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EL-12-1827 ,`j���� Miami Shores Village _ r7n_q _D �1 Building Departments 22 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY. INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. RC— PERMIT APPLICATION Sub Permit No. 'a-- «`_-- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLICWORKS CHANGE ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 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): rC 000p Z Phone#: Address: .s®✓5.J ". W. '7-5-1 City: / l/G�'/i State: A4 Zip: _Zy 1,- 6- Tenant/Lessee Name: Phone#: Email: ,7 CONTRACTOR:Company Name: C, Phone#: 3 u S y V Es Address: V\lbS t--�W ' SA City: \-Nt G�r� State: Zip: Qualifier Name: QSvCA �LtD &U Aazy Phone#: State Certification or Registration#: ©0 L y Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1% %00 Square/Linear Footage of Work: Type of Work: ❑Addition \ ❑ Alteration `❑New ❑ Repair/Replace ❑Demolition .Description of Work: t 1- C_0'\ rQrv�nd 1i(I . Q(l r1®W u) \Aeqpn c1 aryi CR Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ (571 Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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,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 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 inspectio which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not aMapndpection 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 e20 &, by j6rte I Cr�rd� day of ck-X) 20�,by who is personally known to me or who has produced who is personally known to me or who has produced DL, As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign �' ( �. �Kd �✓ Print: Print:6 '� �u✓14 �° C' - MARIA DEL PILAR R DO My Commission Expi s: :+ MANDRADE MY EE 843924 My Commission Expi '`� MY COMMISSION s3 EE220S59 EXPIRES:October 15,2016 .,��f. EXPIRES August 13.2019 Bonded Thru Notary Public UWN,Wftm (4073 398-0163 FIor�NofaYSafvics e9m zo�yr APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014)(Revised 5/2/2012)(Revised 3/12/2012))(Revised 06/10/2009)(Revised 3/15/09)(Revised 7/10/2007) ♦S�tic.r�G Miami shores Village "' Coln Building Department 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 Tale Holder): 4Phone#: 3 Q– s2 7y Owner's Address:�Al W. /IO. City: M_ �`aZ21 I-Aor -v State: GL Zip Code: S?.14 k Job Address(Of where work is being done):_,51 &. w. City: Miami Shores State:—Florida Zip Code:33/gg 8- Contractor's Company Name: T Phone#- �3 � C 68= Address: L 3 s City: �Arv'�� State: f1,. Zip Code: 1j_ Qualifier's Name : 1X,kAo I— OL C�za Lic. Number Architect/Engineer of Record Name: Phone#: Address: City: State: Zip Code: Describe Work: �.c. c c � r c%m� `��a rh u r, %Wvr�l cc I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Offici I an th Ai�:7= for all legal involvement. Signature Signa Signs. oxmei orAge rort#ractor orArohbct The foreg nstrument was aknowledQed before me The foregoing instrument wap aknowledge:7-70�0 this_—day of 5 ,20 I`�by� rwr of this�-�day of 2d`�by Who is personally known to me or who has produced wholspersonal known to me or who has produced TL D L as indentiliccaation. as indentification. Notary Pub l c• Notary,Public: Sign: Sigri: 647 , ' rrA ,�!A.OS PILAR ROeLEDO Seal: Pp�F MY COMMISSION#EE 843924 Seal: t. EE220559 c •a ExPiRESAugust13.2O16 EXPIRES October 15,2016 �,a�.