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PL-15-1600Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit Permit NO. PL -6-15-1600 Permit Type: Plumbing - Residential Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 10/1 2015 Expiration: 04/13/2016 Parcel Number Applicant 960 NE 97 Street Miami Shores, FL 33138- 1132060143160 Block: Lot: UCHENNA UKAZIM Owner Information Address Phone Cell UCHENNA UKAZIM 960 NE 97 Street MIAMI SHORES FL 33138- 960 NE 97 Street MIAMI SHORES FL 33138- •Contractor(s) Phone Cell Phone LEYVA PLUMBING SERVICES INC. (772)871-5893 (772)672-3673 Valuation: Total Sq Feet: $ 13,000.00 2700 Type of Work: REPLACE BATH FIXTURES RELOCATE KITC Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $7.80 $6.83 $6.83 $2.60 $455.00 $3.00 $10.40 $492.46 Pay Date Pay Type Amt Paid Amt Due Invoice # PL -6-15-56135 10/16/2015 Check #: 95056111 $ 492.46 $ 0.00 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground 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, MECH IC WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the fo information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I auth • i ' bored vcontractor to do the work stated. October 16, 2015 Authorized Signature: Owner / Applicant / Contractor / Agent Date Building Department Copy October 16, 2015 1 Miami Shores Village %0147(kk--, R C Pf' TE.k._ JUN 26 215 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 BUILDING PERMIT APPLICATION El BUILDING ELECTRIC ROOFING E rPLUMBING ❑ MECHANICAL El PUBLIC WORKS JOB ADDRESS: 960 NE 97 ST Master Permit No. ❑ REVISION BY: FBC 20 lD Sub Permit No. Ste' 1 CEJ EXTENSION RENEWAL CHANGE OF CONTRACTOR ❑ CANCELLATION ❑ SHOP DRAWINGS Citv: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ► — 39-° `" cj' 4— 31 ' D Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: Uchenna Ukazim OWNER: Name (Fee Simple Titleholder): Address: 1521 Alton rd 426 Miami Beach FL 33139 City: State: Zip: Tenant/Lessee Name: Phone#: Email: UUKAZIM@GMAIL.COM BFE: FFE: Phone#: 561.901.3471 CONTRACTOR: Company Name: LE / v41 9IWMg• . Phone#: 7 -� '� Rze Address: ) D2 i"k• CAA CO* �`. • City: (At) g:( W u Qualifier Name: NOL— State: — Zip: 3� Phone#: State Certification or Registration #: C / ' lam/2 ' 06+ Certificate of Competency #: DESIGNER: Architect/Engineer: 1 •74sI O )9CSCtiliS1':.:c' S Jvretw-r3 Phone#: 5� 'J t.4 Address: \ %l c 5S‘J T��a1O City: ?. ' ttiVtate: 1-17k--- zip: r (1 . Value of Work for this Permit: $ (3 ( bot) — Square/Linear—F1ootage of Work: i Type of Work: El Addition Addition Alteration New L�1 Repair/Replace ❑ Demolition Description of Work: 1 sCe- . • Specify color of color thru tile: \ 3's Submittal Fee $ Permit Fee $ 7 �~ '` ' CCF $ 7 so co/ccs Scanning Fee $ 3 00- Radon Fee $ b. A73 DBPR $ . • Notary $ Technology Fee $ / D - L'%0, Training/Education Fee $ 7 .� 6Double Fee $ Structural Reviews $ Bond $ / TOTAL FEE NOW DUE $ , till] • (Revised02/24/2014) t Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Ever Bank Mortgage Lender's Name (if applicable) Mortgage Lender's Address 301 W Bay ST Jacksonville FL 32202 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 bappro ed and a reinspection fee will be charged. / Signature Signature OWNER or AGENT The foregoing instrument was acknowledged before me this �l7 day of r v c,rc l , 20 15 , by ckkeNrot , who is personally known to 1 ' ,-' � who ispersonally known to me or who has produced �L lOnVfy 1 �Cfn as me or who has educed f/) / as identification and who did take an oath. identification and who •'d NOTARY PUBLIC: CONTRACTOR The foregoing instrument cknowtedged before rpe•ttfis /b2- , 20 by day of Sign: Print: Seal: NOTARY PUBLIC: Sign: Notary Public - State of Florida My Comm. Expires Mar 4. 2018 Commission # FF 098394 ************************************************ APPROVED BY (Revised02/24/2014) eal: i@ 71I WWrYJ ;W ay ,,„4 v ti 316„ �� ***********************lI�k4k�NIM14************************ Plans Examiner Zoning Structural Review Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 LEYVA, ABNER LEYVA PLUMBING SERVICES INC 1502 SW MERIDIAN AVE PORT SAINT LUCIE FL 34953 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 from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. 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 www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantlystrive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 KEN LAWSON, SECRETARY LICENSE NUNI8Eli e ,s1- so• ; :4731 • • • • FE • .„ f, • • efil ,„14 BIC St. 4 0 • ISSUED: 08/17/2014 DISPLAY AS REQUIRED BY LAW SEQ # LI40811=2659 1 2015 / 2016 ST. LUCIE COUNTY LOCAL BUSINESS TAX RECEIPT RECEIPT # 1711-20030004 CHRIS CRAFT, ST. LUCIE COUNTY TAX COLLECTOR FACILITIES OR MACHINES / ROOMS SEATS TYPE OF 1711 AIR COND/PLUMBING CONTRACTOR BUSINESS (PLUMBING) BUSINESS/ Abner Leyva DBA NAME Leyva Plumbing Services Inc MAILING Abner Leyva ADDRESS 1502 SW Meridian Ave Port St Lucie, FL 34953 BUSINESS 1502 SW Meridian Ave LOCATION Port St Lucie, FL 34953 City of Pt St Lucie Paid 07/08/2015 12.35 EMPLOYEES 3 CFC1425666 P00000094412 0025-20150708-016687 EXPIRES SEPTEMBER 30, 2016 RENEWAL ORIGINAL TAX PENALTY COLLECTION COST TOTAL $12.35 $12.35 Law requires this Local Business Tax Receipt to be displayed conspicuously at the place of business in such a manner that it can be open to the view of the public and subject to inspection by all duly authorized officers of the county. Upon failure to do so, the Local Business Taxpayer shall be subject to the payment of another Local Business Tax for the same business, profession, or occupation. Pursuant to State Law, all Local Business Tax Receipts shall be sold by the Tax Collector beginning July 1st of each year and shall expire on September 30th of the succeeding year. Those Local Business Tax Receipts renewed beginning October 1st shall be delinquent and subject to a delinquency penalty of 10% for the month of October, plus an additional 5% penalty for each month of delinquency thereafter until paid; provided thatthe total delinquency penalty shall not exceed 25% of the Local Business Tax for the delinquent establishment. In addition to the penalty, the Tax Collector shall be entitled to a collection cost fee of from $1.00 to $5.00, based on the amount of the Local Business Tax, which shall be collected from delinquent taxpayers after September 30th, of the business year. This receipt is a Local Business Tax only. It does not permit the Local Business Taxpayer to violate any existing regulatory or zoning laws of the state, county or cities. It also does not exempt the Local Business Taxpayer from any other taxes, licenses or permits that may be required by law. Local Business Taxes are subject to change according to law. Abner Leyva 1502 SW Meridian Ave Port St Lucie, FL 34953 A o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/07/2015 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 lieu of such endorsement(s). PRODUCER Emmanuel Insurance & Associates, Inc. 2370 E 8TH AVE HIALEAH, FL 33013-4236 -CONTACT Sarai Medina NAME: ((P,eHONr o, Ext). (305) 693-0003 FAX No): (305) 691-4381 ADDRESS: sarai emmanuelinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Preferred Contractors Insurance.Cop. 12497 INSURED LEYVA PLUMBING SERVICES, INC. ABNER LEYVA Lic # CFC1425666 1502 SW MERIDAN AVE PORT ST LUCIE, FI 34953 INSURER B : PC102047 INSURER C: 07/01/2016 INSURER D : $ 1,000,000.00 INSURERE: $ 50,000.00 INSURER F: $ 5,000.00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IPOLICY LTR TYPE OF INSURANCE INSR WVD POLICY NUMBERLIMITS EFF {MM/DDn'YYI� POLICY EXP (MM/DDIYYYY) A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY PC102047 07/01/2015 07/01/2016 EACH OCCURRENCE $ 1,000,000.00 DAMAGETO RENTED PREMISES (Ea occurrence) $ 50,000.00 MED EXP (Any one person) $ 5,000.00 CLAIMS -MADE OCCUR PERSONAL &ADV INJURY $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 PRODUCTS - COMP/OP AGG $ 2,000,000.00 GEN'L AGGREGATE X POLICY LIMIT APPLIES ^ JECT PER: LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule If more space is required) Residential and Commercial Plumbing . Any Changes or alterations Done to this document after being issued shall constitute it null and void CERTIFICATE HOLDER CANCELLATION Village of Miami Shores 10050 NE 2 AVE Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED R E ATIVE nn ACORD 25 (2010/05) © 1988-2010 ACO R6 ORP RATI N. II rights reserved. The ACORD name and logo are registered marks of ACORD 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: 4/30/2014 EXPIRATION DATE: 4/29/2016 PERSON: LEYVA FEIN: 651046604 BUSINESS NAME AND ADDRESS: LEYVA PLUMBING SERVICES 1502 SW MERIDIAN AVE PORT ST LUCIE FL 34953 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR ABNER 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 certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 Leyva Plumbing Inc 1502 Merdian Ave Port St Lucie, FI 34953 June 15, 2015 State of Florida County of Miami dade 1940 North Monroe Street, Tallahassee, FL 32399 Before me this day personally appered nn gVler J—Q-YV ' whoPp �7� , being duly sworn, deposes and says: That he or she will be the only person working on the project located at 960 NE 97 ST Swor to (or affirmed) and subscribe before me this 9-2—day of 'I v ._, 2015 by A -b - er ✓'A— Personally Or Produ Type of Print, Type or Stamp Name of Notary 1� d0 99SL9133# * • 910Z'60'uef • _ sandx3 •wwo3 AIN 1111 iami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption �Y �t ..i . �. j) { ,/�� .. .p�p �} L ti' -'SLI 7 ��.'! �;�.. •}..� !' �4n Vt4•1•�+���'Yl ';t4-4 AT�A Fr4ti�r ��t����r�.I '.4 .... ... h%u9 :,4c:�•.�� . 7 A�¢a>•J+y F 'ALT' Tr'j*„ 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 -tine 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 B OW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signatu ,A1AP Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this / day of By 11 1 /1 e'er) who is personally known to me or has produced Notary: SEAL: rw as rues 4a'\ �? ADR€AN VIVENE IVES 4 /',�'tl ,,,i,l , ry Pub& - State of Florida 4 ,,�} Commission f FF 904350 osn - My Comm. Expires Alp 9.2019