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MC-15-2903 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-267227 Permit Number: MC-11-15-2903 Scheduled Inspection Date: September 19,2016 Permit Type: M chanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: LIBONATTI,ALEJANDRA Work Classification: A/C Replacement Job Address:689 NE 92 Street 11-G Miami Shores, FL Phone Number Parcel Number 1132060430270 Project: <NONE> Contractor: QUALITY BREEZE AIR CONDITIONING Building Department Comments AC CHANGE OUT Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-247955.'09/14/2016 BYISABEL Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 16,2016 For Inspections please call: (305)762-4949 Page 28 of 39 Miami Shores Village MAY 16 20,E , 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 20/4/ BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION [01EXTENSION [—]RENEWAL F-1 PLUMBING MECHANICAL E]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Len o:E '"I r�2 5�,Qe-� - 11 `C—[ 1 City: Miami Shores County: Miami Dade Zip: �-SJ 3,y� Folio/Parcel#: 11 !>70L-0 04?S 00}" Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ��//�� i OWNER:Name(Fee Simple Titleholder): f'+LIQ.�j a_ L 1CN� 0 I—L Phone#:5tD5 Address: K)E LP A� City: V�1 t�` � S�nt1`( -� State: ��- Zip: Tenant/Lessee Name: Phone#: Email: JD�Xl S CONTRACTOR:Company Name: Uj)_Xa iy e L �one#: _5 4/,5w(/ Address: 14 bLfS ; L Zv City: -i �CX_fyX'+ State: Zip: ' Qualifier Name: 773�;SL_is Phone#: State Certification or Registration#: CP-Uf7�01L_Dq�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 ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: A— Specify color of color thru tile: Submittal Fee$ Permit Fee CCF$ CO/ C$ Scanning Fee$ Radon Fee$ DBPR$ Notry$ Technology Fee$ Training/Education Fee$ Double Fe:$ 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 inspectio which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not pp v and a reins ection fee will be charged. Signatur Signature aa",-L OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The fod oing inst ment was acknowledged before me this 12- day of 20 /(,0 'by I�I day of t,-42�-J 20 I Le by -v �tl m ta,who is personally known to who is personally known to 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.:: ign. Pte,, Sign Print: Print: Sear MY COMMISSION t 007 Seal: *�*,dL ' °* My EMISSION#EEE 034507 EXPIRES:October 24,2016 IMM Tingsi9e EXPIRES:October 24,2016 udgeG►dotwY Services APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 'Ouallity 'Br . . ze . . MAY 16 2016 May 12, 2016 Village of Miami Shores Building Department Re: Permit#MC-11-15-2903 We would like to request an extension for permit number MC-11-15-2903. If we could get the permit extended for six more months, please. AC has not been replaced due to customers' personal situations. Thank you. i dest Regards, Jesus E uela Qualifier y nr aoa BABEL 0.LAN" a�;ye, +rt by COMMISSION#EE 684507 S ag EXPIRES:October r22,4,2016 117.1 l-30e BIXIN�1N B SEIYICBS DADE 305.559.4444 FAX 305-603-8155 TOLL FREE 1.888.393.5725 14345 SW 120 Street Miami, Florida 33186 WEE quality-breeze.com Suite # 104 , „ errrii`ivt Miami Shores Villageloe /#` ,. hanical-Residential 10050 N.E.2nd Avenue NE �A p...