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EL-16-2997 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-271275 PermitNumber: EL-11-16-2997 Scheduled Inspection Date: November 17,2016 Permit Type: Electrical- Residential Inspector: Devaney, Michael Inspection Type' RAh Owner: HERNANDEZ,JACKSON Work Classification: Addition/Alteration Job Address:10555 NE 2 Avenue Miami Shores, FL 33138-2059 Phone Number (186)695-2651 Parcel Number 1122310130720 Project: <NONE> Contractor: QUANTUM ELECTRIC SYSTEM CORP Phone: (786)663-4787 Building Department Comments REPLACE ELECTRICAL SERVICE REPLACE Infractio Passed Comments ELECTRICAL PANEL INSTALL 3 NEW SMOKE INSPECTOR COMMENTS False DETECTORS Inspector Comments Passed ® Failed f Correction ❑ /� Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. November 16,2016 For Inspections please call: (305)762-4949 Page 20 of 26 &s*Wmlc,� Miami Shores Village E �1= >"1t� 10050 N.E.2nd Avenue NE s Additiol #Alkicltmc• Miami Shores,FL 33138-000077F' `q 73.EV'f E..�'S� Phone: (305)795-2204 �� „• r ,r 111'151201 Expiration: 05/14/2017 Project Address Parcel Number Applicant 10555 NE 2 Avenue 1122310130720 Miami Shores, FL 33138-2059 Block: Lot: ALTISOURCE Owner Information Address Phone Cell ALTISOURCE 10555 NE 2 Avenue (186)695-2651 (786)509-8236 MIAMI SHORES FL 33138- 10555 NE 2 Avenue MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuat=Feet: 0 QUANTUM ELECTRIC SYSTEM CORP (786)663-4787 Total S Type of Work:REPLACE ELECTRICAL SERVICE REPLACE Available Inspections: Additional Info:REPLACE ELECTRICAL SERVICE REPLACE Inspection Type: Classification:Residential Final Scanning:3 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $2.40 Invoice# EL-11-16-61895 DBPR Fee $2.25 11/03/2016 Credit Card $50.00 $119.90 DCA Fee $2.25 Education Surcharge $0.80 11/15/2016 Credit Card $ 119.90 $0.00 Permit Fee-Additions/Alterations $150.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $169.90 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing inform on is accurate and that all ork will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above med contract r to the wo stated. November 16, 2016 Authorized Signature:Owner / AppliJ Contractor Agent ate Building Department Cocant November 15,2016 1 Miami Shores Villages (11 � Building Department NOV 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 $Y: Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 'S FBC 201(4 BUILDING Master Permit No. l PERMIT APPLICATION Sub Permit No. ❑BUILDING EkirLECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOBADDRESS: (OSSr) MF bUd )nU City: Miami Shores County:— Miami Dade Zip: T V 7� Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: // OWNER:Name(Fee Simple Titleholder): f7y i 5ouf ek Phone#:�'�f Address: 1660 &ef)nQ �Nt 1,)C 4 760 City:M favi k State: Zip: ®3 2 Sl Tenant/Lessee Name: Phone#: Email: //tt�� CONTRACTOR:Company Name: Q J -C1 n tU VK C I P�6A r- t•G S��ftne#: �'06 -643 / 7- Address: I S9 6 ft &j U) (42 4� Pt V 4-- • A P't- ;2t 27 City: M f IAm t_ 4.a-K e-!5 State: 1— Zip: 0/ ' Qualifier Name: Tu/�,,-,j C. 5^1,C-E-00 Phone#: X36-J663- `t� 8�- State Certification or Registration#:e�k( 30 (5C) ® Certificate of Competency#: 14eOW?-5-2- DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: ca� Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New [ ] Repair/Replace ❑ Demolition Description of Work: R i2 f? G` Ge, t-ke 52 P Vi Le, kePIC,C-� c=I�cT `,c+-k eCx-v►e�-A ]�:446,ll 7?, dem 5moiKe _ Specify color of color tthru tile: Submittal Fee$ 90.00 Permit Fee$ ®° d CCF$ CO/CC$ Scanning Fee$ 07 Radon Fee$ �' Z� DBPQR$ 2� _Notary$ Technology Fee$ 3 • ZO Training/Education Fee$ 0 • �i0 Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$� _ O (Revised02/24/2014) 0 • ' • 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 ,✓u� OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of �'�� � .20 1 4�p ,by �� day of e�)e v-- 020 i( .by h personally known to who is personally known to me or who has roduc - U Z p b Z �U as me or who has produce identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: � ADO . ''4� Print: Print: k CS 132121 Mtn Seal: EXPIRBB April 24.2020 Seal: EXPIRES April 26.20020 (407 J407)30"153 F1WWWdWW;n#"" APPROVED BY /4/ P';if0lans Examiner Zoning Structural Review Clerk (Revised02/24/2014) CI,IVED 2016 _ Quantum Electrical System, Corp. NO r�'_ - 15969 NW 64th Ave.Suite 317 786.663.4787 - - Miami Lakes FL.33014 Quantumelect63@gma%com License No.ER 13015009 License . 