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Home My WebLink About08-7959 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 7959 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: 7959 SIGN FREE STANDING SIGN NOT APPLICABLE Address: 3795 54 ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 2,450.00 6/25/2008 67.50 67.50 6/25/2008 Phone: INSTALL 64 X 11 MONOMENT SIGN ON EXISTING FOUNDATION Name: BOB'S AUTO REPAIR Address: 37959 SR 54 ZEPHYRHILLS, FL. 33542 tWi 'J f!-' s-/-.'7fk co fr'v FOOTER ELECTRICAL ROUGH FINAL REINSPECTlON FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections 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. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management, state agencies or federal agencies. CONTRA R SIGNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Building Department ) Z/ - 41/ Owner Phone Number 181.5 - l1B'eJ - )4481 Owner Phone Number I 1 3354/1 S7Rre fLD Gl1 Z-e'PH'1RHJ~. PLI LOT # 1 I . PARCEL ID#I/{)- ;)/;-,;} J- tJ()IO - /;;8/)/)-OD? 0 1 (OBTAINEO FROM PROPERTY TAX NOnCE) ~ SIGN D MOVE D D OTHER D STEEL Fax-813-780-0021 j( 1q5f Owner's Name Date Received ST. 1 1 ZEPJf4JiJfIU'5/ FL Fee Simple Titleholder Address 1 lilt; 5 3 U>lI~r~r: JOB ADDRESS 13'1969 I I D NEW CONSTR D D INSTALL D DSFR D D BLOCK 0 //IISI1JU /f)bltltJl'J1E11Yr ~I 1 SQ FOOTAGE Lk.1- '&:l ADD/ALT REPAlR COMM FRAME DEMOLISH SUBDIVISION WORK PROPOSED PROPOSED USE TYPE OF CONSTRUCTION ROOFING I 1 I 1 o OTHER I DESCRIPTION OF WORK BUILDING SIZE BUILDING I$~ , 1$ 1$ 1$ D AMP SERVICE o PROGRESS ENERGY D W.R.E.C. l/5D, Pi) VALUATION OF TOTAL CONSTRUCTION D ELECTRICAL D PLUMBING D MECHANICAL D GAS VALUATION OF MECHANICAL INSTALLATION Address SPECIALTY D OTHER FLOOD ZONE AREA DYES DNO FINISHED FLOOR ELEVATIONS ELECTRICIAN I SIGNATURE Address I PLUMBER I SIGNATURE I COMPANY I;fP~ tZ,lbAJ + I}WAJI/'f:b J 4-e: REGISTERED I 'y IN I FEE CURRENT ~ bl 5 (J .. '7 t- J FI.. License # I tfJLA / J gt;) I · I COMPANY I 1 REGISTERED Y / N FEE CURRENT ~ I 1 I I I I I License # BUILDER SIGNATURE COMPANY REGISTERED Y/N FEE CURRENT ~ Address MECHANICAL I SIGNATURE . Address I OTHER I SIGNATURE Address I License # COMPANY REGISTERED Y / N FEE CURRENT ~ License # COMPANY REGISTERED Y/ N FEE CURRENT ~ License # RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) worldng days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence Installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-Q-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance Attach (2) sets of Engineered Plans. -"PROPERTY SURVEY required for all NEW construction. COMMERCIAL SIGN PERMIT Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement Is required. (AlC upgrades over $50001 Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs Sewers Service Upgrades AlC Fences (Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. 