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EL13-409 \ Miami Shores Village 7BY: CEIVED Building Department AY 19 2015 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 16 BUILDING Master Permit No. &11 /,), ,-2156 PERMIT APPLICATION Sub Permit No.G / f 43 ,-LAV ❑BUILDING 1h ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS 'CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: / -4 z_L ) 2 S City: Miami Shores 2/ County: Miami Dade Zip: Folio/Parcel#: Z / / 0/0 3 J - ( O Is the Building Historically Designated:Yes NO Occupancy Type: _Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): a 644 U/o_eT_ Phone#: Address: - 2-!�4 City: 421 f 0' State:' Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 2 / Address: 50o - -1 S City: Yn t"1 6!b)L�Z 4��(,-< State: orl Zip: 3?2 40 2 Qualifier Name: lq�uoali CXRPhone#: �— State Certification or Registration M, j!57 n(?/-2— / Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: / City: State: Zip: Value of Work fir this PnOth$;, _- ly �O Square/Linear Footage of Work: ..err_ r ' Typih of Work9: ;, Addition ] 'Altera ion New / ❑ Repair/Replace ❑ Demolition Des i tion of Work: I 1 cX p Specify color of color thru tile: Submittal Fee$ Permit Fee$ �✓��mG CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ �1 (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 ATTORNOY 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 brochurt will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencemet must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the nce suc a tice, the inspection will not be approved and a reinspection fee will be charged. Signature ---Signature. c The foregoing instrument was acknowledged before me this The foregoing instrument was ack6owledged before me this Z day of r'?c�y 20 t <— , by 4 day of h?a 20 by Di who i ona wn to );rwn4•1 Of 0- TO 2 rl who is personally known to me or who has produced as me or who has produced'rt' +D as identification and who did take an oath. identification and who did take an path. wdbwdbm Z7t�17 Com^ NOTARY PUBLIC: NOTARY PUBLIC: .aiq, DEKA CRUZI Hal f►Pu01k-SWI o1 FW* • the I FF 204543 Sig SVneWL" tow 110"K 7,201 UMA CRUZ Attn. Print: Print:��yla C1Sii00 I FF 204543 Seal: My Comm'Exptru Apr 7,2019 Seal: l J tG ISA C"& SonlsS NpfarY Assn, APPROVED BY � °� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) s Miami Shores Village P-_ECFIVKD Building Department MAY 2015 . 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 ' INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 2016 BUILDING Permit No. PERMIT APPLICATION Master Permit No.V&—p 'C;L15G CtLAJ' GF OF CONTqAC52 Permit Type: BUILDING ROOFING JOB ADDRESS: ' 1/K✓ . City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: // 51 z � 02T2_ _ l Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): Phone#: Address: �� C City: 1W State: Zip: CSS Tenant/Lessee Name: Phone#: Email: CONTRAC OR: Company Name: 3�' / ✓� Com' Phone#: � Address: 1 AD City: State: Zip: , /EW Qualifier Name: / - Phone#: State Certification or Registration#: Z St Z Certificate of Competency#. Contact Phone#:_ 7V 7% Email Address: 3 DE3I � tlEng n erg ksQtaph _r. 3 6 / Value of Work fet4hi6-wr iit:$ v SgBared,,i4gufootage of Vito j c�� • DAddition` `" liilteration ❑New ❑Re air/Re 1 e Dem ition T of Work. P P Type • /A Description of Work: Color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ t f ? 