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PL-14-2762 �2c- 1 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253415 Permit Number: PL-12-14-2762 Scheduled Inspection Date: February 29,2016 Permit Type: Plumbing- Residential Inspector: Hernandez, Rafael Inspection Type: Final Owner: D'ALACIO, DIOGENES Work Classification: Addition/Alteration Job Address:10816 NW 2 Avenue MIAMI SHORES, FL 33168-4302 Phone Number Parcel Number 1121360020160 Project: <NONE> Contractor: ESTRELLA PLUMBING, INC Phone: (305)333-2217 Building Department Comments GENERAL PLUMBING, KITCHEN AND 1 BATHROOM. nfractio passed Comments NEW TITAN WATER HEATER INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-252491. CREATED AS REINSPECTION FOR INSP-225446. MISSING SHUT OFF WATER HEATER AND TRAP ADAPTER FOR KITCHEN SINK. Failed Correction Needed ❑ Re-inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 26,2016 For Inspections please call: (305)762949 Page 34 of 60 � lei Miami Shores Village T 1� Building Department AUG2 2015 g p I 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 0 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 F BC (2.. O BUILDING Master Permit No. ' ` ' 76S PERMIT APPLICATION Sub Permit No. � )•7 b'2,--- ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS / DRAWINGS JOB ADDRESS: �� /1/(i(/ �i/�[G %� "�T�J L �l'Po City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFFE:: Q FFE: OWNER: Name(Fee Simple Titleholder): �e lou ,eS 1_9o`� Phone#:�" 6 4—_227J` _ Address: / l27)- City: DwA61"D f C��S State: FL, '330:2,6 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: �s ���A T L//M13//�%,� �• Phone#: . -� Address:'//,9 {�I/191 05 416- 2 &(0�T/ City: /{.f!.E'x# State: Zip: -H3019 Qualifier Name: A.LoVD 1- 7-04" Phone#: ,��✓�-•�3 /79� State Certification or Regis(ation#: X F490.37a.37 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ ��o 0 t) Square/Linear_,F_000ttage of Work: Type of Work: ❑ Addition ❑ Alteration F1 New LJ Repair/Replace ❑ Demolition Description of Work: Az Specify color of color thru tile: Submittal Fee$ Permit Fee$ . S CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 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 oved and 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 q day of AQ(S( kn—tet ,20 ( L , by e�1�day of �/✓ 20 �� , by —t)J0G S DC:�,L-C-,.AC ,who is personally known to —who is personally known to me or who has produced �� L as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: 4 Sign: Sign- Print: Print: pW poe Notary Public State of Florida �ua.yq Seal: ?° �: Sindia Alvarez Seal: .. MARIEANUNQ MyCommisslon FF 156750 *s MYCOWASSIONi1`172U6583 Expires 0910312018 Tjo: EXPIRES:May 13,2019 Bonded Tuu Notary PubBc UmWwTMn APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) USPS.com® -USPS Tracking® Page 1 of 2 0 English customer Service USPS Mobile \(i Register 1 sign in uspscom, CustoUSPS Tracking@ Havegmetions?We're Have questions)We're here to help. Get Easy Trading Updates> Sign up for My USPS. Tracking Number:70151730000169785420 Product & Tracking Information Available Actions Postal Product: Features: First-Class Mail® Certified Mail- Return Receipt Text Updates See tracking for related Item: 9590940307325196800365 Email Updates DATE&r09 5tTATUS10,f J1, fMiCATit?N September 29,2015,3:00 Notice Leff(No Authorized MIAMI,FL 33196 Pm Recipient Available) 1Je attempted to deliver your item at 3:00 pm on September 29.2015 in MIAMI,FL 33196 and a notice was lefi because an authorized recipient was no4 available.You may arrange redelivery by visiting 17Yfp:;ranvw usps.comtredeiivery or calling 800-ASK-USPS,or may pick up the itern at the Post Office indicated on the notice.If this item is unclaimed by October 14,2015 then it will be returned to sender. September 27.2015,1:33 am Departed USPS Facility MIAMI,FL 33152 September 26,2015,5:21 pm Arrived at USPS Facility MIAMI,FL 33152 September 25,2015,9:21 Departed Post Office MIAMI,FL 33152 Pm September 25,2015,8:16 Acceptance MIAMI,FL 33152 pm Track Another Package Manage Incoming Packages Tracking(or receipt)number Track all your packages from a dashboard. _._.._._....._........._.._..