Loading...
PL-15-895 Ab r Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-232661 Permit Number: PL-4-15-895 Scheduled Inspection Date: May 05, 2015 Permit Type: Plumbing - Residential Inspector. Diaz, Osvaldo Inspection Type: Final Owner: HURLEY,JAMES Work Classification: Gas Job Address: 685 GRAND CONCOURSE Miami Shores, FL 33138- Phone Number Project: <NONE> Parcel Number 1132060172180 Contractor: ADVANCE EXCAVATING LLC Phone: (561)602-5354 Building Department Comments GAS Infractio Passed Comments INSPf,GTOR COMMENTS False I f�" 0 �_ Inspector Comments Passed � Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. May 04, 2015 For Inspections please call: (305)762-4949 Page 13 of 40 Permit NO. PL-4-1"95 �sNORE- Miami Shores Village Permit Type: Plumbing-Residential �y3 10050 N.E.2nd Avenue ' ot Work Ciassificsti n:Gas Miami Shores,FL 33138-0000 Perill .��_* Phone: (305)795-2204 Permit Status:APPOOVED IssueDate:4/24/201-5 Expiration: 10/21/2015 Project Address Parcel Number Applicant 685 GRAND CONCOURSE 1132060172180 JAMES HURLEY Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell JAMES HURLEY 685 GRAND CONC MIAMI SHORES FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 2,100.00 ADVANCE EXCAVATING LLC (561)602-5354 Total Sq Feet: 25 Type of Work: Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Press Test Classification:Residential Scanning:3 Review Plumbing Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# PL-4-15-55219 DBPR Fee $2.25 04/16/2015 Credit Card $50.00 $ 118.30 DCA Fee $2.25 Education Surcharge $0.60 04/24/2015 Credit Card $ 118.30 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. 7 OWNERS AFFIDAVIT: I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ,u her ore,I authorize the above-named contractor to do the work stated. April 24, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy April 24, 2015 1 Co Z S ADDRESS PERMIT NUMBER THIS SYSTEM HAS BEEN MANOMETER TESTED FOR 15 MINUTES. START '5 INCHES W.C. FINISH �' J INCHES W.C. INSTALLER n DATE �.: .i Commission#FF:If i Expires May 1,2 ,R BadW TNu Tray FNn Advance Excavating Specializing In LP Gas ,., Installations Keith Bikes Phone: 561-602-5354 1140 N.E. 23 rd Place FAX: 954-781-5746 Pompano Beach, FL. 33064 Miami Shores Village -1— � Building Department TVFD 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 APR 16 2015 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 BY: FBC 20 la BUILDING Master Permit No./Z C -/ 3� PERMIT APPLICATION Sub Permit No. P ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP nn -- � Q(� CONTRACTOR DRAWINGS JOB ADDRESS: b<�5 CC c 1 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: k% �!Z©(_D SCL� Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): A -eu Phone#: Address: (Actb L(aAOA Qaft(k2l-�U City: &A"CloaY rir�Q� State: Zip: 331 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: A't)Q*0jC-e E4e—L A,-VW*1 'tet Phone#: .5—& c)aS--�5 Address: t \Lk d Ne City: PC-4a f3e.cLCtState: FL Zip: �J 30`a L! _ Qualifier Name: Phone#: v— State Certification or Registration#: 23Cx,!T Certificate of Competency#: 0-1 DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$S.Ion � Square/Linear Footage of Work: Type of Work: ❑ AdditionAlteration ❑ New ❑ Repair/Replace ElDemolition N Descri tion of Work: Ti4 s « j;u5 L• MC iJ-- ! t -.0OL'k--C.0 6tty fry ri+-et� Specify color of color thru tile: Submittal Fee$ Permit Fee$ .40" CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ yO (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspectionwill not be app oved and a reinspection fee will be charged. Signatu �—� Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was ack owledged before me this day of �p(1� 20 by O day of 20 ,by e who is personally known to I LP S who is personally knownlo me or who has produce hL 610T,?L as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sig Print: Print: r o"•• Seal: =.? Commission#FF 102292 Seal: '� .