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,MATERS,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 commencemen must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the abse0c f such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature �f.O / `� Signature 111114 X/ Owner or Agent Con rector The foregoing instrument was acknowledged before me this 7:3— The foregoing instrument was acknowledg d before me this day of 20 45',b -Mi day of 20 L:r,by ' ,, who is personafly kno u d who is personally known to me or who has produced og Ind_WIIWid' ap oath. , WMA t2l, wwaKr is state of Flon a Dw UBLIC 'OLD, Comttlission 8 FF 204543 NOW Public_ " My;omm.Expires Apr 7,2 543Cn2a0 Florida Bonded throuc',Na543 tional s ° Mit tZorlpn.E p ,�ols�� XPk95 Apr 7,2019 Sign: Sign: Print: Print: My Commission Expires: My Commission Expires: APPROVED BY t6 Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) .` _ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET ' TALLAHASSEE FL 32399-0783 CRUZ, WILLIAM WILCON CO 9636 NE 5TH AVE RD MIAMI FL 33138 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA BUSINESS AND A from architects to yacht brokers,from boxers to barbeque restaurants DEPARTMENT OF and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CGC1512642 ISSUED: 05/29/2014 lease!o onto serve you better. For information about our services,re information CERTIFIED GENERAL CONTRACTOR n find more CER .com. There you ca , .m floridalicense Y . www y about our divisions and the regulations that impact you,subscribe CRUZ,WILLIAM to department newsletters and learn more about the Department's WILCON CO initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constant strive to serve you better so that you can serve your IS CERTIFIED under the provisions of Ch.488 FS. customers. i hank you for doing business in Florida, Expiration date : AUG 31.2016 1.140-5290001958 and congratulations on your new license! DETACH HERE RICK SCOTT,GOVERNOR KEN l.AWSON, SECRETARY STATE OF FLORIDA t � DEPARTMENT CONS RUCTION INDUSTRY REGULATION LICENSING BOARD CGC1512642 � The GENERAL.CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2116 CRUZ, IMLLIAM WILCON CO 9636 NE 5TH AVE RD MIAMI FL 33138 1 I-gP1 AV AS RIFOUIRED BY LAW SEQ# L1405290001958 April 16, 2015 Miami Shores Village 10050 NE 2nd Avenue Miami Shores, Fl 33138 NOTIFICATION OF TERMINATION - CONTRACTORS SERVICES Dear Sirs, This is to informY ou that we terdi t 'i endent Contractors services of Mr. Jorge A. Rojas. Address: 254 NW 92 in Miami Sho , FI 33150 Z Thanking you in advance our cooperation. Regards, Diego Agui re Mi ate► �(;a- '00",O+PFY p`9��� MONIDUE DELANCY F = Notary pubic.State of Florida *• :N = My Comm.Expires Sep 2 Commis .2017 sion#FF 050357 Bonded Through National Notary Assn. 003771 Local Business Tax Rece t Miami-Dade County, State of Florida —THIS 1S NOTA BILL — DO NOT PAY 5953626 wuc��.►'x'" RECEIPT�. EXPIRES 9636 NE 5 AVE IM RENOW^L SEP'T`EMBER 621071 30 2©15 MIAMI SHORES FL 33138 Must be displayed at place of business 1'ure ant tO COUMV Code Cheow 8A-Art 9&10 OWNER SEC.TYPE OF BUSINESS WILCON CO 196 GENERAL BUILDING CONTRACTOR PAYMEW RECEIVED Worker(s) 4 CGC1512642 BY TAX COLLECTOR $45.00 09/04/2014 CREDIT CARD-14--035140 Tbis Iwai comfisa Tau ofthReceipt a*ost�n 0s payment of the Local Business tax.The Regi is not a lit stne, PSC ar a cereificalioa of tlls bolder"s carious to do basiaess. Holder laraf in n do l or rloa�tlsrameMsl repytoq laws a adaguireaaeeale which apply to the bum tnew The RECEIPT No.above t4mg w IfiWayed on aR ceamurcial vehicNs— MWM Dada Cain Soc Sa—. For State�fsralation,wi:it ATE(MMIDD/YYYY) P5/4/2015 I-OWN CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: EQUIINSURANCE, LLC PHONE Fax AIC 6839 MAIN ST ADDRESS: No SS: MIAMI LAKES FL 33014 INSURER(S)AFFORDING COVERAGE NAIC# (305)557-_5578 (305)557-5197 _ INSURERA: FEDERATED NATIONAL INSURED INSURER 8: _-- --� WILCON COMPANY INSURERC: NONE INSURER D 9636 NE 5TH AVE RD INSURER E MIAMI, FL 33138 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD B POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER JMM1DDfYYYY1 (MMfDDfYYYY) GENERAL LIABILITY EACH OCCURRENCE $$1,000,000 ✓ COMMERCIAL GENERAL LIABILITY PREM SES Ea occurrence $$100,000 CLAIMS-MADE M OCCUR GL-0000027076-00 3/13/2015 3/13/2016 MED EXP(Any one person) $$5,000 _ PERSONAL 8 ADV INJURY $$1,000,000 GENERAL AGGREGATE $$2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $$2,000,000 JECT ✓ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED F__1 SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS eraccidenl $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC LIMIT: OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE `N I A� E.L.EACH ACCIDENT $ OFFICERiMEMBER EXCLUDED (Mandatory in NH) j E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) DRYWALUBASEBOARD INSTALLATION CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND. AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL, 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD s , w . JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 2/4/2015 EXPIRATION DATE: 2/3/2017 PERSON: CRUZ WILLIAM FEIN: 562609254 BUSINESS NAME AND ADDRESS: WILCON CO 9636 NE 5TH AVE. RD. MIAMI SHORES FL 33138 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 W micon co . GENERAL CONTRACTORS Date: l State of 6 County of Dade Before me this day personally appeared 14ayZ who, being duly sworn, deposes and says: That he or she will be the only person working on the project at �9^n(,cJ Sworn to ( or affirmed) and subscribed before me this day of 1&q ,20 by Personally Know,- Or produced Identification Type of Identification produced GENA CRUZ No1ry PUblle-8191 of Florida COmmisaioo#F FF 204543 My foram.Expires Apr 7,2019 Sond0 tib Nad !Notary Apn. Print, type or stamp 10787 Biscayne Blvd. Miami, F1.33161 Cell(786)399-8855 /Fax(305)893-6298 CGC# 1512642 wcruz23@hobnailcor s OR D� f logo Miami shores Village Building Department AOR o 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Com ensation 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 The foregoing was acknowledge before me this day of 20, By who is personally own to me or has produced U`� / as identification. DENA CRUZ Nou"pwo-Stele o,' Nota ",•• DEKA CRUZ CommleeW•FF 2 04 IAe 1My comm.Ex"Apr / COMMISSlon N FF 201513 Bonded ttrouph Netlonel Nod a,,r, My Eomm.Expkee Apr 7.201! " BoW thm*National Notary Assn. Apcia f 201.." NOTIFICATION OF TERMINATION -CONTRACTORS SERVICES Dear Sirs, This is to inform you that we have terminated the independent Contractors services of Mr. Jorge A. Rojas. Address, 254 NW 92 Stm Miami Shores, Fl 33I SO Thanking you in advance for your cooperation. Regards, Ditgo Agulrr—di IS- Ab f . Natary Public E DELAryCV «or,, l#V Comm F S x tate o1 Flo,-144 Cammlas'on Sep 2.2031 \ 8 1tx 050587 i�Ul i U.S. Postal Service'" RECEIPT Domestic Mail Only ._moi Er co < Postage $ O Certified Fee Postmark M Return Receipt Fee Here C7 (Endorsement Required) O Restricted Delivery Fee 0 (Endorsement Required) ru r� Total Postage&Fees (U Sent To --------------------------- ------ ��.- 3 Street&Apt.No., _POB r Po Box l o.1 � lo vn33/6 Cty Stat ZIP+ 1 :�� USPS.com® - USPS TrackingTM Page 1 of 2 English Customer Service USPS Mobile Register I Sign In aUSPS COM USPS Traeki n g TM Customer Havequestions?We're here to help. Get Easy Tracking Updates> Sign up for My USPS.com. Tracking Number:70143490000157472684 > Updated Delivery[day:Monday,April 20,2015 Product & Tracking Information Available Actions Postal Product: Features: First-Class Mail® Certified Mail— Text Updates DATE 8,TIME STATUS OF ITEM LOCATION Email Updates April 18,2015,11:22 am Delivered NORTH MIAMI BEACH,FL 33160 Return Receipt After Mailing Your item was delivered at 11:22 am on April 18.2015 in NORTH P.11Ar•,•1I BEACH.FL 33,60, April 18,2015,9:32 am Arrived at Unit NORTH MIAMI BEACH.FL 33160 April 17,2015,7:21 pm Departed USPS Origin MIAMI,FL 33152 Facility April 16,2015,9:45 pm Arrived at USPS Origin MIAMI,FL 33152 Facility April 16,2015,7:46 pm Departed Post Office MIAMI,FL 33181 April 16,2015,4:58 pm Acceptance MIAMI,FL 33181 Track Another Package Manage Incoming Packages Tracking(or receipt)number Track all your packages from a dashboard. 