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PL-12-1848 + R'(_ 02 ® S Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239574 Permit Number: PL-10-12-1848 Scheduled Inspection Date:August 25,2015 Permit Type: Plumbing - Residential Inspector. Diaz,Osvaldo Inspection Type: Final Owner: CENOZ,EFREN Work Classification: Addition/Alteration Job Address:51 NW 110 Street Miami Shores, FL 331684318 Phone Number 3051751-5274 Project: <NONE> Parcel Number 1121360030600 Contractor: BEST PLUMBING SERVICES COMPANY Phone: (305)558-8544 Building Department Comments MASTER BATH REMODEL. CHANGE TUB TO SHOWER Infractio Passed Comments AND SWITCH LOCATION OF WC AND SINK INSPECTOR COMMENTS False nspector Comments Passed CREATED AS REINSPECTION FOR INSP-179456. SECURE D/W AND RELIEF LINE PROVIDE ESCUTCHEONS FINISH TILE IN BATH Failed Correction ❑ � �y� Needed �+ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 24,2016 For Inspections please call: (305)762-4949 Page 11 of 33 Miami Shores Village 71C Building DepartmentT 07 2014 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 i Tel:(305)795-2204 Fax:(305)756-8972 py: INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 BUILDING Master Permit No. Ac— — 1671kl, PERMIT APPLICATION Sub Permit No.,/9/ /02— /9yg ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP G CONTRACTOR DRAWINGS JOB ADDRESS: 5l . I& Z�2 .ST City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: /2 136 CC 3L-,*%/o0 Is the Building Historically Designated:Yes Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: c� OWNER: Name(Fee Simple Titleholder): LADY? Phone#: Zl" L Address: SOs5 / ,/,u 27'A ,508 City: 1-YIA/`Yo State: 0�� Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: ,J Z/J�J / Phone#:(�o�� Address: o-5-/ 4'2iST 7 ys City: State: Zip: Qualifier Name: USC. ePhone#: State Certification or Registration#: 5 Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �, � Square/Linear Footage of Work: d Type of Work: ❑ Addition Alteration ❑ New ❑ Rep/air/Replace ❑ Demolition Description of Work: /J�yyrr��jj y� ,�� /�, rAe N Moi3�f/ Oa& Specify color of color thru tile: r Submittal Fee$ Z Permit Fee$ ` 'I CCF$ CO/CC$ Scanning Fee$ Radon Fee$ - 2-� DBPR$ 2_ °2n Notary$ Technology Fee$ L4® Training/Education Fee$ � Double Fee$ Structural Reviews$ Bond$ 0 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 inspect n which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not a pproved and a reins ection fee will be charged. Signature Signature /11 OWNER or AGENT CONTRACTOR The forego 71strument was acknowledged before me this The foregoing instrument was acknowledged before me this day of L4-0- 20 I , by day ofQin 20 1q- , by d who is personally known to iDSG®� I 9L4 uP.Z ,who is personally known to me or who has produced L DL as me or who has produced D L— as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: 14UAar Print: Print: m CHERYLLANDRADE iAt = CHERYLLANDRADE Seak _ :: MY COMMISSION#EE 843924 Seal: -*: r MY�I A EE 843924 by EXPIRES:October 15,2018 EXPIRES:October 15,2018 • a`` Bonded Tbru Notary Public Underwdlers �ltP,.t4`�'• Bonded Thru Nay Pubec Undetivraete APPROVED BY %T Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) Miami Shores Village BuildingDepartment a , , p 0—CT 442012 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 B�'_^_ o INSPECTION'S PHONE NUMBER: (305)762.4949 -�... FBC 20L C�) BUILDING Permit No. PERMIT APPLICATION Master Permit No. T_ c)1 Permit Type: PLUMBING JOB ADDRESS: 51 ti• w 149 J/ City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder): � �rer.o rr.tibS Phone#: Address: SAMe Akul& City: State: Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: /S �/�°/'2�i a�c� S r��`c s Phone#: Address: 2S1 /-/rti S� City: 1i Gi A State: /"'L zip: 3301 3 Qualifier Name: Phone#: State Certification or Registration#:. 