�� Banded Thru Notary Public Urdderw bM (407)398.0153 aan September 2"d. 2014 Mr. Gonzalo Perez CAPER ELECTRIC& MAINTENANCE INC. 10951 SW 93th. STREET MIAMI, FL. 33176 1 inform you that I will use not more your service like the electrical Contractor for the following project Of my house: Project address: 51 NW 1101h. Street Miami Shores FL. 33168 Permit Number: Electrical Permit#EL-10-12-1827 Owner Name: EFREN CENOZ I appreciate all your help in this project. Sincerely FREN OWNER ■ Complete items 1,2,and 3.Also complete item 4 if Restricted Delivery is desired. — ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. R celved b (Printed Name) S�'elivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑ s 1. Article Addressed to: If YES,enter delivery address below: ❑No r741,1 a-cr- 3. Service Type ❑Certified Mail ❑Express Mail 7 ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number- (Transfer from S' umber.(Transferfroma 7013 1090 0000 8289 5247 PS Form 3811,-February 2004 Domestic Return Receipt 102595-02-M-1540 002921 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAY LB 4847647 BUSINESS NAME/LOCATION RECEIPT NO. Tj EXPIRES ARAPSTRONG ELECTRIC INC RENEWAL SEPTEMBER 30, 2015 6965 NW 43 ST BAY 3 5069514 Must be displayed at place of business MIAMI FL 33166 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS AMPSTRONG ELECTRIC INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED EC13004184 BY TAX COLLECTOR Worker(s) 1 $75.00 07/30/2014 CHECK21-14-038615 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0,above must be displayed on all commercial vehicles—Miami—Dade Coda Sec sa-276. For more information,visits miamidada goyAUggilector STATE OF FLORIDA -- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION F ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CARDOZA, OSVALDO ALFREDO AMPSTRONG ELECTRIC INC 6965 NW 43 ST BAY#3 MIAMI FL 33166 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 rangeSTATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, 8 DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Y`^Aj Every day we work to improve the way we do business in order to EC13004184 ISSUED: 06/01/2014 serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL CONTRACTOR about our divisions and the regulations that impact you,subscribe CARDOZA, OSVALDO ALFREDO to department newsletters and learn more about the Department's initiatives. AMPSTRONG ELECTRIC INC Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date . AUG 31,2016 L1406010003093 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION' sr� ELECTRICAL CONTRACTORS LICENSING BOARD ly EC13004184 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 CARDOZA, OSVALDO ALFREDO a' .AMPSTRONG ELECTRIC INC6965 NW 43RD STREET BAY#3 MIAMI FL 33166 16 ISSUED: 06/01/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406010003093 ACORO® DATE(MMIDDNYYY) � CERTIFICATE OF LIABILITY INSURANCE 6/13/2014 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). PRODUCER CONTACT David M. Lopez NAME: p Eastern Insurance Group, Inc. PHONE (305)595-3323 WE FAX .(305)595-7135 9570 SW 107 Avenue EE�,csr@easterninsurance.net Suite 104 INSURERS AFFORDING COVERAGE NAIC# Miami FL 33176 INSURER AMid-Continent Casualty Company INSURED INSURERS: Ampstrong Electric, Inc. INSURERC: 6965 NW 43rd Street INSURER D: Bay #3 INSURER E Mi ami FL 33166 INSURER F COVERAGES CERTIFICATENUMBER:Master 14-15 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 ADDL SUB POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MMIDD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMSES(Ea occurrence) $ 100,000 A CLAIMS-MADE F—I