__...._____.............-...-.....__.___._.....___......._........-__..._...______ ____......_, No tracking numbers necessary. Track It Sign up for My USPS> https://tools.usps.com/go/TrackConfinnAction?tLabels=70151730000169785420 10/1/2015 USPS.com® -USPS Tracking® Page 2 of 2 HELPFUL LINKS ON ABOUT.USPS.COM OTHER USPS SITES LEGAL INFORMATION Contact Us About USPS Home Business Customer Gateway Privacy Policy Site Index Newsroom Postal Inspectors Terms of Use FAQs USPS Service Updates Inspector General FOIA Forms&Publications Postal Explorer No FEAR Act EEO Data Government Services National Postal Museum Careers Resources for Developers Copyright©2015 USPS.All Rights Reserved. Search or Enter a Tracking Number https://tools.usps.com/go/TrackConfinnAction?tLabels=70151730000169785420 10/1/2015 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Al CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 Was 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 TOLAR, FLQYD L JR ESTRELLA PLUMBING INC 7001 WEST 35 AVENUE#116 HIALEAH FL 33018 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 range STATE'OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. i; •'' PROFESSIONALREGULATIOiV Every day we work to improve.the-way we do business in order to RF00,37837 �SUEQ 08!18/2015 serve you better. For information about our services,please log onto = www.myfloridalicense.com. There you can find more information REGISTERED P"`WAB1NG ,"", OR. A. about our divisions and the regulations that impact you,subscribe .i- TOLAR,FLOP to department newsletters and learn more about the Department's initiatives. EST -`LA PL {INDIVIDUAL MUST' Our mission at the Department is License Efficiently, Regulate Fairly. LICENSING REM IRIOR We constantly strive to serve you better so that you can serve your -TO CONTRACTINfG l -•Al ).;'. customers. Thank you for doing business in Florida, HAs REGtsrs_t; r w►der etre pro.vlsions of Ch.488 Fs. and congratulations on your new`license! Ea ue3T,:, LISOSIGM02077 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIt}NAL REGULATION CONSTRUCTION INDUSTRY'LICENSING BQARQ, RF0037837 The PLUMBING CONTRACTOR Named below HAS REG18TERED,_,,,. Ex Beat he provisions AUC f Chapter 489 FS. ' p 31'x'2017 R � (INIJObt UAL MUST'MEET ALL L ICE ISINC REQUIREMENTS PRIOR T �I�i<IVAAREA) TOLAR, FLO)b L JR `` ' � '�1 ❑ ESTRELLA PLBING I 7�I01 WEST-36 VENfK �� q 'H'A1EAH � OfS K e rOR� ISSUED. 08116/2015 DISPLAYAS REQUIRED BY LAW sEa# L1508160002077 ' 8 003734 Local Business Tax Receipt Miami-Dade County, State of Florida THIS IS NOTA BILL DO NOT PAY 6285910• BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ESTRELLA PLUMBING INC RENEWAL SEPTEMBER 30, 2016 7001 W 35 AVE 116 655.1619 HIALEAH FL 33018 Must be displayed at place of business Pursuant to County Code ` Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS ESTRELLA PLUMBING INC 196 PLUMBING CONTRACTOR PAYMENT RECEIVED Worker(s) 1 08P000423 ' BY TAX COLLECTOR $45.00 07/30/2015 CREDITCARD-15-039104 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit or a certification of the holder'sqqualificadoas,to do business. Holder meet comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami-Dade Cods Sec ga_276. For more information,visit www miamidade oov Ycaliec*or Municipal Cantracto(s Tax Receipt Miami—Dade County,_State of Florida P —THIS IS NOT A BILL—DO NOT PAY CC NO: 08P000423 BUSNVESS NAMEJLOCATION ESTRELiA PLUMBING INC RECEIPT NO. EXPIRES HIAL wr 35 AVE 116 SEPTEMBER 30, 2016 HIALEA1i,FL 3301$ 7470302 Pursuant to County Code Sec10-24 OWNER TYPE OF 13USINESS ESTRELLA PLUMBING INC PLUMBING CONTRACTOR PAYMENT RECEIVED BY TAX COLLECTOR 200.00 08/11/2015 0235-15-005727 This receipt is not valid in the following Municipalities:Avemtora,Doral Hialeah Key Biscayne, Miami Gardens,Miami Lakes,Palmetto gay,PiuecreA Sunny Isles Beach,Town of Cutler gay. MIAMI- ADE . For more inionnation,visit m ww.miaR dodo Rcv/tex�iie fur A� CERTIFICATE OF LIABILITYDATEIMMIOW"" INSURANCE 091300,5 THIS CERTIFATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIt3HTS 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 a an ADDITIONAL INSURED,the PORCypes)must be endorsed. N SUBROGATION IS WAIVED,subject to the certificate and coder In 1 of the policy, certain Policies may require an endorsement A statement on this certificate does not confer rights to the cert3Ncate holder In ileo of such endorsement(s� PRODUCER Tadao Insurance Agency,Inc, �Anaeliz C.Tolibia 8201 SW 24th Street 4pi1 261 L I Not: Miami,FL 33155 INSUs11F—FORDING COVERAGE Nair a 0=Rw — __.._ INSURER A: GRANADA INSURANCE Estrella Plumbing,Iris INsuR-B: PROGRESSIVE 7001 W 35th Ave,#116 RSURER C:AMTRU3T NORTH AMERICA Hialeah,FL 33018 INSURER D: INSURER E: --- _ COVERAGES INSUFt�F CERTIFICATE NUMBER: REVISIOL 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 SY PAID CLAIMS. IL 8R TYPE OF INSURANCE GENERAL LLAMM POUCYNUMM POLICY LIMITS X COMMERCIAL EACH OCCURRENCE $1 �. GENERAL LIABILITY I CLAIMS-MADE '"J OCCUR PREMISES tEa oxuttartce $ 100 0 00 AMEDEXP"cr>e Pecan)__.`$ 5,000.0(1 0185FLOOD029414 09/1512015'09115/2018 PERSONAL g AM INJURY $ 1 000 000.00 — - GENERAL AGGREGATE - $2400,000.00- GENIAGGREGATE LIMIT APPLIES PER: _ POLICY PRO LOC PRODUCTS-COMPIOP AGG $ 1 ( _- AUUTOMOsILE LIASILMANYAUTO 8 ALL j SCHEDULED I t SMILY INJURY(P P ) $ 10,000.00 OS I1IREDAUTD3 I.oN�wr eED 08195085-3 08M2/2015 08/12/2016 BODILY INJURY(Per ac**0) $ 20 000.00 AIIT� n E Per $ 10,000.00 UMBRELLA LKS OCCUR r $ EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE ! $ D RETENTION$ AGGREGATE -- WORKERS COMIPENSATION $ AND EMpLt1Y1}>It3 LUIBILtTY i..6AA3lL$L_ OTH_ G ANY PROPRIETOMPARTNERJFXECtmVE YIN _ „..._ OFFICEAeHiEBER EXCLUbk 07 N f A TWG351005309/29/2015 09/29f2016 E.L EACH ACCIDENT $1000 000• _.... RdantlaSary in MH) t ._.L_ _._.. describe under EL I}IS -EA EMPLOY $ 1000 ODO.00 DESCRIEDON OF OPERATIONS E.L.DISEASE-POLK Y LIMIT $ 1,000,000.40 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMICLEgl (Attach ACORD 101 AddiRaeaal Renmrke Bolamlule S mare epee8III regtdred) PLUMBING CONTFtAGOTpRS CERTIFICATE HOLDER CANCELLATION Miami Shores Village SHOULD ANY OF THE ABW DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Avenue THE EXPIRATION DATI1 IMEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH mr LICY PROVISIONS. Miami Shores,FL 33138 AUTtIORi"REPRESENTA Arraeiiz G.TDlibia ACORD 25(2010/06) 0 1088-2A110 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered mar' ORD erinit n O. PL-' x44-27612 ,. Rs Miami Shores Village hype.P[u1Tt71 Ia"r�tt+ifirltlll � non 10050 N.E.2nd Avenue NW Work Cl0sifrcadoa�t:Addi-te AI't� tion Miami Shores,FL 33138-0000 Per ermlt "a".A10 ROVED Phone: (305)795-2204 �40RIDA - - -� .. .:.. , 2712t?t5 Expiration: 09/23/2015 Project Address Parcel Number Applicant 10816 NW 2 Avenue 1121360020160 DIOGENES D'ALACIO MIAMI SHORES, FL 33168-4302 Block: Lot: Owner Information Address Phone Cell DIOGENES D'ALACIO 10816 NW 2 Avenue MIAMI SHORES FL 33150- 10816 NW 2 Avenue MIAMI SHORES FL 33150- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 AA MASTERS MECHANICAL AIR MOV (305)559-7004 _..... _....... __ Total Sq Feet: 0 Type of Work:GENERAL PLUMBING,KITCHEN AND 1 BAT Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-12-14-53951 DBPR Fee $3.38 12/17/2014 Credit Card $50.00 $418.96 DCA Fee $3.38 Education Surcharge $0.40 03/27/2015 Check#:5777 $418.96 $0.00 Permit Fee $225.00 Scanning Fee $9.00 Technology Fee $1.60 Work without Permit Fee $225.00 Total: $468.96 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 ELECT AL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AF DA I ce that the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction n zQQ!ng. Futhe mor authorize the above-named contractor to do the work stated. March 27, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy March 27,2015 1 t � Miami Shores Village _= Building Department FIR a 20 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 j Tel:(305)795-2204 Fax:(305)756-8972 -- - -- INSPECTION LINE PHONE NUMBER:(305)762-4949 F�BC 201 O Ac:'BUILDING Master Permit No. c:'I LA '�7(0 S PERMIT APPLICATION Sub Permit No.q--LA LA Z1 Co 2 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: VV 2 City: Miami Shores County: Miami Dade Zp° ,3Ji G Folio/Parcel#: P 7, 3(a 00-2- 01�V Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 'err e 5 Wt Ci U Phone#Q t) -7 Z 7 5 Addre W- �-�p2 � ta City: ('1 '0�' �� 1 ) State: ��L Zip: -3/3 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: VV-c---16SdeK4,,i(A Phone#: --CAe(r Address: 0 L4 Vf1W • �2z'S City: W1 Sta Zip: Qualifier Name: t V Phone#: State Certification or Registration#: 14Q ertificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ iterati n New Repair/Replace ❑ Demolition Description of Work: �+�Q O OAJ?"I o& 14&Ly fA&o IVE4 Specify color of color thru tile: Submittal Fee$ ,� Permit Fee$ L2� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 14 FP a ITG (Revised02/24/2014) 1 1 ^ � r 'r tr� 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 appy ved and a reinspection fee will be charged. Al� Signature Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this efgoing instrumentwas acknowledged before a this day of�C,ra� .20 O�f 'byy of 20 ( by l0°- fir? who is personally known to who is per known to me or who has produced L=- as me or who has prod ,,NA #FF1666 identification and who did take an oath. identificati n: i9i' ag@iY15 €I�' er 7 Zp1a NOTARY PUBLIC: NOTARY P B114C, • EXP ES Oct s rule®. o IR aam ° `g• FletldeN6t® Sign: Sign: Print: Print: 1-01L)Lkz ♦d v ave Seal: 2° ` MY COMMISSION#EE100114 Seal: yip$3' : EXPIRES:JUN 05,2015 c.9 ?? Banded through 1st State Insurance APPROVED BY �'�� Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 we 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GUERRA, FELIX DE JESUS AA MASTERS MECHANICAL AIR MOVING & ENGINEERING SYSTEMS CORP 15591 SW 105 TERRACE APT 525 MIAMI FL 33196 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 range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. . . PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CFC1426169 ISSUED: .0910212014 serve you better. For information about our services,please log onto , www.myfloridalicense.com. There you can find more Information CERTIFIED PLUMBING CONTRACTOR about our divisions and the regulations that impact you, subscribe GUERRA,FELD DE JESUS to department newsletters and learn more about the Department's AA MASTERS MECHANICAL AIR MOVING& 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. 