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MC-15-926 4rmiovd. MC4.15-92 sO1 y� Miami Shores Village Permit lye:Mechanical,-Residential p�5� 10050 N.E.2nd Avenue NW I�lork'Class�ication:AdditiontAlteration Miami Shores,FL 33138-0000 er Permit Status:APPROVED R�Ae Phone: (305)795-2204 ue pato;611, 012616 Expiration: 11/16/2015 Project Address Parcel Number Applicant 272 NW 111 Terrace 1121360010600 Miami Shores, FL 33168- Block: Lot: ELITE HOME PARTNERS LLC Owner Information Address Phone Cell ELITE HOME PARTNERS LLC 2300 W 84 Street MIAMI LAKES FL 33016- 2300 W 84 Street MIAMI LAKES FL 33016- Contractor(s) Phone Cell Phone Valuation: $ 5,300.00 R B AIR CONDITIONED INC (305)216-7766 Total Sq Feet: 0 I' I Tons:4 Available Inspections: Additional Info:NEW A/C SYSTEM,DRYER 2 BATHROOM EX Inspection Type: Classification:Residential Final Approved:In Review Rough Duct Comments: Date Approved::In Review Review Mechanical Date Denied: Type of Work: Review Mechanical Scanning: 1 Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# MC-4-15-55255 DBPR Fee $2.78 05/20/2015 Credit Card $ 153.66 $50.00 DCA Fee $2.78 Education Surcharge $1.20 04/20/2015 Credit Card $50.00 $0.00 Permit Fee $185.50 Scanning Fee $3.00 Technology Fee $4.80 Total: $203.66 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,P UMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.' OWN "n . ify at II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating const ction or I authorize the above-named contractor to do the work stated. May 20, 2015 orized Signature:Owner / Applicant / Contractor / Agent Date Bu riding Department Copy May 20, 2015 1 04/07/2016 15:29 3058360710 41 PHARMACY DISCOUNT PAGE 01/01 . ......... .7"lo St 'W" off 0.. op I NO' $4SM 07/0711015, Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 nspection Number: INSP-232915 Permit Number: MC-4-15-926 Inspection Date: April 11,2016 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: Work Classification: Addition/Alteration Job Address:272 NW 111 Terrace Miami Shores, FL 33168- Phone Number Parcel Number 1121360010600 Project: <NONE> Contractor: R B AIR CONDITIONED INC Phone: (305)216-7766 Building Department Comments NEW A/C SYSTEM, DRYER 2 BATHROOM EXHAUST Infractio Passed Comments FANS AND 4 TONS GOODMAN EQUIPMENT. INSPECTOR COMMENTS False 4� Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. For Inspections please call: (305)762-4949 April 11,2016 Page 1 of 1 Miami Shores VillagecE =r� Building Department APR 2 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 20(b BUILDING Master Permit No. T?bG iS7M PERMIT APPLICATION Sub Permit No.;l_(�5" 910 F-1 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING [MECHANICAL EjPUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP a� 6 1 �I CONTRACTOR DRAWINGS JOB ADDRESS: 1U tJ --err City; Miami Shores County:d.Gc40?e- Miami Dade Zip:R3/<p Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone#: Email: �y, CONTRACTOR:Company Name: �ji.=J--�a� ie 6yryr? o!2! Z6 c Phone#;0,-=a/0_'77lp(o Address:4PS t� 1 CX � ���-e- '- ?o S City: AA(, e. L i State: Zip: 3,31'7a Qualifier Name: 'P-N I exd-O Phone#:-9OJ CW(0-�(e t�® State Certification or Registration#: I� OS j?� Certificate 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 ElAlteration [ New ElRepair/Replace ElDemolition Description of Work: AIdQ� A�Z i / -4 621�12 Specify color of color thru tile: Submittal Fee$ 'CQ� Permit Fee$ CCF$ �O/cc$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 153. (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State 7-ip 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. /n the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature — r Signature .. OWNER or AGENT CONTRACTOR The foregoing instrumen was agknowledged before me this The foregoing instrument was acknowledged before me this ay of �'� 20 l by day of �� ,20 �� ,by who is personally known to 11^,Dy-.