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RC-15-2087 (2) l Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-265992 PermitNumber: RC-8-15-2087 Scheduled Inspection Date: August 26,2016 Permit Type: Residential Construction Inspector: Mesa, Michel Inspection Type: Final Building Owner: , Work Classification: Alteration Job Address:40 NW 111 Street Miami Shores, FL 33168-4322 Phone Number (786)251-2263 Parcel Number 1121360030360 Project: <NONE> Contractor: FIGUEROA$ DAUGHTERS BUILDERS INC Phone: (786)344-4996 Building Department Comments REMODELING KITCHEN 2 BATHS 14 WINDOWS 2 Infractio Passed comments DOORS AND FLOORS INSPECTOR COMMENTS False 09/21/2015 MISSING EL& PL SUBS. Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-258870. CREATED AS I� REINSPECTION FOR INSP-258106. ALL WORK CONCEALED. MISSING PRIOR INSOECTIONS ❑ 8-216 Failed no access, house has a termite tent. 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 17 of 36 posit: ' - �snOR Miami Shores Village Pill �1 10050 N.E.2nd Avenue NW Miami Shores,FL 33138 000 � � 1+11t?Iki�Sf#tab#cR Alteration (305)795-2204tet ovgPhone: ftOR1OP issue Date.I0%`612015 Expiration: 04/03/2016 Project Address Parcel Number Applicant 40 NW 111 Street 1121360030360 Miami Shores, FL 33168-4322 Block: Lot: 4040 GROUP CORP Owner Information Address Phone Cell 4040 GROUP CORP 40 NW 111 Street (786)251-2263 MIAMI SHORES FL 33168- 9660 SW 72 Street MIAMI FL 33173- Contractor(s) Phone Cell Phone Valuation: $ 21,000.00 FIGUEROA&DAUGHTERS BUILDER; (786)344-4996 __,..,..... __........... .. Total Sq Feet: 00 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Fill Cells Columns Date Denied: Final PE Certification Type of Construction:REMODELING KITCHEN 2 BATHS 1 Occupancy:Single Family Window Door Attachment Stories: 1 Exterior: Framing Front Setback: Rear Setback: Insulation Left Setback: Right Setback: Drywall Screw Bedrooms:2 Bathrooms:1 Window and Door Buck Plans Submitted: Certificate Status: Review Planning Certificate Date: Additional Info: Review Mechanical Review Electrical Bond Return: Classification:Residential Review Electrical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Review Electrical CCF $12.60Review Building DBPR Fee Invoice# RC-8-15.56749 Review Building $9.45 08/18/2015 Credit Card $50.00 $767.50 DCA Fee $9.45 Review Structural Education Surcharge $4.20 10/06/2015 Check#:1014 $767.50 $0.00 Review Plumbing Permit Fee $630.00 Review Plumbing Plan Review Fee(Engineer) $120.00 Review Mechanical Scanning Fee $15.00 Technology Fee $16.80 Total: $817.50 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 eit yself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS, 00 ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing informs' n ' a rate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-na t or to do the work stated. October 06, 2015 Authorized Signature:Owner / Applicant / ntractor / Agent Date Building Department Copy October 06,2015 1 F±G, 8 2015 T Miami Shores Village �� 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 EBC 201V ' BUILDING Master Permit No.