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WS-16-10 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756.8972 Inspection Number: INSP-269237 Permit Number: WS-1-16-10 Scheduled Inspection Date: October 20,2016 Permit Type: Windows/Shutters Inspector: Mesa,Michel Inspection Type: Final Owner: 1 Work Classification: Window/Door Replacement Job Address:2 NW 108 Street Miami Shores,FL 33168- Phone Number (305)773-3101 Parcel Number 1121360110090 Project <NONE> Contractor: CAP PROPERTIES LLC Phone: (305)773-3101 EIluildinti,Department Comments REPLACEMENT OF 14 WINDOWS AND 3 DOORS. 111frac_o Pussed Comments INSPECTOR COMMENTS False TO CLOSE PERMIT#WS14842 Inspector Comments Passed Failed El Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid October 19,2019 For Inspections please call:(305)762-4949 Page 15 of 28 s. f@ 3 3 � � Miami Shores Village ' Per» Ty 10050 N.E.2nd Avenue Nvv '•'• Miami Shores,FL 33138-0000 i y2— Phone: (305)795-2204 <e >m�► �,, 21 �p'16 Expiration: 8/ 0/201 Project Address Parcel Number Applicant 2 NW 108 Street 1121360110090 Miami Shores, FL 33168- Block: Lot: CAP REALTY LC Owner Information Address Phone Cell CAP REALTY LC 12000 BISCAYNE Boulevard (305)773-3101 E MIAMI FL 33182- 12000 BISCAYNE Boulevard MIAMI FL 33182- Contractor(s) Phone Cell Phone Valuation: $ 5,700.00 CAP PROPERTIES LLC (305)773-3101 w.....:m.. _ _.....: m... :. . ......._ __.._ _... Total Sq Feet: 0 Type of Work:REPLACEMENT OF 14 WINDOWS AND 3 DOO Available Inspections: No of Openings: 17 Inspection Type: Additional Info: Window Door Attachment Classification:Residential Final Scanning:9 Review Building Review Building Fees Due AmountPay Date Pay Type Amt Paid Amt Due CCF $3.60 invoice# WS-1-16-58227 DBPR Fee $4.05 02/22/2016 Credit Card $314.70 $0.00 DCA Fee $4.05 Education Surcharge $1.20 Permit Fee $270.00 Scanning Fee $27.00 Technology Fee $4.80 Total: $314.70 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 sp cifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either m sel agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOO ING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is ac a t t all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named cont r t 0 work stated. February 22, 2016 Authorized Signature:Owner / Applicant / Contractor / A nt Date Building Department Copy February 22,2016 1 Miami Shores Villa e w g JAN Q 6 2016 / Building Department rkakq" 0U � 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 201 " BUILDING Master Permit No._'n PERMIT APPLICATION Sub Permit NoJ ,BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION DORENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �-- N v,.-, /aFj �` Com: Miami Shores ' County: Miami Dade Zip: Folio/Parcel#: l 1 24 3Co f O I l—4hD0t i> Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: /rFlood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 14L'c Phone#: ��'��t—� ��L�k Address: I ®O l6lS yew 61�d * v City: M I GAiI State: r%L Zip: 3�l Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Ol ��R� �^I�s LL(- Phone#:����� "3.l®t Address: BA^�®� X11 b lyGl "�- -70y v City: 1_► 1C4Y3 I State: F L Zip: Qualifier Name: X®W l-e� OR, I'CsLe— Phone#: State Certification or Registration#: L L7L l S®�(D-0 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for.this Pcrlmit:$_ Square/Linear Footage of Work:, Type of Work. • ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace �] Demolition s � ,'te�tt ;�• Description of Work: ) Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ C—,Q CO/CC$ Scanning Fee$ � Radon Fee$ DBPR$ , Notary$ Technology Fee$ �Y Training/Education Fee$ 11? 