7 3 Certificate of Competency#: Contact Phone#: �g � ���. Email Addres �s D GSI laT .ArcHte VEn. }neer [.r' aya:2'ii .F' IT15�r dRe ,`��nyf:. � ��. „� � if'r,ftt�• +,' w: V ue,ofWork, r,this,Permit $���� T fr`kAddress ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: 6AC41v!/iC a�Z� fU/3 4NAO G s Submittal Fee$ - Permit Fee$ /�® � CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ Training/Education Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ 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. 1 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 inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will-.9t be approved and a reinspection fee will be charged. Signator Signature wner or Agent Contractor The foregoing instrument was acknowledged before me this e9X The foregoing instrument was acknowledged before me this ®11 day of ®��g ',20 / by 4Frea� ��?r. s day of/✓. � ,20 +;1 by ,�/,,J y-,Aad Z who is personally known t r duced who is personally known to me or who has produced �uwura lL 121. As ` a=d finvo�Aath. /';;e�'i r�t ti�a i ERTHA C pgTEGA °= Public-State of Florida '••• ' my Comm.Ex NOTARY P °z Notes pubik-State of Florida NOTARY PUBLIC: �y, r Expires Sep 27,2018 '=My Comm,Expires Sep 27,2018 �''a'�;alc •�� �.�,,st.�n 8 EE 205198 ''-;gam � Commission#EE 205198 '�'�Wr, f�taTyiAnn. 'rrenri� ended Throtplh if.,-_Notary Assn. Sign: II Sign._ rr //�� Print: P1r a 01- Oy e.Q 4 Print: r�Aa 6. Op kg e1 P My Commission Expires: 5r-e a�i oZ b to My Commission Expires:Sep 41_h,010 160 APPROVED BY Ef Plans Examiner Zoning Structural Review Clerk (Revised3/12/2012)(Revised 07/10/07X Revised 06/10/2009)(Revised 3/15/09) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDnYYY) 04/10/12 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 Ileu of such endorsement(s). PRODUCER CONTACT NAME: Angela's Insurance Agency PHONE I. (305)685-2324 _ ac No): (305)688-6889 585 E.49th St.#20 -MAIL ang26pow@aol.com _ Hialeah,FL 33013 INSURERS)AFFORDING COVERAGE NAIC# Phone (305)685-2324 Fax (305)688-6889 INSURERq:__._._ INSURED INSURER B: GRANADA INS COMP Best Plumbing Services INSURER C: 251 East 44 St INSURER D Hialeah,FL 33013- — 305 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY YIYYrr I MIDD CY EXP LIMITS LTR IYYYY),,,,--- -- -- GENERAL LIABILITY I EACH OCCURRENCE $ 1,00_0,000.00 0 NTED COMMERCIAL GENERAL LIABILITY DAMAGE TO a ocew 1,000,000.00 _PREMISES(Ea occunence� $ ❑ ❑ CLAIMS-MADE ❑ OCCUR GA-4201 NGL 12/07!2011 12/07/2012 MED EXP(Any one person) $ 5,000.00 ❑ PERSONAL 8 ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ CSI POLICY_F-1 Ja ❑ LOC _ $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY -- (Ea accident)____ ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident $ B ❑ AUTOS ❑ AUTOS ❑ HIRED AUTOS ❑ AUTOSWNED PP 08�gdT�DAMAGE $ —� ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ _ $ WORKERS COMPENSATION t— WC STATU- ��OTH. AND EMPLOYERS'LIABILITY YIN J ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA — (Mandatory in NH) U 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,K more space Is required) — I i 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 2nd Avenue Miami Shores, Florida 33138 -.__— - AUTHORIZED REQ ENTATNE ©1988-2010 ACORD CORPORA N. All rights reserved. ACORD 25(2010105)QF The ORD name and logo ard te&thred marks of ACORD 1 07-11-2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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: 08/30/2012 EXPIRATION DATE: 08/30/2014 PERSON: RODRIGUEZ JOSEPH FEIN: 650811170 BUSINESS NAME AND ADDRESS: BEST PLUMBING SERVICES COMPANY 251 EAST 44TH STREET HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: 1- PLUMBING NOC AND DRIVERS IMPORTANT: Pursuant to Chapter 440 . 