& PERMIT APPLICATION Sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION EXTENSION [—]RENEWAL []PLUMBING ❑ MECHANICAL ❑PUBLICWORKS CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: S-t City: i Miami Shores County: Miami Dade Zip: 331�O i) Folio/Parcel#: 1 1 1z I - 3�p- 0 0 3- Q?J(DO Is the Building Historically Designated:Yes NO_X Occupancy Type:SF R Load: Construction Type: CZS Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):. anne#:l 9(p`25 I- 22 b 3 1 Address: %Ooo Sw 12 a City: M i a m i State: L Zip: 31`1 IDN Tenant/Lessee Name: 1 v ! Phone#: Email: M 1 k�Iscl CONTRACTOR:Company Name: 'Ua GAJ ��rt��u,)c s aJ� Phone#:-74 -7 4.916 Address: S4 )�7 V -L b 3 City: (A,ill State: Zi p:321'3 3 Qualifier Name: J erD '� Phone#: "7U34T44 q9 i4& State Certification or Registration#-�- GGci zw 09 Certificate of Competency#: G )� DESIGNER:Architect/Engineer: � i�i� • Tb 1'e d o � Phone#: J� 5-(A9 2'1555 Address: 'iLj Lq '7 S V4 -11 Ave , Sy("-f' w5 City:_mici i'1'1 I State: �-L Zip: c`7 Value of Work for this Permit:$ 2i. 0 t - Square/Linear Footage of Work: Type of Work: ❑ A-.,dodition ❑ Alteration } ❑ New n [1 Repalr/Re`plIVII Demolition Description of Work: i t, ® � 1 Ihlm L S 1 Specify color of color tthru tile: Submittal Fee$ 1 ° (L*) Permit Fee$ 'Or�S CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ � TOTAL FEE NOW DUE$ r, 10-1—An•)M 11M Al 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 estimateg value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lienMw w brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of Jomencement must be posted at the job site for the first inspection which occurs seven days er the building permit is issue n the absence of such posted notice, the inspection will not be approved and a rein ection fee wi be charged. Sig ature Signature _�—F /C WNEftf AGE CONTRACTOR The foregoing instrume as acknowl ed before me this The foregoing i strumen as acknow dged before me this day o 20 / : ,by �day of 20 s,by Ute/ who is personally known to '�f1d,lAQd® 01?M who isper ovally known to me or who has produced %��S �`—� ��g' as me or who has produced a*'5 &15%-50 as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: -- NOTARY PUBLIC: R Sign: Sign: Print: ? •.• • ° 0.FERNANDEZ Pring.COMMISSION#FF 062-2-2-4 t �� Seal: EXPIRES:October 15,2017 my 19910N#FF,-, '^q g'FOOM �`Oe BondedThruBudgetNotaryServices Seal:'' EXPIRES-. '' r Bonded TfhBu*Nota yoervices ALINA 0.FERNANDEZ d c �„ EXPIRES:October 15,2017 '9P�ap:0" Bonded Thru Budget No Services APPROVED BY Plans Examiner ning -VAJI Structural Review Clerk (Revised02/24/2014) • a, ' STATE OF FLORIDA ' DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 I . . FIGUEROA,LEONARDO FIGUEROA&DAUGHTERS BUILDERS INC 5800 SW 127TH AVENUE UNIT 2403 MIAMI FL 33183 Congratulations] WRh this license you become one of