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EL-15-1182 Miami Shores Village I MAY 19 2015 Building Department 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 2010 BUILDING Master Permit No. R C ( –/'-f7 v PERMIT APPLICATION Sub Permit No. E-k—I S — 6 I g Z_ ❑BUILDING �LECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL ❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP t , , CONTRACTOR DRAWINGS JOB ADDRESS: Z� IQ I I I TED 2— City: City Miami Shores County Miami Dade Zia: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: �� _, OWNER:Name(Fee Simple Titleholder):-®�-� EL,TF 1,*At c 0AAtt:-.T1?S Phone#: Address: Z > L0 61<u S is cTt h L City: LL Ak State: Zip: Tenant/Lessee Name: Phone#: 3C -911 <62E Email: om`/ y�/ CONTRACTOR:Company Name:���/`�r?yT(_ `� �17�Ph a � one#: �F-tJ � Address: (_Z __;� l/ y (� y �1TZ City: i-1-f r /�-t i /--J State: 1:7L Zip: 3,3 Qualifier Name: (� ✓ �� _E / U d,Z Phone#: State Certification or Registration#: CW 13®l Yy d' Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ �< C'�c Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New U'Repair/Replace ❑ Demolition Description of Work: LtC) L a 13 '— K Tc Gv — yv I WC O/mak c_ C 0 7_U 1 AV420" P�"L Specify color of color thru tile: Submittal Fee$ Permit Fee$ od 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 approved and a reinspection fee will be charged. Signature `— Signatures, OWNER or AGENT CONTRACTOR The foregoing instrument as acknowledged before me this The foregoing instrument was acknowledged before me this U13 day of 20 (� by ay of 20 by who is personally known to who is personallyI 1511 ARF2/�i, me or who has produced as me or who has prod ced ���`\P• -'A** 0 vog identification and who did take an oath. identification and who did take an oath. 'f:•�y N,archss�oy� NOTARY P IC NOTARY PUBLIC: G lhru9 �� Sign: Sign: /��- / .••P�O\��� Print: 1 (l� l;L ��1 Print: Seal: v'p Caridad Diaz Seal: 2a ? =Commission#FF 160477 ;,,%:4-Exores: SEP 16,2018 B�*�pxED THRII ***********i •* THRU tkkC******************r************t*r*s****rs*********************r***** APPROVED BY SJR l`Ih'�� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 1 i ACSDATE(MMIDDIYYYY) P CERTIFICATE OF LIABILITY INSURANCE 05/11/2015 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,theotic p y(ies) 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 g certificate holder in lieu of such endorsements). PRODUCER CONTACT Roxana Soto Insurance Agency, Inc. NAME: PHONE Ext):, 305-553-6005 �uc No, 305-553-6007 I 8230 Coral Way E-MAIL Miami FL 33155 ADD Ess: aOI9857@allstate.com INSURERS AFFORDING COVERAGE NAIC q INSURER A:WESTERN WORLD INS CO INSURED DEVELOPMENT ELECTRICAL CONTRACTOR INC. INSURERS; BRIDGEFIELD CASUALTY INS CO 15711 SW 59 TERRACE INSURER C: f MIAMI FL 33193 INSURER D: 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. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS p POLICY NUMBER MMlDDIYYYY MMIDD)Yl'YY r- A COMMERCIAL GENERAL LIABILITY NPP1398079 01114/2015 0111412016 EACH OCCURRENCE $ 300,000 CLAIMS-MADE 71 OCCUR DA WAA UE—T-6 RENTED 100,000 PREMISES occurrence) $ MED EXP(Any one person) $ 5,000 iE PERSONAL&ADV INJURY S 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 600,000 �. POUCY1:1 PRO- JECT LOC PRODUCTS-COMPlOPAGG $300,000 k- OTHER: S Y... i AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) � ANY AUTO BODILY INJURY(Per person) $ ALL OWNED LEp BODILY INJURY Per accident AUTOS AUTOSUTOS ) $ ( _ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS _�Peraccidenl - S � UMBRELLA LIAB OCCUR FACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ I �4DED RETENTION$ $ L B WORKERS COMPENSATION 196-36572 04!07/2015 04/07/2016 STATUTE �RH _ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERJEXECUTIVE YIN00,000 OFFICERIMEMBEREXCLUDED? NIA E.L.LEACH ACCIDENT $ a (Mandatory In Nff) E.L.DISEASE-EA EMPLOYEE $ 100,080 Ir yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 G M71 1:31:1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addlllonal Remarks Schedule,may be attached If more space is required) ELECTRICIAN i. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE s 10050 NE 2nd Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ�P,EEI$44 4TA VE i ---@-1-9-88-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Produced using Forms Boas Web software.www.FormsBoss.conr?Impressive Publlshing$00.208.1977 I, > :F Miami—DadeLOcal Bus'%Iiness n tly, State of plc T PAY 6842681, p� p IN \ ..>, TER Al of Too x \ i �, E /✓ ' a � Ec r 6� Y w, - a \ Permit NO. EL-5-15-1182 Miami Shores Village Permit Type:Electrical-Residential 1UOoOm.s.2nd Avenue Nvv t Work Classification:Alteration Miami Shores, FL 33138-0000 Per Phone: (305)785-220* Permit Status:APPROVED issue Date:512012015 Expiration: 11/1612015 Project 272 NW 111 Terrace 1121360010600 ELITE HOME PARTNERS LLC Miami Shores, FL 33168- Block: Lot: Owner Information Address Phone Cell ELITE HOME PARTNERS LLC 2300 W 84 Street MIAMI LAKES FL 33016- 23POVVD4Street MIAMI LAKES FL33DiG' 2014 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED DOCUMENT# L13000121593 Apr 22, 2014 Entity Name: ELITE HOME PARTNERS, LLC Secretary of State Current Principal Place of Business: CC0593838303 2300 W.84TH STREET SUITE 601 HIALEAH, FL 33016 Current Mailing Address: 2300 W. 84TH STREET SUITE 601 IiALEAH, FL 33016 US FEI Number: APPLIED FOR Certificate of Status Desired: No Name and Address of Current Registered Agent: DE LA FE,RUBIDIA M 2300 W.84TH STREET c,U7E 6G1 HIALEAH, FL 33016 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electrcnic Signature of Registered Agent Date ,f.jthorized Pa.-son(s) Detail Title MGR Name EHP ACQUISISTIONS, LLC Address 2300 W.84TH STREET, SUITE 601 City-State-Zip: HIALEAH FL 33016 1 hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under cath,that 1 am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes,;and !ha!my name appears above,or on an attachment with all other like empowered. SIGNATURE: EHP ACQUISISTIONS, LLC MGR 04/22/2014 Electronic Signature of Signing Authorized Person(s)Detail Date � NoREs 5 SNC.1932 �,� I doss ,,,,,r" Miami shores Village y,Ito Building Department OR11D� 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. 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 any person allowed to work under this permit Please check with%our 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. O�cner _Contractor Print Name- _bJPk_ Print Name: �� Signa _f�1__ _ o�--� � Signature: State of Florida) State of F orida County of Miami-Dade) County j-Dade) Sworn to ans{�bscribed before me this r f ° Sworn t su scribed before me s I r h day of •1 J to Qr ,201 J day of U ,201 t1 . By + By (SEAL) (SEAL) vr.��h�iiy knL7 wl') T bg I i- ! t n Type of Identification rodAM(Ins Lorenzo Morales ~ '.Commission#F :°• Comrnission#FF 160487 = :� 'Expires: SEP 16, Vi�, SEP 16,2018 '. BONDED THNU' ••••( BONDED THRU 18T FLORIDA NOTARY LLQ OF t ST FwraDw NOTARY,LLQ mEze x � = z 2.c] m m /amm e �/c< a £/% y ƒ ®<i \/ \\ \ / 3�/0 ° § ¥ 33 0 00- wIo 5 _\ �K/ f2\/-n� \ \z® G0G) 0 m Iwm =/\&moi ; ' 2wmZ »c- oJH } wmr2 MC: / j ! =mo >cem» c a e \/ §��f�� m ® / // $q\ 2 > �a © m¥ \ �< � Mm 0mm qz ¥ r 2 0> kk 2 > oe »� 2 0 \ / /\ 0kq >c m » m \� >> \ m n E -f oR - m >0 W� 0 m \� /-n « > mm > \ > kk oz » �r \/ ) k - 5 z m / OD \ _ e �� . f / 2 o } : > Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT ABILL-DO NOT PAY LBT 6842687 