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 Pasco County Building Inspection Division-Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block- of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy' or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowners Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner", I certify 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. 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, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government 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 Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, WaterlWastewater 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. US Environmental Protection Agency-Asbestos abatement. Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone 'Y' unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction, I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. 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 codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A N PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOR FLORIDA JURAT (F.S. 117.03) OWNER OR AGENT Subscribed and swom to (or affirmed) before me this by Who is/are personally known to me or haslhave produced as Identification. CONTRACTOR ZUbscribed llfld m !ll..(or affirmed) before m~is -q. l5~ by VHlAl- LI/t{~ ~:;]i)[:: Commission No. P D '7;;t ~ Q, (,,, ~. M'A-I< \L W \ 1 \-e tt- Name of Notary typed. printed or stamped Notary Public Notary Public Commission No. Name of Notary typed, printed or stamped G) R. MARK WILLETT ComniIIian 00 722668 EllpiII 0ec:en1lIr 8, 2011 ......, n.u rra, "* _llllHII-lOlt .~~\\1r~ Z4NP - /' '''4' S'Q.Ft" MONlJM~T C;:C6N Apple Sign & Awning f/I- 1635 N. Dale Mabry Lutz, FL 33548 . 1/ ~<""".. . ---.~ ~.~. , --' ':f~,C1 -&:- I S c en m -E ~ or- 0) C') "'~ N g '6> it ex; q-c: -N uJuJ .!:::!cb 0-~~3~ =-<jeq-c;0 n.<J) LO.,- ~O)<-oco ,. .~ <.) a: Q) ::>~ o)c: to) aiO O)en -= ..o(ij enO- 0..... C> a: ~ .,- u r- $ ~ {3 .d: Sf I . A....VM/NUM 6A$e:.. IZ:\" 6' :r-(l€JPS 6XISTCf\)6 r.__ {',,:,,, "1-.' .',' r,")F.:. g ~ . %" ~1t;T}~G- II ~+ ~ll;e:L pu'((e. ./ " \loll g PL ~ r Pt.lOT(~ FIr<e B LDING SHALL COMPLY WITH NI~,lAfPLICABLE CITY OF ~RHILLS ORDThYANCE. 't _I" i 1'1 "" 17/1 + f.:,()S5tnS COMPANY: Apple Sign , PROJECT: 'AP08-04 7 Architectural Services & Engineering, Inc 24710 State Road 54 Lutz, FI 33559 EBO 7882 Robert W. Wall, PE Fla 46021 S~mpl" CillcLllatiollS Willd LOild ~ WL WL = Cf ' WIND psf WL ~ 1.2 * 31.217 Force = 37.460' 80 Force = 2.9968 kips 8' - 0" Area 1 Zreq = Moment' 12 !b 'NC NC C~ NUlllbcr of CO!<11ll11S fb-~ Bendill!! (ksi) 0' ,0 00 8 "x .322 " ASTM A53-S/B Pipe Zact 16.81 in3 > Zreq = 7.4921 in3 LDF = 1 Zreq = 14.98' 12 24 . 1 . 1 Zreq ~ 7.492 in3 Foundation Note: Use anchor bolts with caged steel #5 rebar 6" o.c. each way vertically and horizontally. Concrete ilpprox. 