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 1-1409020001536 DETACH HERE KEN LAWSON,SECRETARY RICK SCOTT, GOVERNOR STATE OF'FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD r Cf C1426169 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 0� .0 GUERRA, FELIX DE JESUS ' AA MASTERS MECHANICAL AIR MOVING& ENGINEERING SYSTEMS CORP 15591 SW 105 TERRACE APT 525 MIAMI FL 33196 tcci ism. 'nam?nn14 DISPLAY AS REQUIRED BY LAW SEQ# L140902000153m 10#"14 2Ol4M8o82ssalpg nie t ,` rx- C 5,.� ad b r t 6 des{A i f ��` g `�ss1+ k �. t S91A � ! �'�'' #4 f�'S d✓INY { tl � � T k } �y l � 3 � ry to � u��,� � � ��.'�'� 5A- fY,Y� �Y }' I •,Ar C d.� 7 ,•{ rr h ��' aL.r� � � �nx{t w rW,%r'� t r { r U4#N +Wh C F N, a sl,x x.+ M"'s1.M40'f £p Y k ,:J• p l 1 1U P t 41 Jye yry'S�, ♦..JRaq'r5h ��Iy�,yyq 5 .� '}ML •P ane, a 1 r �q TTSM CIO IM., r {�� '�st# S t it x f j�: ✓'e t aL4' 1 t. a a � AA*A r.; % a ? 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'. j�S � � �'! , `f a*�fo�f�"S�^ •wrlb � �„ 3 t a ar �' v �-� ,� r s d M r� °' „'f r a,y� k f v z'�3,rtJ,�. .�,+xve..E`j�t i � x5 �'o-w r Ct• '�' ^'F httpsditnail.gaoglacorrdmail/uoMnb)WI48f5273e38c8824?prajeeor=1 111 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE IMPORTANT STATE OF FLORIDA Pursuant to Chapter 440 05(14),F S.an officer of a corporation DEPARTMENT OF FINANCIAL SERVICES who elects exemption from this chapter by filing a certificate of DIVISION OF WORKERS'COMPENSATION F election under this section may not recover benefits or compensation under this chapter CONSTRUCTION INDUSTRY EXEMPTION 0 CERTIFICATE Of WCTION TO BE EXEMPT FROM FLORIDA L Pursuant to Chapter 440,05(12),F S,Canificates of election to WORKERS'COMPENSATION LAW D be exempt appty only within the scope of the business or trade EFFECTIVE DATE: 3110016 EXPIRATION DATE, 3+W2017 listed on the notice of election to be exempt PERSON: GUERRA FELIX DE JESUS H Pursuant to Chapter 440 OSI t 3) F S Notices of election to be FEIN: 732111173211 E exempt and Certificates of election to be exempt shall be suo)ect BUSINESS NAME AND ADDRESS: R to revocation if.at any time after the filing of the notice or the AA MASTERS MECHANICAL AIR MOVING 6 ENGINEERING SYSTEMS CORP Eissuance of the certificate,the person named on the notice or certificate no longer meats the requirements of this section for Issuance of a certificate.The department shall revoke a Certificate 161391 SW 106TH TERRACE APT 525 at any time for failure of the person named on the certificate to MIAMI FL 331913 meet the requireement$of this section SCOPES OF BUSINESS OR TRA CERTIFIED AC LICENSED PLUMBING CONTRACTOR CONTRACTOR OFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08.13 QUESTIONS?(850)413.1609 ♦5�``i°'�s Gr ,,,, Miami V Village Building Department LpRIpA 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 and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELO YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,20 � Bye QeA4-f Dcz las-P _ who is personally known to me or has produced 0� artF as identification. taotasv�C�Feliciano�?s, Notary: - m wRYka�a MY Co s p111 a?.0�0112 SEAL: r7k , MOWS �TM AA MASTERS MECHANICAL & tVlg3,r -0= 440444D - ,�a HVAC TESTING CORP. 10362 SW 212 ST MIAMI FL 33189. 786-413-7647 CFC 142 62629 CAC 057226 TESTING AND BALANCING PE.28531 AIR AND WATER # 02-919-01 NBI PAGES I OF 1 CERTIFICATION LETTER 03/16/2014 STATE OF FLORIDA. COUNTY OF: MIAMI DADE. BEFORE ME THIS DAY PERSONALLY APPEARED ,FELIX DE J GUERRA WHO BEING DULY SWORN,DEPOSES AND THAT HE WILL BE THE ONLY PERSON WORKING ON THE PROJECTD LOCATED AT. 10816 NW 2 AV MIAMI SHORES VILLAGE. SWORN TO OR AFFIRMED AND SUBSCRIBE BEFORE ME THIS 03 DAY OF -16- 2015. PERSONALLYNOW ---------- D TYPE-----------�--------- r z- ANAIDA FERNANDEZ *: Commission#FF 170677 ExpiresFebruary 21,2019 80"Thu Try Fin Umm"809396.7019 1