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MC-15-1966 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-240708 Permit Number: MC-8-15-1966 Scheduled Inspection Date: August 12, 2015 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: Work Classification: A/C Replacement Job Address:715 NE 91 Street 3-A Miami Shores, FL Phone Number Parcel Number 1132060440050 Project: <NONE> Contractor: ARTIC BREEZE AIR CONDITIONING CORP Phone: (305)485-4085 Building Department Comments REPLACE 2 TON A/C UNIT Infractio Passed Comments INSPECTOR COMMENTS False 1 Inspector Comments Passed Failed Correction ❑ Needed Re-inspection Fee v No Additional Inspections can be scheduled until re-inspection fee is paid. August 11, 2015 For Inspections please call: (305)762-4949 Page 25 of 36 R u C x r Miami Shores Village � "ype: Chnl ) �'iClk?8��}tCl# � 10050 N.E.2nd Avenue NE n Miami Shores,FL 33138-0000 Permit*S'to S: ED Phone: (305)795-2204 '��rin►"oP Expiration: 02/06/2016 3 POO' Project Address Parcel Number Applicant 715 NE 91 Street Number: 3-A 1132060440050 IPIP CORPORATION Miami Shores, FL Block: Lot: Owner Information Address Phone Cell IPIP CORPORATION 711 S CARSON Street CARSON CITY NV 89701- 711 S CARSON Street CARSON CITY NV 89701- Contractors) Phone Cell Phone Valuation: $ 700.00 ARTIC BREEZE AIR CONDITIONING C (305)485-4085 Total Sq Feet: 0 uwx, Tons:2 Available Inspections: Additional Info: Inspection Type: Classification:Commercial Final Approved:In Review Review Mechanical Comments: Date Approved: : In Review Date Denied: Type of Work:REPLACE 2 TON A/C UNIT Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# MC-8-15-56600 DBPR Fee $2.00 08/10/2015 Credit Card $64.60 $50.00 DCA Fee $2.00 Education Surcharge $0.20 08/05/2015 Credit Card $50.00 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 informati is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-nd con actor to do the work stated. August 10, 2015 Authorized Signature:Owner / ApplicantFact M Agent Date Building Department Copy August 10, 2015 1 Miami Shores Village V7 AUG 0 5 2015 Building Department 10050 N.E.2nd Avenue, Miami a Shores, Florida 33138 j \ Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-49491 �h FBC 20 BUILDING Master Permit Nolk. /'15— PERMIT `15 -PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: T 1 5 ry City: Miami Shores County: Miami Dade Zip: 33 13(J Folio/Parcel#: 1! Z D - (' 7 y- b0 SO Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Z Z co ge Phone#: 3 o S- -T q0 8S.?a Address: 4-1 S C_a�5A,) S� � 7 City: G Pc 05 O/V CT+y State: Al V Zip: 0 9 �O Tena /Lessee Name: S her Phone#: Email: /� CONTRACTOR:Company Name: L e 419JQ V I Phone#: ,�1.�� /r� ' 71z Address: G P/� K � e� City: State: F-1, Zip: Qualifier Name: Phone#: 3bS State Certification or Registration#: OW N k�;_66 1" Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: —'7 er- Value of Work for this Permit:$ 7�� Square/Linear Footage of Work: Type of Work: ❑ Addition n ❑ Alteration ❑ New ,Repair/Replace ❑ Demolition Description of Work: ,FQgam A Specify color of color.thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE yCJ(4 .60 (Revised02/24/2014) 14 Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. a1:1 "�' Sign re' i •vc��� Signature OWNER or AGENT C NT CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was a.knowledged before me this 2_day of :�u L y 120 /5 by :9-2 day of 20 /S by Sir- flatiD --LAM 3#1 who is personally known to XkA-C�o who is personally known to identification and who did take an oath. NOTARY PUB NOTARY PUBLIC: j- Sign: Sign: Print: Seal: j�•�, Seal: ro`;."::�A�. CARIBELTORRES `'� KAREN L GUZMAN * * W COMMISSION t FF 219820 MY COMMISSION#FF152046a e EXPIRES:April 13,2019 �+ �O August 18,2018 Bonded Thal t Nola $8tr168S EXPIRES Au ry APPROVED BY P r� aminer Zoning Structural Review Clerk (Revised02/24/2014) �5'Ac. Miami Shores Village Building Department ■■■■ ■■■•■�' 10050 N.E.2nd Avenue ` Miami Shores, Florida 33138 �p'�. Tel: (305)795.2204 Fax:(305) 756.