0 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ _E�l 4 ` (Revised02/24/2014) r 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 OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of (kyodl'n dL r .20 ) , by _]'� day of/��/) .20 � b �1.e.� CA.Ootul-ekt .who' rsonally known t � w/GVi•G`lam.who is ersonally know me or who has produced as me or who has produced as identification and who did t ke an ft Mardn identification and who did take an oath. Raloll, A� NOTARY PUBLIC: NOTARY�DA NOTARY PUBLIV. S; NOTA PUBLIC . Conus#FF900119 STATE OF FLOiiM E 7/15=19 Cwnm#FFf Wi19 Sign: Sign: 2019 Print: •� Print: Seal: Seal: APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 4 l STATE OF FLORIDA DEPARTMENT OF BUSINESS ANIS PROFESSIONAL REGULATION a CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CAPDEVIELLE,XAVIER O CAP PROPERTIES LLC 12000 BISCAYNE BLVD SUITE 704 MIAMI FL 33181 Congratulationsl With 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 OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF.BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL:REGULATION Every day we work to improve the way we do business in order to CGC1508653 ISSUED; 07/0112014 serve you better. For information about our services,please log onto www.myfforidalicense.com. There you can find more information CERTIFIED GENERAL CONTRACTOR about our divisions and the regulations that impact you,subscribe CAPDEVIELLE,XAVIER O: to department newsletters and learn more about the Department's CAP PROPER�IES.t:LO initiatives. - 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, Is CERTIFIED under the provisions of Ch.489 Fs. and congratulations on your new licenses &4ftaGoadate:AUG 31,2018 1.14070t000030 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY 1 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD C=60W63 The GENERAL CONTRACTOR Named below IS CERTIFIED Coo; Under the provisions of Chapter 489 FS. i Expiration date: AUG 31,2016 I CAPDEVIELLE,XAVIER O CAP PROPERTIES LLC , .1 12000 BISCAYNE BLVD SUITE:704 : MIAMI FL 33181 ISSUED: 07/01/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1407010001330 003692 i Local �usinss Taxeceip Miarrli-Dade County, State ofi Florida -THIS IS N0T A BILL DO NOT PAY 71£7392 Busuuess`ritAroltanoEA'rtbNt RECEIPT tYO. PROPERTIE51[C E3�RIRES RENIIAI. 12000s15EAYNgBLVI)Toa � say SEPTEMB6R'3Q, 20!6 Ml11AAT Fl 33181 most be displayed at place of business Pursuant to County Code Chapter BA—Art:9& 6 O17NN@R SEC.TYPE C+R BUSINESS CAP PROPERTIES LLC C/0 XAVIER 496 GENERAL BUILDfNG TRACTOR PAYMENT RECEIVED . CAPDEVIELlE CGC4508653 av TAX Cou.ECTOR Worker(s) f $75.00 08/06/2015 CREDITCARD-15_039970 This Local Business Tax Receipt oeloonRmts payment of the Enoal or non or a certificatloo of the holder's qualllica8ogs to do business. Holder wu�at ompl wilb is not a governmental or nenlpiyemmaMal ragnlatory laws and regaFremerits which apply to the busiaes§:, Tire RECEIPT ftp.above must be displayed on aN camatarciafvehicles-OAfami-Dade CodA Sec 8a 276. For more ipiormalion,vlslt c ac RCERTIFICATE CSF LIABILITY INSURANCE DATE(�011005/165/16YYY, 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 poiicyges)must be endorsed. 