� � Wt3rkGlass�ftcatidtt A1C.R�rl�iel� Miami Shores,FL 33138-0000 ; •`ti' r� Phone: (305)795-2204 Permit Status;APO ioRm�► Isstr /17/2011119120,11Ex . ration: 05 Project Address Parcel Number Applicant 689 NE 92 Street Number: 11-G 1132060430270 ALEJANDRA LIBONATTI Miami Shores, FL Block: Lot: Owner Information Address Phone Cell ALEJANDRA LIBONATTI 10401 NE 6 AVE MIAMI SHORES FL 33138-2048 Contractor(s) Phone Cell Phone Valuation: $ 2,485.00 QUALITY BREEZE AIR CONDITIONIN( _...: Total Sq Feet: 0 Tons:2.5 Available Inspections: Additional Info:AC CHANGE OUT Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 DBPR Fee Invoice# MC-11-15-57790 $2.00 11/17/2015 Credit Card $50.00 $67.80 DCA Fee $2.00 Education Surcharge $0.60 11/19/2015 Credit Card $67.80 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 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 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. Futhermore,I authorize the above-named contractor to do the work stated. November 19, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Datei Building Department Copy L November 19,2015 r 1 Miami Shores Village Building Department NOV 17q 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 S01 FBC 20 P BUILDING Master Permit No. _ 2gO3 PERMIT APPLICATION Sub Permit No. BUILDING F-] ELECTRIC ROOFING REVISION F-1 EXTENSION EJRENEWAL ❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP p� p SA-Y-4? 1 CONTRACTOR DRAWINGS JOB ADDRESS: 0-I eve Q S`�' e-T -bl- // Q City: Miami Shores County: Miami Dade Zi 13: 3'S, Folio/Parcel#: I/ - __04?) o 3-4-c) Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Al stay- 1 r c.- L� 9,-Y- H� Phone#: Address: 10KTL- -alp - City: f-4 k ct_j-v�_A State: 4�7-L Zip: ?) / Tenant/Lessee Name: Phone#: Email: ii� CONTRACTOR:Company Name: �,-toJ T� << e e Z - C Phone#: �3r� - qqq q- Address: 5LO 12U ':� 44- !rte j City , State: 4-�_L Zip: 5-3 1 S-t 0 Qualifier Name: `3es"S Phone#: I`�d� � `+IL44q State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ i9y 8f of Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New �Repair/Replace ❑ Demolition Description of Work: �aC c(no,-n Lj e c>Lz+ Specify color of color thru tile: Submittal Fee$_ j\j® Permit Fee$ ` CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DU $ •�� ° (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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature f Signature L��,10,,cai OWNER or GENT NTRACTOR The foregoi instrument was acknowledged before me this The foregoing instrum nt was acknowledged before me this day of �°� 20 / by day of ® 20 l S by PA(kF1C `�1 � . ho is personally known to S Pk—� !�`.who is personally known to me or who has produced as W or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Sign: Print: �c'�jc� /�,cZr'1 r cl C—e) Print: a "*,v BABEL C.LANIGM Seal: MY COMMISSION 6 EE W507* * Seal: do EXPIRES:October 24 * * MY COMMISSION#EE 634507 2016 EXPIRES:October 24,2016 �0FP1Oa ftdadThmBudgelNot�Y$ervic� X19 t,Rwd0l' goaded Ttn Bu l Natwy Seng APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) KEIT LAVVWN,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION,INDUSTRY LICENSING BOARD r The°CLASSAAIR CONDITIONING CONTRACTO "7777-> N*Medbelow IS CERTIFIED- Under ERTIFIED-li r the prop Worts of Chapter 489 FS. � S tatidn°date:'AUG 31;20016 .ESPUELA,JESUS _ y. _ �■ 1.FyA�L G'BREE- - C?NING 1NC y � rte^r '� _ - � �� ��1a,.� ` • . 