q� G °Jh [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: 08/05/2011 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA PERMIT No. 13-SC-1363015 ~ DEPARTMENT OF HEALTH c ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DATE PAID: 08/05/2011 APPLICATION FOR CONSTRUCTION PERMIT FEE PAID: 70.00 y RECEIPT #: 13-PID-1684832 Additional Notes and Comments : County Notes Fields: County Process#: County Permit#: Storage Box#: Zone: Permit Type: County Status: General Comments: This permit is granted to install a pool only. Does not have anyimpact with the existing OSTDS. Pedro Ospina Engineer II MIAMIDADE _. 11805 SW 26111 SI RM 149 I„ MIAMI. fL 33175 2464 r, 786 315 2381 Merchairt I0: 530314459 Term ID: 0010540000530314459004 i Sale zzzzzzzzzzzz7459 VISR Entre Method; Swiped Total: 10,00 08/0S/11 13:14:14 Inv : 000016 Rppr Code: INAS Rpprvd: Online f: C.—tw-, (:Opl THANK YOW l 1 �t�l 1 -iai tl li=. COUNTY BUILDING ANI) NE I GHBOERHOCAD f'=01flp-L_I ANCE DEF PiRTIIEP-- 1. 1805 SW L6 STRE=E= f MIAMI, FL 331,75-2-'474 (786) S 15- '2000 M L-El -E_ANE 0U-j [RE CE.I:PT 08/05/2011 10050 NE 2^d Ave , Miami Shores,FI 33138 Phone 305.795.2204; Fax 305.756.8972 www.miaibishoresvillage.com SWIMMING POOL OWNER'S CERTIFICATION DATE 7—,�/../i MIAMI SHORES VILLAGE BUILDING AND ZONING DEPARTMENT ATTENTION: BUILDING OFFICIAL I certify that I am the legal owner of the property located at: In accordance with Section 33-12(f), Code of Metropolitan Dade County, I certify that I understand and agree that the swimming pool to be constructed at the above address cannot be used or filled with water until a separate permit has been obtained for an approved safety barrier, and such barrier erected, inspected, and approved. I further understand that this certification, however, does not eliminate the need for obtaining a permit and erecting an approved barrier prior to final inspection and use of the pool. Legal Owner Note: This certification is to be submitted with a swimming pool permit application in duplicate. `yyos m1 SAM"`l/0494C • . toll 10050 NE 2ed Ave Folli"vA Miami Shores, FI 33138 Phone 305-795-2204; Fax 305-756-8972 www.miamishoresvillage.com NOTICE OF REQUIREMENTS RESIDENTIAL SWIMMING POOL, SPA AND HOT TUB SAFETY ACT I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at Miami Shores, FL, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statues. Please initial the method(s)to be used: The pool will be isolated from access from the home by an enclosure that meets the pool barrier requirements of Florida Statute 515.29; The pool will be equipped with an approved safety cover that complies with ASTM F 1346-91; �-/ All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound pressure rating of 85 decibels at 10 feet; All doors providing direct access from the home to the pool will be equipped with self-closing, self-latching devices with release mechanisms placed no lower than 54" above the floor or deck; I understand that not having one of the above installed at the time of final inspection, or when pool is completed for contract purposes, will constitute a violation of Chapter 515, F.S. and will be considered as committing a misdemeanor of the second degree, punishable by fines up to $500 and/or up to 60 days in jail as established in C'iapter 775, F.S. CO TOR'S SIGNATURE AND DATE R'S SIGNATURE AND ATE CONTRACTOR'S NAME(PLEASE PRINT) OWN R'S NAM LEASE PRINT) NOTARY PUBLIC NOTARY PUBLIC `,►+ ^. GLORIAP.ALFONSO !"""'"tt; GLORIA P.ALFONSO -'• 'c MY COMMISSION#EE046674 ? :'c MY COMMISSION#EE046674 ',•• - EXPIRES December 06,2014 '•.,q. EXPIRES December 06.2014 !07)398 0153 f erviee.com (407)398-0153 floddallota Service.com RESTRICTIVE COVENANTS PROTECTIVE POOL ENCLOSURE PREPARED BY: �-s�¢s.Q DECLARATION OF RESTRICTIVE COVENANT KNOW ALL MEN BY THESE PRESENTS: WHEREAS,the undersigned�i ����/.LEv�[�[Hare the fee simple owner(s)of the following described property situate and being in the Village Lots) /f Block / of/11/.9tisli3,r.{N�SQ�,j,,0 ,,� 5- A.K.A.(addres (Subdivision), s) /�(w/ /L' /c.:7 ST according to the plat thereof,as recorded is Plat Book S Page of the Public Records of Dade County, Florida,and Whereas,the undersigned owner(s)��Qli:c� - del :Tzt�2 desire to utilize said Lot(s)as a single building site,and the undersigned owner(s)do(es)hereby declare and agree as follows: _ 1. That the property will not be used In violation of any ordinances of the Village or Dade County now In effect or hereinafter enacted. 2. That the purpose of this covenant is to induce the'Village '�o Issue it permit for a pool where the required enclosure is not on the subject property where the pool is located. 3. That If any of our adjoining neighbors remove any portion of their fence or wall,or If our/my property shall fall.to meet code requirements for pool barriers,we,as owners will immediately Install a protective enclosure to meet code requirements and will obtain a permit for such fence. 4. That,we,as owners,hold the Village harmless for any negligence or injury that results from not having the enclosure FURTHER,the undersigned declare(s)that this covenant is Intended and-shall constitute it restrictive covenant concerning the use,.enjoyment and title to the above property and shall constitute a covenant tanning with the land and shall be binding upon the undersigned,his/her successors and assigns and may only be released by the Village 1 ,or its successors,In accordance of said Village then in effect. IN WITNESS WHEREOF,the undersigned has/have caused hand(s)and sell{s)to be affixed hereto on this %/ dayof_._-7L(-'4y WITNESS(ES) IA. Signature and Print Si to and Print �A6Agc. �EcC�,�iva �' � � Signature and Print Signature a Print `C ��— STATE OF FLORIDA): COUNTY OF DATE ): I HEREBY CERTIFY that on this day personally appeared before me./ known to me or has produced d'�' '��' who Is ersona {type of Identification)as Identification and he/she acknowledge ftr&Ishe the foregoing,freely and voluntarily,for purposes there in expressed. SWORN TO AND SUBSCRIBED before me on this i�=day of. __& apo// MY commission expires: NOTARY PUBLIC MTE OF FLORIDA Rev.412' GLORIA P.ALFONSO ;y MY COMMISSION#EE0466714 "•'•,q. EXPIRES December 06,2014 007)398-0153 FloddallotaryServiee.Wm 2011-08-26 1210 BLUE WATER POOLS 305-634-0957» 1800 685 7530 P 1/1 CERTIFICATE OF LIABILITY INSURANCE 1A06/10111 06l1 01111 PROOMM PMCOM IMoUrInce Undwwrkws THIS CERTIFICATE W WSLIED AS A MATTER OF uypmmATION 4809 SW 74th Ct, ONLY AND CONFERS NO RIGHTS UPON THE cERT)!'ICATE Mleml.FL 33155 HOLDER.THIS CERTVICATE DOLM NOT(30ALTER TH RACE AMEND,L)(7Uo OR OW. Phone 6)740-44G0 Fax (305)748-M00 VOURI]IM APFORDIN 13 COVERAG& MAIC# INsLM BLUE WATER POOLS OF SOUTH FLORIDA, INC. I • CATLIN SPECIALTY INSURANCE CO 4811 NW.35 Ave. INSURFR q: Miami, FL 33142- [INSURER D, I ER 305-634-0988 RER E; COVEVAG1Es INSU THE POUCIES OP INSURANCE LISTE0 