the nearly ;... one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range ' STATE ti+.FlOR1D >n; from architects to yacht brokers,from boxers to bar*ue restaurants, •DERQ USI NESS•AND::• - and they keep Florida's economy strong. P © IJ,LATIQN:; '':.:...: �.. Every day we work to Improve the way we do business In order to serve you better. For information about our services,please log onto .. A . yfloridalloense.com. There you carr find more information :_, 'xlFl about-our divisions and the regulations that Impact you,subscribe F ,., .:�.,. to department newsletters and learn more about the Department's . initis es. :t=� _r a :::,.:..: ... Our mission at the Department Is:License Efticiently,Regulate Fairly. We constantly strive to.serve you better so that you can serve your customers. Thank you for doing business in Florida, 6,c���fiYaIE):u'nQflCTli'e ►r8viadort9'Oi 0[i:Aae..Fs: *and congratulations on your-now Ocensel � "'Al1ff42018"r. .r f�a o�oa• .. DETACH HERE RICKSCOTT,GOVERNOR KEN LAWSON,SECRETARY TE � SIQ Ul;fir © ��IE '.1zT r�N`C•.�E. D' ...BU. •I _ES>�• EPART�► .G7J`N6Ru{�71 © "kTt1R �r� ;�p�p.,�,N'^tO w:or,...•'+v ar,+•F.p-n...,^,,..e,�, . ..... q't ...,....:., :eta> �^t+q `-•-n.b,���'e `�:�.�5 1 ••.�,'...��%rr,,e: q'.�,• •.Y v W�,�rsn+p,W��.,-r. /„�x1s°gyp��+T•yp•,,�. _•r•... "'a� '.,,+{' w•.,n-,,:`"`;t.,”•y.,1-'t''"»`�,•,,,.,•.`+s"°.:A�^•.7:a:a4,�,.:..'-n` �+.^`�,�'. ".�a -- .•. �j�J 4& h./kY.'��l� ti+1�I :°.m Y.,�,.,,. �` %•-• 7+R -,9.�,'ve` .!,.,••,,,, a. 0.,S'.. ;�r,�;:-,..,^.<,.�t'..'•_:y�..�`:`i .y ,x'31 .d l4 /d I�ry_!.1�¢.}�.J� +1F.1 p •:FyA` o-lin r.Jy.�`•.:y'NFeeP?t ': ry<{.Y)..' "6,v.��" '..n,.- v^.'�•.`'••,-..h� :•��' ♦';,.',e�`4,`-n'` ,<`, •� n,i ♦ fLGY',1uVf� tvr8�:�l�i/: ":°'P..•.i"`.• f•t•, •�'4,,...ya •'1'"ti�"� dn,\,Cn.•r'¢•.,�'a�= '�t,'t�,'`ap'y t),'�'� t� 1 I•, �IQt,� i~�'..4,R�^5<^4�L+iv�.'>.. c.•_tL�,•♦.n�...a....�,�: '..,t• . Ci ' 'C,. ♦ to ,.�,.�.t'a`'• .` '•1 .,..v:^ r ....d.: <:w...:.. .,.py.:'' 1:... ""*-`.,s+, -"'W..�^xK b,�yr,.!,..,••� ♦• `T`.>�S♦,""•.���tly: ,11 ✓.•'D.,r'� .... -�"r>,".' _ ,_„rte•., ...:%.,.... .,.,�,<.,.o.-....... 4 •..y.;., 'o+'..•� .. o� =, ^,`, F� - �.., .. �.� tSw.. 'af. �,V-. r9.y'6�i. ri T:_ 5.3, �. �+'•, u,,:;?�f v;!`:'.'• -<,.� .ar"•„ �•r�. tip_. !��1,.,r + °..++�.r•^'r++ �.i w.<.-. 'n:...e `+..w••..N. ' �;.. � �'1y,'.;`tOm'.M•e T,4•y•�`:.��,A,.1�M�tl .,,y`',4.pi.`�! .* t t .r'�,.r .�•,.''t,..+-'...,.. "..• ..n,.,``.Po,•,,.o-.. •' •;&:o'...,.::.. i.`':..•. .r;'.s°°�'••m. %a `""•n+�",�.''.'� '• �.�a�R�*.�,A-w<2 i. 1 1. fe��f�� �����,';:c '•��:.,. «•,c-.' '..r. r`.;;'�...,..<:,'„�.�:;�•.,,,.;,�''"�e`'�• "�- '+, •�•p'.��-�j,��roF`�,.�a.�•`'�;ti � � 'ai _. I�i..o"',,'r"`''� 'j ',u��.YV,�� -f�"/1 y.,...:... ....._ .w.,zac:.• Y-to�"�� �. . sfN,4`�'i!•rq' .v�„� X.•,rrd rte,', .'•�-i•"?`e"'. -1,,:'.' yNt ,' .`�.+°� +ay �,..,•.",,. .,;w,c� �. �, •ba' 't& ,'4`?.ac,"`-•.,`'c`S„)ia"'�`+,'r;�"l:S' IM r t1+� ;t` _,+P•`•Rf,,:�:'r�,a..,•.