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address(where the work is being done):_ f/S N 4�— 9/ s�_ A f f City: Miami Shores Village County: Miami Dade Zip Code: ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED \ Change disconnecting means:YES[:] NO;❑ ARHI Sheet Attached:YE NO ❑ Contract Attached:YES ❑ UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER 4 5(5m AHU or PKG. UNIT MODEL# KNSL- 1/M 2.L/f?-JA COND. UNIT MODEL# 93AJ"ri) ZY40/1 KW HEAT NOM TONS 2 AHU CU PKG 1)M.C.A AHU CU PKG AHU CU PKG 2) M.O.P AHU CU PKG AHU CU PKG 3)VOLTS AHU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER YES NO REPLACING DUCTS YES N YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB E NO YES NO NEW ROOF STAND YES NO YES NO I NEW RETURN PLENUM BOX YES NO 1. Minimum Circuit Ampacity(Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size):, 30 3. Voltage of Circuit (208/240/480): 240 4. Size Disconnecting Means: nn Contractor's Company Name: f 6rO Phone: 30'; T� _ State Certificat�ortration No. Certificate Competency No. Signature Date: S_--_ (Quall ier's signa e) (Revised02/24/2014) Artic Breeze Air Conditioning Corp. 9971 sw 4 st Miami, FI-33174 August 3 of 2015 State of: Florida County of: Dade Before me this day personally appeared Ricardo Rodriguez who, being duly sworn, deposes and says.- He ays:He will be the only person working on the project located at: 715 Ne 91 St Apt.#3 Miami Shores, Florida-33138 Sworm to and subscribed before me this 3 day of August. 2015, by Ricardo Rodriguez, who is personally known to me or who has produced driver license R362-720-89-267-0 as identification. rint,Type or Stamp Nam Notary o""Y°it,,. CARIBELTORRES r ;•'••, * * MY COMMISSION#FF 219820 EXPIRES:Apd 13,2019 _1 "O'le Bonded Ttn Budget ry ur" ♦SNuRFs �,,,, of" Miami Shores Village Building Department 1pRipA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: — ------- Owner State of Florida County of Miami-Dade I_ The foregoing was acknowledge before me this 3—day of U 'f ,20_. _iKBy )JC(a N0 t?C OJ., , who is personally known to me or nrod as identification. Notary: cm SEAL: KAREN L GUZMAN EXPIRES August 18,2018 (407)398-0153 FkAftNotaryServioexom •Prepared By&Return To: Thomas G.Sherman,P.A. CFM 2 014 R O 31417 0 Attn: Michael G. Sherman OR Sk 29132 P9s 4833 - 4835; Qpss) RECORDED 05/01/2014 12:06:01 90 Almeria Avenue DEED DOC TAX 853.80 Coral Gables,FL 33134 HARVEY RUVIN+ CLERK OF COURT MIAMI-DADE COUNTYP FLORIDA Property Appraisers Parcel Identification Number: 11-3206-044-0050 SPACEABOVE THIS LINE FOR RECORDING DATA WARRANTY DEED Made this 3& day of April, 2014, A.D. by CARLOS A. CEDANO, a single man, whose post office address is 715 NE 91 Street, Unit 3A, Miami, Florida 33138 (hereinafter called the "Grantor"), to IPIP Corporation, a Nevada Corporation, whose post office address is 711 S Carson Street, # 4, Carson City,NV 89701 (hereinafter called the"Grantee"): (Whenever used herein the term "grantor"and"grantee"include all the parties to this instrument and the heirs, legal representatives and assigns of individuals,and the successors and assigns of corporations) WITNESSETH, that the Grantor, for and in consideration of the sum of Ten Dollars ($10.00) and other good and valuable consideration to Grantor in hand paid by Grantee,the receipt whereof is hereby acknowledged, hereby grants,bargains,sells,aliens,remises,releases,conveys,and confirms unto the said Grantee and Grantee's heirs, successors and assigns forever, all of that certain land, situate, lying and being in the County of Miami- Dade,State of Florida to wit: Unit 3A of Shores Plaza East Condominium,a Condominium according to the Declaration of Condominium thereof, recorded in Official Records Book 8442, Page(s) 1358, of the Public Records of Miami-Dade County, Florida, and any amendments thereto, together with its undivided share in the common elements. Parcel Identffication Number: 11-3206-044-0050 a/k/a 715 NE 91 Street,Unit 3A,Miami,Florida 33138 This conveyance is made subject to the following: I. Easements, rights of way, limitations, reservations, covenants and restrictions of records, if any, which are not hereby being re-imposed;and, 2. Zoning or other regulatory laws and ordinances