4r A6 _. ._._ _....... .... _.__ _..... __..... No tracking numbers necessary. Track It Sign up for My USPS.com> 70�w https://tools.usps.com/go/TrackConfirmAction.action?tRef=fullpage&tLc=1&text28777=... 5/12/2015 April 16, 2015, Mr. Jorge A. Rojas Miami Dade County, Fl. Dear Sir, This is to inform you that we have terminated your Contractor's Services . Property Location: 254 NW 92 St,Miami Shores, Fl. 33150. We are requesting an Invoice in the amount of$20,000 which is due immediately. Thanking you in advance for your cooperation. Sincerely yours, Diego AdufrO U.S. Postal Service"' c(3 Domestic Mail Only .a ru For delivery informatlon,visit our website at www.usps.com". Postage $ $0.49 0122 L i r-q Certified Fee $3.30 233�� cQ C3 Postrtfec 0 Return Receipt Fee $0.00 Here C3 (Endorsement Required) Restricted Delivery Fee f0.00 C] (Endorsement Required) Er -r Total Postage&Fees $ $3.79 04/16/201 M .:I- Sent To r—1 t O Street&Apt.lVo.,---------------------------------------------------------------------- r- or PO Box No. -------- City State,ZIP+4 PS Form :00 July 2014 SAJOR GENERAL CONTRACTOR INVOICE#251 Florida State CGC 1516850 18100 ATLANTIC BLVD#403 DATE:Aprill8,2015 SUNNY ISLES BEACH, FL 33160 PH: (786) 290-1540 SAJOR.GC@GMAIL.COM BILL TO: Diego Aguirre Address: 254 NW 92 ST Miami Shores, FI 33138 Job Site Address: SAME INVOICE This Invoice is submitted for: -Tile Roof replacement $13,000 This Invoice replace invoice#231 dated on February 2, 2015.Then, invoice#231 is null SAJOR GENERAL CONTRACTOR INVOICE#250 Florida State CGC 1516850 18100 ATLANTIC BLVD#403 DATE:April I8,2015 SUNNY ISLES BEACH, FL 33160 PH: (786) 290-1540 SAJOR.GC@GMAIL.COM BILL TO: Diego Aguirre Address: 254 NW 92 ST Miami Shores, FI 33138 Job Site Address: SAME INVOICE This Invoice is submitted for: -Work at attached addition, including materials and labor $7,000 Note:This invoice replace invoice#230 dated on February 2, 2015. Then, Invoice#230 is null. 421 II5 I �rls era From: rongina cooley <originalcutie99@gmail.com> Sent: Tuesday, March 04, 2014 7:00 PM To: Arlenis Silvera Subject: Re: RC-11-12-2156 property address 254 N.W 92 st Miami Shores 33150 On Tue, Dec 17, 2013 at 1:35 PM, rongina cooley <origina]cutie99r�g-rnail.com> wrote: ---------- Forwarded message ---------- From: "rongina cooley" <originalcutie990-�gmail.com> Date: Dec 13, 2013 11:59 AM Subject: RC-11-12-2156 property address 254 N.W 92 st Miami Shores 33150 To: <NaranjoI(&)miamishoresvillage.com> Cc: I am sending this email to request an extension on my permit. To finish renovations on the property mentioned above. The renovations are taking longer than expected. The permits are scheduled to expire on 3-10-2014. I was having some funding issues that have been resolved and now im ready to begin completing the renovation. I am asking you sir to please allow me and extention to complete my renovation. �O r St�OR ES Miami shores Village Bull Building Department -OR r1Dp 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR / ARCHITECT Permit N. Owner's Name (Fee Simple Title Holder): )I C 44 ci/eL 9e- Phone#: (, 2 K-3 Owner's Address: 7-54. /)W• q2-:94. City: )k5'. ri -A 7 (3� State : Zip Code---3 3 Job Address (Of where work is being done): S City: Miami Shores State:_Florida Zip Code: Contractor's Company Name: iyQrLlriora %e-k A C. Phone#: Address: 85-00 f7Gd-2-3.5'4. City:_Fe.M 1-b j5 Pf',yc ' State: Zip Code: Qualifier's Name : ejeeta,7AP 7y „1.S Lic. Number: �Ck O o/23 G Architect/ Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: Nett/ hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hol I ial and the Miami Shores harmless of all le vo em Signature igna Owner or S ent Contractor The foregoing instrument was aknowledged before me �Fegoing instrument was aknowledged before me this day of Aey20ybythis / day of , 2011y f;nNK4 nJO Ira 10apt Who is p kno o me or who has produced who is personally known to me or who has produced as indentification. DENANotary Public Sgte of FloriQa ty A A` 1 No Public: ''•• Nota Public: �CRUZ p.,.,� ' F ' Sign: CommissW N FF 204543 Si nAM- � o Commie MY ae Apf 1. 019 g • DENA CRUZ Seal: /�� 8onlee geouattlMt�afy Assn• 'Seal: � � Notary PubNc-State of Florida i�'c sW I FF 204543 /nfi�3" � 'Emits Apr 7.2019 Ban110tluet�t11s9pM_ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSI ONAL REGULATION ELECTRICAL CONTRACTORS LICENSING HOARD (850) 487-1395 1940 NORTH MONROESTREFT TA L LA 11 1 ASJ S E E FIL 32399-0-183 TOBAPI: S, FERNANDO PRE-cisiONTECH INC s5-ci0 i,,j w 23RD STREET PEMBROKE` PINES i L 33024 Cal lot;-killtions, \Ajjth till, ii(,pnse you j)ecoflle We cif the iseal'y Iicc-,sed by fll(-.!Department of and Professional Regal-aficil Otif P10fessictials a1116 1xisinesses Jallue STATE OF FLORIDA ,uom aictliiect,,,to YaJit b:okert;.from boxers to DEPARTMENT OF BUSINESS AND and they keep I'lut1d;'y econorny strong. PPNOFE9S!ONALWRgGULATION .:SSUED4':-.09/28/2014 vely day we ,jot,. jo imi)mve the way we do business ill(li*(I(!' 11) ER0012361 II serve.yon belief. Voi information about out servicc-.please ic-A, onto "'W,lilyfloridalicense.coll, bto,e volu can find rnore ill forin Almn -CTRICAL CONTPACTOR' REG 3 ELE it 0%0-AR E 3,F iN A %10. 1 0 . to,departi)lent slewsIE-tiom and leat n more abot it the Deoai IMCQl'!, PRECISION TECH,INC.. lillUatives. iINDIVIDUAL MUST MIEETALL LOCAL ,,)tlr rj)ission at the()eparttrient is, License U.ifficienuy,Regulate fairly LICENSING REQUIR�MENTS'PRIOR . VE,constantly strive 10,serve you better SO that you can sctvl�,eouf TO CONTRACTING IN ANY AREA) mstumers rhani,. ycji fu: Gomm mmness in Ronda. HAS REGISTERED undai the ut0';iSirjr)5 Of (,h 48`1 rS aod f-,ungi VcLV —w DEAACI I f IERV" KEN LAANSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD AK Alk ' N The CLECTRICAL VOtj Named betow HAS REGISTERED Under the provisions of Chapter 489 F& Expiration date: AUG 31, 2016 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) TOBARFS, FERNANDO LLj PRECISION TECH. INC, 8500 N.W 23RD STREET PEMBROKE PINES FL 33024 DiSPLAYi\,; RE11')UiRf--D BY LAW SEQ N L'4092150000690 Its �t `;? •s•' � �� �FYc Y�� ,-do-," �a - r . ..1,,31.14..�-�}�.r v ty� fid, � •,F � � ,. .z< 1 r ��`"Nt SKn�.:. �j 3�/i�_-_ s �« ' -, WS��4 St4'�:f;{., c�•d� ai ' �i � :� � � � ��5�����y ,�f-�.�E +"�`�. 2�fi,[� - � .::�+'�....;`,a, ?;{:e�- Y�T`,�{r .,s,...w..• ,. a �:,_ x.a�t�et3•+.,a�.�t�.; ._: ,.;,�%��'3�.`A `)r„�„=$,.,-����: PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE NORTHEAST AGENCIES, INC DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY 6950 CYPRESS RD, SUITE 105 THE POLICIES BELOW. PLANTATION, FL 33317 COMPANIES AFFORDING COVERAGE Phone No.1(866)290-8680 Fax No.