��, �.,�.., •,v... r+`. �;" .r`t, ',"L"'°4•�_�y "L ,i4ti ���, r { �'".'`,,,,>'a'®..'.Y" _ -tY'.`•'a'+: .'•. '^'�-s ''•;,�:w�"•. .?s��,y .;:r•r ' Vit..•.: t� �. 'tea . ;_. ' Z :' I 9•".�.,.{..-`•vY„� e'P_r"'. ...,iro` 'S:J ��•t•a 'pb.. i 1 ���.r�.aw' •2f_,.u..�'..3.�,..�+ �•4r. SUED: 08/25/2014 DISPLAY AS REQUIRED BY LAW sEQ# 1.1406250000808 r A aCERTIFICATE OF LIABILITY INSURANCE DATE(MMNDIYYYI� 08/17/15 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 Ileu of such endorsement(s). PRODUCER CONTACT JULID JIMENEZ Jimenez&Co.,Inc. PHONE (305)264-9900 A o; (305)284-5382 8000 Coral Way jutlo )264>ezandcompany.com Miami,FL 33155 INSURER(S) AFFORDING COVERAGE "Co Phone (305)2649900 Fax (305)264-5382 INSURER A: MESA UNDERWRITERS INSURED INSURER 6: FIGUEROA&DAUGTHERS BUILDERS INC INSURER C: 5800 SW 127 AVE APT 2403 INSURER D: Miami,FL 33183 (786)344.4996 INSURER E: USURER F COVERAGES CERTIFICATE NUMBER: REVIS ON NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD i 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. I INL ti TYPE OF INSURANCE ADD BR PO Y EFF POLICYPOLICY NUMBER MMIA MMD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 © COMMERCIAL GENERAL LIABILITY DA E ToRENT'ED. $ 100.000.00 A ❑ ❑ CLAIMS-MADE ® OCCUR MP0009019000750 MED EJP(Any one person $ 5,000.00 ❑ 03/05/2015 03/05/2016 PERSONAL 6 ADV INJURY $ 1,000,000.00 ❑ _ GENERAL AGGREGATE $ 2,000,000.00 GEN1 AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 1,000,000.00 ❑ POLICY ❑ P O- ❑ LOC $ AUTOMOBILE LIABILITY ---�--- �-- ---- MffiI SINGLE LIMIT E '— ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED AUTOS El AUTOS LED BODILY IWURY(Per acddent) $ ❑ HIRED AUTOS ❑ NED j P�iOPPE�Y ALIAGE --- ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ------ ❑ EXCESS LIAR — ❑ pE AGGREGATE $ DED ❑ RETENTION I AND WORKOMPENSATION ERS UABUM ❑WC ATU ❑OTH f ANY PROPRIETORIPARTNERIEXECUTIVE/N I - OFFICEWMEMIBER EXCLUDED? —j N I A ELL EACH ACCIDENT $ (Mandatory In NH) u E-L DISEASE-EA EMPLOYEI $ DES _— F-L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,%more space Is requked) -- i CG#1512609 CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIB D POLICIES BE CANCELLED BEFORE Village of Miami Shores THE EXPIRATION DATE THEREOF,NOTIPE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRO SIONS. 10050 NE 2nd Ave i Miami Shores FL 33138 nurHIZED ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05)OF The ACORD name and[ago are registered marks of ACORD To: Denis espinosa Page 2 of 2 2015-08-18 12:56:14(GMT) 3053568787 From: Miguel Salgueiro I •r r' •':;JA�''i. i `ji• - J4= die r li• •r' r ,•�.::' � ,t ��i���. ,L A .zi�'>,•M''S ^?i-'Y.`1..T-9,J::.s...u ii �:r,'::S:C'3 •vA 4.:�� '�q,,�_i.i'i':. NO ��' :-.t 'M; .iFi K��,''fr�,[S�M,rtY.' ..•>tn.-a�vt4j,,..:: 5M+.'�.a....:1' ,F' k •�GVti';�'•' sY �nr d.,•.; a+p�rr��1.q, �i •ttY'/�{�' ::q,+V }j;;•• sy-•p,� ;'....... y- •y- `J} �• ::1-Yn.:T.t Lt. p':h'71A��e1Se:Nt3�'. :�IL'I.:.. r..Y`,{::IN d,I^,a'rl�:=��•. .'a{! �4• !