14E000 N0 252 J L j J PROJECT ADDRESS: 10555 NE 2nd AVE., MIAMI SHORES, FL., 33138 TYPE:LOAD CENTER PANEL: "A"NEW VOLTS: 120/240—1 PHASE—3 WIRE PERMIT No.: EL-11-16-2997 MTG.:RECESSED AIC-22K BUS: 200 AMP. MAIN:2P—200 AMP.MLO. LOAD,SEE LOAD CALCULATION LOAND CARCULATION LOAD WIRE TRIP POLE DECRIPTION CKT.No. CKT.No. DESCRIPTION POLE TRIP WIRE LOAD (*)PART OF 3 W/SF LOAD 8 40 2 COOK TOP 3 4 A/C COMPRESOR 2 30 10 6 5 6 SMALL APPLIANC 1 20 12 1500 LIGHTS&RECEPTACLES. 2450 SF X 3 WATT SF.= 71350 VA V 3 KVA @ 100%=3,000 VA 6 2 WALL OVEN 7 8 WATER 30 5000 9500 6 AIR HANDLE 9 10 HEATER 2 30 10 SMALL APPLIANCES= 3,000 VA 8,850 VA @ 35%=3,098 6 50 2 DINT 11 12 WASHER 1 1500 1500 12 20 1 REFRIGERATOR 13 A 14 LIGHT 12 LAUNDRY= 1,500 VA TOTAL OF DEMEND=6,098 VA 1500 12 20 1 1 DISPOSAL 13 B 2 20 1500 12 20 1 DISH WASHER 15A_ 16 RECEPTACLE 12 TOTAL= 11,850 VA 1500 12 20 1 SMALL APPLIANC 15 B GENERAL LIGHTING TOTAL= 6 098 VA 17 A 18 A LIGHT/RECEPTECLE � 17 B 18 B LIGHT/RECEPTECLE 19 A HEATING= 9,500 VA 19 B 20 SPRINKLER 2 20 12 2500 DRYER= 5,000 VA 14 15 1 LIGHT/RECEPTECLE 21A 22 PUMP 20 12 14 15 1 LIGHT/RECEPTECLE 21B COOKING APPLIANCES= 11,000 VA * 14 15 1 LIGHT/RECEPTECLE 23A 24 DINNING 1 20 12 14 15 1 LIGHT/RECEPTECLE 23 B RECEPTACLE 14 15 1 LIGHT/RECEPTECLE 25 A APPLIANCES LOADS $ 26 30 14 15 1 LIGHT/RECEPTECLE 25 B CLOTHE 2 5000 WATER HEATER, DW, PISP.= 7,500 VA * 14 15 1 LIGHT/RECEPTECLE 27 A 28 DRYER 30 * 14 15 1 LIGHT/RECEPTECLE 27 B TOTAL DEMAD 39,098 VA 39,098/240=162 AMP * 14 15 1 LIGHT/RECEPTECLE 29 A 30 A LIGHT/RECEPTACLE 1 15 15 * 14 15 1 LIGHT/RECEPTECLE 298 308 LIGHT/RECEPTACLE 1 15 15 ELECTRICAL RISER DIAGRAM TO PANEL"Am 3C# 2/0 THHN, I C#65/8"X 10'COOPER CLAD GROIJD••�; •••,�� Weather head to INTER-SYSTEM NEC.250.94 THHN,2"COND. RODS, DRIVEN INTO GROUND 6'.0'i.• •sees• FPL BONDING DIVICE MIN. ...... 2" RIGID CONDUIT `•; WITH 3 C#2/0 THHN 9••••� •+�• ��••• . . #4CU WIRE •• •• •s•• •••••• NEW 200 AMP METER "•"' 200 AMP. WATER PIPE ..•.•. MAIN z Lil 0 • :.....................:C ::0:: 2016 Ocwen® Loan Servicing, LLC 1661 Worthington Road, Ste 100 W ..... WW.00WEN.COM West Palm Beach,FL 33409 ............. O C W E N Helping Homeowners is What We Do!® Toll Free:(800)746-2936 Date: Loan Number: Property Address: IUSsS 1339 PROPERTY ACCESS AUTHORIZATION FOR ALTISOURCE®VENDORS AND REPRESENTATIVES To Whom It May Concern, Ocwen,the mortgage servicer for Wells Fargo Bank, NA and the above listed property("Property"), authorizes access by Altisource®, its representatives and vendors to conduct Property inspection and preservation services. OcwenO requests that access be granted to Altisource®vendors issued work orders for these services. Please Note-Refusal to grant Property access will void any HOA or municipal claims related to Property maintenance. Authorized Vendor: Jackson Hernandez A Division of Creative Property Preservation Vendor Phone: 786-509-8236 Vendor Email Address: ERpreservations@gmail.com If you have question or concerns, please contact us at the following telephone number or email address: Altisource® Property Preservation and Inspection Division Toll Free: 1-866-952-6514, Option 3 propertypreservations@altisource.com We thank you in advance for your cooperation. Sincerely, Ocwen® Loan Servicing, LLC NMLS#1852 This communication is from a debt collector attempting to collect a debt;any information obtained will be used for that