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RC-12-2020PERMIT # CONTRACTOR: ' r� �� SUBMITTAL DATE: r 1 b r� o.1 Po ADDRESS: -I 51 C CO fL- NAME: Y`nC_:.N TQ SH RESUBMITAL DATES: PROJECT TYPE: ¶f w H r(/1 L fl \O ZONING FIRE STRUCTURAL IMPACT FEES ELECTRICALA' / HRSIDERM cIK' ' (Cr `?r PLUMBING NOC MECHANICAL B \/ Permit Number: RC -10 -12 -2020 I Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184387 Inspection Date: January 22, 2013 Inspector: Bruhn, Norman Owner: MCINTOSH, ANDREW Job Address: 434 GRAND CONCOURSE Miami Shores, FL Project <NONE> Permit Type: Residential Construction Inspection Type: Final Work Classification: Addition /Alteration Contractor: TRUE LINE CONTRACTING & REMODELING SERVICES INC Phone Number Parcel Number 1132060170050 Phone: (954)290 -4100 Building Department Comments BATHROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS True Passed / X-... Inspector Comments REI SPECTIONEFOR INSP11 06 8. cancelled by ken smith ED AS Not Ready. NB /-/y Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until January 22, 2013 For Inspections please call: (305)762 -4949 Page 1 of 1 NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. 12 TAX FOLIO NO. 1 I Jr�� A__OS -539 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be ma property, and in accordance with Chapter 713, Florida Statutes, the fol is provided in this Notice of Commencement. Legal description of property and s ee :. ass: •O" 2. Description of improvement: _fig 4 roes tw. 4`e ' v 111111111111111111111111111111111111111111111 CFN 2012R0779376 OR Bk 28336 Ps 3264F (1Ps) RECORDED 10/31/2012 13:20153 HARVEY RUVINe CLERK OF COURT MIAMI —DADE COUNTY? FLORIDA LAST WAGE ORIDA, COUNTY OF DADE TIF , t this is a Lai ; py of the `s office on da , A0 20 ii and d • ict Seal. ' RUV N ► ' at cu; = nd County Courts NO Space above reserved for use of recording office y at AiQ1 AI ©f' 14)+9 X31 i< C0U4 c WITNESS m 4‘' ECOU ' 3. Owner(s) name and address: Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, ad and h e number. j.1$ W El t . f 1j P1. 3.161 5. Surety: (Payfnent bond required by °Amer from contractor, if any) Name, address and phone number. Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number 8. In addition to himself, Owners designates the following person(s) to receive a copy of the i.lenor's Notice as provided in Section 713.13(1Xb), Florida Statutes. Name, address and phone number 9. Expiration date of this Notice of Commencement: (the expiration date Is 1 year from the date of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of , or Own Prepared By o ti Print Name .4-"a Title/Office STATE OF FLORIDA COUNTY OF MIAMI -DADE The fo ing trent was ' Authorized Officer/Director/Partner/Mana Prepared B Print Name Title/Office ed . -fore m this dividually, or ❑ as for Personally known, or ❑ produced the following type of identification: Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, l declare that 1 have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signatures f Owner(sOwner(s)'s rized Officer/Director/Partner/Manager who signed above: By day of 1; manowor LSQZZBgd U osel plc t#uaG o at!J6udd +c ° Bold {o aletg'olignd !Ve }o .817t7 By 4''91 C 123.01 -52 PAGE 3/10 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 161701 k'L. BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: /3 9 t r ,,• n d Cop, c 0 `-' (5 -e City: Miami Shores County: Miami Dade Fo1io/Parcel#: 1 f " 3 loG, ° 0/ % —00-3-0 Is the Building Historically Designated: Yes NO Flood Zone: Permit No. FBC20j0 Master Permit No. ROOFING Zip: 33 f 3cS' OWNER: Name (Fee Simple Titleholder): Address: e% 31/ Cna Ad ,elC' .e State: P r • City: eatrv. r -C" or S .4.74.-s Phone #• g 75 —; 5.a La,S" Zip: 3 3 r 3 c? Tenant/Lessee Name: nn Phone#: Email: c Emai /✓� c. /1 i & ihJ fI `ia') S A f el 1) el ro /"s CONTRACTOR: Company Name: U . Lr Cpn'ICA.G'1 Vin J tin e M 6d e'en Phone#: 9'.�'J 2.g C yt©Ca „i c . Address: gq (r / / /w! A 1 Li City: Mc I c ,v owl State: I Qualifier Name: Ke fl 1 't i_., State Certification or Registration #: C G C (ST 105' % Certificate of Competency #: // 1 Contact Phone#:9 14 0 4 %BD r Email Address:'f'PveLe C4/ //1 & J 161 DESIGNER: Architect/Engineer: Oe rA.IO ! f, ra, tee. a-S A 5 CPhone#: q..51/4q 9.9 - 2iT4 10 Value of Work for this Permit: $ / p © <� Square/Linear Footage of Work: 4p 0 S.) Pit, . 0/ 9 Phone #: 9, Y 20 6 m©o Type of Work: DAddition ❑Alteration p ONew Description of Work: 11 q`4' tno Aes re /►^0 cal e l I9Repair/Replace ODemolition Color thru tile: ***************************************F I ********* * * * * * * ** * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ 56 • J� Permit Fee $ r,1 Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO/CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 AFFLDAVIT: 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The fore mat trument was ac wled % 20 by who is personally known to befo 111 me Ih1 ilia►, r who has produced As identification and who did an oath. NOTARY P Notary Public State of Ft Ste le Greene ot° Ex C. Sign: My Commission Expires:9 '611111° )! I, * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY Contractor The fore • oing instrument was acknowledged befo day of u^ 20 by -LII- 1 A Cat 1 who is personally known to m= or who has produced as identificatio an ' who did take an oath. NOTARY PUBLI Sign: Print: v..4411, arlistm„.„4,. lia My Commtsst Expires: Notary Public State -of Florida phenie Greene My Commission D0922351 Expires 0Pf02i2013 2 �3 > *** **, x+ x********* *** ****+x************ ** *******a****** *+ >< ********* **x:********$*c *** / L) 60 Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Zoning Clerk s .. 