5 a kSSUED: 11A) Woes DISPLAY AS REQUIRED BY LAW SEQ1# L1511080001064 M MIAMI-DADE COUNTY -STATE OF FLORIDA WA October 13,2015 LOCAL BUSINESS TAX RENEWAL 5064241 2015 -2016 APPLICATION RECEIPT.5289392 STATE#CAC056694 DBABUSINESS NAME: BUS.COMMENCEMENT DATE:04/01/2003 QUALITY BREEZE AIR CONDITIONING INC SEC TYPE OF BUSINESS BUSINESS LOCATION: MECHS SPEC MECHANICAL CONTRACTOR 14345 SW 120 ST #104 2 MIAMI,FL 33186 OWNER/CORP. APPLICATION DETAILS QUALITY BREEZE AIR CONDTNG INC FEE AMOUNT PHONE#305-559-4444 Receipt Fee 30.00 UMSA Fee 30.00 14345 SW 120 ST #104 Beacon Council Fee 15.00 MIAMI,FL 33186 Bingo Permit Fee 0.00 Nightclub Permit Fee 0.00 Multi-Municipal Contractor Fee 0.00 Restricted Contractor Fee 0.00 Library Fee 0.00 Transfer Fee. 0.00 NAICS CODE: 238990 Doing Business without a License Penalty 0.00 Late Penalty 0.00 Collection Cost 0.00 NSF Fee 0.00 Prior Years Due 0.00 Amount Recently Paid - 75.00 FTOTAL AMOUNT DUE: 0.00 ......»............................................................................................................................................................................................................................................................................................... If no longer In business,please notify us in writing. To pay online go to wrww.miamidade.gov/taxcollector Review and correct the information shown on this application. To pay by mail,make check payable to: Miami-Dade County Tax Collector A 25%penalty will be assessed to anyone found operating Business Tax without a paid local business tax,in addition to any other 200 NW 2nd Avenue penalty provided by taw or ordinance(Sec 8A-176(2)). Miami FL 33128 To pay in person go to: A Certificate of Use and/or City Business Tax 200 NW 2nd Avenue Receipt may also be required. (305)270-4949,fax(305)372-6368 A service fee of not less than$25.00 up to a minimum of 5% will be charged for all returned checks. t RETAIN FOR YOUR RECORDS t ...........«..«................................................................................................................................................................................................................................................................................................ MIAMI-DADE COUNTY- DETACH HERE AND RETURN THIS PORTION WITH YOUR PAYMENT + N/A October 13,2015 STATE OF FLORIDA LOCAL BUSINESS TAX RENEWAL 2015 -2016 APPLICATION RECEIPT. AETE#CAC056694 5064241 BUSINESS LOCATION: 14345 SW 120 ST #104 MIAMI,FL 33186 BUS.COMMENCEMENT DATE:04/01/2003 SEC TYPE OF BUSINESS OWNER/CORP. MECHS SPEC MECHANICAL CONTRACTOR QUALITY BREEZE AIR CONDTNG INC 2 APPLICATION IS HEREBY MADE FOR A LOCAL BUSINESS TAX RECEIPT OR PERMIT FOR THE BUSINESS PROFESSION OR OCCUPATION DESCRIBED HEREON.I HAVE BEEN INFORMED OF ALL ZONING RESTRICTIONS IMPOSED ON THIS RECEIPT. 1 SWEAR THAT THE INFORMATION IS TRUE AND CORRECT. QUALITY BREEZE AIR CONDTNG INC NESTOR MAYORAL PRES 14345 SW 120 ST #104 SIGNATURE REQUIRED SEE INSTRUCTIONS ABOVE MIAMI,FL 33186 Please pay only one amount.The amounts due after Sept 30th Include penalties per FS 205.053. H Rere/ved By Oct 31,2015 Nov 30,2015 Dec 31,2015 Jan 31,2016 Please Pay $0.00 $0.00 $0.00 $0.00 70000000000000000000000052893922016000000075000000[10000006 Oct. 27, 2015 11 :06AfR'riFiCgTE OF LIABILITY i No, 1211 DAIP �roatYYl NSURANCE PRODUCER First If161IIHnCe Group �Urznls THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 10967 SW 40 St ONLY AND CONFERS NO RIGHTS Upi THE CERTIRCATE Mlami,FL 33165 HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE Phone OM)221-7878 Fax (305)554-7080 fNsURERS AFFOR�D1Na c�oVE ERrgpRDk?d BY THE POLI S EL