HAVE 999N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PMOO INDICATED. NOTWITHSTANDING ANY R£GUIRNACNT,TERM OR CONOITION OF ANY CONTRACT CR OTHER DOGUAENT WITH RESPECT TO WENCH THIS CERTIFICATE MAY at ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIEa DESCRIBeD HEREIN la SlIOJCVY TO ALL THE TERMS,EXCLUSIONS AND CONDrTIONS OF SUCH pOUCltS.AOOREaATE LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW, WOR AWL ry'P6OFWOURANCEFf 7tVE au EI�IRA LIlNTa PO�IQTr NtAApQ1t GMERAL LIAs4J�Y EACH OCCURRENcE 1,000,p00 CQWMRrlAL°ENE>aAL1Ae"''Y 09001300192 052212011 05nan012 PR cE.EoRi",-)noel 100,000, A ❑❑ CA/Vh19 MADE ® OCCUR MED EXP(Any one penes) 5,DOD' 1000 6UPD DI=D PERSONAL&ADV INJURY 1,000,0001 GENI!RAL AGGREGATE 2,000,000 0EN'L AGGREGAT!LIMIT APPUE,S PER; PRODUCTS-COMp/Op AGg 1,000,000 Cl POLICY Q PROJECT ❑ — AuTmORILG LKNL ITY ❑ ANY AVTO CCMEINED SINGLE LMT aceldent) rr-❑ ALL owNEo area ❑ u SCHEDULED AUYq* BODILY INJURY IrL�IJ( HIRED AUTOS d n NON QWNED AUTOS BODILY INJURY ❑ (Par—JdwK) PROPERTY DAMAGE PW accident) © ANY Auto Q Ma1tA01 LJA>to AUTO ONLY-EA ACCIDENT Q OTHER THAN ACC AUTO ONLY: AGG III==I UAAbRBLLA L4Ug1.11Y EACH OCCURRk'NCE © Cl OCCUR Q CLAIIMS MAD!` AGOReGATE Q AMDUCTIBLE ❑ ReTENTION i )IMPLOYM L WLMANY Q T OTH- IN OFr`ICtrt//141 NIeeR EEXC UCeD?� YN E.L.EACH ACCIDENT N�e•rylar Af In.,Wunder E.L.DISEASE•EA UMPLOYEE ae.w+e OTNflt s E.L.DIsWe.Poucy Uw POOL CONTRACTORS esaRl►T10W OF OI'taV1S Lu*MO/LOCATIONS!VI�Mctas/E S AOOrD■Y 1MIOoRsmWAT/sPEML PROVI460NB CERTtIFICATE HOLM CANcOLLATIoN OHOULD ANY OF TM AN&A ONSCRaw POLIC,ISS R CANCgLLW 88F;M THR Miami Shores Vlllspe VUHUT'ION DATET11llt"t Tk!MOOING NVJR ll yygL�pEgyOR To MAR. 4r'm� NOTICE TO d "TE IfOLDIEK NAM TO 10060 NE 2nd A'Lue To 0o No OBLN9AT)pN OR LU1BLlFY MIsm1 Shores, FL 33138 THe cR TATWM A ISIDRO VILLAMA ACpltn 25(SppPp1 Qp TIM ACORb I.9 m and1RATION�AA � • IO0° Ie�stered lm*s Ot ACORO MIAMI-DADE COUNTY 2010 LOCAL BUSINESS TAX RECEIPT 2011 FIRST-CLASS TAX COLLECTOR MIAMI-DADE COUNTY-STATE OF FLORIDA U.S.POSTAGE 140 W.FLAGLER ST. EXPIRES SEPT.30,2011 PAID 1st FLOOR MIAMI,FL 33130 MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI,FL PURSUANT TO COUNTY CODE CHAPTER 8A-ART.9&10 PERMIT NO.231 615634-3 THIS IS NOT A BILL-DO NOT PAY RENEWAL BUSINESS NAME/LOCATION RECEIPT NO. 642012-9 BLUE WATER POOLS OF SOUTH FLORIDA STATE# CPC1456451 INC 4811 NW 35 AVE 33142 UNIN DADE COUNTY OWNER BLUE WATER POOLS OF SOUTH FLORID Sec.Type of Business WORKER/S THIS Is 196A � ECIALTY PLUMBING CONTRACTOR 4 BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING OR CG of THE COUNTY OR CITIES. NOR DO NOT FORWARD DOES IT EXEMPT THE OM ANY OTHER PERMrc A IITOR LICENSE BLUE WATER POOLS OF SOUTH FLORIDA REQUIRED BY LAW.THIS IS INC NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA. noNs. FRANK UAZQUEZ 4811 NW 35 AVE PAYMENT RECEIVED MIAMI FL 33142 MIAMI-DADE COUNTY TAX COLLECTOR: 08/26/2010 60010000078 000075.00 26 SEE OTHER SIDE STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET •V• TALLAHASSEE FL 32399-0783 PELLERANO, RAFAEL AURELIO BLUE WATER POOLS OF SOUTH FLORIDA INC 13771 N GARDEN COVE CIRCLE DAVIE FL 33327 .. Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. 