(p ,who is per, sonally known to me or who has produced ®733-73�(p(3 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: Sign: Print: Print: �— Seal: •�••. MAYELIN DOMINGUEZ MAYELIN DOMINGUEt :• Notary Public-State of Florida Seal: '• My Comm.Expires Sep 18,2017 ,� Notary Public-Statile o1 Florida '••,+►f oa°'� Commission#FF 054691 MY Comm.Expires Sep 16,2017 �� Commission #FF 054691 �b6�H�f��BBikiN9JP APPROVED BY ! Plans Examiner Zoning VV Structural Review Clerk (Revised02/24/2014) f STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CAC057175 The CLASS AAIB CONDITIONING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 BENDANA,RICARDO ' R B AIR CONDITIONED INC 2530 WEST 78TH STREET BUILDING C-BAY 1 1 HIALEAH FL 33016 a� ' ISSUED: 08/172014 DISPLAY AS REQUIRED BY LAW SED# L1408170001972 woa-aao( al.tVUMpuo ro•.1opua,VIa y ae aaeIla-WBP.uo X .Saa!na 1uauu03eue 3 o 1uauuxedoa alp l!s!A to laeuoa aua{d'a1111ua 1uaWWaA02 3191S pue Stopun uaaMlaq suonaelalm pawlweauls 1�n aney ya!ym sa!1!n!lae luawa�naad paz!Ieuuaa ap!.halers 3u!uoddns stool epuo{d_{o a1e1S lnoge lno pug oy Print 4/20/15 8:22 AM • J I i t Local Business Ta cPO Miami-Dade CI�u�itye State of FloridaIREGM"NO- ,. tVEXPIR ,�®USINE,Sr NAt4 VLOCr�filA,+l FkEN /+L SEPTIMBER 130* i0 ��qqIRry, ,��yyN�� gg�ry,���y RR 3737773 �^��,��J�4syu�1,1r4d.jj,PtR4'U Or RB�T17V 'V b1l'�1 7 ��IF4d�!'Y� - F ur.,iiw t t�,ou lw CDje 1,530 W S 6 5`T C-1 Chd;$tet 8A-A.4.'*qu HIA,EAH FL 33016 IVED REC.TYPE OF UU69tN ESS RV TAX Ci 46ECTCR ative� a 196 SPi C!!.1�C9�,�NI 't C ;:1 t: a 5 i /1 b�`201 a ALR Co%DiTimED NC CAC0571 o ECHECK,1 -139866 mat a9 tEra w"I BuUUM T°a The Receipt is no a tio"Se y 9 e tteltdlr ar9UN-1 c€rmp9-v uwilh Any t9 * - Th+ r9 6,U idr Receipt nu9X c w7fi{uar tot"algal PH11,1it,wra�ftcaliaeatefiablaOta%41,iririmi unwhi fitly �@t+wfiQdYe��a9 frcgulalc�rtt TLc RFCfIPT t5ily.agar®mutt bit d3pt�td 0j,Aft��n''m�rciaiM,�nra�ape Croda 5a�"TV* F"woo Jarmatium viilt w-4ww about:biank Page 5 of 5 � DATE(MM/DD/YYYY) S '� j� CERTIFICATE OF LIABILITY INSURANCE 4/20/2015 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, the policy(les) must be endorsed. H 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 lieu of such endorsement(s). PRODUCER 7 TA A&D ALL-LINES INS ASSOC INC PHONE305 463-6781 {305 387-2918 5600 SW 135 Ave Ste 106 IL salmactorTbellscutli.ae Miami, FL 33183 INSURER(S) AFFORDING COVERAGE NAIClt AMERICAN VEHICLE INS CO INSURED R.B. AIR CONDITIONED, INC. INSURER B: 2530 WEST 78TH STREET BLDG—C BAY-1 INSURER C, HIALEAH, FL 33016 INSURER D: 305-216-8895 INSURER F, 305-216-7766 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. LTR TYPEOFINSURANCEMIL Z& C IC LIMrrS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 T COMMERCIAL GENERt�ALLIABWTY num" 100,000 CLAIMS-MADE 0 OCCUR MED EXP one rt $ 5 000 A x GL0511056631 1/10/151/10/16 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE UMIT APPLIES PER: PROD CTS-COMPlOP AGG $ 21000,000 PRO- $ AUTOMOBILE LIABILITY COMBINED SINGLE IT lFaaccidantl ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY G $ AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'UABILITYIkfil I- YI TS ER ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N/A (wry In NH) E.L.DI EASE-EA EMPLOYEE 1$ NS bekw El.DISEASE-POLICY LIMIT IS K ,descxibe under DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AltaO ACORD IOI,Addiflonai RemmUs Schedule,if more space le required) AIR CONDITIONING INSTALLATIONS / SERVICE / REPAIRS CERTIFICATE HOLDER ALSO LISTED AS ADDITIONAL INSURED. MIAMI SHORES VILLAGE BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN 10050 NE 2nd AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI, FL 33138 FAB: (305)756-8972 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD N.