RC-13-212Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 185153 Permit Number: RC- 2- 13-212
Scheduled Inspection Date: February 19, 2013
Inspector: Bruhn, Norman
Owner: MARTINEZ, MARTA GAMALLO
Job Address: 10528 NW 2 Avenue
Miami Shores, FL 33150-
Project: <NONE>
Contractor: MIAMI JGL DECO PAVERS CORP
Permit Type: Residential Construction
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1121360020030
Phone: (786)286 -5033
Building Department Comments
REMOVING DECORATIVE CHIMNEY AND COVER
EXISTING COLUMNS WITH KEYSTONE
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 15, 2013
For Inspections please call: (305)762 -4949
Page 16 of 32
PERMIT #
CONTRACTOR:
SUBMITTAL DATE:
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rip
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ADDRESS: 1 02,1cCNW �,�
NAME: , , -
,..
RESUBMITAL DATES:
PROJECT TYPE:
, , ;' , UM
it
ZONING
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC ;
MECHANICAL --BLDG
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
a U� DINGS (62-
PERMIT APPLICATION
Permit Type:
BUILDING
JOB ADDRESS: /05 2 8 Pvu, //vs-
0 3
B Yo Ir-
FBC 20
Permit No. -C1) 3 `
Master Permit No.
ROOFING
City: Miami Shores County:
Folio/Parcel #:
�/ 2 i3 6o o 20 34
Is the Building Historically Designated: Yes
Miami Dade
Zip: 33 150
NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): 7MttT /1 1444 1 L0 : Agevz // Z
Address: /0 5 2 0 ' ,� Aiv�
City: ,✓10191 / ..3— 4O/t , State:
Zip: 33/50
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: *//'t1 jez D6C 2 9j Vb Phone #: ° Z o33
Address: � !ir 3432 .$C ' i6 5 / it
City: I V / # / State: AZ Zip: 33 /45'
Qualifier Name:
State Certification or Registration #: (77 s s-0 062 I
Phone #: f `? 4(
Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
/ 00
Value of Work for this Permit: $ '4%. Square/Linear Footage of Work:
Type of Work: ❑Addition °All`teration
Description of Wo : l/9 _
C'arl� l�l� Ull S1 %Vl )
New °Repair/Replace )
Ve) l ,�JJu �if
UDemolition
Color thru tile:
Submittal Fee $ Permit Fee $ w CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ (! ,l QO
33
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 whic occurs . e 7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be appro -d an a r..' spe•tion fee will be charged.
Signature
The for
day of
0 ' s er or gent
s ►� e. was a knowledg -d be
1 t(.i
personally kn
NOT
Sign:
Print:
1
l.Oy
to me or who has produced
identification and who did take an oath. 0 3
Y PUBLIC: -
a
this
I£
/r
Signature
f
who is
_ JL�
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
* **
dYJ
Plans Examiner
Structural Review
e
Contractor
instrument was ackn. • ledged before, me this
,20� by
ersonally kndwn to me or who has produced i�ly
• O` dentification and who did take an oath.
OTARY LIC: -
Sign:
Print:
" 1.-420 LOAM
CLAUDIA '. ! • •
• .. Public • State of Florida
My Commis
(Revised 5 /2/2012XRevised 3/12/2012) )(Revised 06 /10 /2009XRevised 3 /15 /09XRevised 7/10/2007)
=`'; Expires Sep
-Ie
My Comm. Exp
7 Commission # EE 128810
%FO;,,', °0'�` Bonded Through National Notary Assn.
Zoning
Clerk
,.,, ., .... L., ........
Hollywood, Florida 33020
As a necessary incident to the
fulfillment of conditions contained
in a title insurance commitment
issued by it.
File Number: 120088
Folio Number: 11 21360020030
LIMITED POWER OF ATTORNEY
Know All Men By These Presents:
That MARTA G. MARTINEZ has made, constituted and appointed, and by these presents do(es) make, constitute and appoint
LEONARD MARTINEZ true and lawful attorney for and in name, place and stead, giving and granting unto said attorney full power
and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises,
including but not limited to the conveyance/encumbrance of said premises, execution of deed/mortgage, settlement statement and any
related closing documents; said premises being limited to the following described real property:
Lot 3, Shoreland Heights, according to the map or plat thereof, as recorded in Plat Book 43, Page(s) 85,
of the Public Records of Miami -Dade County, Florida.
As fully, to all intents and purposes, as might or could do if personally present, with full power of substitution and revocation, hereby
ratifying and confirming all that said attorney or substitute shall lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, I /we have hereunto set my /our hand(s) and seal(s) DATE: 7 - Z Sl -
Sealed
elivered in the presence of
Witness Name Printed: j % RTA G. MAR
1Mitne me Printed: (9AJPZ) 41Il l 11/) 1 iC kWi
STATE OF Fe'oiI 'PA
COUNTY OF l 4
J� r
i l OLr+c�,. Q r -1c)e)
The foregoing instrument was acknowledged before a this 1 " ! Z by MARTA G. MARTINEZ who is/are
personally known to me or who has produced a J(. 50-c-74' as identification.
Notary Public
.41 2 e-- I /
Printed Name
My Commission E
(Notary Seal)
MARCIAL R. PENA
1. Notary Public - State of Florida
My Comm. Expires May 3. 2016
'- ao,»,' ` Commission # EE 195509
JE F ATWATER STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMMA: MA LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE
PERSON:
FEIN:
09/1912011 EXPIRATION DATE: 09/18/2013
LEYES JAVIER G
270958838
BUSINESS NAME AND ADDRESS:
MIAMI JGL DECO PAVERS CORP
4485 SW 7TH STREET
MIAMI FL 33134
SCOPES OF BUSINESS OR TRADE
1- CONCRETE WORK
IMPORTANT: Pursuant to Chapter 440. 05(14), F.S., as officer of a corporation who elects exemption from this chapter by filing a certificate of election tinder this
section may not recover benefits ec compensation wider 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 tested on the notice of election to be exempt. Permute to Chapter 440.05(13), F.S., Notices of election to be exempt and certttcates of
election to be exempt shall be subject to revocation if. at any time after the filing of the make 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 certificate at any time for failure of the person
named an the certficate to meet the requirements of this section.
MC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
QUESTIONS? (850) 413 -1809
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CINISTRUCTI0N INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKCERS' COMPENSATION LAW
EFFECTIVE 09/19/2011 EXPIRATION DATE: 09/18/2013
PERSON: JAVIER G LEYES
FEIN: 270958838
BUSINESS NAME AND ADDRESS:
MIAMI JGL DECO PAVERS CORP
4485 SW 7TH STREET
MIAMI, FL 33134
SCOPE OF BUSINESS OR TRADE
T- CONCRETE WORK
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., aun officer of a corporation who
elects exemption from this chapter by filing a certificate of election
I- under this section may not recover benefits or compensation under this
D chapter.
H 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
E the notice of election to be exempt
E 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 Awned on the notice or certificate no longer meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
person nand on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1509
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
Lj /D w PE O% ill E J
OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
, r t
AC®
CERTIFICATE OF LIABILITY INSURANCE
DATE(MA1!DDIYYYY}
2/9/2013
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 POUCIES
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 I y( ) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsentenL A statement on tidy certificate does not confer rights to the
certificate holder In Neer of such endorsement(s).
PRODUCER
ANDYS ASSURANCE AGENCIES
1441 W Flagler St
Miami, FL 33135
CONTACT
NAME:
PHONE (305) 642 -8407 m"0005)643-5R68 C
�S :loreta @andysassurance.com
NEKIRERt81 AFFORINSO commas
NAIC9
INSURER A : GRANADA INS CO
INSURED
MIAMI JGL DECO PAVERS CORP
4485 SW 7th Street
Coral Gables, Fl 33134
INSURER 8 :
INSURER C :
INSURER 0 :
INSURER E :
INSURER F :
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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NOR
LTR
TYPE OF INSURANCE
MIDI
NOR
SUM
t
POLICY NUMBER
(IYU6IDDIYYYYI
iM18N1O0iYYYYN
LIMITS
GENERAL
X
LABILITY
COMMERCIAL GENERAL. LABILITY
0185FL00030051
10/03/1210/03/13
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO
PREMISES Ea =wen*
$ 100' , 000
MED F (Any neeperson)
$ 5 ,000
$ 1,000,000
I CLAIMS-MADE 1 x I OCCuR
PERSONAL& INJURY
GENERAL. AGGREGATE
$ 2,000,000
PRODUCTS - COMPIOP AGG
$ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
—1 POUCw n n �
$
AUTOMOBILE
—
—
—
—
UAMLITY
ANYAUTO
ALL OS D
HIRED AUTOS
—
—
SCHEDULED
NOMOI D
AUTOS
C MB SINGLE LIMIT
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LAB
EXCESS LIPS
—
EACH OCCURRENCE
$
AGGREGATE
$
$
DED I I RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRETOM YI
N/A
I S I I TH-
ER
EL. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEES
0FFI EXCLUDED? I
m NIq
if . desert* under
DESCRIVIION OPERATIONS below
E.L. DISEASE - POLICYLIMIT
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS !VEHICLES (Attach ACORD 101, A aI Remarks Schedule f mme apnea is required)
PAVING
CERTIFICATE HOLDER
CANCELLATION
MIAMI SHORES VILLAGE CONDOMINIUMS
10050 NE 2nd AVE
MIAMI SHORES, FL. 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLI
THE EXPIRATION 0 EREOF, NOTIC t
ACCORDANCE W1TH POLITY PROVISIONS.
NCELLEO BEFORE
DELIVERED IN
ACORD 25 (2010105)
9988 -2ol o ACoRO CORPO ° TION. All rights reset
The ACORD name and logo are = = marks of ACORD