�• �A Expires May 1,2018 7019 REBE=- MY "-�•F•0. Ballad Thru Tcoy-Fan nsuanea eooaes- h COMMISSION P... 0W` EY.PIR APPROVED BY E =�/Y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Advance Excavating Keith Bikes 1140 N.E. 23rd Place Pompano Beach FL. 33064 State Licensed Gas Installer 561-602-5354 keithbike s(a),att.net State of Florida County of Miami-Dade To whom it may concern, I Keith Bikes a gas contractor will be doing work at the Hurley project which is located at 685 Grand Concourse Street Miami Shores, FL 33138. I will be the only one working on site under my permit. If there are any questions or concerns please feel free to contact me at the above mentioned address. Sincerely, Keith Bikes Sworn and subscribed before me this day of ApfA . 20-M, by Personally known Or Produced Identification V't\e_ S(;.i Print: KobeeA 11�• �a��rr�J�c� Stamp: *1p1%-E-:RREBECA M.PASTRANA COMMISSION#EES72624PIRES:February 07,2017 t = G3 , .,R F 140 POMPAN EXPIRES', i x q.. a; CERTIFICATE OF 6f)1VIPETENCY " Defiach and SIGN the reverse side of this card IMMEDIATELY upon receiptl You should carry this carctwith you at all times E t, �a ARM UN Conttadtor must obtain a photo I.D.Certificate of Competency CardC ' k every two years. A� ����� �w .�:. Zgo C 1 '• b k 4I L „)j� "CCS aL4Agov ijg ger p 4 *+ BIKES, KEITH M. 4140 NE 23 PL ' POMPANO BEACH FL.33.064 W3467(Rev.1112)PCE0124790 .ray» `•. a. �ti»r+ _v ..��•. .. p r•. —..._..._ :: _ ............._ Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6700 Tallahassee, Florida 32399-6700 License Number: 23069 Business Mailing Address- Licensed Location Address ADVANCE EXCAVATING,LLC ADVANCE EXCAVATING,LLC 1140NE 23RD'PL 1140 NE 23RD PL POMPANO BEACH,FL 33064-5546 POMPANO BEACH,FL 33064-5546 The Irquefied petroleum gas license at the bottom of this form is valid ONLY for the company located at the - address on the iieense. Each business location of a company must be licensed. All LP Gas licenses must be renewed annually. Any license allowed to expire shall become inoperative because of failure to renew. The fee for restoration of a license is equal to the original license fee and must be paid before the licensee may resume operations. IN THE EVENT OF AN OWNERSHIP CHANGE AT THIS BUSINESS LOCATION: This license maybe transferred to any person,firm or corporation for the remainder of the current license year upon written request to the department by the original license holder. License transfers must be approved by the department. All licensing requirements must be met by the transferee and a transfer fee of$50 will apply. To apply for a transfer,contact the Bureau of LP Gas inspections at(850)921-1600. Pursuant to Chapter 527, Florida Statutes, LP Gas licensees must present proof of licensure to any consumer, owner,or end user upon request when engaged in the business of servicing,testing, repairing, maintaining or installing LP Gas systems and/or equipment. For future correspondence, please make any needed corrections or changes to your business mailing address and/or your licensed location address and return the UPPER PORTION with corrections to: Florida Department of Agriculture and Consumer Services Bureau of Liquefied Petroleum Gas Inspection P.O. Box 6700 Tallahassee, Florida 32399-6700 —� --- ----- — Cut Here .__ . ........................... __.......... State of Florida Department of Agriculture and Consumer Services Division of Consumer Services License Number: 23069 Bureau of Liquefied Petroleum Gas Inspection Expiration Date: August 31,2015 (850) 921-1600 Date of Issue: September 1,2014 License Fee: $200.00 POST LICENSE Tallahassee, Florida Type and Class; 0803 CONSPICUOUSLY Liquefied Petroleum Gas License LP GAS INSTALLER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF OWNERSHIP'OR SALE OF THIS BUSINESS RENDERS THIS LICENSE INVALID This license Is Issued under authority of Section 527.02,Florida Statutes,to: ADVANCE EXCAVATING, LLC ,ti. 140 NE 23RD PL ADAM H.PUTNAM POMPANO BEACH, FL 33064-554+6 COMMISSIONER OF AGRICULTURE Florida Department of Agriculture and Consume. Services Bureau of Liquefied Petroleum Gas Inspection 3125 Conner Boulevard, Suite Taliahassee, Fionda 32399-1650 Master Qualifier Mailing Address Licensed Location Address KEITH M BIKES ADVANCE EXCAVATING, LLC ADVANCE EXCAVATING, LLC 1140 NE 23RD PL 1140 NE 23RD PL POMPANO BEACH, FL 33064-5546 POMPANO BEACH,FL 33064-554 Certificate Number License Number 23006 23069 This Master Qualifier Certificate is issued pursuant to Chapter 527, Florida Statutes. This certificat is valid only for the person and licensed holder listed. Anv changes to the Master Oua lifer st.7t.1-- tsu.;.i at; iUansfer car "termination of employrrient) must be reported to the Bureau of LP Gas Inspection= at(850)921-1600 immediately. The Master Qualifier Certificate is valid only through the date noted on the Certificate. A notice of renewal will be sent to you in advance of your expiration date. A'Master Qualifier Certificate may be renewed if certification of a minimum of 12 (twelve) hours continuingeducation is provided along with the renewal form. If training cannot be documented, an examination must be taken. If there are any errors on the certificate, please submit all changes in writing to: Bureau of Liquefied Petroleum Gas Inspection 1 3125 Conner Boulevard, Suite E Tallahassee, Florida 32399-1650 Cut Here i 'A State of Florida r Department nit', of #ar9 1#calfo 9"ti Coo-sti-mer Sorvices Division of Consumer Services r Certificate No: 23006 ° Bureau of Liquefied Petroleum Gas Inspection Exam Date: February 26,2-107 (850) 921-1600 Issue Date: March 23,2013 Tallahassee, Florida Expiration Date: March 22,2015 vr, y ti , Exam: 0803 MASTER QUALIFIER CERTIFICATE This Certificate is issued under P,uthority of Section 527.02, Florida Statutes, to7 KEITH M BIKES Valid'For r License Number: 23069 ADVANCE EXCAVATING,LLC �".r+.•��� �{�,. ----- . .. 1140 NE 23RD PL ADAM H.PR7TNAM POMPANO BEACH,FL 33064-5546 COMMISSIONER OF AGRICULTURE f E I.. _........_ ... . .. ,, ...m µ BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA: Receipt#:�62 mALLATTUN LP GASS APPL/E P 37 Business Name:ADVANCE EXCAVATING LLC Business Type: l 4STALLATI'ONN LP LASS APPL/EOUP1 Owner Name:KEITH BIKES Business Opened:11/05/2007 Business Location: 1140 NE 23 PL State/County/Cert/Reg:2306g POMPANO BEACH Exemption Code: Business Phone:561-602-5354 Rooms Seats Employees Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 75.00 0.00 0.00 0.00 0.00 0.00 75.00 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 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: KEITH BIKES Receipt #ICP-13-00002878 1140 NE 23 PL Paid 07/09/2014 75.00 POMPANO BEACH, FL 33064 07/08/2014 Effective Date 2014 - 2015 �►nor i r n r+ra 11 A1.1x�r_,t h ___..rx li>i Wit. 411512015 Advance Workmens Comp Oo1.jpg i 6 xrr WF 3 cEaMre�atceti py' �, "' '3$:i TO KVKSW MON X WORNM OOMP94ADON LAW-— poxmiw +a1�r�lih i.pA t� "dt�t irelearlwa - �pg � ,,.. DAW*U Igsr3`txa3t� KAWA 413 13+ t M PLd } i C lel T cow w�wss�w�tdRW,cx,riuuiuwsesraw+Fwas+rw+�.M� aar�evw+.�Fex4ea -.er. „ty.+wseMs,.gz wzawesW ar erear qr 1*raur�k-_e?,gw���,.6n.4�'9�+Mti rarana al+us�y�gis=aM1+i�nsrx^a�w rrrwwr«.a+ snisN Sre�r�sMa�:�+wxar a a�[+r�n.e� �sy rq�a,�wdw .endaxicwwww+w• ama `.sa.. �&ai bwR^K 'Pk aBs*w�ar.�xi$r8srrar.M a .m;�etr+'m.rrca.=s.ed%As +.m fnfo¢aa.4w,rx..ersrrF�.wsaa��.rnan:a 3..l�.awcw,.�bae�.x+�saefss�,.a+a. a.+w.+..lsw� a^�#4+.nMM.✓M+S.�swrMww.,M.w. (( Cd*6rZ*.�sC• G�t*�tLss*¢wSt[^,�SP*'1r':pE�.�'S AL"� wi m.,.� m1CT.Y9+,Y.tl�t-F�yBws�w.x�ie E€I f . i 8 j I i E https://mail.google.com/ /Ses/mail-static fjs/k=gmaiI.main.en.zxi6aW1Bpss.O/m=m_i,t,ittam=PiMaYfly_UGMM2SXPIDZv_g-dOnxs8_j_3sTQLKzAP5v9v8A... 1/1 ---"1 ADVEX01 OP ID:NN ACORU" DATE(MIWDD/YYYYI llhI. � CERTIFICATE OF LIABILITY INSURANCE 03M&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 policypes)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 NAME; Katie Jackson Gateway-Acentria,LLC PHONE 00 No:954-7$5-2852 2430 West Oakland Park Blvd. La,Ila.Extk 954-rJ5.W Ft.Lauderdale,FL 33371 ADDRESS:cortific0m@gatmayacentda.com INSURERS AFFORDING COVERAGE NAIC a INSURER A:Mid-Continent Casualty Co. 23418 INSURED Advance Excavating,LLC. INSURER B: Attn:Mr.Keith Bikes 1140 N.E.23 Place INSURER C: Pompano Beach,FL 33064 INSURER D: INSURER E: 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 NTH 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. I LTR TYPE TYPE OF INSURANCE HNIIL WVD POLICY NUMBER LIAM A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000, CLAIMS-MADE a OCCUR 04GLOM25775 03/21/2015 0327/2016 PREMISES Ea occurrence $ 100, MED EXP(Any one person) $ EXclud PERSONAL&ADV INJURY $ 1,000, GEITL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000, X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000, OTHER: $ AUTOMOBILE LIABILITY COMBINED LMA a accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED ROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,OWON A X1 EXCESS LIAB CLAIMS-MADE 04XS19M9 0&21/2015 0321/2016 AGGREGATE $ 4,000, DED I X I RETENTION 10000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ K es,desWaeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more apace Is requirem Gas Contractor CERTIFICATE HOLDER CANCELLATION MIASH01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2 AVENUE MIAMI,FL 33135 AUTHORIZED REPRESENTATIVE ®1986-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 5N°RES 1 ,,, '� Miami Shores Village ..... Building Department ��OR1Np 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if. 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary" revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.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 BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: zi ,4. Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this S day of 20_ff�__. By � 5 UX \ who is personally known to me or has produced as identification. Notary: SEAL: ` REBECA M.PASTRANA MY COMMISSION#EES72624 EXPIRES:February 07,2017