(954)584-0995 COMA WESTERN WORLD INSURANCE COMPANY INSURED COMPANY PRECISION TECH INC LIC:ER0012361 E 8500 NW 23RD STREET COMPANY PEMBROKE PINES, FL 330254 Office:(854)704.8006 Cell:(305)303-9747 COMPANY �irQ1 p .' + 1x_w. sr e r�i s�. .y k 1 j ti r_ s+sr rir 77 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. CO POLICY POLICY LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS DATE(MMIDD/YY) DATE(MMIDO/YY) GENERAL LIABILITY GENERAL AGGREGATE ' 2,000,000 A ❑COMMECIAL GENERAL LIABILITY PRODUCTS—COMPIOPAGG $1 000,000 0 CLAIMS MADE❑OCCUR NPP1247318 02!28!201 02/28/20PERSONAL d ADV INJURY $1,000,000 ❑OWNER'S 8 CONTRACTORS PROT 16 EACH OCCURRENCE $1,000,000 1:1Q FIRE DAMAGE(Anyone ire) $50,000 MED EXP(My one person) $6000 AUTOMOTIVE LIABILITY B ANY AUTO COMBINED SINGLE LIMIT ❑ALL OWNED AUTOS 8001LY INJURY ❑ SCHEDULED AUTOS (Per person) $ ®HIRED AUTOS ONOM-OWNED AUTOS BODILY INJURY $(Per ecadent) ❑ PROPERTY DAMAGE $ C GARAGED LIABILITY AUTO ONLY-•EA ACCIDENT $ QANY AUTO OTHER THAN AUTO ONLY: El EACH ACCIDENT $ AGGREGATE $ D EXCESS LIABILITY EACH OCCURRENCE L1 UMBRELLA FORM $ AGGREGATE $ OOTHER THAN UMBRELLA FORM $ E WORKERS COMPENSATION AND ar vulTs �R +1= I It EMPLOYERS'LIABILITY EL EACH ACCIDENT 40101000 THE PROPRIETORIPARTERSI® INCL EL DISEASE-POLICY LIMIT $501 D00 EXECUTIVE OFFICERS ARE ENCL EL DISEASE-EA EMPLOYEE $100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS -ELECTRICAL CONTRACTOR-PRECISION TECH. 4. }iY'V Y-it �iyC'"u i 'U 4 f .4M. }• {] 1 G... i?r, pp�� A M•� •-�L!, r -L"� .._.�.Y_k:3Fd< Ls`...:,..._ . ,..�.:.`i a��,,:..;n,. SX.ut�_� k... 'G�NM�!s.._'.t!�l.�ia�w`j.J`.�. _ ir� '.e_�'4 �'7 :37r`,r+ v ,� J�( s'�r �. yr�. 77 >:am 51►ores�lilage � - � - . `.-'. ,..._.,. ,.. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Ismael Naranjo DATE THEREOF,THE ISSUING COMPANY VIALL ENDEAVOR TO MAIL N DAYS WRITER NOTICE TO THE CERTIFICATE HOLDER L SUCH NOTICE SHAL Building Official IMPOSE OBLIGATION O LIGATION OR NAMED ITY OF ANY KIND UPTO THE LEFT,BUT ON THE COMURE TO PANY ITS GENTS OR L 10050 NE 2 Avenue REPRESENTATIVES. AUTHORIM REPRESENTATIVE Miami Shores,FI,33138 LISA A FAINA }�: 1.ssc.�s�� `�s'+•t"ts a {yCh'' �{tti°' :i,ten, ..�?' 1 r r�. y�� F � . .� r` tt vocal nes Tit : Miami-Dde Cou ty, Stato. f' or da - $19 N4T A I."-tS4ty4T T4NPAY 2131324 stsstt+ ss 9 E,*LCC. TION 'RECEIPT NO, EX PIRES' tEa& w..ECM INC WJEWALr SEPTEMBER 30, 2015 DOING eusNEW IN DADE 224i$87 m ustbe a isptayed at place of business COUNTY Pursuant to County Code Chapter BA-Art 9& 10 CL1ER SEL TYPE Of EUSRIESS _ aE^c •'"c' PRECdSION TECH INC 196 ELECTRICAL C/O MARIA TOBARES PRIES CONTRACTOR 82.60 10i14!2014 Worker(s) 1 000018248 0223-15-000117 el3u57aTfeiUacense TMs LocalStsfess Ta,Accepo"ycon"am pnotorr pent.or a cERr•,ati of otthenadw's"l"C ati"T IOdo t%.f5iness Holt]Pf mt&C ompiy l;m arn;at>re."Te tai ' o!nor�+ernrrsr>ial recx,tatory�a�s arcJ req�er�er#s n fv:n aper to me t�a+ness Thef....pTt,oawenmDe splayedonalitamercialvenictes-Mieml-titletitleSKx-276 FOr nue irfof rg0orL NStf ri�v}v--rfk IQ ilt a� i Ili municipal t ntractor s Tax Receipt. M County,Coun State of Florida [M C tSNOT A BILL-DO NOTPAY - CC No.0000182-a SMUESB NAIy�A:OCATION .No. EX�R S . NREOSIOWSE"E TECs nvc biE11i►Ht 1Ess MSER 30, 2015 �p1it sysWESS '�f BADE COt.11t�°W 74911G"2 Must 8e eisptsyed-at,ptase otbusiness Pursuant to County Cote Chatxar8A-,Art:9&10' • OWMR TYPE OF SUSNVESS PAYMENT RECEIVED PREC'S`0".TECr.:NC E-ECTR)CAL CO\TR-.CTOR BY TAX COLLECTOR CJ0 ,-R'.;�TC2,I.RES PRE 20000 ~� ferwero iafKroatiso.vishtppepK,�ia�I�•a...+�n.,esellte�t /►T/1 A i 10787 Biscayne Blvd. Miami, F1.33161 Cell(786) 399-8855 I Fax(305) 893-6298 CGC# 1512642 wcruz23@hotmailcor JEFFATWATER CHIEF I'tNANCIALOFfICER STATE QF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW' ' CONSTRUCTION INDUSTRY EXEMPTION This ceHtifes that the Individual listed below has elected to be exempt from Florida Workefs'Compensation law. EFFECTIVE DATE: 9/2912014 EXPIRATION DATE: 912812016 PERSON: TOBARLS FERNANDO FEIN; 650129851 BUSINESS NAME AND ADDRESS: PRECISION TECH INC 8500 NW 23RD 5THELT PEMUROKE PINES FL 33024 