2.96 cu. yds COllcrete is 3000 psi at 28 days All willd loads designed ASCE 7.02 which Illeets FBC 2004, wi 2006 supp., IBC 2003, IBC 2006 Structural Steel Design Dilly as approved III Chapter 35 of referenced codes. Soil COlldiliollS to be of bearing capacity, verify before cOllstrLlctioll o ~ I I 4' - 0 " \.... X 4' ()I" WIND - ASCE - Exposure C - 130 mph Cf Wind ( sf) AREA (ft2) y (ft) 5.00 FORCE (ki s) 3.00 3.00 MOMENT (k-ft) 14.98 Z REQ (in3) 7.49 1.00 TOTALS 1.20 31.22 80.00 80.00 MEAN SIGN HEIGHT (HB) MOMENT AT GROUND TOTAL FORCE 1 4. 98 k - ft 2.996 kips 5 ft CHECK FOOTING Pallow = S * b * d ^ 2 2.37 * d + 2.64 * HB P allow = 2.5 * 4 * 5 2.37 * 5 + BOLTS AND BASE PLATE Area Bolt Size Num Spacing (in) (in) ^2 2.64 * 5 b = width of footer (ft) d = height of footer (ft) 9.9800 (kips) > 2.9968 (kips) is O.K. Plate Dim. (in) Thick. (in) Load (ksi) MAX (ksi) ASTM-A36 1.000 4 12.000 7.49 14.92 17.00x 17.00 0.750 15.87 27.00 " ClArE: blll~b , 7 .,~ ~:l y. .~::{IJ.-.<;;~-'.-.. ... .~ ,,~ 1".1,""- \tfr.... .. ~ s7l:f'i' <51~ (Z6tTD 51- , 5 l- '1. MONVI\\a3T $\6tJ ~CA110N LDlN SHALL COMPLY W J APPL CABLE CITY OF .r'HYRH LS ORDINANCE. ~ ~~ ~ , f~ \l'\ fi ~ ~ '^ <J -4r 9)" ~:A,) - r (,;.., CD ~ .w~jJ1 en ,"... IiiCic _. N"ca '"' t.':S ." Q) . r--AO (,J(1))t ~fl !~i .~ . .-T' b' il\~(;./ i 1\ 1 ".::. __L ~~_. c'y.(:...~va'.? TJ.'..~ if~.f' - ~ ~..., ~ .' ..." . ',' '~ ~ ~ ~,! . -,--- .-. ----, \ BUILDING SHALL COMPLY wrm ALL APPLICABLE CITY OF ZEPHYRHILLS ORDINANCE. . J ~--:-~ ::U:VLr:,-\ i)ATL: Co I( U CiTY OF l':EP'IYH.y.H S 8mU""" 'WFtC,^, -~ Apple Sign & Awning, LLC POWER OF ATTORNEY Date: t:, - q - 0 f I hereby name and appoint ___E6~~__~L~__________________ Of -Aer~__.?J_0~___~_h_W~~~~~_ to be my lawful attorney In fact to act for me and apply to the ~~"!r--J2f__~~liJJf-1H~[.__ Building Department for a __2i~~__f~_~rI~__________ permit and to sign my name and do all things necessary to this appointment. --------~-ap~~~_M~_kLQ~__~~~AllaL~_______________________ Type or Print Name of Certified Contractor and License Number " ------------------------------------------ Signature of Certified Contractor The foregoing instrument was acknowledged before me this _~_ day of _:IV_~!2:___ 0 f 20 J2% . By --_~~~~_~i?___~~__~~_~__________________________ Who is personally known to me/who produced _______________________ As identification and who did not take oath. State of Florida C f P ~,../..~:t~ R. MARK Wlllm . o. un ty 0 as co. f.f"'\.~ Commisf:ion DD 722666 c --'. ~ \j~R$i Expires December 8,2011 -RJ1J!~~--___________________~".. -~'"~-....." Notary Public 1635 N. Dale Mabry Hwy. Suite 7 Lutz, Florida 33548 813-948-2220 Fax 813- 948-2403 E-mail: apple.signs1@verizon.net City of Zephyrhills BUILDING PLAN REVIEW COMMENTS 4'111e S? J/rI ~-9-cJ8 ~3 775'9 s/ S-c;' Permit Type: ;J;r sW If! () (l U(NIA-f S'r Approved wino comments: / Approved withe below comments: 0 Denied withe below comments: 0 ContractorlHomeowner: Date Received: Site: This comment sheet shall be kept with the permit and/or plans. w? - Plans Examiner Contractor and/or Homeowner (Required when comments are present) -' rri 3: IJ ;n n lJ -I Z r r .;::. () ...... " ...... 01 '.... g lJ '"j':t n fjj 3:-' " -< HrrI D ~~ S b 0::0 :\.-- r J> 1& (fJ::O ~! J!