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MC-14-1775 R r0 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL 1 �� Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-217898 Permit Number: MC-8-14-1775 Scheduled Inspection Date: March 04,2015 Permit Type: Mechanical - Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: JAAR,MIKE Work Classification: AIC Replacement Job Address:360 NE 103 Street Miami Shores, FL Phone Number (786)252-6374 Parcel Number 1132060135000 Project: <NONE> Contractor: ALISAEZ AIC INC Building Department Comments EXTEND DUCTWORK Infractio Passed Comments INSPECTOR COMMENTS False 3 Inspector Comments Passed Failed Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid March 03,2015 For Inspections please call: (305)762-4949 Page 2 of 38 Y � Miami Shores Village c a�VE Building Department AUG 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY� Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201 BUILDING Master Permit No. Q_C.1q Gd PERMIT APPLICATION Sub Permit No.M01-14 - I �5 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING N'MXHANICAL ❑PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: 93 Folio/Parcel#: U -9 /,,-01 3—S000 Is the Building Historically Designated:Yes NO ,Op� Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ame(Fee Simple Titleholder): L t'"' ^ Phone#: Z 403 rEmall: ,/1' ,. L715M 101, ( 4t "'i �� State: `��_, Zip: see Name: Phone#: �1 CONTRACTOR:CompanyName: ALA I AV—�. r' `L, Phone#:31 q65 t Address: t2ft � -241;7t 'A' 13 t City: S''t''i d j^%'l —State: r-L, Zip: 33,S t0 Qualifler Name: 'LQ Phone#: State Certification or Registration#: Cid Certiflcate of Competency#: DESIGNER:Architect/Engineer: ,'�'� �" 1Dt^ARLj'L'0 Phone#: s� Address: d� g CityeaA tea"' State:O'L- Zip: .7J � Value of Work for this Permit:$ 's�� Square/Linear Footage of Work: Type of Work: ❑ Addition Iteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: . Specify color of color thru We: Submittal Fee$ �� Permit Fee$ �� CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$25W, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law rochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of com ncement must be posted at the Job site for the first inspection which occurs seven (7) days after the building permit is issued. In he absence of such posted notice, the inspection will not be approved and a reinspe�fee will b charged. i Signature Signat re OWNER or AGENT ONTRA OR The foregoing instrument was acknowledged before me this The foregoing m t was acknowledged before me this E3 day of *0.LA'1 .20 111 ,by �( day of 20 by N01C44 ActL L ZTAAtZ- ,who is onally now to who is personally known to me or who has produced as me or who has produced as as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: 00%11 IM111111 NOTARY PUBLIC: J D old''% Sign uOiSSiol�o� ' Sign: Print: = : a�1�� a Print: Seal: 9�OZI90� . Seal: ' MARCOS LINARES %�� �;•.. a a d •• �� MY COMMISSION#EE872M i �; ,'�2 . ',, EXPIRES Febncary 07,2017 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) From:Hector Arballo Fax:+1(305)677-2294 To:BUILDING DEPT Fax: +1(305)T56.8072 Page 2 of 5 071=2014 6:21 STATE OF FLORIDA 3DZFARTmmtT OF Busimss AND PRoFnss:rONAL REGULATION' CONSTRUCTION' INDUSTRY MCENSING BOARD (8*50) 487-3,3.95 1940 NORTH X01M09 STR82T TALLAN"ONS VL 32399-0783 -A-r v o-,-- .... ...... I HECTOR OSCAR­ S9 AKE.E.Z., A:ER'C0%1DXZ*JON11q0 INC. 