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BPP-15-801 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-248372 Permit Number: BPP-4-15-801 Scheduled Inspection Date: November 25, 2015 Permit Type: Pools/Whirlpools/Hot Tubs Inspector: Rodriguez,Jorge Inspection Type: Final Owner: MENDEZ, BENIGNO Work Classification: Repair Job Address:551 NE 105 Street Miami Shores, FL 33138-2044 Phone Number Parcel Number 1122310140280 Project: <NONE> Contractor: G.E POOLS CONSTRUCTION INC Phone: (786)355-3382 Building Department Comments RESURFACE EXISTING SWIMMING POOL, REPLACE Infractio Passed Comments POOL COPING AND TILES. TO REPLACE BPP-8-14-1861 INSPECTOR COMMENTS False 04-27-151. Naranjo Stop work until the contractor submits plans for the new work. 07/31/2015- REVISION SUBMITTED Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-248261. Missing option for child safety on pool Side gates must be self closing and locking with lock min 54"from grade Failed .. �R� . Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 24,2015 For Inspections please call: (305)762-4949 Page 37 of 42 ' y Miami Shores Village ) eY , 10050 N.E.2nd Avenue NE Asan irn 3 mr j�� . r z'xx i3 Yz Miami Shores,FL 33138-0000 Phone: (305)795-2204iI rajNEu [oczty ` v Ex iration: l 11 12015 p Project Address Parcel Number Applicant 551 NE 105 Street 1122310140280 BENIGNO MENDEZ Miami Shores, FL 33138-2044 Block: Lot: Owner Information Address Phone Cell BENIGNO MENDEZ 551 NE 105 Street MIAMI SHORES FL 33138-2044 551 NE 105 Street MIAMI SHORES FL 33138-2044 Contractor(s) Phone Cell Phone Valuation: $ 3,000.00 G.E POOLS CONSTRUCTION INC (786)355-3382 Total Sq Feet: 400 �o..,,—, ,. �_. Approved: In Review Available Inspections: Comments: Inspection Type: Date Approved:: In Review Final Date Denied: Review Planning Type of Work:Swimming Pool Occupancy: Private Review Building Additional Info: RESURFACE EXISTING SWIMMING POO Bond Return Classification:Residential Scanning: 1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# BPP-4-15-55116 DBPR Fee $2.25 DCA Fee $2.25 04/13/2015 Cash $ 162.30 $0.00 Education Surcharge $0.60 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 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, P UM G,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: rti hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zonin th oro authorize the above-named contractor to do the work stated. 1 April 13, 2015 Authorize teat :Owner / Applicant / Contractor / Agent Date Buildin ep ment Copy April 13, 2015 1 Miami Shores Village Building Department APR 0 7 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 t Q BUILDING Master Permit No.. ri91)___7145 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �� 1 Q��—i(� n- City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): T e_"Icno H Phone#: Address: City: ;pc`fy�l S�� 'F'c State: �-- Zip: 312 . Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: PocLs-7 Ov'�� fit CA{Z �1 L_ Phone#.-] ' 229 Address: A22 C> i PL City:- State: Zip: 33/ o! Qualifier Name: 'Pars iAr, Ps'vy;el e(- Phone#: 79'v-'3-5s 33E-. State Certification or Registration M Cs� 43' I Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �, 0--kA Square/Linear Footage of Work: t ty30 Type of Work: ❑ Addition ❑ Alteration 1 ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: V,eej C L '" ,r j 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$ l(0 y (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatu o Signature ' O R or NTCON ACTOR The foregoing instrument was acknowledged before me this The foregoing instru ent as acknowledged before me this day of : ,1. ,20 1 by 'Z day of_ r L 120 15 by pTt�r`'►Frr�PZ. _ who is personally known to r o Soor v Sf , ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: Print: Print: ?