`r'• a,36 ;F�': ,.. �-a L�k'•s .,t. s�,..;.r•:t^: ;.Ct .5.. •.tb>-r ,�k:n J`.L ���' .C. �"7.L t�~'�.- �•w icy; p <�. :rye:•, cq V.ra =q s 1� Z� i. A� .... }! >'!'��� ,. s�� •7 :;fie:.'°:i'`{.::q;:`a err{. 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FnwiugtBIritdnnatlon.vi8(. -.-. __.. r .� we 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: 12/20/2014 EXPIRATION DATE: 12/19/2016 PERSON: FIGUEROA LEONARDO FEIN: 263167712 BUSINESS NAME AND ADDRESS: FIGUEROA&DAUGHTERS BUILDERS INC 5800 SW 127 AVE#2403 MIAMI DADE FL 33183 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 chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If,at any time after the filing of the notice or the Issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 t►♦s�OREs Miami shores Village Building Department RiDA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOW GE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. r Signature. O er State of Florida County of Miami-Dade The foregoing was acknowledge before me this 7 day of4Urj9� ,20 Byii:a� o` J who is personally known to me or has produced r1Z/L �� S'� �5�l4-(Z Y3tsidentification. Notary: I c�� �� �� fd'i�. % ��1��. MERCEDES DEL CARWA GMDE8 SEAL: I MY COMMISSION 9 FF198753 EXPIRES February 11.2019 .:: ;y^-c•s� Fwrk{sMam .car Figueroa & Daughters Builders, Inc CGC#1512609/1-1I #5512 Licensed & Insured Date: i /2 a r State of -old D,I Country of Ypersonall Y appeared U,'zAA0� ��r11Ut (°- Before me this da who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at: < w`IZG ,-f1 Sworn to a 'rmed)and subscribed before me this 17 day ofA� ,220/S , by Personally known OR Produced IdentificationC24 Type of Identification Produced �T- may Print,Type or Stamp Name of Notary * * MY COMMISSION#FF 09324 EXPIRES:October 15,2017 mrq'F�FlO��oe Bonded Thru Budget Notary Services i CFN: 20150492105 BOOK 29719 PAGE 2195 DATE:07/30/2015 03:22:01 PM DEED DOC 1,740.00 Record and Return to: Bankers Title and HARVEY RUVIN,CLERK OF COURT, MIA-DADE CTY Escrow Services, Inc. 14125 NW 80th AVE Ste 301 Miami Lakes, FL 33016 File# 15- 1973 THIS INSTRUMENT PREPARED BY. Joseph S.Paglino,Esq. 2131 Hollywood Boulevard,Suite 307 Hollywood,Florida 33420 Polio No.:11-2136-003-0360 WARRANTY DEED (Statutory Form--Section 689.02,F.S.) THIS INDENTURE,made the 61 day of July,2015,by April Johnson, a single woman, whose address is SME ifw' �' ti-'s 'branto to 40140 Group Corp, a Florida corporation, whose address is ` " Qe mew` R. 33n3, as Grantee. Witnesseth, that said Grantor, for and in consideration of the sutra of TEN & 001100 DOLLARS ($10.00), and other good and valuable consideration to said Grantor in hand paid by said Grantee,the(receipt whereof is hereby acknowledged,has granted,bargained and sold to said Grantee,and Grantee's heirs and assigns forever,the following described property in Miami-Dade County,Florida, to-wit: Lot 4,Block 220,of MIAMI SHORES EXTENSION,according to plat thereof as recorded in Plat Book 43, Page 40, of the