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RC-15-1333 _��r4r ° ' ;, y � 1 x j�l y. �, .1• t�11 � ,,F;' e j `' '�. a r �,. �e X� Y ,��� 'F��4 a � ..,,�;, e" •�'� '^•° �r«.:L�y � `..i ..v >t ,.r � l. '�Tr+�`� ' a r:.t. :�+.. �Pd.:� �4 _ a.n`. `. ! 1,-,q,.� -�f.'e _ti'^�' i i - j=� - .r*` '#. ,�*A� ,µ a .'��- ,�;, . ;,i'�" .�-.S.r,y .y.t'��" a :i,:-�• s.,�,y. _ a'_�L'_•�• h '�i;,;,�J, ►5 _ .!ol - - , ".i7/:�, _'a,.�, .-z 1` � mgr¢ - -: =ta� .�' -+�.r��� .W+�.. .•' - _ � - 5ti``i � ti � <. Certificate of Completion t a� Miami Shores Village ; 10050 NE 2 Ave, Miami Shores FL, 33138 ' Tel: 305-795-2204 Fax: 305-756-8972 Building Inspection Department f This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following: Permit Type RESIDENTIAL CONSTRUCTION Bldg. Permit No. RC-6-15-1333 r uQ Owner STEPHANE FERNANDEZ Contractor VPG CONSTRUCTION MANAGEMENT LLCM Subdivision/Project NONE Date Issued 09/13/2016 h Occupancy , . Construction Type VI Load NIA . � . Ay�jl1_ Square Footage 1500 Ocpce pancy Rte ., Description of INTERIOR RENOVATION Applicable Code a r � Work 2014 FLORIDA BUILDING CODE �;�� Location Flood Zone X F.F.E NIA j 1148 NE 105 ST j f W. Miami Shores FL 33138 ORf ! I � tiR e .... ■■■■■M Building OfficialsApprov Ismae aranjo, B � :4% Not Transferable �h � . ��f" �ZpR'1DA POST IN A CONSPICUOUS PLACE' t r- r St.7. ..a'� �-- r,�y��: '-90 �:v---,. k.�- 7f'.,+cr.��... e.aro. 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Or'if�'+ ,p. �,�^'r'.,dt,,�, 1'e!'J�r ;;.t� 7b° 7, n Piz+ l`- � ^11'i..'e �'.�°il�*yr,�,,4�. d h��ter ri.�, c S'�j•�JS�'�T�1Hl'�'+�.� '�i;siR':�ti A .,�Y �-• •���4/,y °6.} ff. � •,� �s '� rr��-ki � ;' 4" .�ly.�,�-1^¢�Ln� ii R 1,r i�•�° * P �° g ��"{'�i�,w S ttt - - .�"^L: .g._«. ___ -.�•_ i����-�r' .. - ��L�'.� _b�RM .' -.. F�1+2 4IYS'- ^�_ a� �ss$� TM.�y��� � �+�rs���. JI Uv�(6,T�Y_rfi .cccyl 93 qyJq I .... ® .....� Miami Shores village Building Department FLORIDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CERTIFICATE OF OCCUPANCY/COMPLETION CHECK LIST Building permit card. ❑ Surveys (2 copies) Final as built- Required Items: Elevations of buildings showing all intended setbacks from property lines and other existing structures. Ingress+ Egress, required parking spaces, Wheel stops, stripping, and all paving to exterior. ❑ Certificate of Elevation—(Sealed by surveyor). Expiration date required on the form. ❑ Certificate of Insulation. ❑ Certificate of Soil Treatment(Final treatment-original)\ CHAPTER 2913-5 TERMITE PROTECTION: "This Building has received a complete treatment for the prevention of subterranean termites. Treatment is in accordance with the rules and law as established by the Florida Department of Agriculture and Consumer Services." ❑ Health Department Approval Letter(On septic or private water). Note: If the house is on septic tank, approval letter is required from Health Dpt. ❑ Soil Compaction Letter(Density report is required) ❑ Final certification letter from the Engineer/Architect(on masonry, trusses, special structure, etc) ❑ Backflow preventor certificate (Required on commercial projects only) ❑ Declaration of use. (Recorded in Miami-Dade Clerk of Courts) PLEASE NOTE THAT THE SAME ITEMS ARE REQUIRED FOR TEMPORARY CO • Emergency CO (Without 24 Hrs Processing)Additional fee is$80.00. • Temporary CO (Up to 90 days max)$75.00. • Residential CO$150.00 / • Residential CC$50.00 • Commercial CO and CC$200.00 �•-�� ih INSPECTION RECORD POST ON SITE Permit NO. RC-6-15-1333 o`'NR' y, Miami Shores Village , P €�riti� rtstttilct�i: 10050 N.E.2nd Avenue � nw Miami Shores,FL 33138-0000 +laic �ergtl+i Phone: (305)795-2204 Fax: (305)758-8972 �torttut' Issue Date:9/29/2015 J J 1 Expires: INSPECTION REQUESTS: (305)762-4949 or Log on at https://bldg.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 #:11223iy�80140 Owner's Name:STEPHANIE FERNANDEZ Owner's Phone: Job Address: 1148 NE 105 Street Total Square Feet: 1500 Miami Shores. FL Bond Number: 2855 Total Job Valuation: $ 15,000.00 WORK IS ALLOWED MONDAY THROUGH SATURDAY, 7:30AM-6:OOPM.NO WORK IS ALLOWED ON Contractor(s) Phone Primary Contractor SUNDAY OR HOLIDAYS. RESTLESS RESTORATION LLC (914)325-4383 Yes BUILDING INSPECTIONS ARE DONE MONDAY THROUGH THURSDAY. ROOFING INSPECTIONS ARE DONE MONDAY THROUGH FRIDAY. NO BUILDING INSPECTIONS DONE ON FRIDAY. NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED. PLANS ARE READLY AVAILABLE. IT IS THE PERMIT APPLICANTS RESPONSIBILITY TO ENSURE THAT WORK 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 RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. INSPECTION RECORD STRUCTURINSPECTION 'DATE INSP INSPECTION ZONING DATE INSP INSPECTION PLUM=ING DATE INSP Foundation Zoning Final StemwallZONING COMMENTS Rough Slab Water Service Columns(1st Lift) 2"d Rough Columns(2nd Lift) Top Out Tie Beam Fire Sprinklers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors ELECTRICAL Gas Interior Framing INSPECTION DATE INSP LP Tank Insulation Temporary Pole Well Ceiling Grid 30 Day Temporary Lawn Sprinklers Drywall Pool Bonding Main Drain Firewall