110 Our professionals and businesses range from architects to yacht brokers,from 1 bi =1 boxers to barbeque restaurants,and they keep Florida's economy strong. a Every day we work to improve the way we do business in order to serve you better._`1, n For information about our services,please log onto www.myforidalicense.com° There you can find more information about our divisions and the regulations that_.. impact you,subscribe to department newsletters and learn more about the Department's initiatives. -��.:5.�..., h°M.. .•a �+�5'�°F Z±:l a R. k^S Our mission at the Department is:License Efficiently, Regulate Fairly.We � � constantly strive to serve you better so that you can serve your customers. a ,- Thank you for doing business in Florida,and congratulations on your new license! I' �r - - DETACH HERE . , pg �� 'Y'' l 1� I^ f'i�4Fh,. /$�� /.�2,f.��6YY./f,y��.,�k"i'4/}�1�""-'��t\•C� � tr•4 '°lr°- ��•`,'JP `+fir`. �,-. 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EFFECTIVE DATE: 12/13/2010 EXPIRATION DATE: 12/12/2012 PERSON: VAZQUEZ FRANK FEIN: 651133099 BUSINESS NAME AND ADDRESS: BLUE WATER POOLS OF SOUTH FLORIDA INC 4811 NW 35TH AVE MIAMI FL 33142 SCOPES OF BUSINESS OR TRADE: 1- POOL CONSTRUCTION IMPORTANT: 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 440.05112), 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 440.051131, 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 [fie 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 any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES " f4'FZ F DIVISION OF WORKERS'COMPENSATION s�`�- :. Pursuant to Chapter 440.05114), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY a 0 elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA p' L under this Section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW D chapter. EFFECTIVE: 12/13/2010 EXPIRATION DATE: 12/12/2012 Pursuant to Chapter 440.05(12), F,S., Certificates of election to be PERSON: FRANK VAZQUEZ H exempt... apply only within the scope of the business or trade listed on FEIN: 651133099 E the notice of election to be exempt. BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt BLUE WATER POOLS OF SOUTH FLORIDA INC and certificates of election to be exempt shall be subject to revocation 4811 NW 35TH AVE if, at any time after the filing of the notice or the issuance of the MIAMI, FL 33142 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 any time for failure of the SCOPE OF BUSINESS OR TRADE: person named an the certificate to meet the requirements of this 1- POOL CONSTRUCTION section. QUESTIONS? (850) 413-1609 CUT HERE Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09-06 Planning and Zoning Criteria Miami Shores Village Permit NO. B P P-7-1 1 -1 245 a� 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Phone: (305)795-2204 Fax (305)756-8972 f#pRNp' Issue Date: Not Issued Expires:NOt Issued Folio Number) 132050240140 Owner's Name:JACQUELINE BUTLER Owner's Phone: Job Address: 1461 102 Street Total Square Feet: 350 Miami Shores, FL 33138-2621 Total Job Valuation: $ 42,000.00 Contractor(s) Phone Primary Contractor BLUE WATER POOLS OF SOUTH FLORIDA (305)634-0958 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 7/19/2011 : Yes Comments: SURVEY DOES NOT MATCH HOUSE FOOTPRINT ON SITE PLAN SUBMITTED AND CLEARLY IDENTIFY THE AREA OF NEW DECK AND ADD TO PERMIT 11-19-11 NEW PLAN OK 8/19/11 NEW PLAN OK Planning and Zoning Criteria Miami Shores Village Permit NO. B P P-7-11 -1245 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Issue Date: Not Issued Expires:NOt Issued Folio Number) 132050240140 Owner's Name:JACQUELINE BUTLER Owner's Phone: Job Address: 1461 102 Street Total Square Feet: 350 