12973 SW 112TH ST 131 MMAMI FL With %A Vv ,y one ffdlgon '.tW this license you become one of the neart N .0 Fad ns licensed by the D Regulation. ` :ePartment of Busifieft and Professibnal ReguL n and Our Professionals busmsiss"range from architects to yacht brokers,from bOxem tO bsrbGquO fustaUrants,and they keep Florida's eixmmy strong. -2 F-Very day we Work to Improve themaywe'do bUsIndw ift order toserve you better For In"agon about our terVices* se *w*.my.ffor1da11cwrse.c0 mm plea Log onto ja There you can find more InIbftistidn'abdut our divisions and'the regulations that impact you,subscribe to department newsletters and learn more about the Deparunerifs fritdavves. 4 4Z� OVI'misslOrl sit the Department Is;License Efficlend y,Regulate Fairly..We VM*- constandy stive-to serve you better so that you Can serve your custonwa. Thank you for doing business ln.MoWd,and wrigratulatlofis on your new 11censaj IA� PETAQ"HQRrE ..J AA m *w"'M A; h. �W_Mr,, -A"N "JIn 40 J T. 44 ftwt. 4d' L •yyk M, -7, W4 It a a ,Am From:Hector A*allo Fax:+1_(306)677-2284 To:BUILDING DEPT __Fax:_+1 (305)7%S072 -Page_3_*f.6 4713112014 6:21 .-N z 9! . ......... .......... OM01"d ic 'V.* is* WOO PAVMON..w wo . 10 /17 3 to /Ml CRE moa G isad Or "Y CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYM 008/14 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. H the certificate holder Is an ADDITIONAL INSURED,the pol"Ies)must be endorsed. H SUBROGATION IS WAIVED,subjed 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 CO le CT Hemisphere Insurance Group P E (305)501-2801 FAX No. (305)553-9010 EMAIL11401 SW 40 St Ste 340 hemisphereinsgrp&d.com Miami,FL 33165 INSURER(S)AFFORDING COVERAGE NAIL A Phone 30 501-2801 Fax 305)553-9010 INSURERA: ACCIDENT INS COMPANY INSURED INSURER 0: ALISAEZ AIR CONDITIONING INC INSURER C: 12973 SW 112 ST 8131 INSURER D: MIAMI,FL 33186 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Icy N TYPE OF INSURANCE ADD UB POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 1 © COMMERCIAL GENERAL LIABILITY PREMISES oou a onenee $ F-1 DE ®❑ CLAIMS-MAOCCUR CPP000747101 MED EXP(Any one person $ 5,000.00 A F-101/11/2014 01/11/2015 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-comp/op AGG $ 2,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY a�E�FID LIMIT ❑ AN AUTO BODILY INJURY(Per person) $ ❑ AAtLL OWNED ❑ SCHEDULED BODILY INJURY(Per accident) $ ❑ HIRED AUTOS ❑ AUTOS AUTOS NONOWNED POPERYGE $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS UAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION $ WORKERS COMPENSATION ❑WC STATU ❑OETH- R AND EMPLOYERS'LIABILITY Y I N ANY PROPRIEfORIPARTNERIEXECUTiVE E.L.EACH ACCIDENT $ O(AFAFICERIMEMBER EXCLUDED? NIA (Nlerld ryy In H) MOM E.L.DISEASE-EA EMPLOYE $ Munder OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more apace Is required)Mechanical Contractor. 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 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1888.2010 ACORD CORPORATION. All rights rmrved. ACORD 25(2010/05)OF The ACORD name and logo are registered marks of ACORD From:Hector A"lo Fax:+1(305)877-2294 To:BUILDING DEPT Fax:. 1(385)758.8872 Page 4 of 5 0713112014 6:21 09-20-x:012 ,EFF ATWATER STATI? OF- FLORIDA CHEF iClA1.OFFICER DEPA1tTNIENT OF FINANCIA€. SERVICES DIVISION OF WORKERS' COMPENSATION CEffnFICATE OF ELECTION TO BE EXEWT FROM FLOWDA WORKERS' COMPENSATION LAW * � CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual' listed below( has. elected to be exempt from Florida Workers' Compemtion law. EFFECTIVE DATE: 11117J2012 EXPIRATION DATE: 6/17/2014 PERSON, AREAL LO HECTOR. O FEIN: 59/970684 BUSINESS .NAME AND ADDRESS, ALISAE2 AIR aN CDITIE�IM INC 1"73 SW 112th ST # 121 MIANT FL 83188-4788 SCOPES Of BUSINESS OR TRADE: I= CERTIFIED AC CM4TRACTOR IMPONTANT. Peraaaat to Chapter 442 . 05414% F.S., an officer of a Corporation who elects exemption from ibis chapter illy blas a contfcate of oteiafon ooder.tbis section may Out rocaaor baneffis or cutup" tied Hofer this chapter. Patsnaat to Chapter 440.05(12% F.Sy C44ifiCatas of elactiod•to be exempt... aPiy only Within 00 scW of the business or trade bated an the ounce of eloctfea to be erraWL Porwout to Chapter 440.9913L F.S., notices of oteotdoo to be exempt aa¢ certfficotas of etecnoa to be exempt shalt be sobiaet to ro"catdon if, at any time Offer the f0feg of the native Vr the fsoaaace of the cooff(com the patted W imed OR the mace'Nil taftnicata so Iouger amefa the resishements of rids aactian fat igeaaase of a certificate. The 4epartmom,shall raimke a certificate at mrV flats for failure of the lis" neared an as certificate to maef nm retwFaments of this.section QUESTi(NS? 050i 413- DWC-292 CERTIFICATE OF ELECTION TO 9E EXEMPT REV= Df-11 PLEASE CUT OUT THE CARO BELOW AND BETA€K FOR FUTURE REFERENCE $'.f AT,rr*.OF RORIRf3 IMPORTANT MW rI TdT i NM1Dff[L SERtIf>rlaS DIViF Pursuont'to Chapter 440.05(14). F.S., at officer of a corporation wills CONSTRUCTION INWSTR1r O eta= exemption front this chapter by filing a certificate of election 00"'MONIV CW SLOCUM TO W OVEMPT MOWISLOOM I. under thls section may not recover benefits or compensation 'under this W0RK9W COMPSISATIM LAW 4DO choter. l7FELTrVE 11/17/2012 EXPIRATION OATS: 11/17/2tit14 Pursuant to Chapter 440.0502i. F.S., Certificates of election to be PERSOit HECM 0 011ALL0 H exempt- apply only within the scope of the business or trade listed o FES 591974884 E the notice of election t4 be exempt tfifSfAZSS coaorrlCOMM E AMAt 55: E Purs"K to Chapter 440.05113), F.S.. Notices of election to pile exam pt AusA�x Ann ataac INC and wtififmtes of election to be.exempt shalt be subioct to nwacetion 12973 OW 112TH ST 6 tet if. at any time after the filing of the dfotica or the Issuance of do WAJA Of, 33186-4706 certificate, the person named on the notice or certificate no longer me the t't:gairements. of this section for issuance of a certt"flema. lbs dopf'tlliellt shell revoke a cortiftwo at any brae for failure of tate SCOPE OF BUSINESS-OR TRAM person named an the cartiflem to meet the rerpiirenonts of itis 1- feRTatt o .Ac cournAcTwt Section. QUESTICAW (850) 413-180 CUT HERE * Carry bottom portion on the job, keep upper portion for yoair records. DWC-252 CERTIFICATE OF ELECTIOK TO Be EXEMPT REvfSED 01—ft .... ��, Miami Shores Village Building Department LORI 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. � �e dntrac'ior Print Name: /''�� ��� J Print Name: Signature: kA L,"*tL '" Signature 221�����j State of Florida) \\\\\����i►inn ��% State of Florida ,. .,.. ..Ari@ ) County ofMiami-Dade) ���'%i County of Miami-Dade) w Sworn to and subscribed bef � ui ? Sworn to and subscribed before me this day of y': = day of L T ,20F. rn CD B (SEAL) A (SEAL) of BaaType of Identification produced ir�i i ,�t� Type of Iden o I RaW Jeff Y o, F�xires as�o3nois