Public Records of Miami-Dade County, Florida. aWa 40 N.W. 11 la'Street,Miami Shores,Florida 33168. SUBJECT TO: (1)Restrictions,reservations,conditions and easements of record,if any, without intent to reimpose the same, (2) Zoning restrictions imposed by governmental authority; and(3)Real property taxes for the year 2015. TOGETHER with all tenements,hereditament and appurtenances thereto belonging or in any way appertaining. TO HAVE AND TO HOLD the same in fee simple forever. AND the Grantor hereby covenants with the said Grantee that the Grantor is lawfully seized of said land in fee simple; that the Grantor has good right and lawful authority to sell and convey said land, and hereby fully warrants the title to said land and will def d the same against the lawful claims of all persons whomsoever;and that said land is free of all on umbrances,except taxes acening subsequent to December 31,2014. CFN: 20150492105 BOOK 29719 PAGE 2196 IN WUNESS WHMOF,Grantor has hereunto set Grantor's hand and seat the day and year first above written. Signed,sealed and delivered in the presence of April n, antor Print Name: 6d 16C Print Name. j�J�t I STATE OF FLORIDA ) } ss: COUNTY OF MIAMI-DADE) The foregoing instrument was acknowledged before me this- day of July, 2015, by April Johnson, who [ ] is or [ W_Im� 1 known to e or who has provided identification in the form of (driver's license,passport etc.),and who.[ di r ] did not takeaoMYCOMMSSS10tf#FF1g2787 ......... �# EXPIRES october 4,2018 NOTARYP Florida at Large FNarldallot9rySenrice com g (4071�9 0163 s My Commission Expires: Print Name: Detail by Entity Name Page 1 of 2 _ ft w� �r,w s�Sk- � N✓3 G � F hg ^Ed f h Cr N 14$ 9 Detail by Entity Florida Profit Corporation 40/40 GROUP, CORP. Filing Information Document Number P15000042722 FEI/EIN Number NONE Date Filed 05/12/2015 Effective Date 05/12/2015 State FL Status ACTIVE Principal Address 9660 SUNSET DR MIAMI, FL 33173 Mailing Address 9660 SUNSET DR MIAMI, FL 33173 Registered Agent Name &Address SALGUEIRO, MIGUEL 9660 SUNSET DR MIAMI, FL 33173 Officer/Director Detail Name &Address Title P SALGUEIRO, MIGUEL 9660 SUNSET DRD MIAMI, FL 33173 Annual Reports No Annual Reports Filed Document Images 05/12/2015 -- Domestic Profit View image in PDF format http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 8/18/2015 'RA'��"�,� N, "< X INSPECTION RECORD i'$= f I� STRUCTURAL ZONING DATE INSP INSPECTION DATE tN5P INSPECTION ATE INSP Foundation Zoning Final stemwail ZONING COMMENTS Rough Slab Water Service Columns(1st Lift) 2'dRou h Columns(2nd Lift) Top Out Tie Beam Fire Sprin ers Truss/Rafters Septic Tank Roof Sheathing Sewer Hook-up Bucks Roof Drains Windows/Doors v Gas - interior Framing INSPECTION DATE INSP LPTank 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 Ceilinggh` )+ Driveway Roug t UMBING COMMENTS Driveway Base Tele u 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 i �5 Alarm Final Underground Pipe s; DOCUMENTS Fire Alarm Rough if Bearing Gert Fire Alarm Final u h 1: * Soil Treatment Cert Service Work Wi Floor Elevation Survey Insulation ` Ventilation Rough sUnit Mrs 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 ' MECHANWX COMMENTS INSPECTION DATE INSP �^ Final Sprinkler Final Aiarm, Ftp A YY (pct iiN'RVk-II(V9 41 ' + CERTIFICATE OF.