9 SUBROGATION IS WAIVED,subject to the tenns 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 fleu of such endorsement(s). PRODUCER C ACT (areal Florida Insurance-Pinecrest (PAT! sxtg 305 256-0616 a 786 522-1889 11205 S Dixie Highway 101 ADDRESS, ane@tegacylinsurance.com Miami.FL 33156 INSURERS AFFORDING COVERAGE MAIC S Phone Wfi 255.0616 Fax 786 5221889 INSURER A: Lloyd's of London Insurance Company INSURED INSURERS; CAP Properties LLC INSURER 0 12060 Biscayne Blvd. #704 INSURER D., Miami,FL 33181 INSURFRE• INSUDER 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 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 TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�t R TYPE Of INSURANCE ADDLSUDR P LI E OL CY EXP LIMITS ICY NUMBER U GENERAL LIABILITY EACH OCCURRENCE 1,000.OW.00 0 COJ;IMERCIAL GENEM LIABILITY 0 PREMM TO£RENTED S 100,000.00 A ❑ ❑ CLAIMS-I.1ADE © N N 02/26/2015 02126/2016 OCCUR AMT006731 LIED EXP(Any one person $ 0.00 ❑ PERSONAL s ADV INJURY $ 1,00000000 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN&AGGREGATE LIMIT APPLIES PER: DUCTS-COMPJOPAGG S 1,000,000.00 ©POLICY 11 PRO- El Loc PROS AUTOMOBILE LIABILITY COMBJNE6 I-WIT F-a accident C] ANY AUTO BODILY INJURY(Per person) S ALL OWNEDSCHEDULED BODILY INJURY(Per acctdeny S ❑ AUTOS ❑ AUTOS p� ❑ HIRED AUTOS ❑ ANUR52w"m pe0t I $ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE S OEO ❑ RETENTION A I I IS WORKERS COMPENSATION WC STATiJ- OTH- AND EMPLOYERS'IJASILITY Y i k _LL MIT ANY PROPRIETORMARTNERIEXECUTIVE EL EACH ACCIDENT $ OFFtCEWMF-AIBER EXCLUDED? NIA #Uandatory+In NH) E] EL DISEASE-FA EMPLOYE $ yea dosaioa under DESCRIPTION OF OPERATIONS bstow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACCORD 101,Additional Remarks Schedule.N more apace is required) General Contractor Roofing operations pertomted directly by the insured arWor the Insureds direct employees is prohibited. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Building&Zoning THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Urban Planning Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores,FL 33138 1, ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105)QF The ACORD name and logo are registered marks of ACORD RditwU .fidfs.comkrreportviewer/reportViewer.aspx?dala=kdvpginc8D7Q3gHSTER6eP1KMZ%2fSz6bXKYfBxkrekeESoPVy1v4NR.. ® ®0® 1�1i ®.®0100e10 R PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE :....................................................••••• . ..........................................................•• ; IMPORTANT I ' STATE OF FLORIDA i P+,urstocractereao. lm,F.s,�lasurdacuc«aG, t 1 r /tif'Qda+seeeRrtimtrrm stt,sp�eatsroaemtEeated • I DEPARTMENT OF FINANCIAL SERVICES ussecrtmtra�rdrecc>Etecmtscr I DIVISION OF WORKERS'COMPENSATION I F uerperaattmw�erwsttu{t«• CONSTRUCTIONINDUSTRYEX@MPTION r r Pwsl,sretoCtWer440.05(1 .F.s.Ceruccffissdete0loto Is IO Dserertst.. u�hwwatteucseduabsueuuttede I IistedcnlMfdtCedE{ediCOfebeeletrp. I Rq tOg L i WERE CRENSAYCH[AWE1tEWtFRCMROR{DA �[I Pigyf3t0teCAeCt8f 440.0ESt3I,FS,NoGeesddltAcntO tO j / t e>erpt erAcerGfiCpesdetetbMto to toelrtt sla76e EMCIVE DATE: 142014 EXPIRAIOtt DAIE: 3/M016 / a�tledl0tewcsam lt.pBftlfirc®a9ef ltdG71rt7 d61911d;te III crsne lesxe Cfve CerUfxrde,tra Cerecnrartedcn 1110 I / PERSON: CAPDEVIEtiE XAVIER O rc race or CAA0040 Welver waft the teoldfeaerrs diNs s seoJrntu Isslance d acatfictte.Tre asrarmen alms feKla � FEltl; Jh4]eb32 iR a k*icateAs%tive totWwedthe Cetter111Andcilthe I 1 1 certieeafef01's fberegdterrerdsdfNSseccal. 