NAIC# INSURED QUALITY BREEZE AIR GOND INC INSURER A. UNITED SPECIALTY INS. 14345 SW 120 STREET SUITE 104 INSURER B: MIAMI FL 33186 INSURER C- INSURER COVERAGES INSURER E: THE ROUGES OF INSURANi'.E LISTOp HgVg BEEN ISSUED TO THE INSURED NAMED ABp pOR THE POLICY PERIOD WDIOA NDTiMTHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY Pl;RTAW.THE INSURANCE AFFORDED BY THE POUOIES DESCRIBED HEREIN IS SUBJECT TO ALL THE POLICIES.AGGROWN MAY TERMS.EXCLUSIONS AND CONDITIONS OF SUCH EGATE LW07 S SHHAVE BEEN REDUCED BY PAID CLAMS. INSR ADM TYPE OF INSURANCE POLICY NUMBER C LICY EFFECTroB bPol E?WMTIDAI GENERAL LIASIRM LIMITS © COMMERCMI.GENERAL LABILITY EACH OCCURRENCE 1,000,000 0❑CLAIML4 MADE ❑ OCCUR 6111006B17743 09123!2015 09/23/2016 PREMISES ocaunenae 1,000,000 A ® MOD III(Any are penin (j5,000 f-1PERSONAL$ADV BURY 1,000,000 iAll. GENERALAGGREGATE 2,000VL POLICY PRRE❑l n OJECT [J LOC LIMIT APPLIES PER: PRODUCTS-COMFIOP AW 2,000'000 POLI ,000 )TOMOBILE LULBILrry ❑ ANYAUTO COMB INED SINGLE UNgT ❑ ALL OWNED AUTOS 0-1 1danfY ❑ ❑ SCHEDULED AUTOS BODILY INJURY ❑ MIRED AUTOS (Per Dorso" ❑ NON OWNED AUTOS BODILY INJURY ❑ (Perscaident) 10 PROPERTY DAMAGE GARAGE LIABILITY Peracallifam ❑ ❑ ANY AUTO AUTO ONLY•EA ACCIDENT ❑ OTHER THAN EA ACC AUTO ONLY. AGG L SS/UMBRELLA LABILITY EACH OCCURRENCE' CCUR Il CLA mMADE AGGREGATE DUCTIBLE TENTION $ 1 WORKERS CXIMPENSATION ANO EMPLOYERS'UNSILITY WC3 ❑ ANY PROPRIETOR I PARTNER/EXECUTIVE YIN H- OFMER I MEMBER EXCLUIJ E.L.EACH ACCIDENT (Man[fps.d cli In undo E.L.DISEASE t EA EMPLOYEE ByeS describe r 3PECAL PROVISIONS below �E;L.DISEASE•POLICY LIMIT OTHER t 6 DESCRIPTION OF OPERATION$!LOCATIONS/VEI(ICLEB I BY GENERAL LIABILITY. ENrrsPECALPRovIsiDN8 LIC#CAC050694 10987 BIRD RD tAham FL 33166 305 2217878 CERTIFICATE HOLDER CANCEU ATION MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORp THE OMRAT ION DATE.THEREOF,THE ISSUING INSUR�t WILL ECELLE DB R M T MIAMI SHORES VILLAGE BLDG DEPT 30 DAYS WRITTEN NOTICE TO THE INSU TE FIOLDfSR IOR T 10 10050 NE 2 AVENUE TME LEFT,BUT FAILI TO DO SO SHALL IMPOSE7FdEPkESJEmTATNM OBLIGATION OR LIABILITY MIAMI SHORES, FL 33138 OF ANY KIND UPON THE INSURER,ITS AGENTS OR . AUTHOR;D;Bp REPRESBNTATIitE �,�,�•„� ACORD 26(20091a1j QF 1888.2008 ACORD II 1111111, TION.AO rights reserved. The ACORD name and iogo Are 1`e9111stered marks of ACORD 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 taw. EFFECTIVE DATE: 7/22/2014 EXPIRATION DATE: 7/21/2016 PERSON: ESPUELA JESUS FEIN: 223881902 BUSINESS NAME AND ADDRESS: QUALITY BREEZE AIR CONDI' 13889 SW 140 STREET MIAMI FL 33186 SCOPES OF BUSINESS OR TRADE: HEATING,VENTILATION, AIR-GOND Pursuant to Chapter 440.115(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 exempL..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 certtficates 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 certificate at any time for fwwre of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)413-1609 .,.. u,„ Miami hores Village Building Department rARI> 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption 'gir6'i R r fi ���°s ����sll��du��t� 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 mbers are allowed to be exempt. Construction exemptions are valid for a period of two years or until a' voluntary revocation is fled 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 be 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 IAND UNDERSTAND ITS CONTENTS. Signature: i74�2 � Ower State of Florida County of Miami-Dade The foregoing was acknowledge before me this 2 y day of 0C-t06e'(- 20 )F . �p � � C By I�c a��.