Miami Shores, FL 33138-2621 Total Job Valuation: $ 42,000.00 Contractor(s) Phone Primary Contractor BLUE WATER POOLS OF SOUTH FLORIDA (305)634-0958 Yes Planning and Zoning Criteria and Comments Approved: No Date Denied: Comments: SURVEY DOES NOT MATCH HOUSE FOOTPRINT ON SITE PLAN SUBMITTED AND CLEARLY IDENTIFY THE AREA OF NEW DECK AND ADD TO PERMIT ♦S�o I n �in. Miami Shores Village -- ��� Building Department �L�pRjp�► 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT#:W I� DATE: `p Contractor o Owner ❑Architect Pi ed up 2 sets of plans and o er) V � ' Address: I 4kc I Ma From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: �5 °Res y Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 ORI Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: 11-11-1245 Job Name: July 25, 2011 Page 1 of 1 Building Critique Sheet 1) Zoning approval is required. 2) Provide a permit application for the decks. 3) Provide a mechanical permit for the pool heater. Plan review is not complete, when all items above are corrected, we will doa complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the resubmittal drawings. Norman Bruhn CBO 305-795-2204 Miami Shores Village Building Department u 10050 N.E.2nd Avenue Miami Shores;Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Permit No. p — .V Job Name y y. PLUMBING CRITIQUE SHEET r t 07/27/2011 09:08 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES 121001 �a TX REPORTx� �xea�xc�c*�c�c�cxex��x�w�xcxcxcxc�cx�x� TRANSMISSION OK TX/RX NO 1607 RECIPIENT ADDRESS 93056340957 DESTINATION ID ST. TIME 07/27 09:07 TIME USE 00'39 PAGES SENT 3 RESULT OK �SN�R£S Gid Miami Shores Village `,.l. nip 1511188M Building Department 10050 N,E,2nd Avenue g�erxg 10 v Miami Shores, Florida 33138 �ZONRtDp' Tel: (305) 795.2204 Fax: (305)756,8972 Permit No: 11-11-1245 Job Name: July 25, 2011 Page 1 of 1 Building Critique Sheet 1) Zoning approval is required. 2) Provide a permit application for the decks, 3) Provide a mechanical permit for the pool heater. Plan review is not complete, when all items above are corrected, we will doa complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. Norman Bruhn CBO 305-795-2204 cI .I c� 4- .SNoREs y Miami shores Village Building Department 10050 N.E.2nd Avenue res I Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: 11-1245 Job Name: July 28 2011 Page oft Building Critique Sheet 2) Provide a permit application for the decks. Plan review is not complete, when all items above are corrected, we will do acomplete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. Norman Bruhn CBO 305-795-2204 2011-08-26 12:02 BLUE WATER POOLS 305-634-0957» 18006857530 P 1/3 BLUE WATER POOLS OF SOUTH FLORIDA " building your backyard paradise " SWIMMING POOL CONTRACTORS&CONSULTANTS 4811 NW S&Ave. Miami, FL 38142 Tel.306-6340958/Fax 905-83"os7 MX To: Bldg. &Zoning From: Gloria Fax: 305-756-8972 Ph: 305-634-0956 Phone: 305-795-2204 Date: 8-26-11 Re: BUTLER POOL Pages: 3 Hi Arlene, Attached please find a copy of the pool contract for: Jackie Butler 1461 N.E. 102nd Street Miami Shores, FI Please feel free to call me if you have any questions. Thank you and have a great day, Gloria Blue Water Pools of So. FI. 305-634-0956 2011-08-26 12:02 BLUE WATER POOLS 305-634-0957» 1 800 685 7530 P 2/3 a,.,N,_ rl: 1!!Chr,;' ��•�{t?r %3eic?