-LIABILITY t N INSURA� YYI'}CE DAM(MMIDDN +�• 04!1112016 THIS CERTIFICATE IS:ISSUEDAS A MATTER OF INFORMATION ONLY AND CONFERS NO RIOHTS'UPON THE CERTIFICATE HOLDER:THIS CERTIFICATE DOES NOT AFFIRmA1 IVELY.Olt NEGATIVELY AMEND, EXTEND OR ALTER THE C01IEFtA a AFFORD.gD BY.THE POiLICIES ` BELOW.THIS dM*IFtCATE AP INSURANCE DOES NOT 06146T'11bTE A CONTRACT BEtWEEN-THE ISSUING INSURER(% AtiT i*mED REPRESENTATIVE OR PRODUCER,AND THE:CERTiFICATE'.HOLDER:. IMPORTANT:If the aertlfk*hblosr Is an ADDITIONAL INSURED,the 0906y(tesj must,be endorsed..If$UOROGATION I$WAIVED,OubjerA to ON terms..ond conditions of the policy;cortaln policies may require an endorsement A statement on tills certificate does not confer rights to tm. ccrditaate holder in Ilev of such endorsemen.s PRODUCER C Plor Magna Ample Insurance Company E : '(321 j 222=94B8 N PO Bax 928 E" mp Is etnpleins.cbm INSultER s dRCI Cov00e NAia tt Oakland PL 34.169 ttlsll A: MESA UNaERRWFtI.ERS aPEGIALTY INSuiMD R a. FIGL)EROA&DAUGHTERS:9U(LDERS`INC pasuaEac $600 SW 497 Ai1E APT:2A09 at >taR o t i�it e PAlsmi PL 331 w. tNsuReR rr r COV RAGES: °CIBRTIFmute AIUMBEC. A VI 10N NUMl§Elt: THIS M.TO:CERTIFY THAT THE POLICIES OF 04SURANC•E LISTSD SELOW HPkVE BEEN ISSUED TO THE INSURED NAMED A AVE FOR THE Pbtj0Y PERIOD INRIEATEP,,N0tWITK6TANU04 ANY.ftau i6N ew TOW OR CQNDrrION OF ANY CONTRACT OR p 0011 T l tlVlTFi RESPECT TOf WHICH THIS i R1 iFISjAT6 NiAY' BE ISSUED OR MAY'P TAUV;TH9 INWRANCE..AFFOi70to ttY THE P(3LIC16S DES RIBED SUBJEGf F0-AU TH6 7�Ft{W3, QtCI.USIONS AND CONI�lTaG7NS OF SIJ PQLIpIE$.:LIFAITS SMIdWN AfAY HAVE=6EEN FtEDIJCED BY PAib CLANS. Rag.' 'fYQlB AP fN>URAIVEE; .. .. ... PaLlay-No MBER P, X .. .. umn 9` . Xl CCMME< OLOEMMALLrASILtrY NO URfiE T .$' I-mono CLAIMS-(BADE:EXI wCuFt p ty Ca hien " S 100,000 t�EDExP An:«ra art'anZ 3 5.(1 A Mf 09019001f36 03L4!&IILQ16, 05l0k017 p.MwtiM.&Aw RY S 1:009.009 Wilt AQ EdATt LIMITA&LlEd PIA OEPtF•RACaAEi(+T��tE $ Z�Q QQ6 pOrcx�. bac. ttas#-CaMiiioi$ncic • .'1.of ,ti00 OTHM 1 s. AuroM6atEa'unetitc[Y a NE Int $ AN LLQAAt}TQ.' 9CBILY,I}�dURY{�'@tp@tsalt}.: :$ AI!dl p LED 6009-Y IWURY Vi't73' NS7S >�7ED+ G $ HI(iEUAf?IQS AFTrt}S S un+tme.tA,L" OCCL* sACH GIt.RI�Entt�l; - I:!(CF,$SLIA13; HtLAjWtLAJW ACtCi OATC $ 66R . 1RETFzf111bIVi3 $ W0MtBRS CQMPSNSAiIONIF _ ANG£ikIP1:GY61{!8'Ws@tt.(Tf ANY{�liOP ECVTIVE Yltti GA HAC6IDEhtT $ QFFFCIHf!/tR, _.QT Q N:! (MandatorY':Iet1(N} Ei WtASE FA-E% wy .g If}�tl�Ccibawl$et' EL'!3f!?ASE F?l?LIC?YLFtid[f DES OI2I P7-1F}N 9 F. .'f iOitS. 4q.Z.f% T!