HomeMy WebLinkAbout00-9133
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788~6611
09133
Date J !c1!OO
Permit
I~'~
BUILDING
ELEC~ICAL
MEC~NICAL
PLU~BING
Sewer Conn
Water Conn:
Property Owner: 6/c.....-.J lieI'; Z.h1J M.u. V.
Job Address: 1'10<0, ~"d.~s J\,Jr.t.
ParceII.D.# "34. '~<:'-J(- 0010.- Of"3oo-oBl..O
Water Meter:
T.I.F.'s:
~.~
, ../:r
,
LuJi'c...J
,
Zoning:
Descriotion of Work
Energy Code:
S c"ri!<2./I r (.;0'-
Radon Gas:
J 1.1 .(..,' I,' Y foO'--'
,
FINAL
2/J!--OJa
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
Valuation or
Contract Price
Inspector
Permit Fee ~'.2
r}~ II- (~J/
10 J 200. ~
,
Signature
Company
Address
Telephone#
'1Bz - iDLY
City License Registration #
State Certified License#
'de,
tS ,~ ~ La" \.~ ... (1.:0(\
BUILDING
ElE TRICAl
Breakers
Ducts Insl.
Compressor
Final
MECH NICAl
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SlB
Tub Set
Water
Sewer
Final
Driveway
~~
1--\'2. -l) lJ> ~
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($ 25.001 shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
C. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
.........
\ ~...I.f\\~~ -'
y\\/'- ~
~~
b ~H- JV1f\s~N.e~
3 Ib tq LrlN Di ~ /tv.
(,;e or :'5 Z-
SQ. FEET PRICE
MAIN OR LIVING AREA
OTHER AREA UNDER ROOF to tJ~ 1<5"- ~~~
OTHER
~ C \:>~
BUILDING: 7~..";.)~
ELECTRICAL: IV If)
PLUMBING: ,JIlt
MECHANICAL: ;J)1t
RADON: b. '-be
CREDIT: ~ I~
SEWER: }J /A-
WATER: I
TOT AL: i'
T.I.F'sl ;J/k
--(.:---rnL . It f> I. 'f, '"
APPLiCATiON FOR PERMiT
CiTY OF ZEPHYRHiLLS
BUiLDiNG DEPARTMENT
J1hJ/~q
DATE RECEiVED - ---
PLANS REViEW FEE
OWNER'S NAME {9l.AtJfJ
JOB ADDRESS 370b1
!-fofL(2 tJ ,J
LAtJPI5 !J-V,-::
PHONE f]fz- I f{gfo
Lor g> z-
SUBDIVISION 6lJMIf) !-IlJ(LI Z IJtJ
LEGAL DESCRIPTION: LOT(S)
BLOCK
PARCEL ID # 3lf'2S"-2f-OOtO- OI300-0fllo
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ~W CONSTRUCTION
~DITION
OALTERATION
o REPAIR
o INSTALL
o SIGN
PROPOSED USE: ~L FAMILY DWELLING
o COMMERCIAL
o MOVE 0 DEMOLISH
4~TI-FAMILY 0# OF UNITS
o INDUSTRIAL
o SWIMMING POOL
o MOBILE HOME
~HER
AWJIII i ,lIv-"\
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK tox 10 SrA~/:;\I /MOM. 101(/0 uJ/"UM1fA. ?DIC. 2J./ r.IJ.OO~(
&00
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
~ILDING
PERMITS REQUESTED
$
JI J O~(), /)0
I
VALUATION OF TOTAL CONSTRUCTION
o ELECTRI CAL
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o PLUMBING
o MECHANI CAL
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
~HER AU/#!. IN C/ h'l
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES
o NO
SIGNATURE
J1^j 1~ ~
COMPAlr$t(+- (()JJ$r(t den {);o/ &F a-:"l.Ifll.Ik. f( ..