��� 6d)') l who is personally known tome or has produced as identification. Notary. SEAL: * * MYOOMMISSION f EE 834507 P R EXPIRES:October 24,2016 Bonded Th BWpt Notary Smm Duality . . Date: October 27, 2015 State of Florida County of Miami Dade Before me this day personally appeared -Ie-5.ls �. aolj'�z "7—)reeek who being sworn, deposes and says: That he will be the only person working on the project located at: LP Sworn to (or affirmed) and subscribedb ore me this Z(y- day of C7c� Pam , 2015, by �e-SUS H CA.UY-r' Personally Known X Or produced identification Type of identification Produced LUBIEL C.Loom * * My COMMISSION#EE 834507 EXPIRES;October 24,2016 Print,type or Stamp Name of Notary DADS 305.559.4444 FAx 786.573.4366 TOLL FREE 1.888.393.5725 14345 SW 120 Street, Suite104 Miami, Florida 33186 WEs quality-breeze.com A logo UM" Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. 'COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Halder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number, u eeeeeeeeeee■■se•■eeeeeeeeeeeeeeeeeeeeeeeeeee■•eeeee■■ee■■eee■■eeeeeeeeeeeeeeeeeeeaseeeee BUSINESS NAME: ��--SC -±L-iO4 BUSINESS ADDRESS: I`f �� 12 ��- CITY He <.l-� STAT �C ZIPS f BUSINESS PHONE: ( 505 ) 6F7c1 ` LfqqY FAX NUMBER( )_ - Iy l CELL PHONE2lj 2q 01 `+-3-U5 QUALIFIER'S NAME: -1-e 3U,S � Lte QUALIFIER'S LIC NUMBER: C)acC) `- Prepared din CFH 217-1 15-R i 6�0 o_11_t.".... Steve Medina HBG Title Company OR BK 29826 P3 1091 i 1Ps s i 11120 N.Kendall Drive,Suite 207 RECORDED 10/23/2015 09:46t10 Miami.Florida 33176 IkED DOC TAX $690.00 HARVEY RtJVINt CLERK OF COLIRI Ric Number: 15-09-018 MAI'll-••DARE COIJNTY? FLORIDA General Warranty Deed Made Ibis September 30,2015 A.D.BY Geerge Swede,a dmfs man,hrdividoaily and as Trustee of the Katherine Swede Revocable Living Trust dated Mardi 12,2012,whose address is:3636 Angela Robin Street,Suite 101,Las Vegas,NV 89129;hereinafter called the raptor,to Tosca Eyherabide,and Alejandra Libousui,whose post office address is:�b�Q��'�?�j, ` ' �C � ' ,hereinafter called the grantee: tWbanever saccihercia the term"gmmat"and"grantee inchtde all the Parties to this inpnumntt and the behs,legal representatives ead assips of individuals,and the avcceaams and assigru of rmparatim) WhilesSedy that the grantor,for and in consideration of the stun of Ten Dollars,{$10.00}and other valuable considerations, receipt whereof is hereby acknowledged,hereby grants,bar§ems,sells,aliens,remises.releases,convoys and confirms tmto the grawce. all that certain land situate in Mia mi-dads Courtly,Florida,viz: Unit I I-G of Shores Plaza West Condominium,a Condominium,according to the Declaration of Condominium thereof,as recorded In Official Records Book 8442,Page 1292,of the Public Records of Miami-Dade County,Florida,and all amendments thereto,together with Its undivided interest in the common elements. Pamet ID Number.11-32416-043-0270 Together with all the tenements,hereditaments and APPu tenames thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee ' le;that the grantor has good right and lawfiil authority to sell and convey said land;tient the grantor hereby folly warrants the title to Said d and will defend the sane against the lawful claims of all persons whomsoever,,and that said land is free of all encumbrances cept taxes accruing subsequent to Docember 31,2014. to Witness Whereof, the said grantor has signed and sealed these presents the day and year first above written, Signed,sealed and delivered in ourprese nce: ,.''