purpose.However,if the debt is in active bankruptcy or has been discharged through bankruptcy,this communication is not intended as and does not constitute an attempt to collect a debt. oc;en LON spa we sM Pmnlw Park Ddve,8M 8 Wee Palm 8920h.FL=W A.t-+n : R-teocd Setriaes LINIITED POWER OF ATTORNEY 3001 1. Wells Fargo Bank, National Association, successor by merger to Wells Fargo Bank Minnesota, National Association (formerly known as Norwest Bank Minnesota, National Association), not in its individual or banking capacity, but solely in its capacity as Certificate Trustee, Indenture Trustee or Trustee,as applicable, (the"Trustee")of those certain trusts set forth on the attached Exhibit A(each,a "Trust," and collectively, the "Trusts") under the respective Pooling and Servicing Agreements and/or Indentures and any related governing transactional and servicing agreement(s) (collectively, the "Agreements")hereby constitutes and appoints: OCWEN LOAN SERVICING,LLC solely in its capacity as the Servicer under the Agreements, and as successor to GMAC Mortgage, LLC (formerly GMAC Mortgage Corporation), Residential Funding Company, LLC, and/or Homecomings Financial, LLC (formerly Homecomings Financial Network, Inc.) (as applicable) as its true and lawful attorney-in-fact, acting by and through its authorized officers, with full authority and power to execute and deliver on behalf of the Trustee any and all of the following instruments to the extent consistent with the terms and conditions of the Agreements: (i)all documents with respect to residential mortgage loans serviced for the Trust by the Servicer which are customarily and reasonably necessary and appropriate for the satisfaction, cancellation, or partial or full release of any mortgages, deeds of trust, or deeds to secure debt upon payment and discharge of all sums secured thereby; (ii) all documents and instruments necessary to conduct any(a) foreclosure, or(b)the taking of any deed in lieu of foreclosure, or (c) any judicial or non judicial foreclosure or termination, cancellation, or rescission of any such foreclosure, or (d) any similar procedure (collectively, as applicable,a"Foreclosure"); (iii) all documents and instruments necessary in the appearance and prosecution of bankruptcy proceedings; (iv) instruments appointing one or more substitute trustees or special purpose entities("SPEs")to act in place of the corresponding entity named in any deed of trust; (v)affidavits of debt,notice of default,declaration of default,notices of foreclosure,and all such contracts, agreements, deeds, and instruments as are appropriate to (a) maintain any real property acquired through Foreclosure, or (b) effect any sale, transfer, or disposition of real property acquired through Foreclosure; (vi)all documents and instruments necessary to effect any assignment of mortgage or assignment of deed of trust;and (vii)all other comparable instruments. 2. This Limited Power of Attorney shall apply only to the foregoing enumerated transactions and shall be limited to the above-mentioned exercise of power. This instrument is to be construed and interpreted only as a limited power of attorney. The enumeration of specific items, rights,acts, or powers herein is not intended to,nor does it give rise to,and it should not be construed as,a general power of attorney. 3. Third parties without actual notice may rely upon the power granted to said attorney-in-fact under this Limited Power of Attorney and may assume that, upon the exercise of such power, all conditions precedent to such exercise of power have been satisfied and this Limited Power of Attorney has not been revoked. This Limited Power of Attorney shall supersede and replace any other limited power of LIMITED POWER OF ATTORNEY Ocwen Loan Servicing.LLC hereby appoints Altisource Solutions.Inc.