Pool Deck Bonding Pool Piping Wire Lath Pool Wet Niche Backflow Preventor Pool Steel Underground Interceptor Pool Deck Footer Ground Catch Basins Final Pool Slab Condensate Drains Final Fence Wall Rough HRS Final Screen Enclosure Ceiling Rough Driveway Rough PLUMBING COMMENTS Driveway Base Telephone Rough Tin Cap Telephone Final Roof in Progress TV Rough Mop in Progress TV Final 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 Service Work With Floor Elevation Survey Ventilation Rough Reinf Unit Mas Cert ELECTRICAL COMMENTS Hood Rough Insulation Certificate Pressure Test Spot Survey Final Hood Final Survey Final Ventilation Truss Certification Final Pool Heater STRUCTURAL COMMENTS Final Vacuum MECHANICAL COMMENTS INSPECTION DATE INSP Final Sprinkler Final Alarm Oct.08/RV 8/31/09 r Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-266137 Permit Number: RC-6-15-1333 Scheduled Inspection Date: August 26 2016 Permit Type: Residential Construction Inspector, Q e el `vq Inspection Type: Final Building Owner: FERNANDEZ,STEPHANE Work Classification: Alteration Job Address:1148 NE 105 Street Miami Shores, FL Phone Number Parcel Number 1122320280140 Project: <NONE> Contractor: VPG CONSTRUCTION MANAGEMENT LLC Phone: (786)763-6643 Building Department Comments DEMOLITION OF DIVIDING WALLS(KITCHEN). Infractio Passed Comments ELECTRICAL PANEL RELOCATION, BATHROOM INSPECTOR COMMENTS False REMODEL. WOOD FLOORS RESTORATION, CEILING LIGHTING INSTALLATION. Inspector Comments Passed 0 Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid August 25,2016 For Inspections please call: (305)762-4949 Page 29 of 36 l➢~ Miami Shores Village �� R�dential113R 10050 N.E.2nd Avenue NE 00, Miami Shores,FL 33138-0000 Phone: (305)795-2204 1% ..-� Expiration: 07/06/201 Project Address Parcel Number Applicant 1148 NE 105 Street 1122320280140 Miami Shores, FL Block: Lot: STEPHANE FERNANDEZ Owner information Address Phone Cell STEPHANE FERNANDEZ 1148 NE 105 Street MIAMI SHORES FL 33138- 1148 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 151 00.00 VPG CONSTRUCTION MANAGEMENT (786)763-6643 Total Sq Feet: 1500 RESTLESS RESTORATION LLC (914)325-4383 Approved:In Review Available Inspections: Comments: Date Approved::In Review is ellaneo Type: Miscellaneous MM'0'0' Date Denied: Miscellaneous Type of Construction:DEMOLITION OF DIVIDING WALLS Occupancy:Single Family Drywall Screw Stories: Exterior: Drywall Screw Front Setback: Rear Setback: Drywall Screw Left Setback: Right Setback: Footing Bedrooms: Bathrooms: Footing Plans Submitted:Yes Certificate Status: Fill Cells Columns Certificate Date: Additional Info: Final PE Certification Window Door Attachment Bond Return: Classification:Residential Framing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Insulation Bond Type-Owners Bond $500.00 Window and Door Buck CCF $9.00 Invoice# RC-1-16-58259 Review Planning Change of Contractor Fee $75.00 01/12/2016 Credit Card $83.00 $0.00 Review Electrical CO/CC Fee $50.00 Bond#:2855 Review Electrical DBPR Fee $6.75 Invoice# RC-6-15-55809 Review Electrical DCA Fee $6.75 06/02/2015 Credit Card $50.00 $1,666.50 Review Building Education Surcharge $3.00 09/29/2015 Credit,Card $1,666.50 $0.00 Review Building Notary Fee $5.00 Review Building Notary Fee $5.00 Bond#:2855 Review Building Permit Fee $450.00 Review Building Plan Review Fee(Engineer) $80.00 Review Structural Plan Review Fee(Engineer) $120.00 Review Mechanical Scanning Fee $24.00 Review Mechanical Scanning Fee $3.00 Review Plumbing Technology Fee $12.00 Work without Permit Fee $450.00 Review Plumbing Review Structural Total: $1,799.50 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 FIDAVIT: I tify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru . n a d zoning. th ore,I ut orize the above-named contractor to do the work stated. Jantlery 12,20/1 1 ,� • ����'�- t Miami Shores Village r Cir Building Department JAN Q0 2,01E 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 N J BUILDING Master Permit No. 1?(i— PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 7/cs 116 /05 slae/ City: Miami Shores County: Miami Dade Zip: ✓9169 Folio/Parcel#: //223202A0140 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Slee/? ne t/e�����`�� Phone#: -,,'-t;2 ` k6 IPV 6LZ fl Address: 6 V 6 `05 17/reea - City: 11111Q?m; sA✓` ej State: 7C L Zip: 6.3 1.38 Tenant/Lessee Name: Phone#: Email: /� CONTRACTOR:Company Name: V>PC p06712 J'j}'W,-&?r7 /i�®s�C19�W40tt l Phone#: 6J06 - 76.3 —X0,641.3 Address:-&no ST City: State: Zip: L Qualifier Name: Ze� l�Gt��ce<60S2Phone#: *7,'b- State Certification or Registration#: C 6? C 1✓G 2✓ j-T 4M Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 16,0000 Square/Linear Footage of Work: I9 500 U Type of Work: ❑ Addition ❑ Alteration // F-1New / ❑ Repair/Replace ❑ Demolition Description of Work: /W4' /O/7 O1 dlV'046n 9 waif a!7Jc4ev7), eleclyi&e 04140(1,e C-4 bal4apr M Y2/Y Ael , gweop .Rm✓ Specify color of color thru tile: Submittal Fee$ Permit Fee$' •(� CCF$ CO/CC$ Scanning Fee$ J • 01Z) Radon Fee$ DBPR$, Notary$ 63 Technology Fee$ Training/Education Fee$_ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ a CO (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 Signature O or AGENT /CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day o /I 20 , by day of 4101 20 /G • by / who is personally known to I "7 5:,G ir�l4 ho is personally known to me or who has produced L as me or who has produced c.