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RF-14-2332 Miami Shores Village _F°C1-,N,7: 7OCT 2 2 2014 Building Department 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 200 0 BUILDING Master Permit No.ul P 4�—,9 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [:] MECHANICAL ❑CCC PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP /�� e1 CO TRACTOR DRAWINGS JOB ADDRESS: "� ' 4 'V I� i S� (a�L S . f 9-3 City: Miami Shores/ tp 1 County: Miami Dade Zip: Folio/Parcel#: 11 -.5206 0 ( / - 0 4-h Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: dWNER:Name(Fee Simple Titleholder): Y� J ° hone#: -;o. X1W6 F3 Address: x 44. i,� lo i c4 City: (' State: Zip: Tenant/Lessee Name: Phone#: Email: C CONTRACTOR:Company Name: ( o'k L Phone#: �'/ v ��� 3 943 Address: u-j City: tate: Zip: ms's I,S Qualifier Name: v to,n "/ Phone#: ( ` State Certification or Registration#: 4 69 Certificate of Competency#: r, DESIGNER:Architect/Engineer: Phone#: Address: City: State: ooZip: Value of Work for this Permit:$ 2 0 0 Square/Linear Footage V Work: Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: �{ Submittal Fee$ Permit Fee$ CCF$ ^� CO/CC$ JO Scanning Fee$ Q- "CO Radon Fee$ DBPR$ `I� Notary$ 6 J u� Technology Fee$ 2,. k4(�) Training/Education Fee$ G � DoubleFee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ ° (Revised02/24/2014) 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. 1 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 su posted otice, the inspection will not be approved and a reinspection fee will be charged. U Signature Signature NER or AGENT CONTRACTOR Th foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before m�ee this day of V QU& z— ,20 by e day of to 20 1"t ,by y�Y r4-'C-"'1(LJ who is persona now to who is personally known to me or who has produced a as me or who has produced Pwkm M Ll f- as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: \\\ ►►11111111//�/pis'/ ® -ice Sign AryP Sign DEBORA ANDRADES 1 COrt11RI01klf11f FF 18 Print: _ :',� Print: 43129 MM QN0188 JWY 17,2018 Seal: ® ��, .CD = Seal: (14,L2/ 7,,l APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 OLARTE, JULIAN ELIECER JOCONS LLC 7087 SW 47TH ST MIAMI FL 33155 Congratulations! With this license you become one of the nearly '"•a ,., —.,.4...:: $5 one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects architects to yacht brokers,from boxers to barbeque restaurants, ,Yj _ QFC- g_1 K. and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services,please log onto - www.myfloiidalleense.com. There you can find more information - ,- about our divisions and the r ulations that impact you,subscribe R to department newsletters and learn more about the Departments tLC initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly. s1 �' We constantly strive to serve you better so that you can serve your ' - 1S L� ({ tED-irt►tteT tb isiorts c#-Ch 4$9 fS customers. Thank you for doing business in Florida, _ • and congratulations on your new license! ! auc as kits _ U4001 14 - r DETACH HERE RIC. OTT,GOVERNO R __ KEN LAWSON;SE-CRETARY IF _. d IgRARTIVIEW.4 FA i i�lAL.1Rl�lUf:1�1'�1©� •;� i11�B�f•S'�R� �...d> -_....__._• � ,..... = �r � -�^�� � %} � `ria h;`4,',.-•, _ - • 3k..,� !PTl,•Y.,. •ems ' N01 R. . �t q t,, �• �:, ".,4 Ell ..ew.' �r rr3 °"'_'_' "royw."..`« �`$4'a p., -• •a1` RY•, '+q •,t a' .� j• t� • �� ..e a.�-i�. y.. + " yip t ''�k�d„ '1 • � ,i ' .dr �.E.�'r +rt�'`�,`"� "`'- �' -:g� aaw��.9� '^'t"�•�' "'.+,� < "�,.y' 'y��`;�4.. � J'1 • 1 '{ m ISSUED: 08/1312014 DISPLAY AS REQUIRED BY LAW SEQ# L1408130001460 ,a� ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) v 10/21/2014 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). CONTA PRODUCER NAME:NAME: T Sarai Medina AX Emmanuel Insurance&Associates, Inc. PHacONE No, o Ext (305)693-0003 F(AIC'No): (305)691-4381 2370E 8TH AVE E-MAIL sarai@emmanuelinsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# HIALEAH FL 33013-4236 INSURER A: Preferred Contractors,Insurance Co. 12497 INSURED INSURER B: JOCONS LLC INSURER C: JULIAN OLARTE INSURER D: 323 Camilo Avenue INSURER E: Coral Gables FL 33134 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 INSURANCEADDLISUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000.00 CLAIMS-MADE ® OCCUR MED EXP(Any one person) $ 5,000.00 A Y PC86400-02 01/02/2014 01/02/2015 PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 POLICY ECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS L - $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION C STATU- OTH- AND EMPLOYERS'UABIUTY y/N TWORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Roofing Contractor Any Changes or alterations Done to this document after being issued shall constitute it null and void. CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2 Ave I Miami Shores Village FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. 305-795-2204 Fax 305-756-8972 AUTHORIZED REPRESENTATIVE S MAd i6K� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD rx'".,�"�c'i'"x�.J��i.5/"" _ "fir ✓` ��'C ," ''b ' OW R i Lf' CE y YM6tUT WED JO LLC 196 ° AL Btu a ev rAX OR J OLARTEMGOR rfa � z�,,�a �,�• ,its ,�;. �. SO �, .' CCC9 " a 14-00 5h r h , w � iw Le Tax Ta payme Lenpis a' dp •,; a it net ermi4s atioR der'sga ostia basin tabaopg.n me r Rang 1 na and imme h Opp a business. The 00. be dispi d to ag aammemial Tobi da Sea oro Who m .t •.;e •ANEW 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: 4/10/2013 EXPIRATION DATE: 4/10/2015 PERSON: OLARTE JULIAN E SR FEIN: 274760980 BUSINESS NAME AND ADDRESS: JOCONS LLC 323 CAMILO AVE CORAL GABLES FL 33134 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL HEATING,VENTILATION, ROOFING-ALL KINDS CONTRACTOR AIR-COND AND DRIVER 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 deparbnent shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 5t1�,REs n ••l. a�..� 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. 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 iniuries of any person allowed to work under this permit Please check with your insurance carver 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 ontracto Print Name: Print Name: i pe n Signature: Signature: State of Florida) i i i uState of Florida) County of Miami-Dade) .`` s;/G%,,,, County of Miami-Dade) Sworn to and subscribed before me t�s� •'' EXP60". �� Sworn to an ,subscribed21 day of ®C. f� 20 IL 9/1 s'' 612016 m — day of X20 EVELYN d1RTOLA Notary Public,State of Florida By B(��:� By $ commissiont EE 1e744e (SEAL) ��yIFFFI)3Q59 y i 7,2016 Type of Identification produced , FLO `\ (SEAL) O i �� Type of Identification produce Z