1 BUSINESS NAME AND ADDRESS: E I CAP PROPERTIES LLC i I 1 r 1 r t I ti11i BISCAYNE BLVD r 1 r i MIAMI FL 3y1S1 I i r 1 1 SCOPES OF BUSINESS OR TRA ' I 1 e r r . ,LICENSED GENERAL , CONTRACTOR , ......................................................................................................................... ! f OFS•F2•DWC•252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS?(850)415.1600 Page 1 of 2 Property Search Application-Miami-Dade County Page 1 of 1 . E . 0 F F IP E R T Y Am OF"OF"Hm" 'Am S K Summary Report Generated On:1/6/2016 Property Information Folio: 11-2136-011-0090 Property Address: 2 NW 108 ST Miami Shores,FL 33168-4311 Owner CAP REALTY LC Mailing Address 12000 BISCAYNE BLVD#704 MIAMI,FL 33182 USA Primary Zone 0800 SGL FAMILY-1701-1900 SQ Primary Land Use 0101 RESIDENTIAL-SINGLE FAMILY:1 UNIT Beds/Baths l Half 4/2/0 ) Floors 1 Living Units 1 Actual Area Sq.Ft Living Area Sq.Ft _ Adjusted Area 1,717 Sq.Ft Taxable Value Information Lot Size 9,194.25 Sq.Ft 20152014 2013 Year Built 1952 -- ---- County Assessment Information Exemption Value $0 $0 $99,082 Year 2015 2014 2013 Taxable Value $274,297 $206,289 $0 Land Value $165,565 $99,043 $45,826 School Board Building Value $107,658 $106,158 $117,199 Exemption Value $0 $0 $25,500 XF Value $1,074 $1,088 $1,102 Taxable Value $274,297 $206,289 $73,582 _..__. .- Market Value $274,297 $206,289 $164,127 Cly Assessed Value $274,297 $206,288 $99,082' Exemption Value $0 $0 $50,500 Taxable Value $274,297 $206,289 $48,582 Benefits Information Regional Benefit Type 2015 2014 2013 Exemption Value $0 $0 $50,500 Save Our Homes Cap Assessment Reduction $65,045 Taxable Value $274,297 $206,289 $48,582 Homestead Exemption $25,000 Sales Information Second Homestead Exemption $23,582 Senior Homestead Exemption $50,000 Previous Sale Price OR Book-Page Qualification Description Civilian Disability Exemption $500 02/20/2014 $280,000 29045-1963 Qual by exam of deed 05/07/2013 $222,500 28629-4267 Qual by exam of deed Note:Not all benefits are applicable to all Taxable Values(i.e.County, School Board,City,Regional). 08/01/1988 $70,000 13779-857 Sales which are qualified Short Legal Description 36 52 41 PB 52-33 DUNNINGS MIAMI SHORES EXT NO 7 LOT 1 BLK 211 LOT SIZE 74.750 X 123 OR 13779-857 0888 1 The Office of the Property Appraiser is continually editing and updating the tax roil.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.govTnfo/disclaimer.asp http://www.miamidade.gov/propertysearch/ 1/6/2016 Detail by Entity Name Page 1 of 2 C 0.h ' Detail by Entity Name Florida Limited Liability Company CAP REALTY LC Filing Information Document Number L06000089951 FEI/EIN Number 20-5550248 Date Filed 09/13/2006 Effective Date 09/13/2006 State FL Status ACTIVE Principal Address 12000 Biscayne blvd suite 704 miami, FL 33181 Changed: 04/13/2013 Mailing Address 12000 Biscayne blvd suite 704 miami, FL 33181 Changed: 04/13/2013 Registered Agent Name&Address CAPDEVIELLE, XAVIER 12000 Biscayne blvd suite 704 miami, FL 33181 Address Changed: 04/13/2013 Authorized Person(s) Detail Name&Address Title MGR CAPDEVIELLE, XAVIER 12000 Biscayne blvd suite 704 miami, FL 33181 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/6/2016 Detail by Entity Name Page 2 of 2 Annual Reports