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RC-14-2814 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253696 Permit Number: RC-12-14-2814 Scheduled Inspection Date: March 01,2016 Permit Type: Residential Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: , Work Classification: Alteration Job Address:435 NW 111 Street Miami Shores, FL 33168-3305 Phone Number (305)790-5467 Parcel Number 1121360010790 Project: <NONE> Contractor. ALL CONSTRUCTION&DEVELOPERS INC Phone: (786)768-4330 Building Department Comments INTERIOR RENOVATION Infractio Passed Comments INSPECTOR COMMENTS False 02/12/2016-MUST SCHEDULE AND PASS ALL BUILDING INSP BEFORE FINAL Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 29,2016 For Inspections please call: (305)762-4949 Page 17 of 22 '`"'-. 7✓ 7 �y This carlificate L compliance w&j Permit Type ........... Owner SubdIvIsionKti! Construction Square IF oota; DescrIption of 4 Lei J11:4 go • Work Locdon ItH �y et f5 435 NW 111 Miami Shore 1, 11911,IZU WJ10i '77 r 'k A ;7 INSPECTION RECORD POST ON SITE Permit NO. RC-12-14-2814 yNORE S L << Miami Shores Village -Permit Type Residential Cnstruction 0 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 ''0% {fir/(G/aSSt/tC2ttOR:Alteration - � Phone: (305)795-2204 Fax: (305)756-8972 �iORI"va Issue Date: 5/22/2015 Expires: 06,1 1!2016 INSPECTION REQUESTS: (305)762-4949 or Log on at https:/Ibldg.miamishoresvillage.com/cap REQUESTS ARE ACCEPTED DURING 8:30AM-3:30PM FOR THE FOLLOWING BUSINESS DAY. Requests must be received by 3 pm for following day inspections. Residential Construction Parcel #:1121360010790 Owner's Name; Owner's Phone: (305)790-5467 Job Address: 43.5 NW 111 Street Total Square Feet: 1538 Miami Shores FL 33168-3305 Total..lob Valuation: $ 17,000.00 Bond Number: WORK IS ALLOWED MONDAY THROUGH SATURDAY, 7:30AM-6:OOPM.NO WORK IS ALLOWED ON Contractor(s) Phone Primary Contractor SUNDAY OR HOLIDAYS. ALL CONSTRUCTION & DEVELOPE (786)768-4330 Yes BUILDING INSPECTIONS ARE DONE MONDAY 1 77 THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING INSPECTIONS DONE ON FRIDAY. asp. NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED_ PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANT'S RESPONSIBILITY TO ENSURE THAT WOR'IS ACCESSIBLE AND EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS", TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDS AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YO INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN` ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD STRUCTURAL INSPECTION _ DATE INSP INSPECTION DATE INSPINSPECTION DATE INSP Foundation Zoning Final Stemwall ZONING COMMENTS Rough Slab Water Service Columns 1st Lift 2"d Rough Columns 2nd Lift Top Out Tie Beam Fire Sprinkler-, Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors ELECTRICAL Gas Interior FramingINSPECTION DATE INSP LP Tank Insulation Temporary,Pole Well Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall -2- 1" /L Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Preventor Pool Steel Under round Interceptor Pool Deck Footer Ground Catch Basins Final Pool lab Condensate Drains Final Fence Wall Rough HRS Final Screen Enclosure Ceiling Roy---, Driveway Rough , ' PLUMBI COMMENTS Driveway Base Tele ie Rou h Tin Cap Telephone Final 4* L.r Roof in Progress TV Rough A 4d y Mop in Progress TV Final 3 Final Roof Cable Rough Shutters Attachment Cable Final Final Shutters Intercom Rough Rails and Guardrails Intercom Final MECHANICAL ADA compliance Alarm Rough INSPECTION DATE INSP Alarm Final Underground Pipe DOCUMENTS Fire Alarm Rough Soil Bearing Cert Fire Alarm Final Rough Soil Treatment Cert IService Work With Floor Elevation Survey Ventilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey c / Final Hood Final Survey Final Ventilation Truss Certification lFinal Pool Heater STRUCTURAL COMMENTS IFinal Vacuum MECHANICAL COMMENTS INSPECTION DATE INSP Final S rinkler Final Alarm Miami Shores Village t 10050 N.E.2nd Avenue NW uA Miami Shores,FL 33138-0000 Phone: (305)795-2204 t „ " v3 Expiration: 11/1812015 Project Address Parcel Number Applicant 435 NW 111 Street 1121360010790 CAPITAL INVESTMENTS LLC Miami Shores, FL 33168-3305 Block: Lot: Owner Information Address Phone Cell CAPITAL INVESTMENTS LLC P.O.BOX 2382 FAIRFAX VA 22031- P.O.BOX 2382 FAIRFAX VA 22031- Contractor(s) Phone Cell Phone Valuation: $ 17,000.00 ATLANTIC ENGINEERING SERVICES 1 (561)358-4140 Total Sq Feet: 1538 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Window and Door Buck Date Denied: Fill Cells Columns Type of Construction:INTERIOR RENOVATION Occupancy: Final PE Certification Stories: Exterior: Window Door Attachment Front Setback: Rear Setback: Framing Left Setback: Right Setback: Insulation Bedrooms: Bathrooms: Drywall Screw Plans Submitted: Certificate Status: Review Structural Certificate Date: Additional Info: Review Mechanical Review Mechanical Bond Retum: Classification:Residential Review Mechanical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical Review Electrical CCF $10.20 Invoice# RC-12-14-54035 C Fee $50.00 Review Electrical CO/CC O/CFee $7 65 12/30/2014 Credit Card $50.00 $561.50 Review Planning DBPRDCA Fee $7.65 05/22/2015 Check#:3222 $561.50 $0.00 Review Planning Education Surcharge $3.40 Review Building Permit Fee $510.00 Review Building Scanning Fee $9.00 Review Building Technology Fee $13.60 Review Plumbing Total: $611.50 Review Plumbing Review Plumbing In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I car fflythat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoni re,I authorize th d contractor to do the work stated. May 22, 2015 nature:Owner / Applicant / ntractor / Agent Date Building Department Copy May 22,2015 1 Miami Shores Village ' - L ` BuildingDepartment d 9 z 15 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`2,01,0 BUILDING Master Permit Nol PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: T'-3 Nt-tl /// g!/- o City Miami Shores County: Miami Dade Zig): Folio/Parcel#: &2-z-) /®O/O 74pe Is the Building Historically Designated:Yes NO Occupancy Type: / P�ad: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 4541 /�2/P /00/ 11.19 G Phone#:C3or2 790 r9w Z Address: ��d 51611� ZK& WIP City: A»?I State: f G- Zip: 3 3>�3 Tenant/Lessee Name: Phone#: Email: qeGs4 374 CONTRACTOR:Company Name: AGC �Oi�srwwePhone#:6*ZM21 0 Address: /000 5'4 57" X00 q City: /,0x'71 1?5f A e# State: Zip: /3 l Qualifier Name: M 4111 I 0 0 Phone#: - 6Wd State Certification or Registration#: G6+C�e A-7 3 Z r, Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ / ®�®•�� Square/Unear Footage of Work: /��tf Type of Work: ❑ Addition Alteration ❑ New9❑ Repair/Replace ❑ Demolition Description of / 770 A) J iltlpn5joo :JAW Q.10 iib�rui?4®9t�!? 7r:dt+g vow49W n g�rw,li 14 9100• 3"60,{Init94' 3ic•.a,8,p ��C�iltilu211'rei'(,• a;d?6: 3r to Y,ftI9?tarl(RQ' .r'• nz2A V'61.:pq t�,rie NO,:,,, 1-1— Specify 1 Specify colo 0 o r e: Submittal Fee$ Permit % CCF$ CO/CC$ Scanning Fee$ ��CAZ) Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 194 , W (Revised02/24/2014) c Bonding Company's Name(if applicable) � J Bonding Company's Address ' City State Zip Mortgage Lender's Name(if applicable) /V4- 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. "WqSignature Signature OWNE T CONT OR The foregoing instr meant was acknowledged before me this The fforegoing instrument was acknowledged before me this day o / 15,,44 20 ,by to day of A, •1,��3 ,20�_�by me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ..Vj Sign: n Print: Print: ff WdG o$m EE 1158 145618 ' Seal: .....t°P`a Tlxm*N Seal 9;;t�•°r miselon# th Thrat�i Ni NoWy limon. APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami-Dade Official Records-Print Document Page 1 of 2 ' CFN:20150670011 BOOK 29820 PAGE 2740 DATE:10/20/2015 08:18:54 AM DEED DOC 1,278.00 HARVEY RUVIN,CLERK OF COURT,MIA-DADE CTY PREPARED BY AND RETURN TO: Arnold Straus,Jr.,Esquire ENTERPRISE TITLE,INC. 10081 Pines Blvd.,Suite C Pembroke Pines,FL 33024 Telephone: (954)4312000 Fife Number: 15-12901 WARRANTY DEED THIS WARRANTY DEED,made this_day of OCtaber,2015 by and between CAPITAL INVESTMENTS, LLC,a Virginia limited liability company,whose business mailing address is P.O.Box 2382,Fahfax,VA 22031,as "GRANTOR",SPIN FLIP 1001,LLC,a Florida limited liability company, whose maiimg address is 5910 SW 74 Street,Unit 410,Miami,FL 33143,as"GRANTEE". OWherever used herein,the terms-GRANTOR"and-GRANTEE"include all the parties to this Instrument and the heirs, legal representatives and assigns of individuals,and the successors and assigns of corporation.) WITNESSETH: THAT the GRANTOR,for and in consideration of the sum of$213,000.00 and other good and valuable considerations in hand paid to GRANTOR by said GRANTEE,receipt whereof is hereby acknowledged,by these presents does grant,bargain, sell.alien,remiss,release,convey and confirm rutto the GRANTEE the following described real property,and rights and interest in real property looted and dkxftd in the County of MIAMI-DADE and Side of Florida,to wit: Lot 31 of Black 3,of NEW MIAMI SHORES ESTATES,according to the Plat thereof,as recorded:in Plat Book 51,at Page 80,of the Public Records of Miami-Dads County,Florkla. (Tax Folio No.:11-2136-001-0790) This corwaymce is subject to the foliewing: i. Tarte for the year 2015 and all subsequent years. 2. Conditions,restrictions,easements,limitations and zoning ordinances of record. The GRANTOR does hereby fully warrant the tite to the real property hereby conveyed and will defend same against the lawful daims of all persons whomsoever. https://www2.miami-dadeclerk.com/officialrecords/PrintDocument.aspx?QS=MwKnucJ... 11/16/2015 Miami-Dade Official Records-Print Document Page 2 of 2 , r CFN:20150670011 BOOK 29820 PAGE 2741 IN WITNESS WHEREOF,Ute GRANTOR has caused ift Werra*Deed to be ex=Aed the day and year first above written. Signed,s led and in the p rce Of. CAP INVESTMENTS, C,a Vlrginla , Z} d Rm mpany #'I S Br With #1 Printed Name Abbas Ghassemi,Manager Y� Witness#1 Itnature Witness rimed Name STATE OF VIRGINIA COUNTY OF FAIRFAX The foregoing irstrurrtent was acknowledged before me this day of Octoar. 2015 by Abbas Ghasseml, Manager of CAPITAL INVESTMENTS,LLC,a Virginia limftd liability company,who[Ills personally known to me[ ]has produced a Driver's License[ j has produced as identification. - Signature _ - MY Commission Expires: J8t Wn T.P&ft ft Jr Printed Notary signature NOW Public 70136419 SEAL Cornm6mveam of Virginia My COihMlsslon Expires FobnMy28,2D17 https://www2.miami-dadeclerk.com/officialrecords/PrintDocument.aspx?QS=MwKnucJ... 11/16/2015 Detail by Entity Name Page 1 of 2 5 Y �- i Detailntl Florida Limited Liability Company SPIN FLIP 1001, LLC Filing Information Document Number L14000112272 FEI/EIN Number 47-1381170 Date Filed 07/16/2014 Effective Date 07/15/2014 State FL Status ACTIVE Last Event LC AMENDMENT Event Date Filed 11/04/2014 Event Effective Date NONE Principal Address 5901 SW 74TH ST 410 MIAMI, FL 33143 Mailing Address 5901 SW 74TH ST 410 MIAMI, FL 33143 Registered Agent Name&Address PARRA, CARLOS G 5901 SW 74TH ST 410 MIAMI, FL 33143 Authorized Person(s) Detail Name&Address Title MGR SUAREZ, RAFAEL I 5901 SW 74TH ST SUITE 410 MIAMI, FL 33143 Title MGR OLIVERO, WILLIAM http://search.sunbiz.org/Inquiry/CorpomtionSearch/SearchResultDetail?inquirytype=Entit... 11/16/2015 Detail by Entity Name Page 2 of 2 119 MEMORES AVE, APT#11 • CORAL GABLES, FL 33145 Title MGR MORASSO, MARIA A 2451 BRICKELL AV-APTO 11 M MIAMI, FL 33129 Title MGR MORASSO, DOLORES E 340 E 64TH ST-APTO 21 K NEW YORK, NY 10065 Title MGR SEIJAS, OTTO 2451 BRICKELL AV-APTO 11 M MIAMI, FL 33129 Title MGR FLORIDA MIAMI REAL 5901 SW 74TH ST- STE 410 MIAMI, FL 33143 Annual Reports Report Year Filed Date 2015 04/23/2015 Document Images 04/23/2015--ANNUAL REPORT View image in PDF format 11/04/2014-- LC Amendment View image in PDF format 09/15/2014-- LC Amendment View image in PDF format 07/16/2014-- Florida Limited Liability View image in PDF format CoOyrlaht O and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 11/16/2015 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CORREDOR. MAURICIO ALL CONSTRUCTION&DEVELOPERS INC 1000 5TH STREET STE 200 MIAMI BEACH FL 33139 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, 1it: DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work toimprove the way we do business in order to CGC1513259 ISSUED: 07/15/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED GENERAL CONTRACTOR about our divisions and the regulations that impact you,subscribe CORREDOR,MAURICIO to department newsletters and learn more about the Department's initiatives. ALL CONSTRUCTION&DEVELOPERS 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! ExpIrStOn ate AUG31 2016 L1407150D00943 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL_REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1 yya CGC1513259 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 CORREDOR, MAURICIO ALL CONSTRUCTION& DEVELOPERS INC f 1000 5TH STREET STE 200 MIAMI BEACH FL 33139 ' ISSUED: 07115!2014 DISPLAY AS REQUIRED BY LAW SF-Q# L1407150000943 haw auk •y 4 #` v BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 302016 �e+` DBA: R@Ceipt#:GE ER7AL7 CONTRACTOR. (GENEP Business Name:ALL CONSTRUCTION & DEVELOPERS INC Business Type:CONTRACTOR) a t,fi Owner Name:MAURICIO CORREVOR Business Opened:o4/27/2007 Business Location:7222 TAFT ST State/County/Cert/Reg:CCC1513259 HOLLYWOOD Exemption Code: Business Phone: Roorns seats (Employees Machin" Profstwionats v 6otln�sM C" Number of Machines: _Vending Type: Tax Amount Transfer Fee NSF Fee +00 �PerwKy"� _ Prior Years Coliedlon Coat Tota!Paid ` 27.00 0.x)0 w� 0 2.'70 O.it4 0.00 29.70 '. j, THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSING`,: � , THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward t^,c �r a a non regulatory in nature.You must meet all County and/or Municipality 'ar, WHEN VALIDATED the zoning requirements.This Business Tax Receipt must be tra .,> , the business is sold, business name has changed or you heave business location,This receipt does not indicate that the buvf.,-mi.is it is in compliance with State or local taws and regulations. Mailing Address: Receipt #30A u 0Q1,*r 000' MAURICIO CORREDOR Paid 10/05/2a' . 1000 5 ST # 200 r MIAMI BEACH, FL 33139 A 2015 .µ CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 10/10/15 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. N SUBROGATION IS WANED,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 SACT GRETELL GONZALEZ Use General Insurance PHONE (W5)386-13055 aC No (8W)330-1123 13631 SW 26st ADORES& GRETELL@USAGENERALINSURANCE.COM Miami,FL 33175 INSURERIS)AFFORDING COVERAGE NAIC# Phone (305)386-3305 Fax (888)330-1123 INSURER A: INTERNATIONAL INSURANCE COMPANY OF HANNOV INSURED INSURER B: INFINITY AUTO INSURANCE COMPANY All Construction&Developers Inc INSURER C: NAUTILUS INSURANCE COMPANY 1000 5th St #200 INSURER D: Miami Beach,FL 33139- (786)766A330 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 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. I TR TYPE OF INSURANCE AN SUBR POLICY NUMBER MI ICY EFF MPOMIL EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 1 D00 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ ❑ ❑ .00 q CLAIMS-MADE 0 OCCUR N N IG06CO03207-01 05/15/2015 05/15/2016 MED EXP(Any one person $ 5,000.00 ❑ PERSONAL&ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,OW,OW.00 POLICY ❑ PECTRO ❑ LOC $ MBIN D SINGLE LIMIT AUTOMOBILE LIABILITY acct eM ,OW•00 ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 509557999221001 BODILY INJURY(Per axider� $ B ❑ AUTOS AUTOS N N 11/10/2014 11/10/2015 NON-OWNEDPt20Pd AMAGE $ 0 HIRED AUTOS © AUTOS R'e ❑ ❑ $ ❑� UMBRELLA UAB ❑OCCUR AN019938 EACH OCCURRENCE $ C EXCESS LIAR ElCLAIMS-MADEN N 04/22/2015 05/15/2016 AGGREGATE $ 1,00,000.00 ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC SST%OR ❑OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIEI.OR/PARTNERMXECUTIVE EL.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) ❑ EL.DISEASE-EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERA71ONS below EL.DISEASE-POLICY LIMIT $ IN N DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) LICENSE#CGC1513259 i i CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES FL 33138 AUTHORIZED REPRESENTATIVE ©1888 2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105)QF The ACORD name and logo are registered marks of ACORD I z- — x j i k Own" STATE OF FLORIDA DEPARTMENT OF F1NANCIAL',SERVICES DMSM QE WORMS'COMPENSATMN "CWT11FICATE OF ELECTION TO BE EXEMPT FROM FLOC WORKERS'COMPENSATION LAW ! #''BION-INDUSTRY EXEMPTION Tbls des th the thcividual listed below has elected to be exempti'rom'Florida 1Norkers'Compensalon laver 'Iltff~DATE. 812212015 EXPIRATION©ATE: $/2112017 CQRREDOR MAURICIO 208363228. Ep0WSS HI EAHDAQDRESS: ALL GTI�OJCTiON&DEVELOPERS INC 1000-'5 STREET l FL 33139 SiCOPES 6F-B11SfJlESS OR TRADE: NSED aEN �tAL LICENSED ROOFINGLC4E NM_ CONTRACTOR FA,anaMm ora - 9d8 �nm e 460.45f E2 e tr a Gt$ A4P 12 (V}(b 82Gdtt �bB Stbe 6r1� P�f6U3{ItbCiF3Atei3d0�tt } bNDg@=Egy�L �� t � +14 f4r � aath8158+renCeQt4 ' ' C3�..'FBt'��1RA'N'E5�+,�Itd '( �lst}iu _ a t -CTRkSED 0$13 t f �4� OuFgnow # C 1 i ,ia� ,����� �f',2t it 7te t�ra `3Y§rt i � !• � I `' e it '��� 7 f�(t _ 1 btl §M k ( ( ( { . i ��� 'Y. t, f 1 7 i Lail T, 9' �:�,_ a}i'•-'�'�a�s 4�f`<'``� t _� i f I 'tl�,}7t� r 1 � R�1 'f'!�`r�7 F«i'� �x�r.i}'F7:'�L>ti��.�'ti I . *u rtmait w twFrr �5( � s i R r - -s R ' & n loon KIM I Miami Shores Village Building Department �lOR1UA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner Workers' Compensation Insurance Exempt on Y o; ^gym f 1 I 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er State of Florida County of Miami-Dade 9 The foregoing was acknowledge before me this day of ?-/Z ,20 . lZs/bog�s o v whois�xs-32 na y mown or has produced �a:"Y"••,,., OLGA VALCM Mtification. Notary: =&Em1618 �''��,,,���t••.•`' > NWMW Nfty Ate. SEAL: Im All CONSTRUCTION & DEVELOPERS INC. 1000 511 STREET STE 200 Miami Beach, FL 33139 CGC#1513259 Phone (786)768-4330 Date: October 28, 2015 State of: Florida County of: Dade Before me this day personally appeared Mauricio Corredor who, being duly sworn, deposes and says: Jorge Valcarcel That he will be the only person working on the project located at:435 NW 1111h ST. Miami Shores, FL 33168. Sworn to (or affirmed)and subscribed before me this 4 day of NWaMeW .201/,by /1/lA-exicia a/zs�m ov Personally know OR Produced Identification Type of Ide • My Coe:E Fab is.at ":� �:• COMMSSW#EE 14Hta. W"ASK Print,Type or Stamp Name of Notary COMPLETE • • TL a Complete Items 1,2.and-2.- ■ Print your name and address on the reverse x O Ad so that we ca,'1 return the card to you. ❑�� ■ Attach this card to the back of the mailpieae, B.Received by. P,) 0.Date of Delivery or on the front Ig space permits. 1. Artlde Addressed to: D.Is deDvery addresstam Yes If YES,enter deUvery address below: p No �� �c ��ra�ca�svc Zg 22 vda�'c rf F91p, Circle �� , FL 3�q.13 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIfll11111111111111 D A P4014 RM ftre%* Q Adult8lgntur• O Regi NIaOTM 0 AduR 8tg�htle OWW 17 [NaCl PMWOWd 9590 94021247 5246 9395 69 o c r D IM 0 boUMcn Del M 2s Amide Number(lta ficrrr service, O on ' "�' 0S Co on70f3 2250 00ov 5*C 239-5 °Mi d o P3 Form 3811,July 2016 PSN Esso-M4*0lW Domestlo Rehm Receipt 4 LISPSTRACKNG#V EE te Man sFew a . o-�o I 4540 4402 1247 5246 4345 64 Unbd Stator •Sender:Please print your name,address,and zrP+4®In this box* Postal sonrice S'P i iv R-t PS t oa / Spin Flip 1001 , LLC 5901 SW 74St, Suite 410 Miami FL 33143 (305) 7905476 November 3rd 2015 ATLANTIC ENGINEERING SERVICES, INC. 2822 Waters Edge Circle Greenacres, F133413 Email: atlanticengsery@gmail.com Telephone: 1 (561) 358 - 4140 Hereby we want to notify you that from this moment we are changing General Contractor for the property located at 435 NW 111 St, Miami Shores FL, 33168. Please, don't hesitate in calling if further information is needed, Carlos .Manage Spin Flip 1001 (305) 7905476