STATE CERT OR REGIST # c/3co '5'7'7 !'Z-
CITY PROCESSING # 2J.p
BUiLDER
******************************************************************
ELECTlUCiAN
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
******************************************************************
PLUMBER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
***********~******************************************************
MECHANICAL
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
A.' NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be
may be more restrictive than City regulations. The
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may be required
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign portions of the "Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs as the contractor, you are indicating that
you, rather than the contractor, are responsible for the work. If the contractor wishes
you to sign as contractor that may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "owner" prior to commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will
be done in compliance with all applicable laws regulating construction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and installation as indicated. I
certify that no work or installation has commenced prior to issuance of a permit and that
all work will be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone "A" or "A, etc.", it is
understood that a drainage plan addressing a "compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
A permit issued shall be construed to be a license to proceed with the work and not as
authority to violate, cancel, alter, or set aside any provisions of the technical codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each six
\
month period, or the project will be considered abandoned.
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. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
H 7-5 ~
SIGNA~ ~ OR AGENT
subject to "deed restrictions" which
undersigned assumes responsibility for
JJ 13~
SIGNATURE:~RACTOR
STATE OF FLORIDA ~
COUNTY OF ] ItS (...(J
The foregoing instrument was _ac_knO~ledge*
Befor~ ,!ll~t~is --E- day C?-( /kUA'MI3M1-, 19
by --WW't 4-:- A. fJ-S ~~L-
~me of person acknowledged)
~o is personally known to me, or
STATE OF FLORIDA i');tS/ 6
COUNTY OF rl ~
The foregoing instrument wa~_acknowledgechn
Before me this _--23-day of );!r.~hl81A., 19li
by B/1.Uu---A:- A-,~ _;t.
~~{name of person acknowledged)
~o is personally known to me, or
o who has produced
~e of identification)
and who Ddid []did not take an oath
BAd A ~
Signature of person taking acknowledgment
T3(UJG([ A. ~ 8ft' (,
Name typed, ~.in~~tamped..
i 6.,.... coznmiIsiOR CC1ll6f1
@;~Ires June 22.2002
o who has produced
~ype of identification)
and Who~id ~id not take an oath.
~AN~ A~ (}d!J.
signat~re of person taking acknowledgement
Name
R'2(/6([ A. A-SBEL
typed, prJ:D.t~amped-
rriZ'I.,. c --'$S\on CC74tJfT1
:S*tIri om...
~_ ~ ExPires June 22. 2002
........."
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2' x 2' Pa t I 0 BeaM B' x 3' Pa t / 0 BeaM B' x 3' T I It BeaM
'1 " w
X )
..) ~
l~. HU"r T
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" n"1
-n44 ; .050. .050. .
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C(J.LllVIEAH - HEIGHr/SPAN TABLE COLUHN/IEAH - HEIGHT/SPAN TABLE COLUHN/BEAH - HEIGHT/SPAN TABLE
.'- WALL/ ~'OL I D WALLI' ~SDI.~ALL/ ~~ SCRE~~D~ALL/ SOL r:oJrALLI'
, -IILJIJF . ROOF
IiiiiIJ , , "- ~ " , - f' IT _ T 'T 3' '6' - 6' -8T _ 8'
-,- -, IT - l :' " - " - " - ... 4' 4' - 4' 7' - -~,
'7 I-T _ !' ., - I' , " - 0' , --1 I' " '2' - 10' 6' - 10'
7" " - . " , - '~ .' , - 10' , - 4-'- . ' l' - 8' bT - 2'
,-,- ,-, - 1 " 4' - , " , - 0' " - 10' " 0' - 10' 5' - R'
" ., - .1' " - 1 'T j7 " - " '7 _ .~ 8' 0' - 2' 5' - .,'
fT 'T _ 0' - " - t' " " - r" ., - ~ ... 9' 9' - 6' 5' - 0'
, " . " - 8' " - l~ r1 IT " - " '7 -lj 1-' ID' 9' - 0' .,7 _ 10'
NDTE, 1) ALL SDLID ROOF CALCULATIONS ARE FOR 4'12 MAX, RODF SLDPES
2) BEAN SPANS HAY RE INCREASED 2DX VHEN CONTINUOUS OVER INTERIOR CDLUNN SUPPORT
3) ALL KItH SPANS ASSlME LATERAL PURLINS (2'x2'J'90. FRANED
ACROSS Rl1I1F , EACH POST IN SCREENeD SI/JE VALLS
4) VALLES HAY BE INTDlPCLATED F'DR INTERNEDIATE LENGTHS DR SPACINGS
2' X 4' T I I t Beaft'l 2' x 4' 2' X 6'
j ,-.- Self' Mating BeaM Self' Mating BeaM
l~. MU'r'
4- 6-
.050- . 11 .12tC /I ..