ReportYear Filed Date 2013 04/13/2013 2014 01/24/2014 2015 03/05/2015 Document Images 03/05/2015--ANNUAL REPORT View image in PDF format 01/24/2014--ANNUAL REPORT View image in PDF format 04/13/2013--ANNUAL REPORT View image in PDF format 04/26/2012--ANNUAL REPORT View image in PDF format 04/08/2011 --ANNUAL REPORT View image in PDF format 03/19/2010--ANNUAL REPORT View image in PDF format 04/25/2009--ANNUAL REPORT View image in PDF format 04/21/2008--ANNUAL REPORT View image in PDF format 04/04/2007--ANNUAL REPORT View image in PDF format 09/13/2006-- Florida Limited Liability View image in PDF format Couvrioht C,,and Privaw Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 1/6/2016 12000 Biscayne Blvd 704 Miami,FL 33181 CAP Properties LLC. Phone:(305)777-1888 Fax:(305)886-9191 E-Mail:Xavier(itcapgroupmiami.com January 29,2016 City of Miami Shores Building and Zoning Department 10050 NE 2nd Ave Miami Shores FL, 33168 State of Florida County of Dade Dear Building Official: Before me this day personally appeared Xavier Capdeville who being duly sworn, deposes and says: That he will be the only person working on the project located at: 2 NW 108t'Street Miami Shores Fl, 33168 Sworn to and sub tribe be ore me this---� - qday o�4 -- ----------------------2016 ,by - --_- >° F Personally known Or Produced Identification Type of identification Produced Print,Type or Stamp Name of N ry A2*M>bOr6Z NOTARY PJBW STATE OF R.ORIDA . CmvW FY909W E>pkft 8113=9 gttoREs Axc.193a G1� �► Miami shores Village .�. "HIM Building Department 10050 N.E.2nd Avenue LORtUp' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if. 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: j/4 Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this �\ day of% ,20� . By 4�ef who ig4jonally known.t�e me or has produced as ide i cation. Notary: NOTARY PUBLIC SEAL: IV, STATE OF FLORIDA Cam*FY909242 Expires 8113=9 MILTON CUBAS, P.E., INC. 1302 N.E. 125t`Street— North Miami—Florida 33161 Phone(305)891-4174 Fax(305)8914175 E-mail:miltoncubas@msn.com January 25, 2016 To: City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 Ref: 2 NW 108th St Miami Shores, FL 33168 Dear Building Official: I, Milton Cubas, P.E., hereby attest that to the best of my knowledge, belief and professional judgment, that for the address mentioned above for the fixed window you may use NOA # 15- 0622.12 and for horizontal slider window NOA# 15-0624.01 may be used. Should you have any questions or need any additional information please do not hesitate to contact me. Very ly yours, C ' Milton Cubas, President Certification Authorization# 27267 F.L. Reg. P.E. # 51902 S.I. # 6999901 MILTON CUBAS, P.E., INC. 1302 N.E. 1251'Street— North Miami—Florida 33161 Phone(305)891-4174 Fax(305)891-4175 E-mail:miltoncubas@msn.com January 25, 2016 To: City of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 WE 2 NW 1081i St Miami Shores, FL 33168 Dear Building Official: I, Milton Cubas, P.E., hereby attest that to the best of my knowledge, belief and professional judgment, that for the address mentioned above for the fixed window you may use NOA # 15- 0622.12 and for horizontal slider window NOA# 15-0624.01 may be used. Should you have any questions or need any additional information please do not hesitate to contact me. Very truly yours, Milton Cubas, President Certification Authorization# 27267 F.L. Reg. P.E. # 51902 S.I. # 6999901