OCCUR 04-GL-000905393 6/16/2014 6/16/2015 MED EXP(Any one person) $ Excluded PERSONAL BADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X AGGREGATE PRO LOC $JFrT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED ALTOS AUTOS Per accident UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER(MEMBER EXCLUDED? NIA (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 I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) Electrical Contractor. License EC13004184 CERTIFICATE HOLDER CANCELLATION (305)756-8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2 Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 David Lopez/ANA ' ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 rgmnnsi m Tho Ornpn names anti Innn aro ranicfararl manta of Or npn / , ® DATE(MMIDD/YYYY) AC40 v CERTIFICATE OF LIABILITY INSURANCE 07/29/2014 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). PRODUCER CONTACr NAME: Automatic Data Processing Insurance Agency,Inc. acN o Ext): ac No: 1 Adp Boulevard E-MAIL Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC A INSURER A: QBE Insurance Corporation 39217 INSURED INSURER B: AMPSTRONG ELECTRIC INC INSURER C: 6965 Nw 43rd St Unit 3 Miami,FL 33166 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 253022 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. ITR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MOM/LDID� LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ETO CLAIMS-MADE FIOCCUR PREMISES CEa occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑jECOT- F-1 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X P H- AND EMPLOYERS'LIABILITY STATUTE ER YIN A ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? �Y N/A N EQB0202085 06/16/2014 06/16/2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Electrical contractor.License EC13004184 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. Attn:Building Department 10050 No 2 Ave Miami,FL 33138 AUTHORIZED REPRESENTATIVE A@ 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD R r� &1 z Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-238426 Permit Number: EL-10-12-1827 Scheduled Inspection Date: July 09, 2015 Permit Type: Electrical - Residential Inspector: Devaney, Michael Inspection Type: Final Owner: CENOZ, EFREN Work Classification: Addition/Alteration Job Address:51 NW 110 Street Miami Shores, FL 33168-4318 Phone Number 305/751-5274 Parcel Number 1121360030600 Project: <NONE> Contractor: AMPSTRONG ELECTRIC INC Phone: (305)468-7988 Building Department Comments INSTALL NEW OUTLETS & SWITCHES ELECTRICAL Infractio Passed Comments PANEL AND INSTALL NEW LIGHT HATS+ INSPECTOR COMMENTS False 04/18/2013- NO PANEL COVER, EXPOSED CONDUCTORS. METAL STUD RESTING IN FRONT OF PANEL. MD Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-179355. 6 july 15 ET Add 1 receptacle in kitchen area. Find missing receptacle in master bedroom area. 20 amp. dedicated circuits require 20 amp. receptacles. Failed ❑ Kitchen receptacles need goof rings. Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. July 08,2015 For Inspections please call: (305)762-4949 Page 19 of 27 Miami Shores Village ` ' ��; ____________meet_. Building Department 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 20 f BUILDING Permit No. El 19-- PERMIT 9-PERMIT APPLICATION Master Permit No&)Z in (P Permit Type: Electrical JOB ADDRESS: 67 IV Lj //C 7;�'( City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes /NO'D Flood Zone: OWNER:Name(Fee Simple Titleholder): 6ereitJ �erj®s Phone#: Address:_ V ltd. W. City: o .TIWAV S Stats; /-/ —zip: 7-7 Tenantdxssee Name: Phone#: Email: y CONTRACTOR:Company Name: 6-A 6�jt�- � "�I s/�phone#: Address: �® City: —State: Zip: Qualifier Name: _ 12024 z4-tv IL—"- State Certification or Registration#: 4Dq 00 f X70 I-7 Certificate of Competency#: Contact Phone#:30r--2-1 Email Address: c DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ + ' t a�rq/Li�ie Footage of Work: Type of Word: O/lddress OAlteration dr/Replace ODemolition Description of Work: iy��i�// r'�., ��/, is fb,�,' ,® 6 � ,�� , � Nv v Submittal Fee$ Permit Fee$ 0,0 CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$a + 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-ftELEC`i'RiEAL 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 1WROVEMENTS TO YOUR PROPERTY- IIF 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 i ctio ch urs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not _app ove ee will be charged. Signature Signature Owner or Agent The fore nstrument was acknowledged before me this b l The foregoing instrument was acknowledged before me this v— day of ,20.1 Z,by I rx (eh eS day of -P.4M ,20.Q--,by , who is personally known to me or who has produced who is personally known to me or who has produced l0`iG�Ct As identification and who did take an a as identification and who did take an oath. NOTARY PUBLIC: BERTHA C.ORTEtiA NOTARY P CHUMAMMM Y P"B�c., Notary Public-State 01 ROT'" ° MYC�1#DD82W5 U ;y�•z My Comm.Expires Sep 27,2018 IR NSe 23 `a COmmisslon#EE 2061l� Sign: Sign: Print: e� Print: My Commission Expires: �.�-2�7l aO I�o My Commission E ices: �I�,'3 `�Z ��,x0,x a„x,x,x,x�,n����,x,x,x,x,x�,x,x,x�,x,x�,x a„x�,x,x,u,x�,xe a,m�0,x,x,��,x��,x�,xOs��m�x��,x�,x=••�s<,x��,x�s<��x�,x,x,x�,�,x,xa�,x,x,x,x,x,x,x,x�,x,x�s<,x��,x���,�,x� APPROVED BY V / Plans Examiner Zoning Structural Review Clerk (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) DBPR - PEREZ, GONZALO N; Doing Business As: CAPER ELECTRIC & MAINTEN... Page 1 of 1 11:57:33 AM 10/2/2012 Licensee Details Licensee Information Name: PEREZ, GONZALO N (Primary Name) CAPER ELECTRIC & MAINTENANCE INC. (DBA Name) Main Address: 10951 SW 93RD STREET MIAMI Florida 33176 County: DADE License Mailing: LicenseLocation: License Information License Type: Registered Electrical Contractor Rank: Reg Electrical License Number: ER0014707 Status: Current,Active Licensure Date: 09/28/1998 Expires: 08/31/2014 Special Qualifications Qualification Effective Dade View Related License Information View License Complaint 1940 North Monroe Street,Tallahassee FL 32399:: Email: Customer Contact Center:: Customer Contact Center: 850.487.1395 The State of Florida is an AA/EEO employer.Convriaht 2oo7-2010 state of Fiorida.Privacy Statement Under Florida law,email addresses are public records.If you do not want your email address released in response to a public-records request,do not send electronic mail to this entity.Instead,contact the office by phone or by traditional mail.If you have any questions,please contact 850.487.1395.'Pursuant to Section 455.275(1),Florida Statutes,effective October 1,2012,licensees licensed under Chapter 455,F.S.must provide the Department with an email address if they have one.The emails provided may be used for official communication with the licensee. However email addresses are public record.If you do not wish to supply a personal address,please provide the Department with an email address which can be made available to the public.Please see our Chanter 455 page to determine if you are affected by this change. https://www.myfloridalicense.com/LicenseDetail.asp?SID=&id=139FBFBC36660101 F82... 