�' '�c COMMISSION if FF 165583 Seal: ?oozy P AIDAPEGUERO Seal: , « 1my COMMISSION t FF 165583 XPIRES:October 5,2018 SM* EXPIRES:October 5,2018 onded Thru tudget Notary Serrkes �►�. �Or et Wary Bankes EOFft�' -14 F`.W, BOflded Thru Budget APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CPC1458454 The COMMERCIAL POOL/SPA CONTRACTOR , Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 LTJ IJ ESQUIVEL GUtLLERMO SR � G E POOLS CONSTRUCTION INC ; 4220 SW 97TH PLACE MIAMI FL 33165 : 1 M S M ISSUED: 06/10/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406100001419 STATE OF FLORIDA % DEPARTMENT OF BUSINESS AND : PROFESSIONAL REGULATION CPC1458454 ISSUED: 06/10/2014 CERT COMMERICAL POOUSPA CONTR ESQUIVEL,GUILLERMO SR G E POOLS CONSTRUCTION INC en v IS CERTIFIED under the provisions of Ch.489 FS_ ., Expiration date:AUG 31,2016 11406100061419 4�. CERTIFICATE OF LIABILITY INSURANCE °"TEiMM'°aYYYY) 04f08H 5 } THIS;CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1- CERTIFICATE 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. --- —-.— .__.... --- —--- .._-.. - IMRORTANT Ifthe certificate holder is an ADDITIONAL INSURED,the palicy(ies)must be endorsed. If SUBROGATION I5 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 CONTA NAME:CT Ricardo Tortens Insurance Specialists Of South Florida PHONN (305)264-0003 FAX No: (305)226-7614 IAIC.2750 SW 87 Ave#204 E-MAIL Richard@isosf.net Miami,FL 33165 INSURERS AFFORDING COVERAGE NAIL# Phone (305)2640003 Fax (305)226-7614 INSURER A: Colony Insurance Company INSURED INSURER B: G.E.Pools Construction Inc INSURER C: 4220 SW 97 PI INSURER D: Miami,FL 33165- INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: _ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR( ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE 1NSR WVD POLICY NUMBER "MM/DDfYYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 50 OOO;OO EV COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ ❑ CLAWSWADE E OCCUR MED EXP(Any one person) $. 5,000,00 A � GL3573986 11 f07/2014 11}0712015 ❑ PERSONAL&ADV INJURY $ 1,000,000,00 GENERALAGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000.00 V POLICY ❑ PRO ❑. LOG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT j (Ea accident) $_.. ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ .❑ AUTOS ❑ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ �❑ ❑ AUTOS Peraccident. $ C UMBRELLA LIAR. [:]OCCUR EACH OCCURRENCE $ ❑ EXCESS LIA@ ❑CLAIMS-MADE AGGREGATE $ E DED ❑ RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N -❑TORY LIMIT ❑E ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E L DISEASE EA EMPLOYE ".$ If yes describe under - - -- -- DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Swimming Pools Installation, Repair,&Service. No op-Up Coverage. I ....... -----..._........... -- .......-- — --_ —---- ....... —'- — ............ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 Ave AUTHORIZED REPRESENTATIVE I Miami Shores,FL 33138 Fax(305)756-8972 silyeraa@miamishoresvillage,com Ricardo Torrens C 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD Cx Miami Shores Village _ � �.. f . Building Department 14 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 ' Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 BY: FBC 20�b BUILDING Master Permit No. - t (D PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County- Miami Dade zip: Folio/Parcel#: .IsA to Building Historically Designated:Yes NO Occupancy Type: Load: Construction Typekoo Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Phone#: Address:. rl€ 1'3 .J City: tYI I .)O)\ State:. Zip: Tenant/Lessee Name: Phone#: Email: {� COj CONTRACTOR: Company Name: C . I CJC��. lYl r l°V !Lyl XV)L Phone#: -196 325 23,?-2- Address: 3 2Address: 422-0 s Com) PL . City: r")(') (I)ryl ( +j (' State: ` Zip: 3 31 (o Qualifier Name: e-'V" tl it, I V OC Phone#: _7L) 3E5 3A2- State ZState Certification or Registration#: C?C [ 4 5 Z`f� Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ .3ooc:), Square/Linear Footage of Work: 0 Type of Work: ❑ Addition ❑ Alteration F1 New Repair/Replace ❑.Demolition K Description of Work: L sl)(FAC(` rX1S ASS Swim eylloc ►��)�� (.��'E Specify color -o(f�color thru tile: 1 /� Submittal Fee$ Permit Fee$ cs ("`-o CCF Pio CO/CC$ -CO Scanning Fee$ Radon Fee$ 4 DBPR$ �— �� Notary$ V ' Technology Fee$ 2 -J C) Training/Education Fee$ Cry 7 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ .p V (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. 1 c Signature Signature O Tt o G11 ENT CO OR The foregoing instrument as acknowledged before me this The foregoing instrument was acknowledged before me this day of _ 20Cr/ by day of t, 20 � by ot" nCr t~1flh F'Z .,who is personally known to who is personally known to me or who has produced as me or who has produced i as identification and who did take an oath. identification and who did take an oath. NOT4PUBLI NOTARY PUBLIC:;►wF¢ ANAI ESQUIVEL �.�` ..... ...MY COMMISSION#FF 145850Sign: EXPIRES:July 28,2018 Sign Y F'.PrintPrint: y Seal: Seal: �PjQA•...... Z c L114-11 APPROVED BY Plans Examiner �.�P Zoning Structural Review Clerk (Revised02/24/2014) 5�►ORES :... .....� Miami shores Village 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: 1 40-n CL Z, Print Name: (50% a c" Signature: Signature: i �'O�•10 X O0 o State of Florida ) State of Florida) 0 3. Count of Miami-Dade H g County ) County of Miami-Dade) N N.-n ri Sworn to and subscb d before me is Z.'s Sworn to and subscribed before me is i?:a day of Us 20 / . C��/y y„�/��ry day of ,20 / i; o By ••••••� W COMMISSION#FF 145850 By f I e n EXPIRES:July 28,2018 (SEAL) �'afld�` Sonde P"6U*N0WyServkxs (SEAL) Type of Identification produced Type dentification producedC I Y. Miami Shores Village -` JUL 3 0 2015 Building Department * 00050 N.E.2nd Avenue, Miami Shores, Florida 33138 1 NE P�fM�*I1l (305)756-8972 795-2204 Fax: { IIBBEER: (305)762-4949 FBC 20 BUILDING a ter Permit No. EPP 15 PERMIT APPLICATION sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 61S/ W _ (dS City: Miami Shores County: Miami Dade Zip: 3_3 (3 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: t`q Flood Zone: BFE: FFE: L OWNER: Name(Fee Simple Titleholder): /�%�L Q�' i tC-O ,J L. Z Phone#: -3o C-, 6 2� Address: ! / tQ e (o 5- S t` City: N A 0( ( 5 State: Zip: Tenant/Lessee Name: b.:NI�NC) J\J0 G-2- Phone#: `_'> Email: �-7X_tL l-i dc.. IZ( A ( /u ..-( -�1/ [ C w n rJ -��-� CONTRACTOR:Company Name:_(� Poo L 55 �i7 s u��j e 0 �inC Phone#: 770-..365-J2-365-J222 Address: �Z Z.Q S LJ -9-7 A- City: �--{ i p M.' State: F(_ Zip: 3 3/ S Qualifier Name: Phone#: State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: /0® Type of Work: X Addition ❑"I Alteration El New __ ❑ Repair/ReplaceMk El Demolition Description of Work: l ' _"etA).&,h A -I)e P-tjf� 4 `4V 5k,2 c► n c, SzG V1 � t S—_L y C-- Specify color of color thru tile: Submittal Fee$ Permit Fee$ ® .CDO CCF$ 1 �� CO/CC$ Scanning Fee$ .- 1 0 /W L Radon Fee$ � �� DBPR$ �J` �I Notary$ 0 Technology Fee$ b, Training/Education Fee$ y Double Fee$ Structural Reviews$ 0 '(2� Bond$ 0 TOTAL FEE NOW DUE$ � 1 (Revised02/24/2014) i 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 Signature OWNER or AGENT O TRACTOR The foregoing instrument was ack owledged before me this The foregoing instrument was acknowledged before me this i 20 day of J�3&)2 20 15 by 26) day of JUN E'_ 20 l3'— by -e Pr,dP 2-,who is personally known to I'l-o); VP i ,who ispersonally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Si ' Sign: : •�� AIDAPEGUERO . * * MY COMMISSION#FF 165583 * MY COMMISSION#FF 165583 Print: Print: EXPIRESs October 5.2018 *70 4 Bonded Thru Budget Notary Services ��rF°F F+�`` Bonded Thru Budget Notary Services Seal: fF` �� Seal: �l ? APPROVED BY ��j Plans Examiner J Zoning Structural Review Clerk (Revised02/24/2014) f oftg . 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: 6/19/2015 EXPIRATION DATE: 6/182017 PERSON: ESOUIVEL GUILLERMO FEIN: 264257051 BUSINESS NAME AND ADDRESS: GE POOLS CONSTRUCTION INC 4220 SW 97 PL MIAMI FL 33165 SCOPES OF BUSINESS OR TRADE: LICENSED POOL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an alrroer of a corporation who elects exemption from this chaplar by O&V a omtlflmle orelection under this aedion may not reower benefifsts or oomperaabon under this chapter.Pursuant to Chapter 410.05(12),F.S.,Certificates or election to be exempt..apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant b Chapter 440.05(13).F.S.,Notices of eied ion to be exempt and certificates of election to be exempt anal be subject to revocation W,at any time~the an of the notice or the issuance of the certificate, tha person named on the notios or co ti)cele no longer meals the requirements of this section for Issuance of a certidcale.The department shat revoke a DFS-F2-D1NC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONV(850)413-1609 1`nge I ur2 ti 1 •" 1 J . r, This property described as : r { ` All of Lot 19 , and the West 1/2 of Lot 20 , Block 110 AN AMENDED PLAT OF SECTION �, amu; f 0OL . I��SUrAnc ��1`, ►4'�qq e NO. S OF MIAMI Sk3ORES , LJ according to the Plat x� h C fYl ffl� JeC It thereof , as recorded in ' -l• ---- -----,. .---•--- - --:- - ... _... . .. Plat Book 10 , Page 47 , -- .d -- - " of the Public Records of L1.L'Y"�-- - � V '--- - -- -- --• 1 • .o•�o ' a:�y F--w Dade County, Florida . 7&.00 _ ra. � �• �-•r'.oe! aG r O i! r� +� � •+7�ic•. +ritii ,t/v,}a l�(1_n�� _ }`'► p �• t 7 Nv c-r!vim 7'7/^' 1 13_00! _ :- _ %�G;'�' ^r:c:-.F� 7 _. •1 �u ,q x � �?.moo....... t�� ..+ s • �l 3 p„+O• 1r -- n _ ;, FC 2 zoo r; G •g m . 4400.G:.Y 17rF1 GG r c. -r.•r ?27/4•'' rwa�AICC� 1w rq =4704r CIA X. (t1 iW Poil z ,N Ir ' , _ ry ��a-v: 'rte►-,ca. V VVU SCJ U1'i •8 . mp N Fence ^us —. . _-...-._'... � ••;75.00� .. �- -- ,� �_r�vry�1.�• �•'ra rr�'? (►� a{?�E iiJf ......_• .. _.-...�......_..... •... _.......__.... ..---s INC !s-e 4_1 n7 2a.oo , :;,A-- yY. U ' zo/V/ r -VIA /ov - -- -- I0,00 .rnx�,a ;=Uy, lt,> . _.105 Sr- elm ' • * • Duarte, Raul A. , and •..;.. • • PROPERTY OF: Mendez , Benigno S . , 55L N. E. 105th Street , , Miami Shores ••F• orj:da*. ' •.••••• 33'138• •ri1 iulurrltlrrnll 11tYKtc�-relate � IIOUNIZARY �� Sl.,xveY S.'•.• ••••:• 1A11 1111 1tF11t:IN.rl.lr.rltil•u�r,.u.111 r hrl0ht 1011111• that the•"ttr�•.e n•pn• LA N N FSA N 1) GA It f•Irk, I N(I...... • '• 1 1111111 I LIf FMKI'..1 sl!I1r 1;1'r,rl tefllell hereon r1,r,e1S Ih0 t drt,n+11rf1 1 • • • .• • q•�••• imam 11111 Ie<hni<al standards tet 111/111111 Ilse 11r/artr 1..11. Il ZZ}�}{ • • •..••' • . or (and Surveyors to r,}tapter 1, cu-6 tit1[ZVi':Y()It,�-f1IAi'I'I':Itti-i,,iNl) I'1.�N1;M;1t'i �••••� .. .... rloriria Adminkuativr Cnsic pvrttNnt 111 • Sc<Iinn 47)•1117•Ila.Slatt+lrt 111.•1•are n1+ Fu RN L:S'r0 E . 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