__._. as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Sign: Print: Seal: ON°&"a Notary 7777 ISeal. °� Notary Public State lorida " ublic Joanna M F State of Florid, Joanna M Feliciano P� MY Comm @1iC18n0 My Commission FF 082753 ?or nog 1SB1 FF 082753 or w Expires 01/12/2018 Expires 01/12/2018 APPROVED BY - Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 5Ho„�s Miami Shores Village uBuilding Department 10050 N.E.2nd Avenue LORMiami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE.OF CONTRACTOR/ARCHITECT Permit N. k C � 6-l i- I S 33 Owners Name (Fee pn1pie Title Holder): ) lV 4 aw ftA G dB Owner's Address: ( HE I o " 2c e-- � Phone#:4,51 I �'S- I 60V X812 City: if 1 i fli�t' S W o eZ ES State : tom c 0A Zip Code: '�,N 11'6 Job Address(of where work is being done):_ ( 4 I Y C 1 ®r S-� R cc-—t City: Miami Shores State:—Florida Zip Code: 33 I Q !Contractor's Company Name: ' �s ifs k"rm4lf—P onek '7144 Z2-9---?F2 Address: 11S'7 NC 111 r>,v°e, City: No . • State: FL Zip Code: 3 ,717 Qualifier's Name : S ePlcR-, Lic. Number: C- 6LC-- t�7crr�3S'' Architect/Engineer of Record Name: Phone#: Address: City: State: Zip Code: /y7® A P L/✓d j�' lki T ch gw° Describe Work: ag2 K e,,aa2 1,✓4Z&A - ny L>�ti7td� I hereby certify that the work has been abandoned and/or the contractor/architect Is unable or unwilling to complete the contract. I hold the Building Official and the MiamiS harmless for all legal involvement. Signature5- 0 Signature orAgent ,-*retractor or AmhW The foregoing instrument was aknowledged before me �� The foregoing instrume t was aknowledged before me this day of„ 2ty4,by A� h - this�day of ,20 AEby / wee.• Who is personally known to me or who has produced who is personally known to me or who has produced PAI'40T as indentiflcation. ��� as indentfffcation. Notary Public: Notary Public: Sign: Sign: Se $o#W Pub. Notary Public State of Florida Seal: � 111� Notary Public State of Florida Joanna M Feliciano Joanna M Feliciano My Commission FF 082753 �o My Commission FF 082753 %4C �o� Expires 01/12/2018 %CW a. Expires 01/12/2018 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 VALECILLOS, MIGUEL ANGEL VPG CONSTRUCTION MANAGEMENT LLC 8500 SW 160TH ST PALMETTO BAY FL 33157 Congratulationsl With this license you become one of the nearly - -----= -- --_---- --- -- --.-- -- _----_ ---_ _- one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses range DEPARTMENT OF BUSINESS AND from architects to yacht brokers,from boxers to barbeque restaurants,and they keep Florida's economy strong. p' PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CGC1523799 ISSdED 11/29/2015 to serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more CERTIFIED GEN�RAL-( QNTRACTOR- information about our divisions and the regulations that impact VALECILLOS,MIGUEL 1-ANQEL -- you,subscribe to department newsletters and learn more about VPG CONSTRt1CTtON IVANAGtMENT LLC the Departments initiatives. , Our mission at the Department is:License Efficiently,Regulate Fairly.We constantly strive to serve you better so that you can d uner ED the provisions ofi Ch.489 FS. serve your customers. Thank you for doing business in Florida, �kMon,date IS CERTIFIED n er L1511zs 615 and congratulations on your new license! DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC1523799 The GENERAL CONTRACTOR Named below IS CERTIFIED � Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 VALECILLOS, MIGUEL ANGEL < - VPG CONSTRUCTION MANAGEMENT LLC r 8500 SW-160TH ST PALMETTO BAY. ..: FL M157— - LZ- -B IA ISSUED. 11/29/2015 L)ISPLA-AS REQUIREDSEQ# L15112900D0615 Local Business Tax Receipt Miami—Dade County,State of Florida THIS IS NOT A BILL-DO NOT PAY LBT 7195025 BUSINESS NAMEILOCAnoN RECEIPT NO. EXPIRES VPG CONSTRUCTION NEW BUSINESS SEPTEMBER 30, 209 6 MANAGEMENT LLC 7477185 Must be displayed at place of business 8500 SW 160 ST Pursuant to County Code PALMETTO BAY,FL 33157 Chapter SA-Art 9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED VPG CONSTRUCTION 196 GENERAL BUILDING BY TAX COLLECTOR MANAGEMENT LLC CONTRACTOR 45.00 12/10/2015 W�ter(s) VAI FrIl I 1�: CGC1523799 0223-16-001675 This Local Bosiness Tex Receipt Daly coubms payment of the Local BasnisIs Tex.The Receipt isnot a Rcense. permit,ore catHScadon of tis holder's quaRRcedans.to do business.Helder most comply with any goveremewd or noogevernaten regalatory hews and requireemats which appiyto the business. The MWIFT N0.above must be displayed on all commercial vehic!