`� 'ti/� `f1. ;(.:£;y'la'(. •� c4'1 J-` .f' C oC_ (Seal) Y v $ vidualty and as Trustee of the Katherine Wt-.P,;aed Name jr Revocable Living Trust Dated March 12.2013 Adams:3636 Angela Robin Street,Suite 101,Las Vegas,NV 89129 fSeal) State of Florida County of Miami Dade The foregoing mArumcat was acknowledged before rite this 30th day of September,2015,by George Swede,individually and as Tntvtec of the Katherine Swede Revocable Living Trust dated March 12,2013,who is/are personally known to roe or who has produced Driver's License as identification. Y(i9f �.�.� / Bary Pahae. `+� � Print Name• '7v,vt My commtsalea Eaplses: t 6 DONNA M.BIERNACKI NOTARY PUBLIC,STATE OF NE10 YORK DEEM btdividval Watraaty Deed-Legal on Faw NO.01816065707 QUALIFIED IN NASSAU COU TY COMMISSION EXPIRES IN 10128)2012 Property Search Application- Miami-Dade County Page 1 of 2 OFFICNOF APPRAINAftER Summary Report Generated On: 10/27/2015 Property Information Folio: 11-3206-043-0270 Property Address: 689 NE 92 ST 11-G KATHERINE SWEDE TRS Owner KATHERINE SWEDE REV LIVING TRUST KATHERINE SWEDE 3636 ANGELA ROBIN ST#101 Mailing Address LAS VEGAS, NV 89129 Primary Zone 3000 MULTI-FAMILY-GENERAL " __...-_ ....... .....--- -- 0407 RESIDENTIAL-TOTAL Primary Land Use VALUE:CONDOMINIUM- RESIDENTIAL Beds/Baths/Half 0/0/0 Floors 0 Living Units 1 Actual Area Sq.Ft Taxable Value Information Living Area 789 Sq.Ft 2015 2014 2013 Adjusted Area 789 Sq.Ft County Lot Size 0 Sq.Ft Exemption Value $25,000 $25,000 $25,000 Year Built 1949 Taxable Value $16,927 $16,595 $15,981 Assessment Information School Board ...._. _ Exemption Value $25,000 $25,000 $25,000 Year 2015 2014 2013 Land Value $0 $0 $0 Taxable Value $16,927 $16,595 $15,981 Building Value $0 $0 $01 City Exemption Value $25,000 $25,000 $25,000 XF Value $0 $0 $0 - - Taxable Value $16,927 $16,595 $15,981 Market Value $98,180 $93,500 $55,000 Regional Assessed Value $41,927 $41,595 $40,981 Exemption Value $25,000 $25,000 $25,000 Benefits Information Taxable Value $16,927 $16,595 $15,981 Benefit Type 2015 2014 2013 Sales Information Save Our Homes Assessment Cap Reduction $56,253 $51,905 $14,019 Previous Price OR Book- Qualification Description Sale Page Homestead Exemption $25,000 $25,000 $25,000 Corrective,tax or QCD;min r cond Homestead Exem tion $0 $0 $0 03/18/2013 $100 28535-1328p consideration te:Not all benefits are applicable to all Taxable Values(i.e.County, 2008 and prior year sales;Qual by hool Board,Cit , Re tonal . 05/01/1982 $46,000 11449-1625 y g exam of deed 2008 and prior year sales;Qual by 06/01/1979 $31,500 10436-2154 Short Legal Description exam of deed SHORES PLAZA WEST CONDO 03/01/1979 $28,400 10340-0899 2008 and prior year sales;Qual by UNIT 11G-2ND FLOOR BLDG 2 exam of deed UNDIV.03690%INT IN COMMON ELEMENTS CLERKS FILE 73R-213196 Tha()ffira of tha Prnnarfv Annraicar i�rnntinimlly adifino and tindMinn tha tax roll Thic wPhcitP may not raflart tha mnct ri irrPnt infnrmatinn on ranord Tha PrnnPrfv Annraicar http://www.miamidade.gov/propertysearch/ 10/27/2015 2a0 3 �� FF �S OREy� 11��`'' " ' Miami Shores Village NOV 17 2015 Building Department Big post" IF 10050 N.E.2nd Avenue Miami re iDA ;:�r f �' el: ( 5)7 5.2 4 a 05) 6.8 2 AIR CONDITIONING REPLACEMENT DATA z PERMIT NUMBE :� C ® w c� This form must