affecting the land, 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 that said land is free of all encumbrances except taxes accruing subsequent to December 31,2013. -Warranty Deed- Page 1 of 2 Book29132/Page4833 CFN#20140314170 Page 1 of 3 'TARY F STA E f� �1 t V A CERTIFICATE OF EXISTENCE WITH STATUS IN GOOD STANDING I, ROSS MILLER,the duly elected and qualified Nevada Secretary of State, do hereby certify that I am, by the laws of said State, the custodian of the records relating to filings by corporations, non-profit corporations, corporation soles, limited-liability companies, limited partnerships, limited-liability partnerships and business trusts pursuant to Title 7 of the Nevada Revised Statutes which are either presently in a status of good standing or were in good standing for a time period subsequent of 1976 and am the proper officer to execute this certificate. I further certify that the records of the Nevada Secretary of State, at the date of this certificate, evidence, IPIP CORP, as a corporation duly organized under the laws of Nevada and existing under and by virtue of the laws of the State of Nevada since December 7, 2011, and is in good standing in this state. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the Great Seal of State, at my y office on January 13, 2014. ROSS MILLER W Secretary of State Electronic Certificate Certificate Number: C20140113-3432 You may verify this electronic certificate online at http://www.nvsos.gov/ + STATE OF NEVADA ROSS MILLER Secretary of State Commercial Recordings Division 202 N. Carson Street Carson City,NV 89701-4069 SCOTT W.ANDERSON ■ ■ Telephone(775)684-5708 Deputy Secretary Fox(775)684-7138 for Commercial Recordings OFFICE OF THE SECRETARY OF STATE Josue Rodriguez Job:C20140113-3432 IPIP CORP January 13, 2014 711 S Carson ST#4 Carson City,NV 89701 Special Handling Instructions: Charges Description Document Number Film Date/Time Qty Price Amount Cert of Existence(good 20110863946-60 12/7/20112:26:25 PM 1 $50.00 $50.00 standing-short form Total $50.00 Payments Type Description Amount Credit 0856191 14011307723912 $50.00 Total $50.00 Credit Balance: $0.00 Job Contents: Web Certificate of Good Standing 1 Short(s): Josue Rodriguez IPIP CORP 711 S Carson ST#4 Carson City,NV 89701 j Silv- e&�Ium�e NEVADA'S BUSINESS PORTAL IPIP CORP gplinto Business Entity Information Status: Active File Date: 12107/2011 Type: Domestic Corporation Entity Number. E06559720111.3 Qualifying State: W List of Officers Due: 12/3112014 Managed By. Expiration Date: Foreign Name: On Admin Hold: No NVBusiness ID: W20111764033 Business License Exp: 12131/2014 Additional Information Central Index Key Registered Agent information Name: RESIDENT AGENTS OF NEVADA,INC. Address 1: 711 S CARSON ST STE 4 Address 2: City. CARSON CITY State: W Zip Code: 89701 Phone: Fax Wiling Address 1: Wiling Address 2: Wiling City. Wiling State: W Wiling Zip Code: Agent Type: Commercial Registered Agent-Corporation Jurisdiction: NEVADA status: Active View all business entities under this registered agent Financial Information No Par Share Count: 26,000 Capital Amount 1$. 0 Officers Include Inactive officers President-STEFANO RACCIATTI Address 1: 711 S CARSON STREET#4 Address 2: City. CARSON CITY State: W Zip Code: 89701 Country. Status:I Active Email: Secretary-STEFANO RACCIATTI Address 1: 711 S CARSON STREET#4 Address 2: City. CARSON CITY State: W Zip Code: 89701 Country. Status:I Active Email: Treasurer-STEFANO RACCIATTI Address 1: 711 S CARSON STREET#4 Address 2: City. CARSON Crrf State: W Zip Code:_89701 County. Status: Active Email: Director-STEFANO RACCIATTI Address 1: 711 S CARSON STREET#4 Address 2: City: CARSON CITY State: W Zip Code: 89701 Country. Status: Active Email Actions%Amendments Click here to view 5 actionslamendments associated with this company Q Disclaimer p ■ I ■ i Certificate of Prouc Ratings AHRI Certified Reference Number: 4525391 Date: 8/3/2015 Product: Split System: Air-Cooled Condensing Unit, Coil with Blower Outdoor Unit Model Number: 13AJN24 Indoor Unit Model Number: RHSL-HM2417+RCSL-H*2417 Manufacturer: RHEEM SALES COMPANY, INC. Trade/Brand