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES DEVELOPMENT ELECTRICAL RENEWAL SEPTEMBER 30, 2016 CONTRACTOR INC 7116684 15711 SW 59 TERR Must be displayed at place of business MIAMI, FL 33193 Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS RECEIVED DEVELOPMENT ELECTRICAL 196 ELECTRICAL BAY TAX COLLECTOR CONTRACTOR CONTRACTOR 75.00 09/24/2015 Worker(s) 1 11E000008 0229-15-008370 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 boldei s qualifications.to do business.Holder must comply with any governmental or nongoveramental regulatory laws and requirements which apply to the business. The RECEIPT N0.above mess be displayed on all commercial vehicles-Miami-Dade Code Sec Ila-276. MIAMM For more information,visit vn wjniamidade.00vLlaxcollhhctor CTQB Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY ,- l l E000008 DEVELOPMENT ELECTRICAL CONTRACTOR INC tD-B.A.: MUNILUIS E Is certified under the provisions of chapter 10 of Miami-Dade County 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: 6/14/2015 EXPIRATION DATE: 6/13/2017 PERSON: MUNOZ LUIS E FEIN: 274013230 BUSINESS NAME AND ADDRESS: DEVELOPMENT ELECTRICAL CONTRACTOR INC 15711 SW 59TH TER MIAMI FL 33193 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL ELECTRICAL WIRING CONDUIT CONSTRUCTION BURGLAR AND FIRE CONTRACTOR WITHIN BUIL FOR CAB ALARM INSTALL 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 440.0.5(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 DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 I i 1 I E r I Local Business Tax Receipfi Miami—DadeCou:nty, State of Florida -THIS IS NOTA SILL DO NOT PAY 6842&87 BUSINESS NAME/LOCATION RECEIPT NO. E DEVELOPMENT ELECTRICAL EXPIRES RENEWAL CONTRACTOR INC 7116684 SEPTEMBER i3O, 2016 15711 SW 59 TERR Must be displayed,at place of business MIAMI, FL 33193 Pursusntto:.CoumyCode Chapter BA.-Art,9&10 ! i OWNER SEC.TYPE OF BUSINESS DEVELOPMENT ELECTRICAL 196 ELECTRICALPAYMENT RECerVEo CONTRACTOR By TAX COLLECTOA CONTRACTOR 75.00 09/24/2015 i Workers) 1 11 EOOOOQ8 0229-15-008370 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's qualifications,to do business.Holder must com i with an or nongovernmental regulatory laws and requirements which apply to the businass. `�Y y governmental The RECEIPT N0.above.Mutt he displayed on all commercial vehicles-Miami Dade Code Sec Ba-216. MIAMrl7ADE FoIrmore informoiionisi ek27j_d ,vtwww miamid il. ov/taxcol,l for I i J '_ Construction Trades Qualifying Board y s c ,BUSINESS CERTIFICATE OF COMPETENCY ' Il 000008 D1:VELOPMENT ELECTRICAL CONTRACTOR INC D_B.A- MUtVt�Z LUIS E Is certified under the provisions of Chapter10 of Miam[Dadt`County i RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD rig i s:.A. ER13014583 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED e r, Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 (INDIVIDUAL MUST MEETALL LOCAL LICENSING w REQUIREMENTS PRIOR TO CONTRACTING IN ANY AREA) MUNOZ, LUIS ENRIQUE DEVELOPMENT ELECTRICAL CONTRACTOR,-INC. 15711 SW 89TH TER MIAMI FL 33193 Sr ISSUED: 08/06/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1408060001841 i o�ztie sy a JEFF ATWATER ,hooawe�`�• CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES i 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: 6/14/2015 EXPIRATION DATE: 6/13/2017 1 I PERSON: MUNOZ LUIS E FEIN: 274013230 BUSINESS NAME AND ADDRESS: DEVELOPMENT ELECTRICAL CONTRACTOR INC l 15711 SW 59TH TER MIAMI FL 33193 I SCOPES OF BUSINESS OR TRADE: i LICENSED ELECTRICAL ELECTRICAL WIRING CONDUIT CONSTRUCTION BURGLAR AND FIRE CONTRACTOR WITHIN BUIL FOR CAB ALARM INSTALL 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 an the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 i I i I e I t it i jIt t 1 t