®s-Miami-Dade Coda Sea 88-276. M For mare hrfortMtion.visft�e mlamidadaaov/tancoRecior ACC>REF CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) . lk. 01/07/2016 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 po0cy(les)must be endorsed. If 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 Hsu of such endorsement(s). PRODUCER 786-233-2004 866-289-2080 cN°nME:cr Rodolfo Bo 'a D&S Insurance Inc PHONE Ew 786-233-2004 FAX No);866-289-2080 8181 NW 36thSt Suite 13 D ADD'ARESS:rudy@dsinsinc.com Doral, FI 33166 INSURER(S)AFFORDING COVERAGE MAIC S INSURER A:Accident Insurance Co INSURED INSURER B V.P.G.Construction Management LLC INSURER C: 8500 SW 160 Street INSURER D: Palmetto Bay, FI 33157 INSURER E: SURER 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 TYPE OF INSURANCE ADDL R POLICY EFF POLICY EXP LTR POLICY NUMBER MMID MM/D LIMITS GENERAL LIABILITY �/ ✓ EACH OCCURRENCE $1,00 .000 DA AGTO RENTED A ✓ COMMERCIAL GENERAL LIABPLIrY PREMISES Ea ocuurrence $100.000 CLAMS•MADE ❑✓ OCCUR CPPOO18327 00 03/13/2015 03/13/2016 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000.000 GENERAL AGGREGATE $2 OOO.00O GEN'L AGGREGATE LMR APPLIES PER: PRODUCTS-COMP/OP AGG $Included ✓ POLICYF—IJECT F-1 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (I.. n .ant ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Par accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMSAkADE AGGREGATE $ DED I RETENT N$ $ WORKERS COMPENSATIONWC STATU. OTH- AND EMPLOYERS'LIABPLfrY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes describe under DESCRIPTION OF OPERATIONS below EJ-DISEASE-POLICY LMR I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) LICENSE NUMBER CGC# 1523799 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Rodolfo Boda ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DATE(MMMD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE 1/8/2016 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. 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT TriGen Insurance Solutions, Inc. NAME: PH315 SB Mizner Blvd A/C No Ext: (877) 987-4436 aC No):(954) 252-4426 Suite 213 E-MAIL Boca Raton FL 33432 ADDRESS: certs@trigensolutions.com INSURERS)AFFORDING COVERAGE NAIC q INSURER A:Guarantee Insurance Company 11398 INSURED (904) 731-9014 INSURER B: Convergence Employee Leasing, Inc. Convergence Employee Leasing II, Inc. INSURER C: 3951 Saymeadows Road INSURER D: Jacksonville FL 32217 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 13810 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POUCY NUMBER MM/DD/YYYY MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F1 OCCUR DAMAGES( RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 1:1 JECTPRO LOC PRODUCTS-COMP/OP AGG $ PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acc dent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDPROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS UMBRELA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENT I I $ WORKERS COMPENSATION PER A OTH- AND EMPLOYERS'LIABILITY YIN WCPS00075001GIC 9/30/2015 9/30/2016 X STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F—] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under 1,0 0 0,0 0 0 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached N more space is required) Coverage provided for all leased employees but not subcontractors of: VPG Construction Management LLC. Location coverage effective: 1/4/16. License Number: CGC#1523799 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami SHores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores FL 33138 C^A,r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD Page 1 of 1 { Miami Shores Village01 10050 N.E.2nd Avenue NE „ INd Its -0UOn Al Miami Shores,FL 33138-0000 Phone: (305)795 2204F P� Y Expiration: 0312712016 5-5 r #' P Project Address Parcel Number Applicant 1148 NE 105 Street 1122320280140 Miami Shores, FL Block: Lot: STEPHANE FERNANDEZ Owner Information Address Phone Cell STEPHANE FERNANDEZ 1148 NE 105 Street MIAMI SHORES FL 33138- 1148 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 15,000.00 RESTLESS RESTORATION LLC (914)325-4383 Total Sq Feet: 1500 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fill Cells Columns Date Denied: Final PE Certification Type of Construction:DEMOLITION OF DIVIDING WALLS Occupancy:Single Family Window Door Attachment Stories: Exterior: Framing Front Setback: Rear Setback: Insulation Left Setback: Right Setback: Drywall Screw Bedrooms: Bathrooms: Window and Door Buck Plans Submitted:Yes Certificate Status: Review Planning Certificate Date: Additional Info: Review Structural Bond Return: Classification:Residential Review ElectricalReview Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical Bond Type-Owners Bond $500.00 Review Building CCFInvoice# RC-6-15-55809 Review Building $ .00 06/02/2015 Credit Card $50.00 $1,666.50 CO/CC Fee $500.00 Review Building DBPR Fee $8.78 09/29/2015 Credit Card $ 1,666.50 $0.00 Review Building DCA Fee $6.75 Bond#:2855 Review Structural Education Surcharge $3.00 Review Mechanical Notary Fee $5.00 Review Mechanical Permit Fee $450.00 Review Plumbing Plan Review Fee(Engineer) $80.00 Review Plumbing Plan Review Fee(Engineer) $120.00 Scanning Fee $24.00 Technology Fee $12.00 Work without Permit Fee $450.00 Total: $1,716.50 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 AFFIDAVI • I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru 'on nin . FutheT uthorize the above-named contractor to do the work stated. September 29, 2015 Arng Ignature:Ow r / Applicant / Contractor / Agent ate Buildepart ent Copy September 29,2015 1 6-I '#�OfAA �J Miami Shores Village dkk Building Department 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 JUN 2 2015 Tel:(305)795-2204 Fax:(305)756-8972 7BY INSPECTION LINE PHONE NUMBER:(305)762-4949 �J FBC 20(0 BUILDING Master Permit N& PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ S,,HOP CONTRACTOR a' DRAWINGS JOB ADDRESS: k i Nile 11a City: Miami Shores County: Miami Dade Folio/Parcel#: t t 2� �-� ® i 40 Is the Building Historically Designated:Yes NO Occupancy Type: '� Load: Construction Type: F-f—'r;01Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): S t e P O we i; fwA N./� 2 Phone#: M S 2 ( �'f1 fW 68 12 Address: 1� 4IS NE t ®s Srk L C C n City: �1 l c�A A-1 C d Tj&CS State: 9E c C1 e' Zip: � 1513 Tenant/Lessee Name: Phone#: Email: 114% q't 'A i;1 1 CiR R i L a I"0 n CONTRACTOR:Company Name: e-SS fegTD P-A-fills Phone#: t q Address: (�51 N� i Q( ST- DC City: W Add 1 : &tea State: Zip: ?27 L Qualifier Name: 5keL,Do,,� Phone#: State Certification or Registration#: G I� ( y 336, Certificate of Competency#: c DESIGNER:Architect/Engineer: W��D � �F'g Phone#: S ress:, &,:,9 a aaesA I�(YN 5? City: �S'lr o�N� (,Z�Ecf'S State: PL Zip: 33 vl� ug;o .; c� hgroylit: ` ^ 1000 Square/Linear Footage of Work: o ear 33 rhe ,,,` pp,of Wpr� M�^AdtIi0on '' eration ❑ New [Repair/Replace ❑ Demolition Description of Work: ���t-�b"►�A� t= [�. W I t��d�9(� l�tl.S rB�T(c�f�al o E.L�c�"�t�L ��,�L ��t7�C'-��d� o � M �aVI.Pi ✓�(.�21 iR��y!� �l.c�(L �Si7)b��9'rtiai o Specify color of color thru tile: /'� '�5 Submittal Fee$ Permit Fee$ �1�C) U ' CCF$ 1 - CO/CC$ 5v wD Scanning Fee$ !2A-OD Radon Fee$ .�5 DBPR$ Notary$ - Technology Fee$ I ?�y'LI) Training/Education Fee$ C�7 Double Fee$ '50.C Structural Reviews$ 7S ® -� Bond$; O TOTAL FEE NOW DUE$ (Revised02/24/2014) r i Bonding Company's Name(if applicable) r 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:he 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 Signature 'i 24z'L� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this AA r� day of 20 by T day of (� ,20 5 ,by &7N qhno is personally known to o_ lam° �� ,who is personally known to me or who has produced M CcAsl �"'�" '���A-as me or who has produ ama'" �•.••� o'4., ARIM K.MALIK identification and who did take an oath. identification and wh ` Amy pub"c-State of tea NOTARY PUBLIC: NOTARY PUBLIC: el 16 0 2018 \\\\,�u i i i u�u Commiaston N EE 185070 Bow Through National NotBl)r Aasn. Sign: ^ Sign: Print: r, �� :�' Print:CD Seal: N01'a�o'``�'� Seal: %% 'o" APPROVED BY Plans Examiner Zoning Iq S Structural Review Clerk (Revised02/24/2014) 10/13/2014 09:,29PM 3057048494 RESTLESS PAGE 01101 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PEARGE, SHELDON RESTLESS RESTORATION LLC 11 SOUTH HIGH STREET TUCKAHOE NY 10707 Congratulations! With this license you become one of the nearly „ ......���xa,�y���t�, one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range . STATE.QF FLORIDA. from architects to yacht brokers,from boxers to berbeque restaurants, DEPARTMENT-OF-BUSINESS AND and they keep Florida's economy strong, PR FE GULATION ' Every day we work to improve the way we do business in order to " :CGC'f 514335 0-9/21/2014. serve you better. For information about our services,please log onto www.m floridalloonse.com, There you can find more information Y Y ':. •:•CERttFll=•D G ...... . about our divisions and the regulations that impact you,subscribe " to department newsletters and loam more about the Department's pOF"SR initiatives. REvTL1;SS:RE�°�, , 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, ar'•, ,., ., l 218de""UG'3l„201fr < ”^^." : lw 4993101I�43,• :,..,: and congratulations on your new license! DETACH HERE RICK kOTT 66VERNOR KEN LAWSON,SECRETARY .STATE OF FLORIDA ,{ j.. DEPARTMEN7"OF-Bti.iI irss AND P.ROFESSlOt4AL•REGuL'ATION • i ........ C0NSTRUCT10 INDUSTRY,LICENSING BOARD }....Tfai~ral �i `(:O:IdTtu4CTOR ":'.....: ="Nestled'petav�r.IS.'iCE f`,Under"fhe•- rovisi©ns of_Ci3apte�4$.5•FS: • • .,� °` ,��;;' - € XC ;,•••Ex' lr�a�io.�a••d,�tsr'�AtJC 3a;,'20.1.E.....,.�;� •. ' ....:,.��.��.., ,,. �� .�n: ��.��,� _€ /,'�r,,��(y��y w v� .,..+^.- ., ':•^rtw,...,,,w. , "'r..;.,+-.•.,.` •,"..yti:' . •''.� t,+ ti 1 `'• i';y,✓, ! �� �, •L .M"', •, 6p.Ko.r....,.w rrV. , ..'F. +•...£ t••'yi 'aM."4'•l•.��s „ `4.4~�y•L'iy�`b, y • ' iy ,#fP,1f a�tMe"" n"�r w ".r,,M'^�+.+^ `ry'`�" +S• "°•,'•'�•."� 4,• �. ""., k ••. .�:�k ''� ❑• • �' ISSUED, 09/21/2014 .r DISPLAY AS REQUIRED BY LAW SEQ# L1409210003343 c gnm IRV jik MEa r / •i ,�; -�'.. f 1E, .E- '` Y=om" �£s a...y �. �� g< � t c ^ ` Y ' ,...x ,c -✓zC"b' d G-:/ ,: ..; .': c i;+I'a^`," _-' ::: z�,."f' ,:F �- { ^�" ,�C., ",F d ,, �.