�:: ,. r'i-':;:.rp.,ice::r::: . ;`i-i5 ^._�1gr47 P t C'i i' r!tief,'i•:. :"i'' 7 rl t3S ".IVVfSo eeS t0 COf^str't^` *C`• r{Cei^, M11,CAM-- '?P,42 -- �u r��: 2- the SlVimininW pool ^ic,i:,Ci oqujp;ncir{5: :-�.criu :: ;�::::iwr (here!il coHectivety Called the "Work") to be installed at Lot!U o. r9i a.r- 1135 � t-t,.,�-.•�•.. '��v� Plat suct� 5 c. - iP S aCtlorl - -- --• Couniy Water Su de area. +�w� �t�LaiP�- Perimeter ___-- s^,Ydi� SPECIFICATIONS 1. -R%A!P to supply Pool laYO :t plena and structural engin:ti.i'ir';r.; ;;!�;r,s for pool.............. 2. B%VP to obt:airl svt•ir llc-ni I-1},c,Ql a0i1:trUr;0on p�--t'rniis fo:i:;i.,F:'.....� ................................. t: l', 'Lrcied J. P,c:Gess vl'a?l G!'fotlt:C1'<�fSIGVC'�i$ by[7VVP lr`.- ......... ......................... ........... I................ ii,G:4{::iat:a •f., l_•.1�lti:.Y:i ::Gt3V3i:+ j.i�;v.ui ii r�I}IOVC C?:'Ce_S _ ... .................I........................ Replr'7,ce-d JV 0%vvf ar- J. Wf\(+lig 'i0 Ul':rGCt Sitlrii S•c:ilC� eil"If'UtJ �.,, _:.-. ._.._.. ................ ..•..---................................. ..,. .,..`.1 .. t3VVP i S in acc -Ss 3r,:i Ci'of. to remove from pool Site on clay r_ x `(ra •�^ riurntis yes ., y if c�sv%it!,;t, - �.._.�_ .-:onC,-ete :'es�_--___ 'Yes No r'•tah)l ic;it �r�J _.,.__.__ 1 :C, .�__...._ ._... ' 3i'::'I• YQ&�_ r`iC.7 F. Sa_rlitai-100 arc:'.'✓u'Ler suupiy 5Syalcsms,E1.0 1, G-Jiitir:; a�•: '" - yr�� h� _- a. C"Vh 'i7 Ua- !J brd Fer Oute ci where Use_,'!Itjineer:r i s:r_.c�l r� - ,l.:.r �. required.,... r xh=sr- �::;- �Afill &h L.;, ruocurs... `I••v rS... Et. .. GC l`_.I,I iC �,C•. �e:C:i:i.I'i i7,L:'+'.. CC,ii;:�'c. _ . .:cii,,`' codes „��li:io� (o t rJ , tt: •�. :,. , :: ,. -<_ Ir'c:�t::W s ii;•IlcysB oche 1•!❑ • ,: s ►.-tri -si_' _ i s y :lam �` r�4........... ..._.. r�: . tc _ .,':!;• lirlear feet o, Color 1...... _..._ -.__.._ ... _ ..;rte.., -�t... _ ..,...- ✓� .. ............................. . rn,-Aor, 'i:5- ✓4AU):C?'ti -, fish.:':Lr c.CiU:": _- -- .1.... __„__ ']r r� G. � (ir►7��,� �+Y7LitV1'1 I ; ri ti!'iv7t:,l,Sr�'i;,,�i -!-�:; :... :: , .: ,� ,.,�,” 'rfV=,.TSU r•'t',Zii-r �r F' ............. +N. ��:'_/f�';,� erc?r-uy 5i({C[E9rrT i7Fi�:`• r � ...., �._. - .... ✓ . ... evoba li '- ,. e iilpG °:•y�:t..t:l. ... ........ •.. ...............r.. '.�.,_.. --V- r•'�rv!t=_gtrit:rl' 'rr,:-a ill:;>:cifc.c?v✓ii151:1 - ... ........ .... ..................................... �. __..... ? . ...... .,•..... .•......................•ii�lt{E1J.. 21. c r, yr�4N�G �— •;�!„ r:� ..... ,. >. ullc'I'21C. •` ..__r d :C r^t!l:UL.(!�teerGi i:�77{:�ri;►?-il:(t-:��;r:��.!;�!:"i r:ii'-=`t��. t ............... .. ot7 Y- es a-i2JpPyioC. ......K ..................... - � -!- :P.iere6p1'ral!r{e-7:1O l'R-iftirC:ALIL,:NTfH' eiCil C;le-z'ii-l•lCeSi•............sf} `� CiA-�l! __..,� .• ...... YYeess26. Automai'„ t,!c0 a•tG. � ir:GCi 26. iloo{tuf ,v.pip{ tciucl;y=1._ '4t ......... r ..._..1`:.•OC Cr ri 11 ".'r.' ...., .. -.� ••- .Y13.- �' ;'.:i.i n-' ''•`'1,'i,!l �i C=r'i•ia.,'ir.(, •ta Ci't.J(}',;;r,,.. . - - •........................................... ......Y 4T.tr- -3, _irhtt:Typo^-,! w 7 W Gju, :'•: :i:'= r -... t-�k ~copte. les vv Local Code.. ci93 _? _, 2%'- VVaterproo'f tlr)iG?• •t - t�"_' �� L p ry 0, Decking lnstaiieci l�•il;l {:ter. R4odei — N!3vv Derck! •il:-t enol aite accorditl`?Er;y ap {-ilr?^l-!r r;i, i7�li:•... .............. .......os^ ,-,,_; f t`pe _.._.—.. ckl3tln In ,_w sq, 9 deck tO --... — PP Q Types._._--w� J I. Sub-surface drainage.-Typo, --.•'_._.___..,_.._ .� t;. ---..