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL CONTRACTOR PU(9uan)10 Cltayf it 4.40t)S(14).F-8,,art effiter of a rurporauan who eiecl6 exemption Ifoin Oils chapter by Giing a cefYnrale of election undaf llrii w0ieai met 110L recover H.eneGls or compensation under this chapier.I•ursuant to umpier d4ff.05t 121.F.S..Cefficetea of efocwt lobe exempt—apply only vinhin Ow-scrape or uw busovess or trade fitted on the notice of etocaiat to be exempt.Pufsbimt to Chepter 440.0511 S1.F.S..Nolicet of electbn to be exempt iutd certificates of elaction to be exrmpt shalt be subject 10 fevotalien it.e1 any time after the Ong of the Polito ar the isuFance of the ceruGcale. U4 yurson nernod on the nvfice of Certafirate no lortyet Meru the fegL*eMentt of thw secuon for issuance o(a aer6fccote.The depanmenr shall revoke a L) S-F2-DVgC•252 CERTIPWAIE OF ELECTION TO THE EXEMPT REVISED 07-12 QUESTIONS?113'f)1413.I bras f { iili r Electrical Construction & Nlaintenance 00 12 361 m Date.. �sca�� sii County of Dade Before me this day personally appeared �EVLfI/fM `T who, being duly sworn, deposes and says T hat he or sire wiii be the uniy per`sua 1 wei Kiiiy on the projeU ai 2 �4 Sworn to ( or affirmed) and subscribed before me this Lj� day of _,20_1�7by Personally Know -� Or produced Identification �'1 b � 0 type tai identification pr(Aucera PA-Y-- 619t--✓� DENA CRUZ Naim►Pry-SM of fWWa ,7 20 FF 0-J x tfii43 Eitpirts MK 7',2oi9 801rafdgMlY�tMlMo�lelMarvn r f =? bpe air sto 11 _ter S�OREs ZtIC.Il32 C) .... „...� Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if- 1. f:1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ner State of Florida County of Miami-Dade The foregoing was acknowledge before me this. day of ,20L7 By 1 ewho is sonally kn TT DENA CHU:jJ C ' as identification. C-CoMmission Notary Public-Stat * FF NotaryrE , w.Expires tlrouph Natlsi SEAL: Miami Shores Village �. Building Department JAN 07AVL2_6o5_ 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 )0 BUILDING Master Permit No.-y-F IS_ 3c PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP � CONTRACTOR DRAWINGS JOB ADDRESS: N""J,( Zf City: Miami Shores County: Miami Dade Zip: 33 150 a Folio/Parcel#: it -3/ d/ d 3-5 /L 60 Is the Building Historically Designated:Yes NO X Occupancy Type:1Z Load: Construction Type: C > Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 61 0 Phone#: Address: City: o/-E'_3 State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ME` Phone#: 3 oS 2-(F> - 113v Address: 70 -f City: '9_'7 State: �- Zip: S 3 o/9 Qualifier Name: ��W/ D / 7 � S Phone#: � State Certification or Registration#: C t*C d S `f Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: t Address: n City: State: - Zips: Value of Work for this Permit:$_10g Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New 4 XRepair/Replace ❑ Demolition Description of Work: E._ I� %l L /moo o r Specify color of color thru tile: 'frA-A�';f G%U rte' Submittal Fee$ 1n Permit Fee$ 2 -0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ �:-5 ono TOTAL FEE NOW DUE$ 25 C9 • 2 6 (Revised02/24/2014) _:�'E; Q 12—6 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. Signature I _ Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instr ment was acknowledged before me this -j dA24 day of r 20 �'7 by day of L c 20/.`� by 6 040L ho is personally known to o is personally known to lo 10, me or who has produced ,� �,i r7—P L �;%',f Qas me or who has produceILL i2 eA- identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: - Sign: 6Z4�� azd4� Print . u A(/ ,,.,. �.,, Pr' �•' PA !