�r, � , ,q•.. � "�, syn , 'I 4 t s j 7f, , l. - C", nr s s' t fF Pg Jk OF a3' �S�+• _ � �' ,__. �� � tom• '� 5�. z` stns. ,ice '��r "� --"�.-�.as` ,��A�'' t a^ .a�.- `•�� a,. r; �` +r � 3 ,�',A+. .�._1 �` �•,`�, Y`'; `g=am �:. t v. ,/ T � ._- ; _.,-/ �,,; ..,. .;.. :'S..^." ''•ra 'ice v? x mss «,o. SIM x �F e a•3 3s h <w .M a< �^ ..b vl, `a ..mr1,,:: ' ro ....,..,wv^......,,-. _�s���._....__ _.._._ ...-..-.__..� ...,;....,.Ei_�.w,,,..�.:i. .. .__..:A�.�, .,1,.,.... M_-,.....,_..,.a..�'� ...�......�_.,.__..,,.;�_w •:�'.".�...-... .._:..=�.....,..w:.«....,,:..e... .::: �' 001341 yn 3 / : Arl E T o r4-NNE- Ifw �r wk la :.x a �,.,:, acs_., ._ '� ..i....„ �',• � .- i., � -x�r , 3 i M.: W / ' PA MEW UILD / EST Wr 4 _ x� l rm ti a c y Al -19 25 OM liv, Oil ' *W ". ' i > _ t CERTIFICATE OF LIABILITY INSURANCE DATE(MW NYYY) 5/27/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AUD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY Olt NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTER CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poticy(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 certificate holder in lieu of such endorsement(s). PRODUCER_. E- Mark Mitchell FAX Strategic Insurance;Services E (727)213-1890 No):($W)812.1730 2727 Ulmerton Rd,Suite#300 ADDRESS: mwWampaboyinsurance net Clearwater,FL 33762 INSURERS)AFFORDING CO GE NAI IN A: SCOTTSDALE INSURANCE COMPANY INSURED IN B: Restless Restoration,LLC. 11 South High Street INSURER 0: Tuckahoe,NY 10707 IN E: INSURER F: COVERAGES CERTIFICATE NUMBER: MIXIM00-0 REVISION NUMBER: 3 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEAEV POLI CY EBF PO ICY:EXP LIMITS A COMMERCIALGENERAL LIABILITY CPS2087054 09/1812014 0911812015 EACH OCCURRENCE $ 1,000,000 xi CLAIMS.MADE Q OCCUR PREMISES $ 10,000 MED EXP Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LiM1T APPLIES PER; GENERAL AGGREGATE $ 2,000,000 POLICY 1 JECT 1 LOC PRODUCTS-COMPIOPAGG' $ 1.000.000 OTHER $ AUMMOMLE LIABILITYNEDSINGLELIMIT M $ I ANY AUTO BODILY INJURY(Per person) $ ALL AAUTO$AlE2! AUTOS BODILY BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED P PROPERTY DAMAGE $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORI(ERSCOMPENSATION P 0 - AM EWLOYEPS LIABILITY Y I N ANY PROPRETORIPARTNER/IXECUTNEEL.EACH ACODENT $ OFFICERIMEMHER EXCLUDEDa - a N'IA (Martdetory(nW EL DISEASE-EA EMPLOY $ MIt es.describeundor I ON'OF A IONS ow E.L.DISEASE-POLICY UMIT $ DESCRIPTION OF OPERATIONS I LOCAT1OPSJ VEHCLES(ACORD 101,AdManal Rornaft Schefte,may be attached Ifmore space Is reVred) License number-CGC 1514335 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 Northeast 2nd avenue Miami Shores,FL 33138 AUTHORIZEDRIff4WWNTATIYE MAM 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Printed by MAM on May 20,2015 at 11:51AM 1/8114 Report Viewer (1 100% 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: 1/11/2014 EXPIRATION DATE: 1/1112016 PERSON: PEARCE SHELDON FEIN: 260672892 BUSINESS NAME AND ADDRESS: RESTLESS RESTORATION LLC 1951 NE 191 DRIVE NORTH MIAMI BEACH FL 33179 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chappter by fifi a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certlflcates 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(1 ,F 3 .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 uance 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 deparbnent shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirernents of this section. DFS-F2-D%C-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(950)413-1809 https://apps8.fldfs.com/crreportviewer/reportViewer.aspx?data=kdvpginc9D7Q3gH6TER6eP 1 KMZ%a2fSz5bXKYfBxkrekeESoPVy 1 v4NPOPN42XeirDRGXV WIx... 1/2 e RESTLESS DEMOPM N June 2, 2015 State of Florida County of Miami-Dade Re: Project located at 1148 NE 105th Street, Miami Shores, Florida Before me this day personally appeared Sheldon Pearce who, being duly sworn, deposes and says: That he will the only person working on the above referenced project except for Subcontractors who will carry their own separate Workers Compensation Insurance. Sworn to (or affirmed) and subscribed before me this 2nd day of June, 2015 by 904:044. U04 ?EAVX Personally known Or produced identification?(DZO �92' r3 -75GZ-0 Type of identification produced aetosr°�iG� Notary Public State of Florida Sindia Alvarez a� My Commission FF 156750 9jtoF�.o'P Expires 09/03/2018 Print, typ a ame of notary X r Sheldon Pearce www.RESTLESSDEVELOPMENT.coM 914 325 4383 PHONE I 305 704 8494 FAX RESTLESS DEVELOPMENT, LLC I RESTLESS RESTORATION, LLC NY LICENSE # WC-1 2196-HDI I FL LICENSE # GGC-1 514335 1 1 SOUTH HIGH STREET I TUCKAHOE I NEW YORK 1 10707 1951 NE 191 DRIVE I NORTH MIAMI BEACH I FLORIDA 1 33179 Miami shores Village Building Department CORiD1� 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-rime 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: r State of Florida County of Miami-Dade The foregoing was acknowledge before me this day of ,2 g . By✓1 �H� ``1� � 0��r "� who is personally known to me or has produced -A VV1.Qas identification. Notary: SEAL: itts ,0\\ 4 Act CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) `--�� 