10/10/2012 02:52 NAT I ONW I DE -i' 19549220007 ACORD CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE DOES is Issued R A MATTER OF INFORMATION ONLY EXTENO OR ALTER RIGHTS COVERAGE AFFORDED Y THE OLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: certificate is ADDITIONAL N d st. �� terms a conditions of the icy ato $ pD1S maayrequire an nrem n A statement on this certificate does not confer rights to the certificate holder In lieu et such endorsement(Sl- PRODUCER NO.171 D02 1 OAT51NMIUDrvrrrl 10/10/2012 T x TOSEIROS INSURANCE AGCY INC 604 PALM SPRINGS AVE ALTAMQNTE SPRINGS INSURED FL 32701 TRUE LINE CONTRACTING AND REMODELING SERVICES INC 846 HOLLYWOOD BLVD HOLLYWOOD FL 33018 -1604 LIduN1eR P : REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEC. 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 9Y THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAws's. _ POLIGYEXP L1NIT8 IN I .vueOm INSURANCE P6 NUMB Jn +.kW r� 1 -, EACH OCCURRENCE 1 1,000 OM_ ( , D � $ 100.�� \- ' MED @XP (Any one Perms) $ 5 000 ACP 0120 5914005866 03/14/2012 05/14/2013 PERSONAL a AIN INJURY S 1.000,000 ___ GENSfiAL AGGREGATE S 2,0,000 PRODUCTS • COMPtOP AGO 8 1.000.000 s A � • � FAIt S.MAI ADRRE0S: frennutatatAPPBRAINGSPYgRAPP. NAICJ .. ItgURER A: NATIONWIDE INSURANCE COMPANY OF AMERIC2533 INSURER a : INSURER C: INSjd$o: -- GENERAL UASWTY COMMERCIAL GENERALUA UTY I CLAWS-MADE © OCCUR A I ENL AGGREGATE LIMIT APPLIES PER X POLICv PRO. • U)C AUTOMOBILE UA0ILl1 "I ANY AUTO AU 00 OWNED MIRED AUTOS UMtaREIJ.A LAB T-- EXCESS LIAR I"" �D AUTOS OCCUR 0E0 - woRNSRS COMPENSATION AND EMPLOYERS' Lamm, vim ANY PRDPRIEYORIPARTNERIEILBCUTIYE OFFICEALENSER EXCLUDED'/ IM*Odarory I NH) Yoe, dmdba under tIMIEPrlDy ItgiPERATIONS Arittm 1.717 DESCRIPTION OF OPERATtONE 1 LOCATIONS / VEHICLEe IAimaN ACORO 101 CERTIFICATE HOLDER Miami Shores Village Building Department 10050 NE 2nd AIm Miami Shore6 EIILY INJURY tPor PrsoU SLY INJURY (Pet mom ti OAMAGE OCCURRENCE AGGREGATE au• $ $ E S EL. EACH AGGIDENT EL0ISEs • EA EMPLOYEE S E.L DISEASE - POLICY LINT S 5 ASOENTh l waits 8cnV0 Ie, If mono spat* Is roqut1 1 FL 33135 CANS LLATION SHDULe ANY OF THE ABOVE DESCRIBED POLICIES ee CANCEL -L0 BEFORE NCT � 0URIOE WILL SE DELIVERED N ACCORRDACE W H tC POVIN AUTHORIZED Fd3PRESENTAT V8 Theoeore K.Tombros ®1888.2010 ACORD CORPORATION. Alt rights reserved. ACORD 25 (2011505) The ACORD name and logo are registered marls of ACORD 600012 -9 0T N ki ACESNG INC a DOING BUS IN DADE CO THIS IS NOT A BILL — DO NOT PAY RENEWAL STATEMN10547 iKUE LINE CONTRA & REMOD SRVS IN selYgegagnt BUILDING CONTRACTOR WORKER /S TIES IS ONLY A LOCAL 1 BUSINESS TAX RILL IT DOES NOT PERIM* HOLDER TO VIOLATE THE EXISTING S OP THRE COUNTY OR cm . NOR DO NOT FORWARD DOES n. Exam THE HOLDER PROM PERMIT OR ANY O ER NOT A c S� TRUE LINE CONTRACTING & TwHS REMODELING SERVICES INC KENNETH G SMITH PRES PAYMENT RED 846 HOLLYWOOD BLVD COLLECTOIN COt1tR"A" HOLLYWOOD FL 33019 60000000013 000075.00 t ii {{t fi ii ( ii { 13l!3tt jl rj�erF�ii�FriiFFiti�il FFttl/ ti lipil�ittf!ll�t�iifFf�fFlifiit SEE OTHER SIDE FFRST -C .ASS U.S. POSTAGE PAID MAIL PERMIT � 626037 -6 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 SMITH KENNETH GARY TRUE LINE CONTRACTING & REMODELING SERVICES INC 846 HOLLYWOOD BLVD HOLLYWOOD FL 33019 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,myfloridalicensecom. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Departments 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, and congratulations on your new license! DETACH HERE (850) 487 -1395 ATE OF FLORIDA ACS S -3 a S_ ,GO TN ENT'. OF .BUSINESS AND::, SSIONA:L REGULATION CGC15054 128050291 T$ . GERTIFI�D under the;prevlsions at di„ 489 FS .. sxp ratios Gate AUG 31, :2.014 L12090702 57 rc�EM STATE OF FLORIDA D E P A R T N T O F B U S I N E S S AN D P R O F E S S I O N R E G U T T I O N coNs i INDUSTRY' ._.Lim:Norm BOARD amw L120'90702957 LICENSE NBR, d DATE - BATCH NUMBER 09/07./2012. 128050291E The GENERAL CONTRACTOR Naitied:..below IS CERTIFIED Under the provisions of Chapt Expiration date: AUG 31, 2014 VERN DISPLAY AS REOUIRED`RY. i A KEN LAWSON SECRETARY 11-17-2011 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER 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 taw. -1 EFFECTIVE DATE: 12131/2011 PERSON: SMITH FEIN: 200603088 BUSINESS NAME AND ADDRESS: TRUE LINE CONTRACTING & REMODELING SERVICES ANC 848 HOLLYWOOD BLV HOLLYWOOD FL 33019 EXPIRATION DATE: 12/30120/3 KENNETH G SCOPES OF BUSINESS OR TRADE: 1- Painting or Paperhanging * IMPORTANT: Pontoon to Chapter 440. 05(141, RS., an officer of a =pored= who elects exemption from this chapter by filing a certificate of election Under tell section may not recover benefits ar compensation under this chapter. Pursuant to Cbepter 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 t0 Chapter 440.05{13), F.S., Notices Of election 10 be exempt and cenuf aces 01 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 ceftifitate ao longer meets the requirements of this section for issuance of a certificate. The deparnnant shall revoke a certificate at any time for failure of the person named on the certificate to moot the requirements of ibis section. OWC -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 CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 12/31/2011 EXPIRATION DATE: PERSON KENNETH G SMITH FEIN 200603088 BUSINESS NAME AND ADDRESS: TRUE LONE CONTRACTING & REMODELOIG SERVICES INC 848 HOLLYWOOD N.V HOLLYWOOD. FL 33013 SCOPE OF BUSINESS OR TRADE 1- Painting or Paperhanging 12/30/2013 IMPORTANT Pursuant to Chapter 440.05(14 F.S., an officer of a carporation who elects exemption from this chapter by filing a certificate of election L 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 Rexempt.. apply only within the scope of the business or trade listed on 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 tensed on the notice or certificate no longer meets the requirements of this section for Issuance of a certificate. The department stall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? {650) 413 -1609 CUT HERE e Carry bottom portion on the job, keep upper portion for your records. MC- 262 CERTIRCATE OF ELECTION TO 8E EXEMPT REVISED 01 -11 846 Hollywood Blvd. Hollywood, FL 33019 Oweees Mr. & Mrs. McIntosh owneeBAddress 434 Grand Concourse Fax 954.922.0007 truelineinc@bellsouth.net FL License No. CGC1510547 sir Miami Shores 's Zip Cade 33138 Ownees Hone Phone 105 756 6365 (Names Work Phone Project Address Project City Project Zip Code ( Project Phone Date 9/27/12 Construction Fund Holder Name Of any) Construction Fund Holder Address Construction Fund Holder City, State, Zip T/WE, the Owner(s) of the premises described above authorize Trice Line Contracting, hereinafter referred to as "Contractor", to furnish all materials and labor necessary to construct and/or improve these premises in a good, workmanlike and substantial manner according to the following terms, specifications and provisions: a. Description of the work and the materials to be used_ __ -- Bathroom: Remove vanity, sink and faucet . Remove mirror. Remove toilet. Remove wall light and save. Remove all wall tile . Remove tub. Remove floor tile in vanity area Remove all wall board to studs (entire bathroom) . Relocate electrical outlet near vanity. Update electric to today s codes Build (2) alcove. Remove existing wall heater. b. Description of any areas that will NOT be worked on: This Ust of specifications may be continued on subsequent pages (sae page number below). c. Payment Contractor proposes to perform the above work, (subject to any additions and/or deductions pursuant to authorized change orders), for the Total Sum of $ 12,480.00 Down Payment (if any) $ 480.00 PAYMENT DUE WHEN AMOUNT 1. Upon completion of demo. $4000.00 Upon completion of plumbing and 2. electrical rough. $3000.00 3. When walls are closed. $3000.00 4. Upon completion. $2000.00 CI gat !. i. ELI ■ ._ a _.sir~ _._ • �. s . C, grynonre enonfandCenplattnnof Work rnmmenermept of unlit chall /TIMM tke physical delivery ofmaterials onto the premises and/or the perfonnance of any labor and commencement shall be subject to permissible delays as described in provision (6) on the reverse side. Approximate Start Date: Approximate Completion Date: e. Acceptance; This contract is approved and accepted 1 (we) understand there are no oral agreements or understandings between the patties of this agreement The written tenns, provisions, plans (Wavy) and specifications in this contract is the entire agreement between the parties. Changes in this agreement shall be done by written change order only and with the approval,, (both parties. Changes may incur additional charges. is Contract Are On The Reverse Side And May Be Continued On Subsequent Pages (see page number below). lo OWNER /AGENT, see the "Arbitration of Disputes" provision on page two (provision 14) and the NOTICE following this provision. If you agree to arbitration, initial on the line below the NOTICE where indicated. Also, initial in the same place on EACH COPY of this contract. NOTE: This contract may be withdrawn after 30 clays from 9/27 / 12 N not approved and signed by both parties. Form GCI-C Copyright 1998-2007 ACT Contractors Forms (800) 820 -5658 www.calform.com Page one of 3 Total Pages A t IUNAL tKUVI;iIUN`.i- unless otherwise specified herein, the following additional provisions are expressly incorporated into this contract Contract: Plans, Specifications, Permits and Fees. The work described in is contract shall be done according to the plans and the plan specifications (if any) except in the case of conflict when the provisions of this contract shall have control over both the plans and the plan specifications. All required building permits will be paid for by Owner and obtained by Contractor. All other charges, taxes, assessments, fees etc., of any kind whatsoever, required by any government body, utility company or the kyle shall be paid for by Owner. 2. Property Lines. Owner is responsible to locate and inform Contractor of the location ofall property lines. At the discretion and directionofConhactor, Owner may be required to provide at Owner's expense, a licensed surveyor's map of the property showing property lines. 3. Installation. Owner understands that Contractor may or may not install the materials. Contractor has the right to subcontract any part of or all of the work herein 4. Change Orders Should Owner, construction lender, or any government body or inspector require any modification to the work covered under this contract, any cost incurred by Contractor shall be added to the contract price as extra work and Owner agrees to lay Contractor his normal selling price forsuch extra work. All extra work as well as any other modifications to the original contract shall be specified and approved by both parties in a written change order. All change orders shall become a part of this contract and shall be incorporated herein. 5. Owner's Responsibility: Insurance etc. Owner is responsible for the following: (1) to see that all necessary water, electrical power, access to premises, and toilet facilities are provided on the premises. (2) to provide a storage area on the premises for equipment and materials. (3) to relocate and proteetany item that prevents Contractor from having free access to the work areas such as but not limited to fiuniture, appliances, draperies, clothing and other personal effects, TV or radio antennas, vehicles, tools or garden equipment In the event that Owner fails to relocate such items, Contractor may relocate these items as required but in no way is Contractor responsible for damage to these items during their relocation and during the performance of the work. (4) to obtain permission from the owner(s) of adjacent property(ies) that Contractor must use to gain access to the work areas. Owner agrees to be responsible and to hold Contractor harmless and accept any risks resulting from the use of adjacent property(ies) by Contractor. (5) to correct any existing defects which are recognized during the course of the work. Contractor have no liability for correcting any existing defects such as, burnot limited to, dry rot, structural defects, or code violations. (6) to maintain property insurance with Fire, Course of Construction, all Physical Loss with Vandalism and Malicious Mischief clauses attached, in a sum at least equal to the contract price, prior to and during performance of this contract If the project is destroyed or damaged by an accident, disaster or calamity, or by theft or vandalism, any work or materials supplied by Contractor in reconstructing or restoring the t shall be paid for by Owner as extra work. 6. Delay. Contractor shall not be held responsible for any damage occasioned by delays resulting from: work done by Owner's subcontractors, extra work, ads ofo er or owner's agent including failure of owner to make timely progress payments or payments for extra work, shortages of material and/or labor, bad weather, fire, strlke, war, governmental regulations, or any other contingeneks tmforeseen by Contractor or beyond Contractor's reasonable cxntroL 7. Surplus Materials and Salvage. Any surplus materials left over after this contract has been completed are the property of Contractor and will be removed by same. No credit is due Owner on returns for any surplus materials because this contract is based upon acomplete job. All salvage resulting from work under this contract is the property of Contractor. 8. Cleanup & Advertising. Upon completion, and after removing all debris and surplus materials, wherever possible, Contractor will leave premises in a neat, broom clean condition. Owner hereby grants to Contractor the right to display signs and advertise at the job site for the period of time starting at the date of signing of this contract and continuing unintemmted until fourteen (14) days past the date the job is completed and payment in full has been made. Owner grants Contractor the right to publish the project street address on a "references" list which may be given to prospective customers. 9. Unanticipated Conditions & Concealed damage. Expense incurred because of unusual or unanticipated conditions shall be paid for by owner as extra wort (conditions such as, but not limited to, ground conditions that require fit1, or unusually hard soil, rocky soil, or the price of ground water). Contractor will inform Owner of any dry rot or other deterioration or unanticipated condition which is concealed and is discovered dining the course of the work. Contractor is not responsible to repair any such dis covered deterioration orcondition and any work done by Contractor to remedy such will only be done as extra work in a written change order. 10. Hazardous Substances. Owner understands that Contractor is not qualified as a Hazardous Material Handler or Inspector or as a Hazardous Material Abatement contractor. Should any hazardous substances as defined by the government be found to be present on the premises, it is the Owners' responsibility to arrange and pay for abatement of these substances. 11. Right to Stop Work and to Withhold Payment on Labor and Materials. If any payment is not made to Contractor as per this contract, Contractor shall have the right to stop work and keep the job idle until all past due progress payments are received. Contractor is further excused by Owner from paying any material, equipment and/or labor suppliers or any subcontractors (hereinafter collectively called " suppliers"), during the period that Owner is in arrears in making payments to Contractor for bills received during that same period. If these same "suppliers" make demand upon Owner for payment, Owner may make such payment on behalf of Contractor and Contractor shall reimburse Owner for this amount at such time that Owner becomes current with Contractor for all past due payments. Owner is responsible to verify the true amounts owed by Contractor to these same "suppliers ", prior to making payment on behalf of Contractor. Owner shall not be enticed, under any circumstances, to collect as reimbursement from Contractor any amount greater than that exact amount actually and truly owed by Contractor to these same " suppliers ", for work done or materials supplied on Owner's job. 12. Collection. Owner agrees to pay all collection fees and charges including but not limited to all legal and attorney fees that result should Owner default in payment of this contract. Overdue accounts are subject to interest charged at the rate of 18% per annum or at the highest rate allowed ' law. 13. Legal Fees. In the ev litigation or arbitration arises out of this contract, prevailing party(ies) are entitled all legal, arbitration, and attorney fees. The court or arbihatorshall not be bound to award fees based on any set, fee schedule but shall if it so chooses, award the true amount of all costs, expenses and attorney fees paid or incurred. 14. Arbitration of Disputes. Any controversy or claim arising out of or relating to this proposal/contract, or the breach thereof, shall be settled by arbitration in accordance with the applicable Construction industry Arbitration Rules of the American Arbitration Association which are In effect at the time the demand for arbitration is filed. A judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Any arbitration award shall be subject to correction andlor vacation for the reasons stated in the law. The arbitrator shall award reasonable attorneys fees and expenses to the prevailing party. After being given due notice, should any party fait to appear at or participate in the arbltratlon proceedings, the arbitrator shaft make an award based upon the evidence presented by the party(les) who do (does) appear and participate. Notwithstanding Contractor's right to arbitrate, Contractor does not waive any of its lien rights. NOTICE: By Initialing in the space below you are agreeing to have any dispute arising out of the matters included to the "arbitration of disputes" provision decided by neutral arbitration as provided by law and you are giving up any rights you might possess to have the dispute iftigated in a court or jury trial. By Initialing in the space below you are giving up your judicial rights to discovery and appeal, unless those rights are specifically, included in the "arbitration of disputes" provision. ti you refuse to submit to arbitration after agreeing to this provision, you may be compelled to arbitrate under the authority of the applicable laws. Your agreement to this arbitration provision is voluntary. We have read and understand the foregoing and agree to submit disputes arising out of the matters included in the "arbitration of disputes" provision jo neutral arbitration. IAgree to Arbitrattotc s l t Agree to Arbltratt (Mats of Owner) Page two of 2 Total Pages orm GSI-C Copyright © 1996-2007 ACT Contractors Forms (800) 820 -5656 www.calform.com Page 3 of 3 Total Pages 27 i " '6 ° R _ J''° + I219 Hollywood Blvd. Hollywood, FL 33019 Office. Project owner's Name: Mr. & Mrs. McIntosh BM Descripuan of Project Bathroom remodel Fax 954.922.0007 truelineinc @bellsouth.net FL License No. CGC 1510547 Project Address 434 Grand Concourse Podect Cfty Miami SbnroA Project Zip Code 33138 This is a continuation of that certain contract \ briefly described above between True Line Contracting, and the project owner named above which is dated 9/27/12 install new customer supplied tub. Install new customer supplied tub drain and over flow. Install new customer supplied mixing valve for shower. Purchase and install Hardie Board in shower area from floor to ceiling. Purchase and install green board on all other walls . Purchase and install drywall on ceiling. Install customer supplied tile on all walls from tub to ceiling in shower area, floor in vanity area and approximately 6" high on walls through out bathroom. Install new customer supplied vanity. Install new customer supplied sink and faucet. Install new customer supplied toilet. Install existing customer supplied wall light above vanity . Install new customer supplied towel bars and toilet paper holder. Remove existing door and wall. Purchase and install new pocket door system. Build new wall to accommodate pocket door. Re air wall inside of closet due to installation of .ocket door s stem. Prime and paint bathroom. This price does include permitting. This price does not include Architectural drawings or city permit fees. } rim ma f m ..agirr-, AdOlf iii ":�► orCofe . , r. -' ,.... / Tr- orm GSI-C Copyright © 1996-2007 ACT Contractors Forms (800) 820 -5656 www.calform.com Page 3 of 3 Total Pages Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 180723 Permit Number: PL -10 -12 -2022 Scheduled Inspection Date: January 09, 2013 Inspector: Hernandez, Rafael Owner: MCINTOSH, ANDREW Job Address: 434 GRAND CONCOURSE Miami Shores, FL Project: <NONE> Contractor: BEST PLUMBING SERVICES, CO. Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060170050 Phone: 305/556 -2641 Building Department Comments BATHROOM REMODEL NEW TUB MIXING VALUE FAUCET AND TOILET Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments January 08, 2013 For Inspections please call: (305)762 -4949 Page 13 of 40 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 BUILDING PERMIT APPLICATION FBC 20 ID Permit No. ? I �" 22_ Master Permit No. I% Permit Type: PLUMBING JOB ADDRESS: 13(-( (� t4p J (a,t C a t F. City: Miami Shores County: Miami Dade Zip: 13 3 gi Folio/Parcel #: 11- 3 3..06 O/ 7- 00,56 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): .� A(CTn tee L Phone#: /a,3 7S �. S'4� Address: 3 Z( �T'�nl -e City: A4 /A N, , S kp r e state: /` l zip: 3 3 / 3(r Tenant/Lessee Name: r� (( Phone#: Email: b/44. TA I-e1" )±r�✓+SM O/l l ,5 CONTRACTOR: Company Name: 1 ]ES P/ / fr b e� g f v l C,e C Pfione7 305" ? e% 4c Address: E iK t City: '� '�► t e A v` State: P / . Zip: 3 © ) 3 ty. Q a p. 3 Qualifier Name: S� /t Opl r 1-�f YJ c_ z_ Phone#: ' j Q ,� %q q WIC) State Certification or Registration #: CF C / y; 6") 3 2. Certificate of Competency #: Contact Phone#: 3 a5- 7 Litt 0 ) Email Address: best 0)14 big S ef dt c-t S A! 5 x: 1 DESIGNER: Architect/Engineer: tr /b. /A4 Re 1,5 vim. D s s 5/ S Z t CPhone#: €33-9' 9 8" 0 Value of Work for this Permit: $ 04-) Square/Linear Foo �e of Work: 60 S� Fr Type of Work: °Address °Alteration °New Lift pair/Replace °Demolition Description of Work: �� C'®p, rei i,� I v 2.,) S n le 1 Faod C■r_i— A,r, rat 1-e, f /,i S IA. I I e t.s -f-v6 r, ,44:x• n, * * * * * * ******* ** * *+aa *** * *** ****** * * ***** Fees **** ***** **** *** ** **** say * *** *** *** ** +******* Submittal Fee $ 5d' t Permit Fee $ /fl CCF $ CO /CC $ Scanning Fee $ - Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 110 '� 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 FLF,CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOTI.FRS, 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 uch posted notice, the for the first inspection which occurs seven (7) days after the building permit is issued. In the absence inspection will not ' e approved and a reinspection fee will be charged. Signature 6" ®��e f✓�� o Signa Owner or Agent The foregoing instrument was .... . owledged b re me this The fore : g in trument was acknowledged be day of (14-- -, 20 'Lb ANALII Ij li day of ho is personally known to maor who has produced Contractor NOTARY P Sign: Print: 20 5 Notary Public State of Fionda Stephenie Greene -n um D0922351 ?2/201? as identification NOTARY PUBLIC: uced did take an oath. Sign: Print My Commission Expires( re01c * * * ***x* , ********** **,x**ec*** <,::. * *a* * ** * * * * * * * * ** * *** * * *** * * * ** APPROVED BY E Plans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) 4 is �. �„ tat -y lo' y4 Steahenie Greene ,,ssion 009 '4„„. - ,o2I2013 Zoning Clerk CERTIFICATE OF LIABILITY INSURANCE DATE O° CW10112 I HIS 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. INVD IMPORTANT: lithe ate holder is an ADDITIONAL INSURED, the polkyfieru must be endorsed. 11 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statementon this certificate does not confer rights tothe certificate ie holder in lieu of such endozsement(s). D) r%) PRODUCER Angela's Insurance Agency 585 E. 40th St #20 Hialeah, FL 33013 Phone (305)685 -2324 Fax (305)688-6889 Orr ;' E. - (305)68&2324 fir pa, . (305 .: - r.: :%! A D -,,:. ang2epow@aotcom GA- 44201NGL INSURER* coMINAOE NAM# INSURERA: $ 1.000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) INSURED Best Plumbing Services 251 East 44 St Hialeah, FL X113- 3056 Hamm B: GRANADA INS COMP a 5.1 .00 PERSONAL BADV*Limn msuReuc: GENERAL AGGREGATE INSURER D GEN'L AGGREGATE LRearAPPUES PEI POLICY • • LOC Q JE PRODUCTS -COMP AM a INSURER F AUTOMOBILE LIABIUrY ❑ ANY AUTO ALL OVNVED SCHEDULED ❑ AUTOS ❑ AUTOS COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: - THIS IS TO CERTIFY THAT WE POUGIES OP NSURANOE LISTED-BELOW-HAVE-BEEN POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT Oft 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. ItIN TYPE OF INSURANCE ADDLSUBR INSR INVD POUCY NUMMI D) r%) f T1 ,T GENERAL LIABILITY COMMERCIAL GENERAL LWB9ITY El ■ CLAIMS-MADE ■ OCCUR GA- 44201NGL 12/07/201! - 12!0712012 I EACIi OCCURRENCE $ 1.000,000.00 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000.00 amo �P;,y one m a 5.1 .00 PERSONAL BADV*Limn $ 1,000,008.00 GENERAL AGGREGATE $ 1,000,000.00 GEN'L AGGREGATE LRearAPPUES PEI POLICY • • LOC Q JE PRODUCTS -COMP AM $ B AUTOMOBILE LIABIUrY ❑ ANY AUTO ALL OVNVED SCHEDULED ❑ AUTOS ❑ AUTOS (Eis accident } SINGLE UMJT BODILY INJURY (Per person) $ BODILY INJURY (Per dent) $ ❑ HIRED/m.0$ • %JIMMIED ❑ ❑�7) PaUFE J DAMAGE $ • UMBRELLA LAB .00CUR • EXCESS LAB • CIA -MADE EACH OCCURRENCE $ AGGREGATE $ • DED ❑ RETENTION$ $ WO/KM CONPENSAntai EMPLOYERS' LIABILITY YI N ANY PROPRIETORIPARTNERIEXECMIVE N I A ❑ WC $TAL - ❑ ER TORY AND E.L. EACH ACCE ENT $ OFFICER/NEWER EXCLUDED? (Mandatary In NH) If yes, describe under DESCRIPTION OF OPERATIONS be EL. DISEASE - EA EMPLOYEE $ EL. DISEASE - POLICY $ DESCRIPTION OF OPERATIONS I LOCATIONS( VEHICLES (Attach ACORD tai, AddMarta, Remade Scheduler Nmore apme is r CERTIFICATE HOLDER CANCELLATION e ViUa`t $rtrn' Aver SHOULD ANY OF THE ABOVE DESCRIBED POUCiESBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VIM THE POLICY-PROVISIONS. 38 AUTHOREED ACORD 25 (2011105) CIF 1988 -2010 ACORti rights reserved. RD name and logo are' marks of ACORD STATE OF FLORIDA DEPARM1ENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET 32399-0783 TALLAHASSEE RODRIGUEZ, JOSEPH BEST PLUMBING SERVICES COMPANY 251E44THST HIALEAH FL 33013 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.m alicense.com._ There you can find more information about our divisions and regulations that impact you, subscribe to department newsletters and learn more about the Department's 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 far doing business in Florida, and congratulations on your new license DETACH HERE TN 'S DOCUMENT" f-AS A COLORED BAC(Cri?OUND STATE OF FL A AC# G l8 t, 5 is 2 13EPARTIOINT OF Busman AND PROFESSIO•AL REGULATION CFC1426732 2 128002001 CERTIF3 ED + il`It'ACTOR RODRIGUEZ BEST PLUMB COMPANY tit IS (platrIPTBD Hader the -gravitates of Cb.489 ice data: AUG 31, 2014 L12070400326 MICROPRINTING. _.rNEMARK' ' PATENTED PAPER AC# 6184542 STATE OF FLORIDA DEP t7 igOF CTION LICENSING . '' ° PROFESSIONAL RE TION +STRY BOARD *mbar L12070400 326 BATCH NUMBER LICENSE NHL 07/04/2012,1.28002001 CFC1426732,; The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapt Expiration date: AUG 31, 2014 RODRIGUEZ, JOSEPH BEST PLUMBING SERVICES COMPANY'„ 251 E 4403 ST HIALEAH FL 33013 RICE SCOTT GOVERNOR' )iSPLAY AS' REQUIRED BY LAW 07 -11 -2012 JEFF ATWATER STATE OF FLORIDA CW FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * e CERTIFICATE OF ELLVION TO BE EXEMPT FROM RORIDA WORMS CONWENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Honda Workers Compensation law. EFFECTIVE DATE PERSON: FEIN: 08/30/2012 RODRIGUEZ 850811170 BUSINESS NAME AND ADDRESS: BEST PLUMBING SERVICES COMPANY 251 EAST 44TH STREET HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE 1- PLUMBING NOC AND DRIVERS EXPIRATION DATE 08/30/2014 JOSEPH c-"J IMPORTANT: Pursuant to Chapter 440. 05(14) F.S.. an *freer at a corporation who elects exemption from this chapter by filing a certificate et election under this section may not recover hits or compensation ander this chapter. Pursuant to Chapter 440.05(12), F.S.. Certificates of election 10 be exert... apply only within the scope of the business or trade listed on the notice of elecnoa to be exempt. Pursuant to Chapter 440.05(13). F.S., Notices at election to be exempt and cetiilicaios al election to be exempt shall he subject to revocation it at any time after the Ming of the notice or the issuance of the certificate, the person named on the notice or certificate ee (eager meets the requirements of this =MUDD for issuance et a certificate. The depotmeet shall revoke a certificate at any time for failure of the person earned on the certificate to meet the requirements of this section. DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 QUESTIONS? (850) 413 -1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS CONDENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW EFFECTIVE 08/30/2012 EXPIRATION DATE: 08/30/2014 PERSON: JOSEPH RODRIGUEZ FEIN 850811170 BUSINESS NAME AND ADDRESS: BEST PLUMBING SERVICES COMPANY 281 EAST 44114 STREET HIALEAH. FL 33013 SCOPE OF BUSINESS OR TRADE 1- PLUM0010 ROC AND DRIVERS IMPORTANT F Pursuant to Chapter 44005(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election L tender this section may not recover benefits or compensation udder this D chapter. Pursuant to Chapter 44005(123, F.S., Certificates of election to be H exempt... app(Y oily within the scope of the business or trade listed on E the notice of election to be exempt. E Pursuant to Chapter 44005(133, F.S., Notices of election to be exempt and certificates of election to be exempt ski be subject to revocation if, at arty time after the filing of the Mice 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 iaihle of the person named on the certificate to meet the requirements of this section. QUESTIONS? (8503 413 -1609 CUT FERE • Carry bottom portion on the job, keep upper portion for your records. OWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 DO NOT FORWARD BEST PLUMBING SERVICES CO JOSEPH RODRIGUEZ PROS 251 E 44 57 HIALEAH FL 33013 EE OTHE SIDE 592005 -6 Bus/NESS NAME / LOCATION BEST `PLUMBING SERVICES CO 251 E 44 ST 33013 HIALEAH (FIRE& S •PLAYEDi: THIS S NOT A BI OWNER BEST PLUMBING SERVICES CO Sec. Type of Business �` 196APLLLJMBING CONTRACTOR LOCAL THtS TAX I�S NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR BONING OR CITIES. NOR THE Does BOiAER FROM ANY EXEMPT ' PERMIT OR LICENSE REQUIRED BY LAW. THIS 15. NOT - A CERTIFICATION OF THE HOLDER'S OUALIFIOA A4 201 FLORIDA BUSINESS A - AI T. 9 dY 11 LL — DO NOT PAY RENEWAI RECEIPT NO. STATE# CFC1426732 WORKER /S DO NOT FORWARD BEST PLUMBING SERVICES CO JOSEPH RODRIGUEZ PRES 251 E 44 ST HIALEAH FL 33013 PAYMENT RECEIVED CTTDOER UN COTY TAX COLLE 07/17/2012 09010066001 000045.00 SEE OTHER SIDE FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 409294 -6 1111111111 I I I1 Y 1,,, 111 1,1111 5111 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 183857 Permit Number: EL -10 -12 -2021 Scheduled Inspection Date: January 09, 2013 Inspector: Devaney, Michael Owner: MCINTOSH, ANDREW Job Address: 434 GRAND CONCOURSE Miami Shores, FL Project: <NONE> Contractor: CLARKES A/C & ELECTRIC LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132060170050 Phone: (561)239 -2917 Building Department Comments BATH ROOM REMODEL Infractio Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments \Y-Y-ti 2cef/i January 08, 2013 For Inspections please call: (305)762 -4949 Page 35 of 40 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: Electrical /' JOB ADDRESS: 1. 3 q 6th f\6 (o A e ®J (se__ RECEIVEL OCT U 5 2012 FBC 2010 Permit No. Eli " 2-0 2 Master Permit No. I z �--Q.D City: Miami Shores County: Miami Dade Folio/Parcel#: l'1 ° 3 2 -On - 005-0 Is the Building Historically Designated: Yes NO Flood Zone: Zip:'a 31 3it OWNER: Name (Fee Simple Titleholder): .,/ I /C1 A 10 3 t Phone#: 636S-7 Address: ," -' (T (IU( Cc," Cap.) r S City: Tenant/Lessee Name: State: Ff. Phone#: Email: /3 ✓1 -i /4131.. -FAN ASM ©% / 4r) f C4A- zip: 3 3 / 3 1S CONTRACTOR: Company Name: 4 4 fi /ec:�Plc_ LCC Address:34'5 A ‘ � 7t'C.rp J City: PC1).4-. 7 QcG/,/" State: Qualifier Name: ,C -�itrs, rc,C State Certification or Registration #: C Phone 93- S-©ZO 9 YS Phone#: Zip: 3306 y Certificate of Competency #: Contact Phone# :9j.S / a.) 9 Q ?VII Email Address: Gs /KC Q. c t A4: f Cc' :4 et //,, DESIGNER: Architect/Engineer: &eta, (at Be/ 121 $ ns L�_Phone #: 15 �/ 29 7o J J Value of Work for this Permit: $ / 206 s Square/Linear.Footage of Work: (�O J J°- Type of Work: OAddress DAlteration ONew ORepair/Replace Demolition Description of Work: (De /1"..- Ur lB_ f ve 4e e r a c ***************************************Fees**** Submittal Fee $ 50 Permit Fee $ ti—e0 '4 Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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, B011.F,RS, 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 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 d�L Signature Owner or Agent The foregoing trument was day of 0 , 20 , by who is personally known to me As e owledged befo tht the �Ihr who has produced ♦ �Y PUB �. /r,,,93 PQ jyptvp , ''�!btic State of Florida tiie C V� �2eT'Y �' Stephen�e Greene 2 Q MyCommlaSron1039 ie of.. NOTARY Print: My Commission Expires: *********************** * * * * * * **** * * ** * * * * * * * * * * * * * * * ** �Po�y ...?.4'er-C3P1ans Examiner APPROVED BY Contractor The foregoing ins nt was acknow day of 20 y who is personally known to me who has produced as identification and who did take an oath. NOTARY PUBLIC: 4 Sign: Print: iiih1.11111-_ AO) i P Stepnen a Greene G c My Commission D0922351 of op Expires 09/02/2013 before 11" Structural Review (Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) * * ** 13 * * * * * * * * * * * Zoning Clerk • BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 Business Name L. CAR.X S A/C & ELECTRIC LLC \r Owner Name: RICHARD W CLARKE Business Location: 3450 NE 6 TERR POMPANO BEACH Business Phone: 954- 427 -5730 Rooms Seats Employees 5 Receipt #'1-L i6cML /ALARms/cONrTRA Business Type: {MASTER ELECTRICIAN co • - Business Opened:08 /07/1997 State/ County /Cert/Reg :Rp. g 9 T AN Exemption Code: t>-1 ot) Machines Professionals For Vending Business Only Type: Tax Amount Transfer Fee ....... NSF Fee Penalty Prior Years Collection Cost Total Paid 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. WHEN VALIDATED Mailing Address: RICHARD W CLARKE 3450 NE 6 TERR POMPANO BCH, FL 33064 2012 - 2013 Receipt #01A -11- 00008583 Paid 07/06/20.2 0.00 f _ IrbrAA{AIA /"lI% "4.16 ■w /TV ■ eaoa A i • ■wu�w�w .r ��•� IS CERTISILD under the provisions of ch 489 1143 Expiration eater: AUG .31 , 2014 L12052403.153 R) Oct 11 12 03:51p Clarke A/ C AND ELECTRIC 9545327769 Oot 11 2012 3:45PM A. B. INSURRNCE 954- 878 -8145 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE 15 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 INSUREDS }, AUTHORIZED REPRESENTATIVE OR PRODUCER: AND THE CERTIFICATE HOLDER. IMPORTANT: If the ceriNlcate'holder is an ADDITIONAL INSURED, the pulleyAles) 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 IMs certificate does not confer rights to the certificate holder in des of such endorsement{s). p.1 p.2 l CITE S�Dmwt it 10111i2012 rPROOUCER A.B. INSURANCE GROUP INC. 2300 W. SAMPLE ROAD SUITE 314 POMPANO BEACH, FL 33073 ACT • „r,. E.g. 954-979-7090 IAIC. Nay INSURER[$) AFFORDING COVERAGE NASC • INSURER A: Underwriters at Lloyds of London INSURED CLARKES AIR CONDITIONING AND ELECTRIC LLC 3450 NE 6TH TERRACE POMPANO BEACH, FL 33084 D IBURER R : IMOUREa C INSURER 0 : INSURER E : INSURER F • COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NA MEG ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 11TH RESPECT TO INISCH THIS CERTIFICATE NAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN LS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND COMMONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L� PO:J tfF POLICY HIP 7R TYPE OF INSURANCE 1311001. o R POLICY NIJYBER IMAI/1D1YYY'II flYeD1YYYY1 GENERALtJASL1Y 0$H4/2012 05!14/2013. EACHDCCURRENIE 5300,000 HGULU -C �DANAGETaReNrED $$50,000 X COMMERCIAL GENERAL UABILI PREMI ES [Fa oe iY 1Cet ! GAIMS.IIADE © OCCUR L MED FxP !Any ate aenwa? $$ :00, .000 PERSONAL & ACV INJURY � g 500,000 1 LIMITS GEHL AGGREGATE LIM�R.'APPUES PER POLICY + ) jp25T fl LOC ALIMINCB0.E LABILITY GENERAL AGGREGATE ANY AUTO AUTOS AUTOS HIRED AUTOS � O UMSREL AUA0 EXCESS LIAR OOCUR CLAIMS -NADE DEC I I RETENTION WORKERS COMPENSATION AND empurrear UABI.I'rY vi N ANY PROPRIETOMPARTNEVEXECUTIVE N/A OFPICER?MEM HER EXCLUDE? Mandatory Ifpae, RipTI rs OF S DEJ�RtPTION OF DPER4TIpNS below PRODUCTS -CM P/OPAGO $ 300.000 S j( Es nonld SNC LIMIT BODILY INJURY (Per pens/ $ BDDI LY INJURY {per ocddenlj $ DAMAGE 0 EACH OCCURRENCE AGGREGATE S a a 1, M % I 10,111- E.L. EACH ACCIDENT $ E.L. OEEASE • EA EM PLOYEE S E1. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS 'VEHICLES f hACORD WI, Additional tUaurksSche dule.ImetasPu.13+Ta i AIC UNIT INSTALATION AND ELECTRICAL SERVICES CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED "• THE EXPIRATION DATE THEREOF. N -• " ACCORDANCE WITH THE POLICY PROYIS� AUTNODIacPJTElSNTATHfE /r ACORD 25 (201W05) 6)198$ -2010 AC 8 BE CANCELLED BEFORE VILI. BE DELIVERED IN CORPORATION. All rights mewed. The ACORD name and logo are registered marks of ACORD Oct 11 12 04:12p Clarke A/ C AND ELECTRIC 9545327769 p.1 Oct. 11. 2012 4:03PM Insure —Link, Inc / Florida No. 1269 P. 1 A e CERTIFICATE OF LIABILITY INSURANCE lr` THIS CBRTIFICA'W IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS BELOW. CERTIFICATE CERTIFICATE OF INSURANCE R0055 NOTCC AMEND, NSTITUTE A CONTRACT BETWEEN THEE ISSUING INSURER(S), AUTHORIZED KEPRESENTATIVEOR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cortlilcale holder 5 on ADDITIONAL INSURED, the policy(Ie$) roust be endorsed. II SUBROGATION IS WA f, subject to the terms and cendhons oI the policy, certain pollcles may require tin endowment A statement on this manta does not solder r rights to the aRiticate holder In Ileu of such endorsement(s). _ PRODUCER Insure-Link 14050 NW 14th Street Suite 100 Sunrise FL 33323 maim Clarke's it Conditioolag s Elaotrio, LLC 129 SE 5 Ave S-= ,•hanio Smith (954)908 -1340 etephaniegiasure- link.emo rysal30$ -ISS$ IMIC 0 Cl6e -field Desch FL 33161 INSURuRF: COVERAGES CERTIFICATE NUMBER:Nester 11 -12 SSE 12/1/11 REVISION NUMBED TIi!S 1S TO CEI$TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED. NCI lMTHSTANows ANY REOUiREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 1`WS CERTIFICATE MAY OE ISSUED DR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN 1$ SUBJECT TO AU. THE TERMS. E (CLUStONSAl90 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAU) CLAIMS EfF PIluCY _..._. TWEOFIFSUI+JINCE �y R ;mrmm ies!: +•.al LL"� >•1�{+ eemuiLUAsourf CONMERcAL seem uNsLITY CLMVS.BMME 0 OCCUR Mrs AAA O AAWED MOM AUTOS l a S EAcHoc IRRENCE S me 1 1 flawless WORKERSC0MPEN9ADON pllp IE1 PL0TERV UABU1rr rY dYP'1. tfNware Atl61NY 140 NOF0PERA110NSbeta. 4296 -06M-0 r 2/ 1 2011 1211/2G12 EL EACH ACCDENT aL OI®EAS$ -EA EIS EL cISEA0>` - POLICY L'MIT • 100,000 • • r.00,aao 500 000 0538010177D01 01enAYfoIS /LOCAiI=1YEINCLEB Umais+ ACOe019bAS ffUWNlRaanl fsSdiEQid6, TIMER lWcalsiegnTrld} CERTIFICATE HOLDER Miami Shores Village 10050 NE 2nd Ave, Miami Shores, FL 33138 ACORD 25 (2010105) ROOFS gammon The ACORO name and logo are registsredtnarks of ACORD CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANOELL W BEFORE THE EXPIRATION OATS THEREOF, NOTICE WILL. ex DELIVERED IN ACCORDANCE WISH 11* POLICY PROVISIONS. ITNORg110 REPRESENTATIVE Brett Liakteig /KZRAS �' --•-3 tD 19528 -2010 ACORD CORPORATION. All riofit$ reserved.