10/2/2012 FROM CAPER GROUP OIC FAX NO. 3059385050 Sep. 07 2012 03:38PM P1 ,•;:;., Gin Trades Qualffyin8 Board SUSiNESS C6RTtFICATE 4F COMPETE 98E000232 ::.CAPER ELECTRIC&MAWnS�AIt{CE SNC D.B.A.: PE. `bbf-& 'LO N is ii77 eit3tii;d%unde he 0roviswm:of•Ct .Pter 0 of'Mar�FDade Ccartly. Y 07-15-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFMCER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO SE 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 taw, EFFECTIVE DATE: 07/19/2012 EXPIRATION DATE: 07/19/20141 PERSON: PEREZ GONZALO N FEIN: 650782703 BUSINESS NAME AND ADDRESS: CAPER ELECTRIC & MAINTENANCE INC 10951 SM 83 ST MIAMI FL 33178 SCOPES OF BUSINESS OR TRADE: 1- BURQLAR ALARM INSTALLATION 2- ELECTRICAL WIRING WITHIN St1ILD IMPORTANT: Porsoaaf to Choptel 040 . clidal, f.s, an officer of s comorwoo Who niocra eaemptioA from this chapter by filing o certificate of otectivo uedar ibis section may not rocovar baeoflls of eompaasatioa under this chapter, Porsaaal to r,baptor 448.06(12), r.5„ Certificates of eloclfoo to be oaompi... apply only within we scope of an btisloess of trade fisted an the notice of election to be exempt_ Pursoant to chapter 440,6fAl3l, Vs., Notices of election to be exempt and certificates of elect!** le Ile exempt shell be, subject to revocation If, st nay time after the filing of the notice or the faaganCO of the 131`0004e, the person named on the notice or cordficate no longer meets the requiromocts at this seetloo fat isseshce of a eartilicase, Tao 4eportma t shall revoke a certificate at any time for fatiure of the Verses 00af44 an Ike ceflificate to meet the requirements of this section. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 UUESTIONS7 (960) 413-16 PLEASE CUT OUT THE CARE} BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT • DWaRTf�Nr OF FINANCIAL asRviCas DIVISION OF WORKERS'COMPENSATION Pursuant to Chapter 440,05041, F,S., an officer of a corporation who CONSTRUCTION INDUSTRY O etects exemption from this chwiter by filing a certificate of election CIRATIMCATE OF MACTION To Be EXEMPT f=RoL1 FLORIDA L under this Section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW D chapuncle ef. EFFECTIVE: 07/19/2012 EXPIRATION DATE: 07'/18/2014 pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: GONZALO N PEREZ H extsmpt, apply only witnin the scope of the business of trade listed on FEIN, 830982703 the notice of election to be exempt, BUSINESS NAME AND ADDRESS_ 1095x1 t is E Pursuant to Chapter 440.05!131. F.S., Notices of election to be exempt 3 sr& MAtntf Narrct tilt and certificates of election to be exempt shall be subject to revocation AMIif, At any time after the filing of the notice or the issuance of the MIAMI,, sw 9ss FL 33178 certificate, the person named an the notice ar certificate no longer meets the requirements of this section for issuance of a certificate. The department Shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this t' RUACLAR ALARM I14$TAtkAT1pN 2• 1F.kgCrRICAt WIRiNC, WITION BUILD section, QUESTIONS? 