accompany ALL air conditioning replacement permit applications. Each ung han e be on its own data sheet.Multiple units on single sheets are not acceptable. a _ � Job Address(where the work is being done): 1P yq � City: Miami Shores Village County: Miami Dade Zip Code:j' a � I ° o ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CO Clli-T'E� o 0 ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION z w A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS Z ® c AHRI DATA SHEET REQUIRED Change disconnecting means:YES❑ NO KARHI Sheet Attached:YES$ NO❑ Contract Attached:YES UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER i —t- AHU or PKG.UNIT MODEL# gJ ` r7 COND.UNIT MODEL# It 61lipi A 030 KW HEAT NOM TONS AHU CU PKG 1)M.C.A AHU CU1-5 PKG AHU CU PKG 2) M.O.P AHU' CU PKG AHU`L aU ZOKG 3)VOLTS AH CU ZWKG PKG UNIT / / PKG UNIT 0 t11 EER/SEER YES NO REPLACING DUCTS Y N YES NO REPLACING THERMOSTAT YES NO YES NO NEW 4"CONCRETE SLAB OtS NO YES NO NEW ROOF STANDYES N YES NO NEW RETURN PLENUM BOX YES N 1. Minimum Circuit Ampacity(Wire Size): Ihl�g 2. Maximum Overcurrent Protection (Fuse/Breaker Size): c� ��y•"I ... .. 3. Voltage of Circuit(208/240/480): 1 _® ••� 0 see 4. Size Disconnecting Means: -t uf,h e �• �•� f�' � Contractor'sComp y Name. C�y�c eC e E:••1•C Phone: 4 49 State Certificate or gistration No.CA��. �. Certificate of rom etenc No. so 00 P Y Signature 40 ••• • Date: a�' /5 (Qu i atu-) ••• • • • • ••• • • ••• • • • ••• • • (Rev1sed02/24/2014) ® This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17,2009 and Dec 31,2014. P&*,a,&duct Ratings Certificate U-P-11 AHRI Certified Reference Number: 6946487 Date: 10/28/2015 Product: Split System: Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number: 116BNA030****A Indoor Unit Model Number: FX4DN(B,F)037L Manufacturer: BRYANT HEATING AND COOLING SYSTEMS Trade/Brand name: BRYANT HEATING AND COOLING SYSTEMS Region: Southeast and North(AL,AR, DC,DE, FL,GA, HI, KY, LA, MD, MS, NC,OK,SC,TN,TX,VA AK,CO, CT, ID, IL, IA, IN, KS, MA, ME, MI, MN, MO, MT, ND, NE, NH, NJ, NY,OH,OR, PA, RI,SD, UT,VT,WA,WV,WI,WY, U.S.Territories) Region Note: Central air conditioners manufactured prior to January 1,2015,are eligible to be installed in all regions until June 30,2016. Beginning July 1,2016,central air conditioners can only be installed in region(s)for which they meet the regional efficiency requirement. Series name: LEGACY LINE PURONAC i J Manufacturer responsible for the rating of this system combination is BRYANT HEAVING AND COOLING SYSTEMS Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third party testing: Cooling Capacity(Btuh):, 28800 EER Rating(Cooling): 13.00 SEER Rating (Cooling): 16.00 IEER Rating(Cooling): Ratings followed by an asterisk(*)indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. •• ••• • • DISCLAIMER • • • • •• • •• • • ••• AHRI does not endorse the product(s)listed on this Certificate and 1 kes no itpre*Rtafone,vmrmties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all Ilakility to:dv:nates pf dny$fha arisihS out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified rAt*igs av*mlld a*forenodals and configurations listed In the directory at www.ahridlrectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRLeThis GwWcate shay orpylye used fgrJngvWal,personal and confidential reference purposes.The contents of this Certiflcate4m*not•in whole or4n past,be reproduced;wopled;disseminated; entered Into a