09/29/2015 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(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 certificate holder in lieu of such endorsement(s). PRODUCERCONTACT NAME: Ph Alis Pirko Strategic Insurance Services PHON; , (727)213-1890 AI No:(866)812-1730 2727 Ulmerton Rd,Suite#300 ADDRESS: phyllis@tampabayinsurance.net Clearwater, FL 33762 INSURER(S)AFFORDING COVERAGE NAIL# INSURERA: Scottsdale Insurance INSURED INSURER B Restless Restoration, LLC. INSURERC: 11 South High Street INSURERD: Tuckahoe, NY 10707 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000000-216343 REVISION NUMBER: 10 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. ILTR TYPE OF INSURANCE INSO ADDL WVD BR POLICY NUMBER MM1DDY YY MMIDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY BINDER-LATBU-B 09/18/2015 09/18/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE NTED OCCUR PREMISES(Eaoccurrence) $ 100,000 MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JET 171 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acc dent ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y f N STATUTEI ER ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ License#CGC1614335 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 Northeast 2nd Avenue Miami Shores, FL 33138 AUTHORIZEDREPRESENTATIVE PAP C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Printed by PAP on September 29,2015 at 02:01 PM :^3575 Local Business Tax Receipt Miami-Dade County, State of Florida -THIS IS:NOTA BILL -OO NOT PAY 6126197 0:T1 BUSINESS NAMIULOCATION. RECEIPT NO. EXPIRES RESTLESS RESTORATION uc RENEWAL SEPTEMBER 30,2016 1951 NE 191 DR 8389036 MA l be alspiapetl at place of busiz ass NORTH MIAMI BEACH FL 33179 Pursuant to County Code Chaptet:SA-An.9&1e OWNS" SEC.TYPE OF BUSMSS pAYNIEN'T RECEIVED CGC1514335 RESTLESS RESTORATION LLC 196 GENERAL BUILDING CONTRACTOR sY Tax COLLECTORD WOtltet(s) 1 - $45.40 07/28/2015 CHECK21-15-147783 This Lttal SesiamTax Reteigtedy C fiT pp—R fthe Letd Smieeae Tax.71e11-dptisestelitseae. pem+h.ar�oetiiRoaUov at the heldera ualit(tadess WHo 4saieem.Holderammaampty omHh e�y govetamentel et eo�aremmenleiregdemry lewae�regoinmmaNartdthapptymthe Dadvess. ,. The SECEfPT S0.ehena moat i»disglel`ed oa ali cemmeroid nedicies-Miami-Dede �age-27& iargenreiaiarmafim Asttarww.miamidedasanAa> iissL w- . Aa/13/2014 09:29PM 3057048494 RESTLESS PAGE 01101 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1385 4.0 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-'0783 PEARCE,SHELDON RESTLESS RESTORATION LLC 11 SOUTH HIGH STREET TUCKAHOE NY 10707 Congratulations! With this license you become one of the nearly 4"kszi2�dtat? 2vY�c�: +?�2t� tea .�tr�es� r�at.�t"ea €�crczat .. . one million Floridians licensed by the Department of Business and - Professional Regulation. Our professionals and businesses range STATE OF FLORIDA. from architects to yacht brokers,from boxers to barbeque restaurants, pi`pgFtTMENT t1r'E3t!$.1NE5S AND and they keep Florida's economy strong, PRQFE GULATION Every day we work to Improve the way we do business in order to CGC 7 1.4355' _,:• . • 09121/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com, Thereou can find more information y •;• 'C�R1idFtEt)'G• about our divisions and the regulations that impact you,subscribe 1? E;5 ' to department newsletters and loam more about the Department's initiatives. "RESTLI .SS::Ei :' Our mission at the Department is:License Efficiently,Regulate Fairly. We constant iy strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, rrs'eltR,rl r.l•ED-'ij:ridar^ o-ns=�&f 7 C h,.4$,9:Es;. : and congratulations on your new licensel DETACH HERE RICK SCOTT GOVERNOR KEN LAWSON,SECRETARY i -STATE OF FLORIDA ,. . .., 3 DEPARTMEN'1 OF BLI I ESSAND P.ROFESSj0t4AL•REGULATION 3.. G NSTI�UCTI .IN USTRY LICENSING BOARD i..,.-rhe:-ta:E'IV7= CC}:NTt4ACTOR"""..':'^:...,. •,•.:° :',.,..:;' ^ . -:'.N ri 4biloW.18FOE:f7TWI'E1).- :;.Under fhe;provisiorfs`a�f Cktapte�•48.J` AW-AUC5 31-20.15 MKMNL�FYC�k1°�^^'''"�'`�, T.-�o.Mo�'M. ,o.,.,.,M , :"`°••,,, 'e`",,ti+.y.,.. '�°'°'a,�^*'",,,��'?..' '' 1�}t`�i '`:,q'+� �A'f°' f�v'M��.^fir`""�v.M`�"^„'••” .. 'aik•4::�+•' iN. '`:��`"`��`4 •�'ti. 0.��x ''^` �. • • 9� ,"d u'I° mat' J y A. ..Y t".. �'w Y, '} •, �,• ISSi1Ba:> 081/2©14 a bISPLAYAS REQUIRED BY LAW s��t# L14o$21QD03343 Oc_ 9/14/2015 (12408 unread)-johnwestc dg-Yahoo Mail Inspection Drafts m Sent Edward Landers Today at 11:10 AM Spam(10) To john wester Trash(10) -r Hi John.I did a walk thru inspection at 1148 NE 105th Street,Miami Shores. Smart Yews The following are recommendations from my inspection: Important Unread A. Add three(3)additional 4'x4"ridge support posts in addition to the ~ four(4)installed, Starred B. Screw in the two sheets of drywall in the ceiling to prevent from • _ People falling, - Social G Pick-up all nonrelated construction items and store in the garage, ••• D. Organize all construction items neatly within the space. Travel E Screw down the plywood floor in the hall area, Shopping F. Electrical