18501 413-1609 CUT HERE +� Carry bottom portion on the job, keep upper portion for your records. DWC-2S2 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 ZO'd Xfir3 Lzf*d3STq dH RdZZ:60 ZT/9T/80 • _­., I' N 1-16.1 CERT1FICk(E OF LIABILITY INSURA% .E DArE(nln IX01TYY) WOW— 0"U2012 THIS CERTIFICATE IS ISSUED AS A W ER OF WORMATION ONLY Mlmui Dimcutrt Ine Inc 62 DDA Cwnonu Insava m Croup AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 10682 SW 24 ST CERTIFICAW DOES NOT AMEND, EXTEND OR ALTER TME MWML FL 33165 COVERAGE?AFFORDS'[!gY THE pOL(CIES MOVV. IN INSURERS AFFORDING COVERAGE NAfC� �� lN6UAERA Uoyd%9 of L rWon CaACr 1S1CCtriC$1V18IAtOR>tr►C8,Inc, 10951$W 93RD ST UN&URER& MLAM1 FL33176 INSURER Q: INOURERD: DQUICR& COVERAGES THE R° QU IES OF INSURANCE USTCON D BELO SEEN SSU13D !NS REO NA(ulEO A80VE FOR THE POLICY PERIOD INDIt3ATED, I V J'fM DtNC ANY R�QWREMBJT,7J<RNl OR CONDITION OF ANY CONTRA T OR OTHF,.R ppCUMENY WITH RESPECTl'O WHICH THIS CERTIFI(?gYE pggY BE 186UEDR MAY O PERTAIN,THE INSURANCE AFFORDED Sy THE pOLICKS DESCRIBED NIEREIN 18 8U13JECT TOALL THE TERMS,EX POLICIES,ACGRI_GATE UMI'M SHOWN MAY HAVE BEEN REOU=BY PAID CL ma. CLUSIONS AND CONbIYIBE I OF MR NSVoK D O LTR ►NSR TTPEOFMURMCE POUCYNUMak pq lg D)WTES ►MI 00"vi Uwe A oUM LMOU Y GYPSCO-' 06/OE/2012 06!01/2013 EACH OCOURENCE 63MOOO tBF 9 cOmwRICAL PAL UABRRY oANwc�To RONTED ❑0 CLAMMWO 0 OCCUR PRf]N S aomauR sz5,000 ❑ MWaw(my an*PWON 8;5.000 PERSONAL&ADV INJURY 5300.000 %WLAGGW"Ta UWAPPI.W6 PER; GENERAL A60PZMTE 5600,000 PoucY❑x 0jew Q LOC PRODUCTS-COMPIOP A(M $300.000 auToMDau.!L+Ab►LIrY s 0 ANY AUTO COMBINW SINGLE L"TT (Each O=ff-) S 13 ALL OVAVBD AUT08 El BODILY INJURY SCNEDliLEOAUTOS NS2ED Auras BODILY INJURY l�NON CVWD AUTOS (Per"016a,m 8 u PROPERTY DAMAGE 5 (Pur uaald."t) SAGE AUTO ONLY.EA ACCIDENT S ©ANY AUTO ❑ OTHER THAIV EA ACC S AUTO ONLY. AGO $ O E%oI; WW AIMLLALIAVILRY EACH OCCURRENCE g ❑OCCUR ©CLAWS MADE AGGREGATE S Q DEDUCTIBLE S ❑ReTENrcaN s s v YYQRiCERB CDAIPE1NeATION AND Q y LfA/IT$ ❑CT SEAPLOYEW WWLITY ANYPROPRIETOR/PARTNE WXECU. >eL.EACH ACCtpSNT TIPS OPffCER/}/L JVABt:R DCOWDED7 5 If M 6auarma ardor E.L 0I49A29-EA'Ei19ALOYEt: g W9OWL PROVISIONS below ILL.DISEASE-POLICY LIMIT g OTHER DE9CrzIPnONOFt7PERAT10N5lLOCA7YONS►t/CNICLBS/e7tCLWttGnEpDDr:DBY +�DOtgsr:M�NT/SPEGIALPROVISK1Ns 131cotric Company CERTFICATE HOLDER OANCELLA770R Miami Shores'Village SHOULD ANY OF Tole AIWVB DESOMMb PWCIEB BE CANCELLED BEFORE THE U4RATION DAT9 TWWWF,TO INSURER AFFORDING CWERAG@ WILL.ONDEAVOR TO 10050 NE 2nd Ave MAILS DAYS INR►a7 EN Uca"M NAftb Ta TNM Lnrr,uttr Miami,FL 33138 FAILURE TO COrSO SHALL IEAPOSE NO OBLKIATION CR LIABILITY OFANY mND UPON THE Fax:(305)756-8972 INGURFA ITSAGIFINT50R MOP AUTFICRB;PA RBPRt9IINT �COE�25(2Jf01/t)S �VACO=DCOR�PO �ONIM� 10 39VJ SNI VNOWHVD IT98699GOE bT:bT Z10Z/Z0/0T FIRST-CLASS 1..S.POSTAGE ll. `i EMIT.. 307013-5 OQ WT PAv Mt,t "F I Arfffftfe"& MAYI�T MANCE YNC CG ,PEC 10951 SW 93 ST 0232�414333�5 FIE yy 33176 UNIN DARE COUNTY OWC�A�''ER ELECTRIC & MAINTENANCE INC Be Clygofffty&ICAL CONTRACTOR WORKER/S THIS IS ONLY A LOCAL 1 BUSINESS TAX RECEIPT.{T i�LDER TO YFOALA a ANIitY EXISTINQgRCULATOAY ON zIrIG OF.oNLaws OTH OR CYTIF NOR DO NOT FORWARD CONING DOER iT EXEN07 TNe N AWT FNOft ANY _tCENBE OYIflR CAPER ELECTRIC $ MAINTENANCE INC in;{{MIT Oft NEt}UTAEDgY ITHIS GONZALO N PEREZ PRES NOT A C�gTIPlCAYICAripN Op OP DIN Ha.PEq,S Ou"CA, TIONe. 10953. SW 93 ST MIAMI PL 33176 I111liyMAM, TTAX _TOR, 07/18/2012 09..01.0040001 000075.0© �,Iflill�f►►1,11I:3,f,ll,fiYf,1J111111►1111111►I,Ilii,1Jl7♦ � TO .d�_ w _ XV3 lZf'd3SV7 dH KdZZ:60 ZT/9T/80 OFFICE COPY 4M If fed �r4om Permit Holder a�A C Permit # F.B.0 Violation Ifl Pi-C (:2F 01' Thi Zee, Address Date� `� PX B� Building Official