computer database;or otherwise utilized,in any I'ojrli or 4annW or W%ny rbeang,excIpt forshe user's individual, AM personal and confidential reference. • •• • •• •• •• AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION 000 • 000 • • • &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verify Certificate"link Ave make life better- and enter the AHRI Certified Reference Number and the date on which the certificate was Issued, which is listed above,and the Certificate No.,which Is listed at boriEifi4igNL • • • ••• •. ©2014 Air-Conditioning,Heating,and Refrigeratio•In•It to CERTIFICATE NO.: 130905361874826228 ESTIMATE CONTRACT ,--00 U ityy 10/8/2015 0000022402 0000230 Breeze AIR CONDITIONING is Quality Breeze A/C Bruno Libonatti Alejandra Libonatti -Mother www.quality-breeze.com 10343 Ne 6th Ave 689 HE 92 Street Email: info@quality-breeze.com Miami Shores FL 33138 11 G Toll Free: 1-888-393-5725 Miami Shores FL 33138 Ph. 786-200-4774 Ph. : . +4N t ECE 1.00 1311630FB4CNF BRYANT 2.5 TON 2,485.00 2,485.00 MODEL#116BNA0/FB4CNF0/8 KW HEATER/DIGITAL PROGRAMMABLE THERMOSTAT DIMENSIONS: SINGLE STAGE 1.00 XTDWTY10-10-5 Extended Warranty 10 Compressor-10 Parts-5 Labor Please check if u want to add it INCLUSIONS • Hurricane be downs for exterior compressor • All labor, materials and supervision • Disposal of old system • Emergency flow switch • New drainage with t-cap to pour clorox • This Solo is g amted ac=ding to Flarida Building Code EXCLUSIONS • Any wall or ceiling patchwork,painting • Any damage cause for water leaked,per existing drainage line • Any closet or door modification • Any electricity job/changes RECOMMENDATIONS • Clean or replace air filter monthly • Louvered door for closet(a✓h locate} • . .• • Clean existing drainage line(clor®x)•o: • Yeasty segula,maintenan�g�'�p anWrecamma�nqukko►s) • Any electricity job/changes • .. 0 . •. .. .• ••• • • • o ••• • • • • • • • • • • • • • •• o• • • • •o •• ESTIMATE I CONTRACT Page 2 ,0-- uanty qtz�:� 101812015 0000022402 0000230 Breeze AIR CONDITIONING 19 Quality Breeze A/C Bruno Libonatti Alejandra Libonatti -Mother www.quality-breeze.com 10343 Ne 6th Ave 689 NE 92 Street Email: info@quality-breeze.com Miami Shores FL 33138 11 G Toll Free: 1-888-393-5725 Miami Shores FL 33138 Ph. 786-200-4774 Ph. �6 )M�ON tlPt 4,W� Notes: Open Balances must be paid in full after Installation is completed.All materials are guaranteed to be as specified.All work to be completed in a professional manner to standard practices.Any alteration or deviation from the above specifications involving extra cost will be executed only upon written orders, and will become an extra charge over and above the estimate.All agreements are contingent on strikes,2009 accidents or delays beyond our control. Homeowner must carry fire,flood and any other necessary insurance. QUALITY BREEZE is not responsible for regular maintenance issues such as water leaks, plugged drains,dirty filters, blown fuses,electrical surges or acts of nature. This proposal may be withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices,specifications,and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified above. Payment will be made as outlined,and I ustand that should I cancel this contract;a 15%cancellation fee will be* 01po d. Client's Signature: rid1w, Clients Name(print): � f , ra-j Date: A5 so: : : • : : a a 0 Email Address: V: FPL ACCT: 00 0.: :* :06 :0 :0 :0 0:0 • : : 040 0 0 0 TOTAL $2,485.00