wires should be bundled,but I understand that there is no • Finance power to the > Folders(3849) building.and work is in progress. ---=- •i • -- M=- > Recent Edward A.Landers,P.E A.T u or > SEP 1 015 • • 0000 0000•• • • • • 0000•• 0000 0000•• • 0000•• • • • :9000 • 0000 • • • • • •••••• 0000 • ••••& s••••• •••• 0000• •• •• 0000 0000•• • 0000•• • • • • • • • • • • • W1412015 (12408 unread)-johnwestcdg-Yahoo Mail Inspection Drafts(7) Sent Edouard Landers Today at 11:10 AM 4_ *>, Spam(10) To john west Trash(10) Hi John.I did a walk thru inspection at 1148 NE 105th Street,Miami Shores. " Smart Views The following are recommendations from my inspection: -- Important Unread A. Add three(3)additional 4"x4"ridge support posts in addition to the four(4)installed, Starred B. Screw in the two sheets of drywall in the ceiling to prevent from ® o People falling, Social C. Pick-up all nonrelated construction items and store in the garage, ® � D' Organize all construction items neatly within the space. Travel E. Screw down the plywood floor in the hall area, Shopping F. Electrical wires should be bundled,but I understand that there is no Finance power to the > Folders(3849) building.and work is in progress. ®� > Recent Edward A.Landers,P.E. i � or e- e January 7, 2016 Village of Miami Shores Building & Zoning Department 10050 NE 2"d Avenue Miami Shores, Florida Attn: Building Official Re: Special inspection Project: Residence 1148 NE 105"' Street Miami Shores, Florida Dear Sir; This letter is to advise that we inspected the progress of the Structural modifications to the above referenced project. We inspected the following items, at the jobsite, on January 7, 2016: A. Hurricane twist straps were installed on the rear wall to tie down the existing roof rafters to the existing tie beam at alternate rafters. The straps were installed to supplement the existing straps and were installed in compliance with the Product Approvals. B. Hurricane twist straps were installed on the front wall to tie down each existing roof rafter to the existing tie beam. Straps were installed in compliance with the Product Approvals. C. We inspected the welds at the beam end plate, column top and bottom plate, roof rafter ties at the top of the beam to secure the roof ridge. All welds are approved and are in conformance to the requirements of the 2014 Miami-Dade Building Code. D. We inspected the installation of the new steel column on the existing masonry knee wall and foundation. We recommend installing a new footing under the existing foundation and placing the column directly to the top of the kneewall. (per sketch) The installation would then be similar to the detail on the approved plan. We will re-inspect after revision. ' 4 r , All work will be in compliance with the requirements of the Village of Miami Shores, the Approved Plans as well as the 2014 Florida Building Code. Please call if we can provide any additional information. {{IIIBtlippppp Very truly yours, P � NSF•.;��. Edward A. Landers, ,E No 38398 r • • r STATE OF . ...:.::.. ....:. xv v1w, t PP r m Li .v6g —' hit }7//5 n � ®®®0eaaaa ®®® ® No 98 9 yep r•' �.#0383�8 lr A.)6= Ed , a rd �, tr ��++ stt ,AN DERS o °°,1305)823-3938 CONSULTING EN ® °�� ��C M- 6'7+ , aq a9p,�Po. a January 7, 2016 Village of Miami Shores ` Building & Zoning Department 10050 NE 2nd Avenue Tile 0/9I Miami Shores, Florida Attn: Building Official Re: Special Inspection Project: Residence 1148 NE 105th Street Miami Shores, Florida Dear Sir; This letter is to advise that we inspected the progress of the Structural modifications to the above referenced project. We inspected the following items, at the jobsite, on January 7, 2016: A. Hurricane twist straps were installed on the rear wall to tie down the existing roof rafters to the existing tie beam at alternate rafters. The straps were installed to supplement the existing straps and were installed in compliance with the Product Approvals. B. Hurricane twist straps were installed on the front wall to tie down each existing roof rafter to the existing tie beam. Straps were installed in compliance with the Product Approvals. C. We inspected the welds at the beam end plate, column top and bottom plate, roof rafter ties at the top of the beam to secure the roof ridge. All welds are approved and are in conformance to the requirementsflf the 2-014-Miami-Dade Buik#ing Code. O, We-inspected the installation of the new steel column on the existing masonry knee wall and foundation. We recommend installing a new footing under the existing foundation and placing the column directly to the top of the kneewatl. (per sketch) The installation would then be similar to the detail on the approved plan. We will re-inspect after revision. All work will be in compliance with the requirements of the Village of Miami Shores, the Approved Plans as well as the 2014 Florida Building Code. Please call if we can provide any additional information. Very trul yo , eeeeee®�'y I.ANpF9®,�° Gt�� dward . I_ander*�r �$ •'•., 1�MM '• s U1 w of �W� Nv , m ® ,F`.O \s ova SFS S I 0 �eaee