05114), 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 440.05113), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW --� , D chapter. EFFECTIVE: 08/30/2012 EXPIRATION DATE: 08/30/2014 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON: JOSEPH RODRIGUEZ H exempt... apply only within the scope of the business or trade listed on FEIN: 650811170 E the notice of election to be exempt R BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt BEST PLUMBING SERVICES COMPANY and certificates of election to be exempt shall be subject to revocation 251 EAST 44TH STREET if, at any time after the filing of the notice or the issuance of the HIALEAH, FL 33013 certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this I- PLUMBING NOC AND DRIVERS Section. QUESTIONS? (850) 413-1609 CUT HERE +� Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 RX-2-480-67-299-0 91 E �a ,��ita� `�afir�aaoexxnxisrauarrod Du4�,. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1.395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 RODRIGUEZ, JOSEPH BEST PLUMBING SERVICES COMPANY 251 E 44TH ST HIALEAH FL 33013 ..._........ _ Con ratulationsl With this license you become one of the near) one million STATE T E ToA ACI 6184511,12 g Y Y DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque restaurants,and they keep Florida's economy strong, cFc1426732 07J04/12 128002001 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.myfloridalicense.com. CERTIFIED PL'U14BING CONTRACTOR There you can find more information about our divisions and the regulations that RODRIGUEZ, JOSEPH impact you,subscribe to department newsletters and learn more about the BEST PLUMBING SERVICES COMPANY Department's initiatives. Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. IS CERTIFIED under the provisions of ch.489 FS Thank you for doing business in Florida,and congratulations on your new license! Expiration datee AVG 31, 2014 L12070400326 DETACH HERE 6184542 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING HOARD SEQ#L12070400326 LICENSE NBR 107/04/20121128002001 ICFC1426732 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 VS'. Expiration date: AUG 31, 2014 RODRIGUEZ, JOSEPH BEST PLUMBING SERVICES COMPANY 251 E 44TH ST HIALEAH FL 33013 RICK SCOTT REN LAWSON GOVERNOR SECRETARY DISPLAY AS REQUIRED B1'LAW F IATACOUNTYOP �.#,PIIS T Pt4i3 FIR^�T-CLASS TAX COLLECTOR � � � 'OF,FLO `; U.S.POSTAGE ? D t .I"LA ST PAID �a Fl R LA A PLACE OlISIN MIAMI,FL 8� 3 pu aU t[+!1`' 1UIdTY II13 CH�1l�� Tr 9d� PERMIT NO.231 THIS IS NOT A BILL-IAC NOT PAY 392005-6 RENEWAL BUSINESS NAME t LOCATION RECEIPT NO. 409294-6 BEST PLUMBING SERVICES CO STATE# CFC1426732 251 E 44 ST 33013 HIALEAH OWNER BEST PLUMBING SERVICES CO Sec.Type of Businme WORKER/S 196 PLUMBING CONTRACTOR 3 THIS I$ ONLY A LOCAL BUSINESS TAX RECEIPT.IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE DO NOT FORWARD COUNTY OR CITIES. NOR DOE$ IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY ACEFCAIONOBEST PLUMBING SERVICES CO TI HOLDER'S c3ALIFICA' TIONS. JOSEPH RODRIGUEZ PRES 251 E 44 ST PAYMENT RECEIVED HIALEAH FL 33013 @ UMt-DARE COUNTY TAX COLLECTOR: 07/17/2012 09010066001 000045.00 �i 36�i84(�3��4 t3I i!lliB��E&38�(BI89}8}pj�Sl YlFH43f8 P4&7# 'def Pf SEE OTHER SIDE OATS(MM(DD(YYYY) � CERTIFICATE OF LIABILITY INSURANCEF 09/23/2014 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 andorsement A Statement on this certificate does not confer rights to the certificate holder In Ilou of such endorsement(s). PRODUCER CONE CT MARIA A RAMOS Proper Insurance Agency PHONE FAX 471 E 49Th St 1S&Ne.E,,1.305-681-1645 NO:306-688-9362 E'�"�" ro-erins mail cam Hialeah FL 33015 15DpI:Es�_P__P..