(hereinafter called"Altisource"), as its true and lawful attorney-in-fact to act in the name,place and stead of Ocwen Loan Servicing for the purposes set forth below. Ocwen Loan Servicing.LLC is the Servicer of many securitizations(the "Agreements"see Exhibit A attached for a listing)now in existence and that will be formed from time to time. The said attorneys-m-fact,and each of them,are hereby authorized,and empowered,as follows: i. To execute,acknowledge,seal and deliver tax authority notifications and declarations,bills of sale,and other instruments of sale,conveyance,and transfer,appropriately completed,with all ordinary or necessary endorsements,acknowledgments,affidavits,and supporting documents as may be necessary or appropriate to effect its execution,delivery,conveyance,recordation or filing,including the marketing and sale of real estate owned. This instrument is to be construed and interpreted as a limited power of attorney and does not empower or authorize the said attorneys-in-fact to do any act or execute any document on behalf of Ocwen Loan Servicing.LLC not described herein. Ocwen Loan Servlchi&LLC Dated.December 1'.2009 Witness: Name:Scott W.Anderson Titre:Sr.Vice President of Residential Loan Servicing Name:Juan Pardo eoMler_ State of Florida ), County of Palm Beach } BEFORE ME.Noemi Morales,a Notary Public in and for the jurisdiction aforesaid,on this 1st day of December,2009,personally appeared Scott W.Anderson who resides at Palm Beach County and who is petsonally known to me(or sufficiently proven)to be a Sr.Vice President of Residential Servicing at Ocwen Loan Servicing,LLC and the person who executed the foregoing instrument by virtue of the authority vested in him/her and he/she did acknowledge the signing of the foregoing instrument to be his/her fee and voluntary act and deed as a Sr.Vice President for the uses,purposes and consideration therein set forth. Witness my hand and official seal this 1"day of December,2009. I;U My Commission Expires: 11/1/2013 No blic ------------ MMtit RM nroMJMstrtsn EXPM Kmwftr 1,2M lOmNeWyP�Wttea Page 1 of 22 attorney executed by the Trustee in connection with the Agreements in favor of the Servicer and any such other limited power of attorney shall be deemed revoked by this writing. 4. This Limited Power of Attorney is effective as of the date that servicing for the Trusts listed in Exhibit A is transferred to Ocwen Loan Servicing,LLC pursuant to the servicing platform sale conducted in connection with the voluntary petitions filed by the debtors in Case No. 12-12020 in the United States Bankruptcy Court for the Southern District of New York and shall remain in full force and effect until (a) revoked in writing by the Trustee, or (b) as to any specific Trust, the termination, resignation or removal of the Trustee as trustee of such Trust, or (c) as to any specific Trust, the termination, resignation or removal of the Servicer as a servicer of such Trust, or (d) as to any specific Trust,the termination of the Agreement related to such Trust,whichever occurs earlier. 5. Nothing contained in this Limited Power of Attorney shall(i)limit in any manner any indemnification obligation provided by the Servicer to the Trustee or Trust under the Agreements or any document related thereto, or (ii) be construed to grant the Servicer the power to initiate or defend any suit, litigation, or proceeding in the name of the Trustee or Trust except as specifically provided for herein or under the Agreements. Dated:October 14,2013 Wells Fargo Bank,National Association, not in its individual or banking capacity,but solely as Trustee on behalf of the Trust(s) Attest: J By:Barryi vermetz Its:Vice President By:Al •flumphries Its: A991stant Secretary Unofficial Witnesses: Amanda Popo itch ate Craft STATE OF MARYLAND COUNTY OF HOWARD ss: On the 14" day of October 2013 before me, Kathleen A. Dean, a Notary in and for said State, personally appeared Barry Silvermetz, known to me to be Vice President of Wells Fargo Bank,National Association, and also known to me to be the person who executed this Limited Power of Attorney on behalf of Wells Fargo Bank,N.A., as Trustee, and acknowledged to me that Wells Fargo Bank,N.A.,as Trustee,executed this Limited Power of Attorney. IN WITNESS WHEREOF,I have hereunto set my hand and affixed my office seal the day and year written above, Q K4TNM N A.wN Notary Public:Kathleen A.Dean NOTARY pUBW My commission expires 2-6-2017 HOWARD COUNTY I�ARWMD �Y Cww*' pnEvkw2 gm7 sell nm Miami Shores Village 0 Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 CONTRACTORS' REGISTRATION Fax: (305) 756.8972 IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: Gy a,"-to yll C I e,c.fir%,c Sy rA BUSINESS ADDRESS:1--2a 6q QW !d t-O'AV API" tJCInALAW STATE EL ZIP-- � BUSINESS PHONE: (21�6 ) (-6-3 �L l ffi- FAX NUMBER CELL PHONE % 66?> q-713?-QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: 4- Z, 3 _ Z® —;( 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: 7/7/2016 EXPIRATION DATE: 7/7/2018 PERSON: SALCEDO JUAN C FEIN: 465058222 BUSINESS NAME AND ADDRESS: QUANTUM ELECTRIC SYSTEM CORP. 15969 NW 64TH AVE. HIALEAH FL 33014 SCOPES OF BUSINESS OR TRADE: LICENSED ELECTRICAL ELECTRICAL WIRING CONTRACTOR WITHIN BUIL 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 Rated 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 9,at any time after the filing of the notice or the Issuance of the certificate, the perm named on the notice or certittcete no longer meats the requirements of this section for issuance of a certificate.The department shall revoke a DFS-172-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 MiamishoresVillage Building Department �tpR ► 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 lir 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: Owner State of Florida County of Miami-Dade g} The foregoing was acknowledge before me this day of -k )bey- ,20�. By0�eVY*CAqZ— who is personally known to me or has produced asidentification. Notary: SEAL: AM OLG�A DELGADO MY l88K10 FF98TM I, ! Quantum Electrical System,. Corp. 15969 NW 64th Ave. Suite 317 786.663.4787 Miami Lakes,FL.33014 Quantumelect63@gmail.com License No. ER 13015009 License No. 14E000252 Date: October 31, 2016 State of Florida County of Miami-Dade Before me this day personally appeared Juan Salcedo who, being duly sworn, deposes and says: That he will be the only person working on the project located at: 10555 NE 2nd Avenue Miami Shores, FL 33138 Sworn to (or affirmed)and subscribed before me this 31st day of October 2016, by Juan Salcedo. Personally Known Or Produced identification X Type of identification Produced Driver ATA. OL" DB4GAiD0 License S423-420-63-177-0 " . MY CO MMOWN W96M teo yes .� Public Notary Ac R CERTIFICATE 4F LIABILITY INSURANCE DA;,11oll D►YYYY) 11/01/2016 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 INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(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 NAME: GEICO Insurance Agency,Inc. GEICO Insurance Agency,Inc. PNtkINE : 877-515-2191 Fax No): PO BOX 5316 E-MAIL Binghamton,NY 13902 ADDRESS: commercialservl omesite.com INSURERS)AFFORDING COVERAGE NAIL S INSURER A: Midvale Indemnity Company 27138 INSURED INSURER B: QUANTUM ELECTRIC SYSTEM INSURER C 15989 NW 64TH AVE INSURER D Apt.317 INSURER E: HIALEAH FL 33014 INSURER F: COVERAGES CERTIFICATE NUMBER:01477019231101 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 SUEPOLICY EFF POLICY EXP SUER POLICY NUMBER LIMITS LTR INSR WVDRMID GENERAL LIABILITY EACH OCCURRENCE $500,000 A X COMMERCIAL GENERAL LIABILITY N N GLP1001195 06/2611016 06126/2017 DAMAGE RENTED $100,000 GAIMS-MADE IX OCCUR MED EXP(Any one Person) $5,000 PERSONAL 8 ADV INJURY $500,000 GENERAL AGGREGATE $1,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $1,000,000 X POLICY JPERO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE UMIT EB ac,ident ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY AUTOS AUTOS acddent HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per acddmd 4D7 3UREACH OCCURRENCE$ MS-MAD AGGREGATE RETENTION$ WOPKERRS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECU E.L.EACH ACCIDENT -TIVE OFFICERIMEMBER EXCLUDED N/A (Manchdory In NH) E.L DISEASE-EA EMPLOYEE N yes,describe under DESCRIPTION OF OPERATIONS below EJ-DISEASE-POLICY UMIT PROFESSIONAL LIABILITY OCCURRENCE AGGREGATE DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attmch ACORD 101,Additlonal Remmks Schedule,H more space Is regtdad) Electrician CONTACTOR LICENSE#ER13015009 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED MIAMI SHORES VILLAGE BUILDING DEPARTMENT BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE MAIMI SHORES FL 33138 AUTHORED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD BID 013 20130603 Page 1 of 1 9STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 SALCEDO,JUAN C QUANTUM ELECTRIC SYSTEM CORP. 15969 NW 64TH AVE.APT.317 MIAMI LAKES FL 33014 Congratulations! 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 DEPARTMFNT`OF BUSINESS AND restaurants,and they keep Florida's economy strong. PROFESSIQW--kiEGULATION Every day we work to improve the way we do business in order ER13015009 ISSI11 09!22/2016 to serve you better. For information about our services,please log onto www.myfloridalicerne.com. There you can find more REG ELECTRICAL_COj#, _a informaation about our divisions and the regulations that impact SALCEDO,JUAN-C �a YOU,subscribe to department newsletters and learn more about DUANTUM ELECTRIC *� EM* Rt? the Department's initiatives. (INDIVIDUAL MUST'Ci� LtSCAL Our mission at the Department is:License Efficiently,Regulate LICENSING REQUIREP&'T`SP.RIOR Fairly.We Constantly strive to serve you better so that you can TO CONTRACTING IN- AREA) serve your customers. Thank you for doing business In Florida, HAS REGISTERED under the provisions of Ch.499 FS. and congratulations on your new Ikcensel date:wa 31,2018 L1 73 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ER13015009 _ The ELECTRICAL CONTRACTOR Named below HAS REGISTERED f VMS Under the provisions of Chapter 489 FS. - Expiration date: AUG 31,2018 _ rx (INDIVIDUAL MUST MEET ALL L A LICENSING REQUIREMENTS PRIOR TO RR"NG IN ANY AREA) SALCEDO,JUAN C QUANTUM ELECTRIC SYIiT� RP. 15969 NW 64TFLAVE-ABT.T7_µms � MIAMI LAKES - fl- 014 V, + "w ' t lime ISSUED: 09AIM016 DISPLAY AS REQUIRED BY LAW SEQ# L1609220002273 CTQB Construction Trades Qualifying Board PERSONAL CERTIFICATE OF COMPETENCY 200700418 r � SALCEDO JUAN C Exp. Date: 09/30/2017 QUALIFYING TRADE(S) MASTER 0001 ELECTRICAL ®n is cerbfivislone of Chapter 10 of Miami-Dade County Ju6aru K Sate.P.E. > Secretary atow Sowd mexcntlaneeeas.povteommny otsrso Local Business Tax Receipt Miami-Dade County, State of Florida -THIS ISNOT ABILL-DO NOT PAY LBT *l 7188528 BUSINESS NAMBILMATIGIN- - _ RJECE111VT No. EXPIRES QUANTUM afef sy"CORP RENEWAL SEPTEMBER 30, 2017 15969 NW 64 31Z� 74$9664 Must be displayed at place of business MIAMI LAKES FLL33014 Pursuant to County Code Chapter IIA-Art.9&10 OWNER SEC.TYPE-OF BUSINESS QUANTUM ELECTRIC SYSTEM CORP 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED C/O JUAN SALCEDO,PRESIDENT 14EO00252' BY TAX COLLECTOR Worke(s) 1 $45.00 07/17/2016 CREDITCARD-16-041429 This Local Business Tax apt only cow paysmat al tho Local Sushawa Tax.The Receipt ban a Gose, or no parm�al regulatory tol�daa uoa a%which Halder must e=comply xritll auT Baser t cad apply lathe bnsiaeas. ,r;.- The RECEIPT NO.above MOO he dhrylayed oo all commercial Vehicles-Miami-Dada Code Sac ea-M For more hdormadoo,visit nowfincollecter- CTQB Construction Trades Qualif}nng Board "BUSINESS CERTIFICATE OF COMPETENCY 14E000252 r ' QUANTUM ELECTRIC SYSTEM CORP D.B.A.: SALCEDO JUAN C Is certified under the provisions of Chapter 10 of Miami-Dade County QUAUFYINO TRADE(S) 0001 ELECTRICAL END JUlam H Sales P.E. tl � Seadmyofft fiaard dJ �wwtMao�eAe.poNecm�mn7 Whamni-Rdde Casey relanu e8 s -