¢Nl1F 4P.ERt1'1 OMitoCAti7GN$fV iES(ACORb10t_AddilFonarRa=ft$chedl leo*bealtaahedlf;;;r a...z5i Akq 1612609 CFRTIFICATE HOLDER bANGIELLATidN SHQULD ANY 0f:TNEJ VE QE 8GRIRED i�4LI GANCELLEt2$EfORE. THE. 2)CRIRATP 0 DATE T.HER£dl,, N0 0 ILL BE D... ED IN CI CY t?F MIAMI SHORES tES Ai.6 RDANCE.WkfH THE. LidY WILDING-AND ZgM14p AUTHOr=KE W89NTAT" 10060 N.E. 2ND AVENUE iviIAMI SHORES.FL 3.M.S It 2014ACORO CO RATIQN:'AIi rigt is reserved. ACORD 26(2014101) The ACORD name and logo are register rhsof ACORD • ••• r i :•.•� •:• �•� �0 •0 0 • S U.S.Structures. Inc. ; ... • • • • "' Project: Miami Shores Renovation ` CA 8439 PROJECT NAME: Miami Shores^poyaiion •• •' • 0: :• Single Famillyger� etide • • : • 0 40 NW 111th StrVbt'•• • • '•• • Miami Shores,FL 33168 DESIGN LOADS: Roof Live Load • 0• :•• •• Roof Dead Load••• • • •• •• 30 psf [30 psf for flat roofs!20 psf for slopes> 1.5:12] •• ;•; : • •• • ; 25 psf Floor Dead Load,0• ; ; '.' : : :00 •' n/a psf Floor Super Imposed Dead Load n/a psf Floor Live Load n/a psf Stair Live Load n/a psf Balcony/Terrace Live Load n/a psf(100 psf for areas> 100 sf) CODE REFERENCE: All work,designs and calculations shall be designed in accordance with the Florida Building code,2014 edition. WIND LOADS: In accordance with ASCE 7-10-Analytical Procedure Code Reference County Miami Dade Risk Category II FBC 1620.2(Table 1.5-1) Wind Speed-V= 175 mph FBC 1620.2(Table 26.5) Exposure case C Roof Slope(4:12) 18.40 degrees Max Roof Height-z 15.25 feet Mean Roof Height-h 15.00 feet Least Horiz.Dim.//to Wind-L 26.00 feet h/L 0.58 6.5.5(Table 6-1) Kh= 0.85 30.3.1/table 30.3-1 Kz= 0.85 30.3.1/table 30.3-1 Kd= 0.85 26.6/table 26.6-1 Determine Topographical Factor-Kzt K1 0.00 fig.26.8-1 K2 0.00 fig.26.8-1 K3 0.00 fig.26.8-1 Kzt=(1+K1*K2*K3)A2= 1.00 equation 26.8-1 BASIC PRESSURE: Components and Cladding-Exposure C [Note:0.60 convertion from strength design to ASD] qh=0.00256*Kh*Kzt*Kd-VA2*0.6 qh= 33.99 psf equation 30.3-1 MWFRS-Exposure C [Note:0.60 convertion from strength design to ASD] qh=0.00256*Kh*Kzt*Kd*VA2*0.6 qh= 33.99 psf equation 27.3-1 qh=0.00256*Kz*Kzt*Kci*VA2*0.6 qz= 33.99 psf equation 27.3-1 Tele 305.665.4555 Jose A.Toledo,P.E. August 2015 Fax 305.665.5522 FL License#54891 Page 1 T S • • ••• :•••• •:• •�•••• • K 1 U.S.Structures, Inc. ... . • Project: Miami Shores Renovation CA 8439 • ;DESIGN WIND PRESSURES-Wlndowsicnd6aors t�rx to roof condllt$nsl- -- _ __`� _� ,___W zone width a: ••• ••' .:• •2.60 felt*Ag.9-11 A notation no.6a criteria But not less than, 3.00 feet Therefore,'a'= M. fepl .. A=g h[(GC p)-(GC pi)],whet? ; : �•• *c/a ...eMation 6-22 00 (GC p;) _ ±0.18 n/a (Figure 6-5) n/a n/a Gcp Gcpi Pressure p ps Typical Window n/a 1.00 -0.18 40.10 (Area<10sq-ft) Zone 4 leeward -1.10 0.18 -43.50 Zone 5 windward 1.00 -0.18 40.10 Zone 5 leeward -1.40 0.18 -53.70 Typical Door Gcp Gcpi Pressure p ps (Area approx.21 sq-ft) Zone 4 windward 0.98 -0.18 39.32 Zone 4 leeward -1.04 0.18 -41.29 Zone 5 windward 0.98 -0.18 39.32 Zone 5 leeward -1.30 0.18 -50.13 I Tele 305.665.4555 Jose A.Toledo,P.E. August 2015 Fax 305.665.5522 FL License#54891 Page 2