�� r°; •, c �`••,`'fT�'�"� ,t * ISSION 16 FF 103507 MY COMMISSION: MY COMMISSION g FF 103507 Seal. ,r * S EXPIRES:Mardi 18,2018 J EXPIRES:Marct EXPIRES:March 18,2018 ,�, B0�°dv N YSenixe gw&d Thru Buec-.:t�'Agr�y •c BOW TMu Budge!Nawy Servicer *************************** **** *** ******************************************************************** APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) CFN: 20140867542 BOOK 29435 PAGE 926 DATE:12/18/2014 03:59:51 PM ` DEED DOC 1,680.00 HARVEY RUVIN,CLERK OF COURT, MIA-DADE CTY Prepared By and Return to: Daphne Tako, Esq. Biscayne Law Firm,P.A. 1125 NE 125th Street, Suite 114 North Miami, FL 33161 Parcel Identification Number: 11.3101-033-1260 WARRANTY DEED ft PMtrieci warna n This Indenture,made this-T04b day of December,2014 between RONGINA C.COOLEY,0 9533 NW 26 Avenue, Miami, FL 3314, a married woman, hereinafter Grantor, and DIEGO AGUIRRE, of 254 NW 92 Street Miami Shores, FL 33150,a single man,hereinafter Grantee. Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee,and grantee's heirs and assigns forever,the following described land, situate, lying and being in Miami-Dade County,Florida,to-wit: Lot 7 and the East One-half(E 112)of LOT 8, In BLOCK 136,of MIAMI SHORES,SECTION SIX,according to the Plat thereof,as recorded in Plat Book 10,at Page 39,of the Public Records of Miami-Dade County,Florida. `NOTE.GRANTOR REPRESENTS AND WARRANTS THAT THE PROPERTY HEREIN DOES NOT AND HAS NEVER CONSTITUTED THE HOMESTEAD,DOMICILE OR PRINCIPAL RESIDENCE OF GRANTOR NOR IS IT CONTIGUOUS'THERETO. Subject to following: 1.Taxes for the year 2014 and subsequent years; 2. Restrictions,matters appearing on the plat, limitations,and easements of record,if any,but this clause shall not operate to reimpose same; 3.Comprehensive land use plans,zoning and other land use restrictions. and said grantor does hereby fully warrant the title to said land,and will defend the same against lawful claims of all persons whomsoever. "Grantor"and"Grantee"are used for singular or plural,as context requires. In Witness Whereof, grantor has hereunto set grantor's hands and seals the day and year first above written. Signed,sealed and delivered presence: Wit e$s Name- Rongina C Cooley,Grantor Witness Name. STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me thisday of Neer,2014 by Rongina C.Cooiey and,who are personally known to me or who have produced %fQ I,r4 ( as identification. .,, NEI SY ZAGALES M may( Public-State of Florida Y _ • My Comm.Expires Joe 18,2017 N Rl(PUB LI , tate' loy la Comndssion aR EE878218 fionde0 through Rational Notary A . 5t! Res googol" Shores Village sell4 Building Department �[OR1Dp' 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.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you may be personally liable for the worker compensation injuries 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 Print Name: 0 1 Print Name: r_)GO-r�2 D Signature: 7rz ,.y, Signature: State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Sworn to and subscribed before me this Sworn to and subscribed before me tbis day '"rf _. day of * * MY COMMISSI #FF 103501 ,�¢s;`;;�k¢ PAUL LOISEAU By EXPI BY 1 —,:d-IrBu*N Se ices *1342 EXPIRES:March 18,2018 (SEAL) (SEAL) e� W N Type of Identifi u Type of Identi cat n r O CME CONSTRUCTION MANAGEMENT 7405 W 14 CT HIALEAH,F133014 License CCC-157494 JAN 22,2015 STATE OF FLORIDA COUNTY OF MIAMI DADE PERMIT#RF 1 15 32 Before me this day personally appeared Edward Rojas who,being duly sworn,depose and says. Edward Rojas will be the only person working on the Re-roof at Property and is Fully responsible At 254 NW 92 ST Miami Shores 33138. Sworn in(or Afirmed end subscribed before me this 21 day of 2015 by (EDWARD ROJAS) � Y oua Personally Known V •••.,aPAUL LOISEAU Or Produced Identification � h1Y COMMISSION B FF 103507 EXPIRES:March 18,2018 Type of Identification Produced p"�a p,�`Op Banged ThN Budget N ervicee A