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE F— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — RTANT STATE OF FLORIDA Pkseuent to 1 440AR14],FSS.an ofiiosr of a corporation DEPARTMENT OF FINANCIAL SERVICES who elects examoon bw tffis drapes by f V a eeraiscate of DIVISION OF WORKERS'COMPENSATION F ekmtkn under cis�n may not recover benefms or CONSTRUCTION INDUSTRY EXEMPTION X01 order .tles otkapter. O CWMV►te ot:&WTl n ro ee attW MU nr mm L Pu w chapbx44o.OR14 F.S,caw=tes cf decoon oo Wax0aw coww a UN tAW p ba apply�N vrelffir bre scope the 6usirkess or trade ERECT ME OATL 3HSMS EMMATION DATE: 3110=7 Dated on the notice of alecdon to be emnpt. PEReOlC FEMMHDEZ FEANANDO A e� FERNA�s H Purorrant to Chapter 440.0ki 3j,F.S,Not=of decdon to be E exempt and cites of ern to be exempt shau be subject BUS MSS NATE MID ADDRESS: R to revocalion if at arty tine ager the bung of the nodw or the R 6 AIR CONDITIONED INC E tasuamoe of the mate,the peri , rkarrred an the nodce or Ift,le no longw mmets the requhmterds of this section for �slamce of a oet�te.The deperinent shoo revoke a certi8r� 2530 WEST 78 ST BAY 1 at any dam for tauure of the person marred on the cwffltm to to MALEAM FL 33015 meet the requbornents of this section. SCOPES OF BUSNESS OR TRA EATING,VENTILATION, R-COND — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — DFS-F2-0V W,-=CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(&%0)413-1609 ININEV" Miami shores Village Building Department fiR 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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signamre4- --�____;_ Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,20 I By 1 U 21 C.LrL J_�e ICL who is personally known to me or has produced pZ D 9l D7 3,37-3-70(o-0 as identification. .....w MAYELIN D0Ml�lWEZ Notary: Notary Public-State al Florida cPr My Comm.Explree H 1F12017 Commission#t FF 054891 SEAL: •„��,,,,, Not*poic rare of Florida •'E \• • PMV1001MEXpire, Sep, 1&2017 COIOtia�11# �1n91 Company Letter Head Date:April 201h,2015 State of Florida County of Dade Before me this day personally appeared Ricardo Bendana who,being duly sworn, deposes and says: That he will be the only person working on the project located at 272 NW 111 TERR, Miami Shores,33167. Sworn to and subscribed before me this 20th day of April 2015.By Personally known Or produced Identification Type of Identification provided MAYELIN DOMiNBUEZ z Notary Public-State of Florida N My Comm.Expires Sep 16,2017 commission #FF 054691 Print,Type or Stamp Name of Notary Detail by Entity Name Page 1 of 2 a: i T, a Detail by Entity Name Florida Limited Liability Company ELITE HOME PARTNERS, LLC Filing Information Document Number L13000121593 FEI/EIN Number 37-1755159 Date Filed 08/28/2013 Effective Date 08/22/2013 State FL Status ACTIVE Principal Address 2300 W. 84TH STREET SUITE 602 HIALEAH, FL 33016 Changed: 02/05/2015 Mailing Address 2300 W. 84TH STREET SUITE 602 HIALEAH, FL 33016 Changed: 02/05/2015 Registered Agent Name&Address DE LA FE, RUBIDIA M 2300 W. 84TH STREET SUITE 602 HIALEAH, FL 33016 Address Changed: 02/05/2015 Authorized Person(s) Detail Name &Address Title MGR EHP ACQUISITIONS, LLC 2300 W. 84TH STREET, SUITE 602 HIALEAH, FL 33016 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/20/2015 Detail by Entity Name Page 2 of 2 Annual Reports Report Year Filed Date 2014 04/22/2014 2015 02/05/2015 Document Images 02/05/2015--ANNUAL REPORTF View image in PDF format 04/22/2014--ANNUAL REPORT View image in PDF format 08/28/2013-- Florida Limited Liability View image in PDF format Coovright 6 and Privacy Policies State of Florida,Depai4ment or State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/20/2015