__09_.... INSUR S AFFORUM UOVERA4E NAIC OF tNSUIMA:ACCIDENT INSURANCE COMPANY INSURED BEST PLUMBING SERVICES CORP INSLIRER B I 251 EAST 44TH STREET INSURER C: —..... HIALEAH Fl-33013 NSURERD: I rINSV RBR 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, !NSR AODL S �— - KWCY EFF POLICY EXP LTR TYPE OF INSURANGt � POLICY NUMBER tdlOn!`lYYY Moemn UMrr3 COMMERCIAL GENERAL LIAE1IUTY EACH OCCURRENCE $1,000,000 CLAIMS-MAOE M OCCUR PREMISES,(EdaC�r�tee)_ S 10Q,t)� A cPP 0011073 00 12/0712013 12/0712014 MED RT An 5,000 _ PERSONAL&ADV INJURY $1.000,000 GEN'L AGGREGATE 41MIT APPLIES PER; GENERAL AGGREGATE $2,000,000 POLICY ElJECT 0 Loc PRODUCTS-COMP(OP Am $2,000,000 OTHER $ AUTOMOBILE LfAetl.JYYLi CaN�SINGLE U 1 S ANY AUTO BODILY INJURY(Pet pemri) $ ALL T©SHED a'T0EDULED BODILY INJURY(Per awident) $ HiREDAUTOS AAUUTOS 6D PROPERTY DAMAGE UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCIiSSLIAB_— ,{,wMS-MADE AGGREGATE 5 DED RETENTIONS 5 WORKERS COMPENSATION PER OTH. AND EMPLOYERS'LIABILITY YIN .STATUTE_ ER ANY PROPRIETORIPARTNRR/EXECUTIVE © NIA E,L.EACH ACCDENT S OFFlCERIMEMBER IXCLUDED7 (MyandataryIn NH) E.L.DISEASE-EA EMPLOYE $ _ �ORpN OF OPERATIONS bnkw E.L.DISEASE-POLICY LIMIT $ 010 DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(ACORD 101,Adaltiobaf Remarks SehedU[e,may be ettaehod If mom space Is required) RESIDENTIAL COMM PLUMBER CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE UESCRIDED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATF: THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS, MIAMI SHORES,FL 33138 AUTHORIZEDREPRESENTATME ©1988-2014 ACORD CORPOIkATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Produced using Forms BaSG WEA SanYYere.tNMN.FOrrh880aa.eemt T Impressive Publlahlnp 80&208-1077 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: 8/30/2014 EXPIRATION DATE: 8/29/2016 PERSON: RODRIGUEZ JOSEPH FEIN: 650811170 BUSINESS NAME AND ADDRESS: BEST PLUMBING SERVICES C 251 EAST 44TH STREET HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),F.S..an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a 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 ' mi shores ills e IYlla Building Department 1pR�► 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: I. 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 anyperson 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. ner Contractor Print Name: V c� Print Name: Signature: Signature: - State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Swornto d scribed before me this �� — Sworn to d bsc . ed before me this day of ,20J1_. day of 20 1`} . By By (SEAL) (SEAL) Type of Id T e of Identification OiERYLLANDRADE CHERYLIANDRADE •: ::__ MY COMMISSION A EE 843924 ,, EXPIRES:October 15,2016 EXPIRES:October 15,2016 ' �' Banded 7hru Notary Public UndemNiters ;; ' Bonded That Notary Public UWwwriters I RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE_OF^FLORIDA�., � .. �Pt4RTM�NT OF BUSIIVES ND-P�R F S IONAL R GULATIQN CQNSTRUCTIQ ! IpUBTRX ME] NG BOARD Nam 4267 32 r T LUIiBING C }NTRACTCR Name below I;S CERT[1=1ED ixcr provss ca#�i�apr 489�FS. U plia bn ato:.`AU -3'f; 209 n d I NMI ■ Q y l lj R4DRIGUEt8Z, JOSEPH, 6{E$T P: U8I• V El i Y' - Owl PAS{Y 4 s e ' 251 E 44TH S`C . ]SIR c � 18�'Y '� � ��f '�`� 1 _ ■ HIAL�AN la e f ISSUED'. 07/15/2014 DISPLAY AS REQUIRED BYLAW SEQ# L1407150000913 007658 tat arm F f < fi 77 a ..: dtWNE4 rF SEC BUSINESS M BEST ING SERVICES RAC 3 96 PLL9 G CO TE Pavnae ecetvt�� �f 6 t3�TAX ECtt t� �' y $x#5.00 oil 9EDlTC�p-14-�59C ir.K Tb usi apt o #iulfirtns pattt#eM e of th t*ai Business Tax.The Ris not a P +Gtt certifi the hoif Uahhceti ,to do business. Notderau � anq goeda " ofne�rentai #atory taws `rgequirems whicbptV to the buses. � cetPthovehe PiaTed � i➢arvehi r�aseuaa= s x 4 F4t`�lpteiia�mation,v �' �