't- .120.
.
~ \
1. -:-055
]
1
I.. 2- ~i
ClLLllVICAN - HEIGHf/SPAN TABLE CDLUHN/IEAH - HEIGHT/SPAN TABLE
JlALL/ SOL I D JlALL/
ROOF
10 - 8
9 -
.044
~~ SCREf// JlALL/ SOLID JlALL/
ow ROOF
7 , - , , - ,
, , - 4 ' , - ,
, , - . , , - ,
. " " - .~ ' " - "
7' !I' - 4' 8" - ,
8' 5"- 4' 8' - 0'
9' 4' - 4' 7' - 8'
10' 3' - 8' 7' - 2'
COLUHN/BEAH - HEIGHT/SPAN TABLE
SCREEN JlALL/ sa. I D JlALL
OOF RDDF
8 - 8
,
JMVID NDRRI$ ENGINeeRING
IJC$l~ TD ,,..., $TAN1JItIm MJIUING CIJDC
N:R CHAPT. l'tW FUI JDD ItPH tllND
Pg, l-A
EXPIRE$ AFTDI 2/1/01
EDGE BEAM SPAN TABLE (OPEN BUILDING)
MAX IHUH COLUMN SPACING - $fH:,~ SPAN
NUGUS
~D~ MAN SPAN
~DG~ Ii~AH SIZE 10 12 14 1& 18 20 Sx
2'x2'x.044 4'- 6' 4'- 2' 3 '-J 0' 3'- 8' 3'- 6' 3'- 4' 0.23
Po. t I tl E~t. 5'- 6' !J'- 0' 4'- B' -4 ';" , 4'- 2' 4'- 0'
2'x3'x, 050 6'- 4' 5 '-10' 5'- 4' 5'- i. , 4 '-10' 4'- 8' 0.44
Po. t I tlE~t. 7'- 6' 7'- 0' -6'- 6' -i) '- ," 5'-10' 5'- 6'
2'x3'x.050 5'- 6' ~'- 2' 4 '-10' 4'- 6' 4'- 4' 4'- 2' 0.3~
TIlt E~i. 6'- 8" '- 2' 5'-10' 5'- 6' 5'- 2' 5'- 0'
2'x4'x.044x,120 9'- 4' I '- 8' 8'- 0' 7'- 8' 7'- 2' 6 '-10' 0.98
S~ 'F No. tIn 0 E~t. 11 '- 2' 1 '- 4"... 9'- 8' '- 2" 8'- 8' 8'- 4'
2'x4'x, 050 7'- 0' 6'- 6' ~'- 0' '- 8' 5'- 4' 5'- 2' 0.55
Tilt E~t 8'- 4' 7'-10' '- 4' '-ltJ' Ii.'- 6' 6'- 2'
2'x6'x.055x.120 13'- 2' 12'- 4' 11'- 6' 10'-10' 10'- 4' 9 '-1 0' 1. 97
S,lf /rIo.1:/no E~t. 15'-10' 14'- 8' 13'-10' ':1'-0' 112'- 4' 11'- 8'
2'x7'x. 062x. 120 J5'- 0' J3'-10' J3'- 0' r2'- 4' 11 '- 8' 1 J '- 2' 2,~
s. I F No. tin 0 E~t 18 '- 0' 16'- 8' 15'- B' 4'- 8' 114 '- 0' 13'- 4'
2'x7'x. 062x, 120 1~'-10' 17'- 6' 16'- 4" 15'- 4" 14'- 8' 14 '- 0' 4.00
S, If HQ t I nQ Ext. 2 '- 8' 2J '- 0' 19'- 8" J8 '- 6" J 7'- 6' J6'- 8'
w/ In ~,.,.t
2'x8'x.072x,224 J9'-10' 18'- 4' 17'- 2' 16'- 2' J5'- 4' J4'- 8' 4,44
Self Hat/no ~xt. 23'-10' 22'- 0' 20'- 8' 19'- 6' 18'- 6' 17'- 8'
2'x9'x. 072x.224 ~O'- 4' J 9'- 2' J 8'- 0' J 7'- 0' J 6'- 4' 5.47
S~(f HOot/no Ext, 24'- 6' 22'-10" 21'- 8' ;)0'- 6' 19'- 6'
2'x9'x.072x.310 - 6' 122'- 8' 21 '- 2' 20'- 0" 19'- 0' 18'- 2' 6,77
S,(f Ho.t/na Ext.129'- 6' 127'- 4' 125"- 6' I~ '- tJ" 22'-10' 21'- 8'
~ ~ 'D/H <TYP.) ~ ~ 'o/H <TYP.)
1/4'/FT, (HIN. )
~ .12' At. , RDlF PItHS ~
~ :t ~ ~
~
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e e
SPAN
SPAN
EDGE BEAM PLAN
CENTER BEAM PLAN
CENTER BEAM SPAN TABLE (OPEN BUILDING)
HAXIHUH COLUMN SPACING SIHPLE SPAN
CDNTINUOUS
12 '
9'-9'
10'- 8'
10'- 8'
12'- 8'
13'- 4'
16'- 0'
13'- 0
13'- 0'
15'- 8'
16'- 4'
19'- 8'
12 ' -4 '
12'- 4'
14'- 8'
15'- 4'
18'- 6'
11 '- 8'
11 '- 8'
14'- 0'
14'- 8'
17'- 6'
LJ
I
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Cl~~ '\I
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14 '
9'-0'
9 '-1 0'
9 '-10'
11'-10'
12 '- 4'
14 '-10'
19'-10' 14'- 0' 0' ,
23'-10' 16 '-10' 8'
22'- 0' 15'- 7' 5'
26'- 6' 18'- 8' 4'
24 ' - 6' 17'- 4' 0'
'- 6' '- 0' '- 4'
'INTERLOCKING ROOF PANS
12-
.032 .'01 15'-'
, .,
/8 -to
ROOF PAN (AUOY JOOJ H-tl)
't' v.
ff 't' - .032, { .0J2 .:s46 11'- 0-
I. .1 /3~D"
12-
*" NOTE: PANS AlAY OVCRHANfJ 1/5 OF S/IJPLE SPAN. SPANS AlAY BE lNafEASED 2-
FOR EACH 12- OF O'fGHANfJ IJP 7D J'- ~ CONSIJLT AN ENQINEDI FOR
QItf'A TER O~Q.
lPCN
IUIUIN/j
. Il1lJI
13'__~
16'__~
IJ' ,__~
II ,__~
10'__~
10 '-O~
13'-4
11'-01
1J'-41
14 '-41
13'-1/1
ll'-I/~
16'-01
IJ '-01
10'-41
13'-11
16'-41
II '-III
lJIe,(16 M1IlIfI$ ENGINCERING
lJC$1GNC1J TO 1"7 $TANlWllJ IUIUING aJIlC
N:If t:HMtT. I'M Ff1R 100 NPH tlllm
EXPllla AFTER ej / 0/
Pg, 1...,
((PT.) " STEP FItSCIA W/ ,. X I'
. JI' D.C. 'OR
2' X e' X D. IUD
STIFFENER
Narc, FTR OUTSI1JC SPANS >
USE e')(3' (VERT.)
IJIJIE.
JbCN IDST STRUCTURE
IS HASDNRY use , 10
X e' THUNJJCR MJL TS.
J' X J' X e' X D,
ANGLE CLIP W/ (e)
, 8 X ~8' W, fE:A1J
SHS. EACH WA Y.
J2' (J) 18K~8' ,,/HEAD
SNS. TOP, 6DTTDH
tF EACH RISER.
(3) PER RaT PAN
, 8 X 5/8' W. IEAJ)
SHS. ~ CENTER
INTO ~.
MEAN PER DeSIGN
TARLE .
(3) PER RDIT PAN
, I D X 1-1/2' 'W.
$HS. THRU R/JDF PAN
, 6DX HEA1JER ON
CENTER INTO IDST
STRUCTlIlI: .
ex ALlM.
TYP. SECTION DETAILS
t:.AST ALLM. ~ INSDtT tV (e) v.' .,14. x 3 In' CONe
A.B.~ , (e) 1/4' .,14. TWlIJ....r.r t1/ 6l4SID$ .
OR
e' x e' x In' ALLM. ~ tV (e) 1/4' DIA. X 2.1;'1" TAPCON
CA. sur tT calM wi (Z) 1/4' .,14. THRU....r.r
tV IiI4WJtS OR
3 In' x I In' x I~ !lECEVING CHMMEJ.
tV (e) v.' DIA. x ~ In' CONC. A. B. '05
OR
t:.AST ALLM. ~ INfCM tV (4) ,JO S.H.S. INTO IaUI HEADIR(2."MIN.e:MBe:~)
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IIIMI 1m II 11m 0111111111 RII III 1111
11111982
Reptl 382814 Reel 6._
DSI 8.. IT. 8..
81/M/. _______u___ Dpty Clerk
JED PITTIWI, pASa) COUI'n CLERK
81/M/. 12.13p. 1 af 1 ~ ~ A
OR . 429(2) PG ~~...
State I,t t:L-D 121 Pit
NOTICE 011' COkKENC;!H.CNT
County of
f PrSC 0
7UB lINoeRSICNeD hereby 9ive. notice that improvoment will bo modo to c:lrt.:!in
re.:!l property, and in accordanoe with Chapter 713, rlorido StatuteD, the
follo....ing intormation i. provided in this Notice of CornmonCnlncllt.:
~q -~ - Z I-DolO'" 01 JtJo .-o~z.o
I,
e)
2.
>,
Central Description of
f ~ (' kA(,;13
J. OHnor Infornlationl Name GtANf /-kILl 2/)"," M.f/./.
r.dcl e es s '~'7{P{)1 t..AIJ9lJ A vt. City '? E PH 'f RHI t(. $ 5 tat e r;L .
Interest in Pr.upertYI
Naln. of fee Simple Tithholderl
(It other th,n owner)
Address
City.
State
R:
.~;~:.
1\ ,
Contractor: N.3me B~'~ {'O!J9rfLc)c1'itJ,J CF- Cf1V/ll.IIL I~.
^udress 111./'" ?cOIf/? ~. City ~~l/ILt..1f State (i,. ~l/blt(
5, Suroty: N.3rne
Addross
City
St4t~
NlIount of Bondi $
6, Lllnder: Name
Adtlrol8
City
Stiltc
7.
Persons within the State of Florida
notices or other document. may be
71J.1J(II(a)(7), Florida Statutell
de.i9noted by Owner upon ....r.c:n
served 01 provided ~y Section
N.,ma
^c1drela
City
st.:1L-!
$, In additi.o.n to himself, O....n.r cfcui9n&.t.S
ot to roceive a copy of t~e
Lienor', Notlce a. provlded ln Sectlon 713.13(11(bl, FloridA statll~cs.
'.I. r.l<plrnc..ir,m dnt.e ot Nat-J.ce of COlllmoncement...(t.he expiration d.HU i~ I year
tr?m the u~to of rucordin9 unle.. a different date is specified.)
5 i lJ n a t u reo f Ow n e r :
OCA.llv ,:.tL
~
:..J/vJiI 1M.- t.(
Ni
Sworn to
ttI~.
~A.~
Not,)ry Pllblic:
My Com;nl!lS ion Expires:
~. ~AAs~
* *Mv comrmSSlUII CG1'4'"
~...~ ElcpIres June 22, 2002
'C' )QUO.'