name: RHEEM; RUUD;WEATHERKING Region: North(AK, CO, CT, ID, IL, IA,IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY, OH, OR, PA, RI, SD, UT,VT,WA,WV,WI,WY, U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1, 2015,are eligible to be installed in all regions until June 30, 2016. Beginning July 1,2016, central air conditioners can only be installed in region(s)for which they meet the regional effic"ency requirement. Series name: Manufacturer responsible for the rating of this system combination is RHEEM SALES COMPANY,INC. Rated as follows in accordance with AHRI Standard 210/?40-2108 for unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored,independent,third party testing: Cooling Capacity(Btuh): 2 100 EER Rating(Cooling): 11.00 SEER Rating(Cooling): 13.00 IEER Rating (Cooling): Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS.which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING.HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.atirl(lirectory.org,click on"Verify Certificate"link xe make iifi-bcrtar M and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which islisted above,and the Certificate No.,which is listed at bottom right. 130831064909305444 ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 60 TCI is reviewing its first year of operations. During this time, TCI invested $4,000 in organizational expenses including $-;',,,500j;: professional fees. These startup fees may be over several years. A. Depreciated B. Deferred C. Amortized D. Capitalized 61 Which of the following is NOT an advantage of a corporation? A. Continuity of existence B. Specialized management C. Closely regulated D. Fringe benefits are tax deductible 62 our company has just signed a standard AIA 201 agreement to build a residential room addition on an existing house. The total contract value is $78,500 for which you have received $10,500. Since this was an advanced deposit in excess of 10%, once the permits are obtained, how long does your company have to actually start the work? A. 30 days B. 60 days aC. 90 days D. 120 days 61certificate holder or registrant knowingly combining or conspiring with an unlicensed or unregistered person by lowing his or her certificate to be used may be subject to which of the following actions? A. Revocation B. Suspension C. Fine not to Exceed $5,000 per violation 6: D. All of the above 64. ow long should records of employment taxes be kept for the IRS to review? A. 4 years B. 3 years C. 7 years D. They do not need to be kept. payroll tax information filing deadline for the 2nd quarter of a given year for an employer who has deposited all taxes when due would be which of the following dates? A. June 1 B. June 10 C. July 1 D. August 10 Gold Coast School of Construction,Inc. Contractor's Cram-Day 1:Exam Number 6 Page 8 of 16 Y JEFF ATWATER C441EF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS"COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Comoensatian law. EFFECTIVE DATE: 6/1012015 EXPIRATION DATE: 6/9/2017 PERSON: RODRIGUEZ RICARDO J FEIN: 262522087 BUSINESS NAME AND ADDRESS: ARTIC BREEZE AIR CONDITIONING CORP 9971 SW 4 ST MIAMI FL 33174 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-GOND Pursuant to t napier 440.Vi(14).FS,an Officer of a corporation who elects exemption from this chapter by tiling a oed trate of etedion under this section may not recover benefits or cornpansehon under this chapter.Pursuant to Chepter 440.05(12),F.S.,Cartit9r les of election to be exempt..,apply only wilkin the scope of rhe business or trade fisted on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to to exempt am cerurioates of arecnon to be exempt Wkm be subject to revocation it,at any time atter the ftwtg of the notice or the Issuance of ttte oertgR:age: tha person named an the notice or certificate no longer meets the requirements of this section for tssuanoe of a cartificete.The departrro t shelf mrow a DrS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413.,1509 This Page is Left Blank Intentionally. Gold Coast School of Construction, Inc. Contractor's Cram-Day 1:Exam Number 7 Page 8 of 15