__...,� '•---......'fec_�1•So t/ -{CZ = t §h V---—_..,.,,. __._..... feet: color — Yes .. .. ...:•�.'-....=•lizo. .`,�i�rr.-:r.�-,:..,o-__ ....-- ...,....._. 1iri„'.. .. .., - --.. _.......YE3 E'•l_�f L/ 2011-08-26 12:03 BLUE WATER POOLS 305-634-0957>> 1800 685 7530 P 3/3 2 of 2 THERAPY SPA YS ' 34. Spa constructed of C _Size •� �c C7` Water surface area sq.ft. Depth Perimeter 35. Spa to be elevated /2' with a tiled dam wall between the pool and the spa. The spillway will be con$tructed of ' to allow for a cascading effect............................. .....................................Yes ✓�Vo 36. BWP to install coping:Type Size Color 37. BWP to Install a 8"band of water-line tile:Style ............yes No Additions: ......................Yes /No 38. Glass Block design: Style QuantityYes No 39. Spa main drain(S)with anti-volex cover. Quantity: . ......................Yes 7No 40. Spa skimmer Yes No e/ 41. Filtering Jet(s): Number of Jets: ......................................................Y@s—��No !, .......... ........................................... 42. Therapy Jet Design: Number of Jets Type:_ dam, / 72-S.-Yes y No 43. Venturi air controls. �/ 44. Heater: Manufacturer: ............... .TyP.................S,�ritl%'. �f. .........................................�,.Inciuded 45. Spa Light:Manufacturer, v. @ �` Yes No Type ....Yes �No 40. Initial startup service and instructions 47. State,county and city sales taxes. ....... .......................................... ................. .................................................... Included ................... ...................`................................................... .... ...................Included 48. Guarantees and Warranties(see ection orl.these Included in Contract)..... Included 49. Miscellaneous: Co« it.• ..................................... .......................... Starting Date: Approximately 30 �E�^ days after acceptance of Contract or upon issuance of building permit. Completion Date: Approximately L.y7- days after excavation, unless delays due to conditions beyond contractor's control.such as strike.weather conditions,Inability to obtain building materials,or similar causes and conditions. Walk-thru will be scheduled before marbietite placement. Final Payment must be made the day of marbletite. NOTE: It is the Buyer's responsibility to install approved fence or screen enclosures, and If required, proper door alarms prior to the pool being surfaced. TERMS Buyer hereby agrees to purchase the work for cash price, payable as listed below. TOTAL PRICE: i YQpp �'- 10% Deposit 001 BANK TERMS: % Deposit 20% At Excavation op(J 96 At Excavation 40% At hotcrete t`o 60J %At Shotcrete 20% Al n[ # � 4/o At Deck 10%Plaster & Equipment `l LYS %Plaster&Equipment Buyer nowledges that he/she has read and received a Complete legible copy of this contract, including terms and conditions contained therein. 6 s signature Date '3 r rs signature Date / 0 = ntoUve/Offloerof BWP Date Z f�8� LL/ This Contract is valid upon the acceptance of a BWP Officer. Date of Transaction NOTICE OF CANCELLATION You may cancel this transaction without any penalty or obligation within three(3)business days from the above date.To cancel this transaction, mail or deliver a signed and dated Copy of this cancellation notice or any other written notice, or send a telegram to BWP, no later than midnight of the third business day. I hereby cancel this transaction. u o o.gna ury Date: