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RC-15-750 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-234285 Permit Number: RC-4-15-750 Scheduled Inspection Date: May 13, 2015 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Building Owner: VILLAMIZAR, FELIPE Work Classification: Alteration Job Address:547 NE 94 Street Miami Shores, FL 33138- Phone Number (786)371-4869 Parcel Number 1132060140880 Project: <NONE> Contractor: HOME OWNER Building Department Comments INTERIOR REMODELING TRASFORMING Infractio Passed Comments INSPECTOR COMMENTS False PERMIT REPLACEMENT FOR RC13-1087 INSPECTION HISTORY UNDER PERMIT RC13-1087 Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. May 12,2015 For Inspections please call: (305)762-4949 Page 17 of 30 Permit t 4. =4-16-75{} Miami Shores Village Pem*Type,Re dential"Const' mon 10050 N.E.2nd Avenue NErm, W**Cjassffrca96rt:Aiieration„ Miami Shores,FL 33138-0000 %viae Phone: (305)795-2204 = Petn7lt S`t8tts: F`°RtDAiration: 1 /05/2015 tam 1 18/2ti i Expiration: Project Address Parcel Number Applicant 547 NE 94 Street 1132060140880 FELIPE VILLAMIZAR Miami Shores, FL 33138- Block: Lot: t Owner Information Address Phone Cell FELIPE VILLAMIZAR 547 NE 94 Street (786)371-4869 MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone $ 6,000.00 HOME OWNER Valuation: Total Sq Feet: 800 is Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Window Door Attachment Date Denied: Framing Type of Construction:PERMIT REPLACEMENT FOR Occupancy:Single Family Insulation Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Final PE Certification Left Setback: Right Setback: Window and Door Buck Bedrooms: Bathrooms: Fill Cells Columns Plans Submitted:Yes Certificate Status: Review Building Certificate Date: Additional Info: Review Planning Review Electrical Bond Return: Classification:Residential Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Structural Review Mechanical CCF $3.60 Invoice# RC4-15-55032 DBPR Fee $2.70 DCA Fee $2.70 04/02/2015 Credit Card $50.00 $ 159.00 Education Surcharge $1.20 04/08/2015 Credit Card $ 159.00 $0.00 Notary Fee $5.00 Permit Fee $180.00 Scanning Fee $9.00 Technology Fee $4.80 Total: $209.00 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: ytht all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zor*b. hee,I thorize the above-named contractor to do the work stated. April 08, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 08,2015 1 < �flf<, Miami Shores Village g v-D Buildin artment APR 42 201q10 g Department 5 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 ® /L__ Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 10 BUILDING Master Permit No. �57' 4� PERMIT APPLICATION sub Permit No. BUILDING F-] ELECTRIC ROOFING F-1 REVISION Ej EXTENSION ERENEWAL ❑PLUMBING F-1 MECHANICAL PUBLIC WORKS [:] CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS: _51-1z •7' v 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): I�V Ll>E ('( [ i 4tq(24k Phone#: 16(0!2 Address: 5 u 9- ryF— q# 5� City: W1�� C LD re 5 State: 1-'L- Zip: 3 �� Tenant/Lessee Name: ( . Phone#: Email: e��'P1,v,(ICA ui� zRtr yaU 00-eom CONTRACTOR:Company Name: h C tLxQ ecg7(_RSL2 Phone#: Address: City: State: Qualifier Name: Phone#: State Certification or Registration M Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: tate: Zip: Value of Work r—this $ 4,,o0c) Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: o4 Aa .D; C ec\ uA;j Specify color of color thru tile: Submittal Fee$ ��®`/®�� Permit Fee$ �iVO, CD CCF$ ® CO/CC$ Scanning Fee$ /•d FJ Radon Fee$ 7�® DBPR$ Notary$ Technology Fee$ Training/Education Fee$ �. Double Fee$ Structural Reviews$ Bond$ r Q TOTAL FEE NOW DUE$ (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 a ve nd a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 7 1 20 )—�— , by day of ,20 by �- who is personally known to who is personally known to me or who has producedLL�a7,9?���das 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: St.tP f Florida rin Joanna M Feliciano Seal: my Commission Ff 082753 Expires[11 11 212 0 1 8 ffi+k k k k k k k k N#4k k k k k k k k ek k Me k k Nk kk k k +k k k k k Nt ' Ne k+k k k k+k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k#kk kk k+k k k k k k k k k&k k k ffikffi 3 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: DATE: 20/5 ADDRESS: 5 A A t-ja 9 "r Apt Skt�r2ES ,''L -3163 Do Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida,F.S 489.103(7), And I have read and understood the following disclosure statement,which entitles me to work as my own contractor;I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor.You have applied for a permit under an exception to the law.The exemption allows you,as the owner of your property,to act as your own contractor even though you do not have a license.You must supervise the construction yourself.You may build or improve a one-family or two-family residence.You may also build or improve a commercial building at a cost of$25,000.00 or less(The new form states 75,000).The building must be for your own use and occupancy.It may not be built for sale or lease.If you sell or lease a building you have built yourself within one year after the construction is complete,the law will presume that you built for sale or lease,which is a violation of this exemption.You may not hire an unlicensed person as a contractor.It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances.Any person working on your building who is not licensed must work under your supervision and must be employed by you,which means that you must deduct F.I.C.A and with- holdings tax and provide workers'compensation for that employee,all as prescribed by law.Your construction must comply with all applicable laws,ordinances,buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner-builder permit under an exemption from the law.The exemption specifies that I,as the owner of the property listed,may act as my own contractor with certain restrictions even though I do not have a license. Initial 2. 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that,as an owner builder,I am the responsible party of record on a permit.I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding.I may al build or improve a commercial building if the costs do not exceed$75,000.The building or residence must be for my use or occupancy.It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or ubstantially improved it for sale or lease,which violates the exemption. Initial 5. 1 understand that,as the owner-builder,I must provide direct,onsite supervision of the construction. Initial 1pv- 6. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons workin on my building or residence.It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. lnitiaI4&/,1 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner-builder permit that erroneously implies that the property owner is providing his or her own labor and materials.I,as an owner-builder,may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully a ' as an owner-builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. 1 understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done.Any person working on my building who is not licensed must work under my direct supervision and must be employed by me,which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act(FICA)and must provide workers compensation for the employee.I understand that my failure to follow these may subject to serious financial risk. Initial —I/L/- 9. 1 agree that,as the party legally and financially responsible for this proposed Construction activity,I will abide y all applicable laws and requirement that govern owner-builders as well as employers.I also understand that the Construction must comply with all applicable laws,ordinances,building codes, and zoning regulations. Initial 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service,the United States Small Business Administration,and the Florida Department of Revenues.I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htt ://www.m oddalicense.com/db r/ ro/cilbfiindex.ht Initial 11. 1 am aware of,and consent to;an owner-builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. 1 agree to notify Miami Shores Village immediately of any additions,deletions,or changes to any of the information t have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public.If you contract with a person who doest have a license,the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court.It is also important for you to understand that,if an unlicensed contractor or employee of an individual or firm is injured while working on your property,you may be held liable for damages.If you obtain an owner-builder permit and wish to hire a licensed contractor,you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued,this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit.A copy of the property owner's driver license,the notarized signature of the property owner,or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this g2 day of , 20 2- B y o� ' , who was personally known tome or who has . ` a m�oZ Produced they ' ense or V�s222`Ze5��2 as identification. a m o 1 �N So- Uy 0 0 Tn,CD CO T Q7 CD OWNER TA Y NO V p N W 2 tU t 1 r � Miami Shores Village Building Department \(� 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 - �/ V Tel:(305)795.2204 Fax:(305)756.8972 -_- INSPECTION'S PHONE NUMBER:(305)762.4949 FBC 20(Z::) BUILDING Permit No. PERMIT APPLICATION Master Permit No.ec 13 - I C) Permit Type: BUILDING ROOFING JOB ADDRESS: 547 Nr,- 14 St1-e e,fi City: Miami Shores County: Miami Dade Zip: 13 Folio/Parcel#:'x /I - 3 Z Q(o - 46 014- 0880 a Is the Building Historically Designated:Yes NO Flood Zone: 90� pp i QQ`` OWNER:Name(Fee Simple Titleholder): Ci� I )Q V I I Z61 r Phone#: -78(a- 3?1 - l V 69 Address: 51 -7 NE q-4 S"f f P F'f City: Hr a m 1 ,Sh o res State: � zip: .3S138 o-- Tenant/Lessee Name: Phone#: Email: 'Ia/I e — vi 1A/n GGirAh i'Y) CONTRACTOR:Company Name: Address: City: 1�k\ V!rt i State: L Zip: ai(7 Qualifier Name: P`� F'2r Phone#: 30-0 L Sl gS10 State Certification or Registration#: CCIL C tate of Co(mpetency#: Contact Phone#: )1L IZ - (a N NIzZ Email Address: 0`�5"� tl f Cto.—VA 6tJ C.'�t 0���r\ C©•���A DESIGNER:Architect/Engineer: 1 Y (ei n LI e 1 Phone#: Value of Work for this Permit:$ 00c) Square/Linear Footage of Work: 000 SCl -Pt Type of Work: OAddition eAlteration ❑New ❑Repair/Replace ODemolition Description of Work: 1&er or _rrRnCN1m1,()9 (2)(1S11nq m a5fer- 0,1-MraOm t 176W and Me kr h master Vo-MrddIn /�7o of @A GY,417er_ � Moil, odor thru tile: Submittal Fee$ -� Permit Fee$ (0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ ' P ' Bonding Company's Name(if applicable) XI)A Bonding Company's Address City State zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS and AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR ,LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM [EIRCEMENT." Notice to Applicant: As a condition to the issuance of a building=permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commenceotentlnd construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified co recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after tOg'e ng permit is issued In the absence of such posted notice, the inspection will not be a ov and a reinspection fee will b, d Signature Signature Owner or Agent // Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledgV before me thii �Z s l day of h 20 a,by e �i C����� day of 20�,by Kl A l who is personally known to who is personally known to me or who has produced 1� Y As idetake an oath. as identification and who did take an oath. NOTARYV6®LET P ISSION#EE091622 NOTARY PUBLIC: «: «: MY MM'SS IRES M" 14, Sign: E s rvwe�m Sign: (ao Print: Print: M Commission Expires: A n �� L� Pedro A Go oY My p Ivt �� , �(j OS My Co s o Q sic my Gommissi n EE084764 ` s"bve�o4` Expires 06130/2015 qa�$a ag Ha Ha$o aIa sg���R ag sk g s$A@ sR R A as Ha s§ga a$aR I%ae=k 89���s$//k�sR sR sR av eR aN Ha sR aR sR sR eY sR=R sIa sR sA ff+A9 HnR�s��R aA�a R$a sIa�e�A9�A9 s�aR=R=A sR s8 R R sR:A Ia�Le�A sk:R�av to �+8 s+R sR sR sR sA sR Ha Ha sk sk sg H i APPROVED BY ZJPlans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) T' WSq � P npr{ (M y s +a�ua rc�+�cr^ gds p �e.Sn�+geo*za�ated�z,au STATE OF FLORIDA AC# C,a O Pa q ? 2 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGM ATION CG3CC1516021 08/27/12 128056168 T. CERTIFIED GENERAL CONTRACTOR ! GAT AMEZ, ABEL RANDOLVO AG STAR CONSTRUCTION INC IS CERTIFIED under the provisions of Ch.489 rs sgdsatUm Hate: AUG,31, 2014 L12002701953 STATE OF FLORIFT., AG# 6 a®G 6 7 1 DEPARTMENT,0FbBUSINESS AND ! PROFESSIONAU� MGULATION n• s CCC1329029 08/27/12 128056168 CERTIFIED ROOFING CONTRACTOR GALDAMBZ, AM RAMDOLFO AG STAR CONSTRUCTION INC IS CERTIFIED under the provisions of ch.489 Fs sasirattoa date. AUG 31, 2014 L12082701652 f ) CERTIFICATE OF LIABILITY INSURANCE OA7 6/Z71Y} 61271/201201 3 I 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-8). CONTAPRODUCER NAhM T NANO I PRO a 1-800-277-1620 x4800 727-797-0704 (An:,No,Ex1g (AlC,NoX FRANKCRUM INSURANCE AGENCY,INC. e,=L (AODRea); ! 100 S.MISSOURI AVE. INSURERS AFFORDING COVERAGE NAIC6 CLEARWATER FL 337$6 INSURER A: FRANK WINSTON CRUM INSURANCE CO. 11600 INSURED INSURER 8: INSURER C: FrankCrum 1-800-277-1620 INSURER O: 100 S MISSOURI AVENUE INSURER E; CLEARWATER FL 33756 INSURER F. COVERAGES CERTIFICATE NUMBER; 227197 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. MR TYPE OF INSURANCE ADDL BURRPOL10Y EFF POLICY EXP LTR INSR YMPOLICY NUMBER (MMWDryyyY) (MMWfDDIYYYYI LIMITS GENERAL UAB)LIT7' EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PRF-Ld18E8 EA ooaprohoe OLAIMS-MADE =OCOUR MED EXP one PERSONAL AADVINAIRY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER! PRODUCTS-COMPIOP AGO $ POLICY PROJECT LOC $ .j AUTOMOBILE LIABILITY E SINGLE LIMIT- AUTOMOBILE (Ea-adder,!) $ JELRO ABODILY MURY(Perparson) $ D SCHEDULEDBODILY INJURY(Per acaWw* $08 AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS aramidenq $ _I UMBRELLALUAB OCCUR EACHOCCURRENCE $ EXCEL"AS CLAIMS-MADE AGGREGATE $ .1 IDED1 RE7ENTWN$ $ 1 A WORKERS COMPENSATION AND VVC201300DGD 1/1/2013 1/1/2014 WcsTAru ER EMPLOYERS'LIABIUTY X TORY LIMITS ER ANY PROPRIETORIPARTNLRXXECUTIVE { EACH ACCIDENT E.L. $1,000 OOO OFFiCERiMEMBER EXCLUDED? N/A l tblandalory in NH) .� Irgee,deawfhaund-r EA..DISEASE-EA EMPLOYEE $1,OOD 000 DESCRIPTION OF OPERATIONS WaW e.LDISEASE-POLICY LIMIT $1,000000 i i ) i i OESCRIPTION OF OPERATIONS f LOCATKM I VEHICLES(Attwh ACORD ICI,AddklorW Rem-rka achedOle,Amore spam b roquired) i EFFECTIVE 0612612013,COVERAGE IS FOR 100%OF THE EMPLOYEES OF FRANKCRUM LEASED TO AG STAR CONSTRUCTION,INC(CLIENT)FOR WHOM THE CLIENT IS REPORTING HOURS TO FRANKCRUM.COVERAGE IS NOT EXTENDED TO STATUTORY EMPLOYEES. i i CERTIFICATE HOLDER CANCELLATION s SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,N0110E WILL BE DELIVERED IN VILLAGE OF MIAMI SHORES ACCORDANCE WITH THE POLICY PROVISIONS, ATTR BUILDING DEPARTMENT 10050 NW 2ND AVENUE AUTHORIZED REPRESENTATPJE MIAMI,FL 33138.. 1988-2010 ACORD CORPORATION. Ali rights reserved, ACORD 25(2010106) The ACORD name and logo aro registered marks ofACORD f JUN-22-2013 03:43A FROM: TO:3057568972 P.1 CERTIFICATE OF LABILITY NSURANCE °"'E" '°°"'"YY' `rte 08/19/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON0 AND CONFERS N RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, ND Ott AL THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTR A CONTRACT B N THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(Imust be erldor ted. f SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,Certain potIclas may rsgl .1 snL A std4mud on this certiflcste does not confer rights to the CwWkM to holder In lieu of such endorsement(,). PRODUCER J E HERRERA All Florida Insurance SaM9941 810-7321 (954)510'-7323 7782 Wiles Road Jhs myBln..00m Corel Springs,FL 33087 ' APPORDINGI COVERAGE NAIC Phone 984 810-7321 Fax 064 510-7323 INSURER EV ON INSURANCE COMPANY INSURED g. AG Star Construction Inc. INSU c: 1827 NW IST STREET R b: MIAMI.FL 33125 (306)224-2188 IN Ri COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA BEEN IS .ED TO E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION F ANY CONTRACT O OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED Y THE POLICIES D CRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HA BEEN REDUCED 13Y AID CLAIMS. I TYPE OF INSURANCE ADD USR CY UM Y LIMITS GENERAL LIABIlm EACH OCCURRE CE , 1,000,000-00 ® CoMMERcm(3ENERALuABvrY g O. D $ 100,000.00 A ❑ ® CLAIMS-MAW ❑ OCCUR Y N B20130287 p�1$/201 08/18/2014 MED EXP ane n s 5,000.00 ❑ t PERSONAL 6 AOV INJURY $ 1,000 000.00 ❑ GENERAL AGGREGATE $ 2 000 000.00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS•C0MPIOP AGO $ 1,000,000.00 ❑POLICY ❑ MO, ❑ LOC i DED $ 1,000.00 AUTOMOBILE LIABILITYINGLE LIMIT — W.aal I ❑ ANY AUTO BODILY INJURY(Par parson) $ ❑ ¢UYNED ❑ SCHEDULED BODILY WJURY(Par.edda,d S ❑ HIRED AUTOS ❑ A AWNED P O ER MAGE a ❑ UMBRELLA J1 tJAH ❑OCCUR i EACH OCCURRENCE $ EBCESS LMCLAIMS MADE AGGREGATE $ cap 0 RETENTION WORKERS COMPENSATION WG IITATU OTH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORMARTNEWEXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA If yea Manddwy�deEarmeunder E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E,L DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATUM I LOCATIONS i VEHICLEG(At>och ACORD 101,Addhlonsr SohWub,n mora s 4 rogWrod) 98877-ROOFING COMMERCIAL 88879-ROOFING RESIDENTIAL 91 !NERAL CONTRACTOR I i i CERTIFICATE HOLDER CANCELlATIO SHOD ANY C F THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ViAage Of Miami Shorts THE EOXPI ATI VAODATE TH THE POLICY PROMS Ns. BE DELIVERED IN Building Departumt I W50 NE 2nd Ave Aunty TATM Miami Shores,FL 33138 i PHONE:305-795-2204 i L®1888-2010 ACORD CORPORATION. AO rights reserved. ACORD 28(2010/05)QF i The ACORD name and logo aro reglatered marks of ACORD j �rTTp 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: 5/9/2013 EXPIRATION DATE: 519!2015 PERSON: GALDAMEZ AXEL R FEIN: 262568565 BUSINESS NAME AND ADDRESS: AG STAR CONSTRUCTION IN( 1827 NW 1 ST STREET MIAMI FL 33125 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL ROOFING-ALL KINDS CONTRACTOR AND DRIVER Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by Offing 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 or the certificate,the person named on the notice or certificate no longer meets the requirements of this section for Issuance or a certificate.The department shall revoke a certificate at any time for failure of the person named on the carlificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO 8E EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 . I flllf lllf 111 f ifff f ff f fff llfff if ff C--FN 2013R04-8-549434 OR Bk 28668 Ps 2581; Qpq) NOTICE OF COMMENCEMENT RECORDED i 6/07/2013 11:45:10 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION HARVEY RUVIN r CLERK OF COURT MIAMI-GAGE COUNTYP FLORIDA LAST PAGE PERMIT NO. TAX FOLIO N0. C Ay-p%%ri STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Chapter 713, Florida Statutes,the following information is provided in this Notice of Commencement. 1. Legal description of property and street/address: M iA\4s 5,VqP.Zb _9k, \o-3a L4; LC U k �� '3LK LO S�ZS '+5.c= x \Zg cz< —'SMO oU ICON 1 CQC ZI'2-1 ICAZ2\ 0A Z_Q: 6 2. Description of improvement: 9,EHIOD1Z7 LZNG NIASTE� Ut��1��0U� AND 0��1, 3. Owner(s)name and address: V L&R 3 V'S.�\-IIZZA�1%_ Interest in property: a ITANIF.ZZ Name and address of fee simple titleholder: R UZA r 4. C�on�racto�r�sPaQieaddress: 5'"�'� , G Vn% ) 4 L 23'3 i!w 5. Surety: (Payment b nd required by owner from contractor,if any) Name and Address: Amount of bond$ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s)to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement:(the expiration date is 1 year from the date re ding unless a different date is specked) f AIR pADE o Cowvq. � 1HEREBY I FCERTIFY CMJU►`� 8yor Z�;i'gnature of Owner Off<cial am'A vo. Print Owner's Name tZLI �ti Pkv 4L__ Cmb Sworn to and subscribed before me this ! day of Address: Notary Public: t� L (A M�a _�Print Notary's Na e: My commission e i A F dro A G doy . . o my Commission EE084764 'peFayoe Expires 06/30/2015 +CFN 2013RO255382 OR 8k 28562 Pss 3722 - 37231 (2pss) RECORDED 04/03/2013 1538:57 DEED DOC TAX 3.294.00 HARVEY RUVIHr CLERK OF COURT MIAMI-DADE COUHTYr FLORIDA Prt: rpa ed by and return to Eric van der Vlagt,Esq. Vice President Clear Title Services,Inc. 1111 Kane Concourse Suite 209 Bay Harbor Islands,FL 33154 305-865-5718 File Number. 13-0194 Topel (Space Above This Linc For Recording Datal Warranty Deed This Warranty Deed made this 1st day of April,2013 between David Topel,a single man whose post office address is 901 Diplomat Parkway,Hollywood,FL 33019,grantor,and Felipe Villamizar,a married man whose post office address is 547 N.E.94 Street,Miami Shores,FL 33138,grantee: (Whenever used heroin the terms"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,trusts and trustees) Witnesseth,that said grantor, for and in consideration of the stun 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 20,and the East 1/2 Lot 19,Block 55,Miami Shores Section No.2,according to the map or plat thereof,as recorded In Plat Book 10,Page 37,of the Public Records of Miami-Dade County,Florida. Parcel Identification Number:11-3206-014-0880 SUBJECT TO: 1) Taxes for the year 2013 and subsequent years and all applicable zoning ordinances and governmental regulations. 2)Conditions,restrictions,limitations,and easements of record,if any,but without the Intention of reimposing same. 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 31,2012. In Witness Whereon grantor has hereunto set grantor's hand and seal the day and year first above written. DoubleTltnem Book28562/Page3722 CFN#20130255382 Page 1 of 2 SN,osEs � Miami Shores Village Building Department Evil , M 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 ZORII)P' Fax: (305) 756.8972 May 20, 2013 Permit No: DGT13-1045 Building Critique Review 1) Provide a plan of the existing floor plan. Provide a demolition plan. 2) If the den is an added room with a closet, then provide approval from Miami Dade County Health Dept. (DOH/HRS) 3) Identify the emergency rescue and escape window in the new den. STOPPED REVIEW Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. Norman Bruhn CBO 305-762-4859 Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re-submittal drawings. ♦S-uREs yi Miami shores Village ,�� Building Department OR'0 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT#: /1 J I DATE: lJ (NAME) ❑ Contractor Owner ❑Architect �dup2 sets of plans and ther) )�� Address: From the building department on this date in order to have corrections done to plans And/or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: (Sig e) PERMIT CLERK INITIAL: RESUBMITTED DATE: PERMIT CLERK INITIAL: