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CC-14-1409Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218458 Permit Number: CC -7-14-1409 Scheduled Inspection Date: August 27, 2014 Permit Type: Commercial Construction Inspector: Rodriguez, Jorge Owner: TANYA DE LA ROSA, OMAR OSMAN Job Address: 9101 PARK Drive Miami Shores, FL Project: <NONE> Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1132060141370 Contractor: ALL PROFESSIONAL CONSTRUCTION & DESIGN, INC Phone: (954)439-0359 comments REPLACE DRYWALL INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 26, 2014 For Inspections please call: (305)762-4949 Page 8 of 14 Miami Shores Village 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 D JUL o z 2014 BY: FBC 2n. P BUILDING Master Permit No. 14— M (39 PERMIT APPLICATION Sub Permit No. �/BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR JOB ADDRESS: -1 to 1 Tcr-r L Or DRAWINGS Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction T e: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Giti1� rZ _�;.-� - �.o� / Phone#: Gs S 7 Ge) Address: CH G) A"-� o rlC City: State: Zip: Tenant/Lessee Name: �� w1 ++ f( Phone#: Email: CONTRACTOR: CompanyName:kL �1LO-+CSkoWk CqjCMC�TyC�Phone#: �C�6 LP}v?ct- W D cNc� Address: a City: T—MA at.= State: Zip: ( -1 Qualifier Name: 3--000 Phone#: V4-411 AS Sq State Certification or Registration #: C� ! 5+ 13q2L. Certificate of Competency #: DESIGNER: Architect/Engineer: 6464!' Phone#:, Address: City: State: ®� Value of Work for this Permit: $ y �om Square/Unear Footage of Work: ot5 Type of Work: ❑ Addition ❑ Alteration ❑ New IT Repair/Replace Zip: (-4-- ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ • /� CCF $ CO/CC $ Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ ^ ff TOTAL FEE NOW DUE $ II 1 5, 10 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 a#irove# and a reinspection fee will be charged. OWNER or AGENT The foregoing instrument was acknowledged before me this JT day of J(��')P_ ,201V- .by who is personally known to me or who has produced 0�S7X--'I6- 171 as identification and who did take an oath. NOTARY PUBLIC: Sign - t4 ` emery Public state Of Florid, Seal: k . Joanna M Feliciano �Y Omnmfssion FF 082753 i;npi►ee 01J1202018 APPROVED BY (Revised02/24/2014) Signature Z4 CON RACTOR The foregoing instrument was acknowledged before me this "' day of :S LW t" 20 14 , by 1 0 C V —PX -7-7 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLI9illunlulJ,,. A Sign:Cn 'a o Print: ®; Seal: 11101100 II►11100 �k�k+k*�kakakak�k+9*�k�k+k+k�Ft��k&�Nb4M�N�k�k�k�k�k�k�k+k4*�k�kffi*�k�k�k�k�4�k�k�k+k�k�k�R�k�k�N�k�k�k+k**&�k�N Plans Examiner Structural Review Zoning Clerk STATE OF DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING 4 a' • • • • i TALLAHASSEE FL 1 BERTA, JOCO JOZSEF ALL PROFESSIONAL CONSTRUCTION & DESIGN INC 6186 LAUREL TAMARAC FL 33319 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 vaww.m yfloridallcense.com. There you can find more information about our divisions and the 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 for doing business in Florida, and congratulations on your new license DETACH MERE (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGC1513922 07/12/12 128007439 CERTIFIED GENERAL CONTRACTOR BERTA, JOCO JOZSEF ALL PROFESSIONAL CONSTRUCTION & IS CERTIFIED under the provisions of cu.489 FS sspi.ratim date: AUG 31, 2014 L12071200863 ��.��N�SaDO@Uh7YE ETAS i# C©Lp1[] $k9l ER}Ut1s1+( Wkikl?7+1�^v*^ s AC# STATE OF FLORIDA DEPARTMENT • , BUSINESS i • r • REGULATION CONSTRUCTION .� = • 'i.SEC#L12071200863 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 BERTA, JOCO JOZSEF ALL PROFESSIONAL CONSTRUCTION & DESIGN INC 6186 LAUREL LNTAMARAC EL 33319 Wta*11kT411AWq!KW DISPLAY AS REQUIRED BY LAW REN LAWSON SECRETARY 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 DBAss : 7 BUBIn@s8 Name.ALL PROFESSIONAL CONSTRUCTION & Business Type: GENERAL TRACTOR DESIGN INC CONTRACTOR) c Owner Name: BERTA JOCO JOZSEF Business Openeed:0 4 / 0 3 / 2 0 0 7 Business Location: 911 SW 15 ST 203 State/C0unty/C0rf/Reg:CGC1.513922 POMPANO BEACH Exemption Code: Business Phone: 954 -4 39- 0359 ROOM seatt$ Employees Machines Professionals 1 For Vending ausinesa Oniq Nur of Ailaehln�: lrensttna Tvne: Tax Amount Transfer Fee tdSF F Felty Prior Years Gane tion Gast Total Paid 27.00 0100 0.00 4.Op" 0.'194, 0.00 27 , 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 andfor Municipality planning WHEN VALIDATED 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. Mailing Address: BERTA JOCO JOZSEF 6186 LAUREL LN STE D TAMARAC, FL 33319 Receipt #02B-12-00002327 Paid 09/25/21113 27.00 2013 - 2014 * * 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: 2/14/2014 EXPIRATION DATE: 2114/2016 PERSON: BERTA JOCO J FEIN: 223962625 BUSINESS NAME AND ADDRESS: ALL PROFESSIONAL CONSTR 6186 LAUREL LN #D TAMARAC FL 33319 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.0.5(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 fisted 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 sublect 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 meds the requirements of this section for Issuance of a certificate. The department shall remke a cartificate 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 Miami'shores vilage Building Department 10050 N.E.2nd Avenue Miami Shores, Fiorida 33138 Tet: (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. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of w person allowed to work under this permit. Please check with your insurance career since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. ., Owner ,� l Print Name /��'t IL OS N Signature: VL NJ V State of Florida) County of Miami -Dade ) Sworn to and subscribed before me this day of ;�.�Z , 20 Lo (SEAL) Tvae of Identffication Contractor Print Name: 7$ 03 Hits State of Florida) s �i County of Miami -Dade) Q b Sworn and subscribed before me this Z. c U day ofd , 20 z g By 47 Aha Of ALLPR-C OP ID: KM '4� vR CERTIFICATE OF LIABILITY INSURANCE I 0�iOMMw 23i2014 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(SL AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policAles) 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 ruts to the certificate holder in lieu of such endorsement(s PRODUCER Sena & Whitney Corp Office Sena & Whitney, LLC 190 Glades Rd Suite C Boca Raton, FL 33432 CONTACT PHO N E -MAL ADDRESS' INSURER(S) AFFORDING COVERAGE MAIC ! INSURERA : Mid -Continent CasuaMf Compny 23418 0811412014 INSURED All Professional Construction & Design, Inc. 6186 Laurel Lane #fD INSURER B: INSURER C: PERSONAL & ADV INJURY $ 11000, Tamarac, FL 33319 INSURER D: INSURER E : PRODUCTS- COMPIOP AGG $ zow'000 INSURER F : 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. L TYPE OF INSURANCE ADVIL " POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR A lJffORIZEDREPRESENrATIVE 04GLODOB82726 08114/2013 0811412014 EACH OCCURRENCE $ 1,000,000. DAMAGE TO RENTED PREMISES Ea occurrence $ 100, MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 11000, GENERAL AGGREGATE $ Z000,000 GENT AGGREGATE LIMIT APPLIES PER, X POLICY PRO- JECTLOC PRODUCTS- COMPIOP AGG $ zow'000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS EeM�BIINdED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT) UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ANY PROPRiETORIPARTNERF—<ECLMVE OFFICERRuEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N 1 A WC STA U- OTH- 1 I S ER E L. EACH ACCIDENT $ EL DISEASE -EA EMPLOYEE $ E.L DISEASE - POLICY umrr I $ DESCRIPTION OF OPERATION I LOCATIONS! VEHICLES (Aftaeh ACORD 101, Additional Remarks Schedule, irmore spate is required) License#CGC1513922 rFRTIFiraTP 411131 nsR ramnpi i amnw MIAMIS4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES VILLAGE BUILDING DEPARTMENT A lJffORIZEDREPRESENrATIVE 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 (2010105) U 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BI ZONING NG DATE � SIRUCTU ELECTRICAL PLUMBING M ECHAWCAL 3UuJECT TO qREG!JLAflo,iS 6TATE AND COUNTY RULES AND 0000 000000 . . ... �y�.a • s *00 . s ••. • •000.0. 9 a� .a-.--� - m•. _0000_._ ... .. 0000.. .. ... • .. 0000. 0000. .-......- -. • •.. . 0000 , r� y Gl/lll-L— 124J tlSOsl�•--�lcJl % ' vs..�♦ + a•y+�# F _94 L U