EL-15-2971 L � k
11
s Miami Shores Village t
®e�� 10050 N.E.2nd Avenue NE t
rr, ' '
Miami Shores,FL 33138-0000 T
syr Phone: (305)795 2204 .
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Expiration: 06/1112016
Project Address Parcel Number Applicant
1298 NE 104 Street 1122320300100
Miami Shores, FL 33138- Block: Lot: KRISTINAGUILLEN
;;
Owner Info:.nation Address Phone Cell
KRISTIN; GUILLEN 1298 NE 104 Street
MIAMI SHORES FL 33138-
1298 NE 104 Street
MIAMI SHORES FL 33138-
Contractor(s) -- _ Phone Cell Phone
------------ Valuation: $ 350.00
APC ENGINEERING ENTERPRISES IN (305)219-8261'
Total Sq Feet: 0
Type of bboik.INSTALLArION OF POOL LIGHT ti Available Inspections:
Additional Info: Inspection Type:
Classification:Residential Final
Scanning:1
Light Niche
Bonding
Review Electrical
Alarms
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60
DBr•R -e�r� Invoice 4 EL-11-15-57878
$3.38 12/14/2015 Ch,,, 9:1 .37 $236.:6 $0.00
DCA F-ie $3.38
Educauon Surcharge $0.20
Permit Fee-P dditions/Alterations $225.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $236.36
In consideration of the issuance to me of this perrr t, I agree to perform the work covered hereunder in compli-ince with all ordinances and regulations
pertaining ther::to and in strict conformity with the plat s,drawings,statements or specifications submitted to the prol er authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all i ror'< d:nc '_, : .z. ..; _!', ..., . ployes I understand that separate permits are
require^s.,r l=I FrTpICQ.L,PLUMBING.MECHANICA ,WINDOWS,DOORS,ROOFING end SWINfiM!NG POOL wor,(.
OWNEF,S F,I=r1D IT: I c a0ge f 4inlaccurate and that all work win; be done in compliance with all applicable laws regulating
construction 2 zoning a ore, autho' he F tractor to do the work stated.
Decouiber 14,2016
Authrized Signature:Owner / p Ica ct r / Agent Date
Builde?%g �wartment G®p.
Decerrher"4,2015 1
Miami Shores Village N V 2 5 2015
Building Department nc9
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795.2204 Fax:(305)756.8972
INSPECTION'S PHONE NUMBER:(305)762.4949
FBC 201
BUILDING Permit No.
PERMIT APPLICATION master Permit No. ��{� /0 /r Z401
Permit Type: Electrical �{/
JOB ADDRESS: Z /1i o
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:
Is the Building Historically Designated:Yes NO Flood Zone:
OWNER:Name(Fee Simple Titleholder):_ Monet
Address: 0VF d
City: State: Or Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: At!eG Ev►Ji^tL&i n a en+ . Phone#:.70 9"-Zl`P-1 ZA'z
Address: 2 l S 6 t a > L 0*%% a v L
City: t-�l State: V Zip: 330(to
Qualifier Name: '&ja O r 124 G k a&ti t Phone#: JOS - F P S-S 3'7
State Certification or Registration#: E&I Y AQ f,"1 S 3 tt Certificate ofooCompetency#:
Contact Phone#: Email Address: OeQUe�Ot���tl t r• M
DESIGNER:Architect/Engineer: Phone#:
Value of Work for this Permit:$ 3,50- 10 Square/Linear F�oo�e of Work:
Type of Work: ❑Address ❑Alteration ❑New I epair/Replace ❑Demolition
Descriptio�M �r�, ' 9�� ��fifi' PoD( LaOla�'
xx��x�wxxx�x�xxx+x�a���xx�x��x��x�xex�sx�F�xxnx���xxxs +vsa� �e+� :, .
a
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$ oR
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: edition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good f th t is cop of the notice of commencement and construction lien law brochure will be delivered to the person
whose property 's subj t to n Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first ecti wh' r seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection ill not a ap o e reinspection fee will be charged.
Signature Signature - 1
Owner or Agent Contractor
The f regoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of J '2-b-, 20 JK,by 164 it-!E day of 20 LS-,by --VAa,eS 2 t[�G►a$ ,
who is nally kno to me or who has produced who-it-%M y o o me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: S Sign: Ram- .14
Print: S;2,., u�-C) Print: u4 I f OVI
My Commi M o
IMMNOWRO
Newry toe•elm drf R q
� VN M�otWNodryl4�
APPROVEA ,181 EXAminer ,,,a,. _ Zoning
Structural Review Clerk
(Revised 3/12/2012)(Revised 07/10/07)(Revised,06/]0/2009)(Revised 3/15/09)
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TIP& fmhL 70 NOT PAY
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1iiQ EXFS
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A 30, 2018
lilayed at place of truskum
FRP
Pursuaeiti to County Code;
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Chapter SA—Art 8&10
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PAYMENT RECEnRo
APCEiidimNG INC 1 ELECTRICAL fl
EC13006753 BY TAX COLLECTOR
IAlgrke►{s) 5 $45.00 10/08/2015
CREDITCARD-16-{#11341
Tl *Is not a license,
ara certiR t dre Iitioatio r Holdef :e VM any governmental
ata� latsry I:w<'. , r�ir whlclray to the b .
The RECEIPT•N0.above meet bs,, oa all tx�unercial ve6lcles-Mfg-D�Ia CodeSec es-216.
Fer�ei�om�atlon,vl�C
CERTIFICATE F L.I 1LI 1 C °li
11 15
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMTM ONLY AND Ct1NFERS.90 RIGHTS UPON THE COMFICATE HOLDER.THIS
CERTIFICATES DOER NOT AFFmmTwmy OR NEGATIVELY AMEND,EXTEND OR ALTSR.THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT COmsnrUTE A CONTRACT BETWEEN THE IMMO OISURER(S),AUTHORIZED
REPRESEKtATM OR'P6>oaucM AND THE CERTiRcATE HOLDER.
MOKWANt: Rahe. ckfer Is an ADDITIONAL MURED,the policy{i }trust be SUBROGATION. N SUBROGATION 13 WAIVED,submit to
the terms aand ..' of the Policy,certain policies may require an endorsement.Astidenumt on this certificate does not confer rights to the
In.iia of such, s
PRODUcot comrw Monica flmdez
Finney InsurovA Corporation 553 1 f ss�-ess^:i20a
Sheridan SVftt e johnWnm0uwzwm*r;Lcm
Hollywood,FL 330-1 Aiwas"" NAIC 8_
A: INTERMADMIAL INS CQ
WSUHE'R6:
All Pro Contracting Group Inc _
DBA APCineeriFang ng Enterprises Inc.ttlC.
2150 West 10th Ave.
Hialeah,FL 33010 a'
f:
COVERAGES CERTIFICAT>:'N 11"m REVISION MJ : 12
TH►S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDMO14 OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHowN fimAY RAVE BEEN REDUCED BY PAID CLA ms.
-LTRTYPE POLICY Elf mmnnnm PtWCY Lam
A a tti 941-01 1etAW$ 10rAme Emmoomfimm E a 1
MW Exp WW one $ _ 51000
PERSONAL.a ADV INJURY S 1,000,000
Qt.AGGW447t I WT*VUES PEW. GEMOM AGOREOATE'-- s 2,000,000
padeoc Pa;otx�Ts-G081�'/�?AO6 $ 2.000.000
POUCY0
a $
Aus I masu rf S
}ANY AUTO SwLY muftY(Per PeBna) $��
ALL DUarNEOWIM a Y tNJtRtY{Per eoddeart) &
AUTM AU�aftl
01
I AUTOS AUTOS a
$
w" u" H FAG"OCCUPOU NM $
mam"L!AS CLAWs kAAI AcaaRE6A7E s
ISD ' I ROOITION �.
AM EMPLOYEW UA85AY
ANYPROPR1Er0WA�RT Y/W NIA EI.EACHACGOgNT _$
OFFICEPJAMMURMmmim-YInMM F(.OISFA9E-EA $
MPTION OF dastfto undw
OMRATIQNS bellow E.L.DISEASE•POLICY UNIT
DESCRWMMDFOPlUtATiON41LOCATWMIVVMM(ACORDIM.AddWonalmmnaftsdadute.. boa llmore tar**drw4
Electical Contractor
CERiiEIGA
0KCIEUATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCOIRD SWORE
CITY OF NMI SHORES THE EXPIRATION DATE Tim,NOTICII WILL BE DELIVERED Of
Buildings Deparbrient ACCORDAMM VM THE POLICY PROMSMS.
10050 HE 2 Ave
Miami Shares,FL 33138-
1"7iNMI
0 19W2014 ACORD CORPORATIOX AN dgft reserved
ACORD 23(2014101) The ACOAD name and logo are registered marks of ACORD
Pdrrted by MIM on November 20,20iEi at 03:24PM
i
JEFF ATWATER
CHEF 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: 911812015 EXPIRATION DATE: 9/1712017
PERSON: RICHARDS JAMES P JR
FEIN: 200290135
BUSINESS NAME AND ADDRESS:
APC ENGINEERING ENTERPRISES INCORPORATION
4300 58TH ST N APT1816
KENNETH FL 33709
SCOPES OF BUSINESS OR TRADE:
LICENSED ELECTRICAL
CONTRACTOR
Pursuant to Chapter 440A5(14)F.S..an oto of a corporation who elects exemption from this chapter by Ming;a ate of election under this sect n
may not recover beneths or carnpensation urs this moo.Pursuant to Chapter 440 05(121,F.S.,Cel of election to be exempt...apply only
*Viln the scope of the busheas or trade lided on the mice of ern to be exempt Pummut to Chapter 444.0.5(13).F.S..Notices of election to be
exempt and certificates of election to be exoript shah be subject to revocation M,at any time aft the Mfng of the notice or the Issuance of the fie,
the person narned on the notice or certificate no IoW rnreels the requirements of this section for issuance of a cerftele.The depab►mnt ahall revoke a
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609
APC Engineering Enterprises,Inc.
2150 West 101h Ave
Hialeah,FL 33010
Ph:305-885-5371
Fax:305-885-5073
November 20,2015
State of D R.i J 4-
County of Dq de
Before me this day personally appeared Tames Q to Aa Q d s who, Being duly
sworn,deposes and says:
That he or she will be the only person working on the project located at: (Z A$ N C 0 s+.
Sworn to(or affirmed)and subscribed before me this IL,day of 016414 .20by
4✓nQS a�i(°,t 4"T
Personally Know
OR Produced Identification
Type of Identification Produced
&'qby q&VV1
Name of Notary
. iry►Pra1Bo-�d poft
APC Engin n KMVP
ri �.5619
2150 West 10th Avenue■Hialeah,FL 33010■Phone:(305)50-337 r I M. eedng@gmail.com
Page 1 of 1
a
,,,, Miami shores Village
Building Department
tOR 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- ' e ployees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will
be the only pet wed wof on your project.In these circumstances,Miami Shores Village does not require verification of
workers'co mpe ti n' coverage from the contractor's company for day labor,part-time employees or subcontractors.
BY SIGNING O KNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of F ride
County of Miami-Dade
The foregoing was acknowledge before me this _day of t j ,20B .
By I IJZIAIA 1#056,99-oY�,%�� who is personally known to me or has produced
as identification.
Notary: A 6401
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