~ :::' , ....,..,1 ~ I '-IH '-' .-!.:: D rri I X I ..... lJ I n-l o! 0 J>i r -I: r rd i- ITl ~ ,-' -I Iv';' 0 --r:::-:ti IV IV<\; ro () :..-l r......J> -...] CO''' ! -I u:ri'; ru f-',J en r () fTI "tJ ::) Z ~ co UJ 0..... :x:- r DCi') OJ I-l rz r CJ ~ fTl m f1l !?, -f Z '---< 3: 0 tn (J) J>J> fTl H "Tlttt:E :s: 2 r:;oz ^ -( ffi -(H fTl W Z m D (I] :c G:l 0 ::0 (J) (Jl~ r +--<r C/) ~ CD r 0 IUln en ~z r;J -l :2.lm - ~ C) G) ~ ()'-J X Z (") 0 ~ r ::I: r UlD m I-ln CJ m (") nn trj -f 0 JJ 0 nc . :JJ oz m - t:1-1 ;d :c fTl 9 () ~ -...]1)- OJ W.....:l CJ 0 .........0 0 X roo!> l\) -...] (') ...... 5J'I 0 c ~ :x:- c m (") :::j 'i ~-< S II r w ~ W 01 ~ l\) O'l I 0 l\) ...... O'l 0 <..f\ ~ m r::. ...... " ...... U1 '.... , . OJ STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 (85 0 ) 4 87 - 13 95 L;I:NER, FRANCIS M APPLE SIGN & AWNING LLC 1635 NORTH DALE MAnRY #7 LUTZ FL 33548 , , STATE OF FLORIDA AC#2692 ~ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ;F'; CBCA1~~:~,? 08/02/06 0670015: :;;CERTIFIED BUILDING CONTRACTOR ;,:LTNER: FRANCIS M . :-:APPLEhSIGN & AWNING LLC IS CERTIFIED under the provisions cf ch.4:89 Expiration date. AUG 31.~ 20.08 LD60802008~ DETACH HERE I AC# 2 692 3 2 4 STA TEOF FLORIDA,: ,:~,,~:I" :~::~.':',!,:~".E.;; '- ,oj,;, '., DEPARTMENT OF BUSINESS_AND PROFESSIONAL REGULATION'" :it}:i;;}:,:"; . CQNS TRUCTI ON INDUSTRY ':LICENSING BOARDS.EQ#Lo~ba:D'~6oi3: "'~"r'\t(~ "1', :':~r.;'::'(.~ '. ":: LICENSENBR :~.~: ~.~ : ~ I ",;. ,I.r-.l::<". ~:.-t'.1,\.' _ ':;';::bg<X02-}(t2';oo'i>~ ~:t7:9"oir516 . CBCAl1812 :;':}'/'rhe"'~P'It..D J1.NG;>cbN;;ti:i~ACTOR ;Name'cfb'elow ; I:S'~:'CERTIFTED Under'the provisions of Chapter 489 FS. Expiration date: AU,qc031i' 2().q.{3 ~-;~I:~:hi' . r'~ . . '.~IN1!:R _l<'RANCI~ Iv1. . APPLE SIGNc&,:.AWNING LLC >1635' ~ORTH;:.~DAtE;MABRY #7 ;. LUTZ FL 33548 'j.:l ... .~ , ,: .'~' ,i.:.::'; . JEB.BUSH GOVERNOR :"::'::i: . DISPLAY AS REQUIRED BY LAW SIMONE MARSTILLER SECRETARY 06-09-2008 00:33 FROM-OAKES AND ASSOCIATES INS +8139964706 T-714 P.001/00l F-757 ~ .... ",. ....,.. vL-I'\.11I I \J.M. I a:: vr LIMO) LI I T II~\:)U I"V'\I~vt: ~~K _... - ,.....---.... APPLE-2 06/09/09 PRODUCER THIS ceRTIFICATE IS IssueD AS A MATIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Oakes ~ A$soc~a~es ~n$urance HOLDER. THIS CERTIFICATE DOeS Nor AMEND. EXTEND OR 4111 Land. 0' Lakes Bl. vel. #lOB ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Land 0 I Lakes n 34639 COMPANIES AFFORDING COVERAGE COMPANY Phone No. 813-996-4111 F8>c No. A Auto OWners insurance CO INSURED COMPANY B COMPANY Apple S~gn & Awn~nq, LLC C 1635 N. Dale Mabry Hwy #' 7 -.- COMPANY Lutz FL 33548 0 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED Baow HAVE BeEN ISSUED TO THE INSuRED NAMeD ABOVe !'OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RE:QUIREMENT. TERM OR CDNDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESpeCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PeRTAIN. TtoIE INSURANCE AFFORDED BY THE POLICIES DescRIBED HEREIN IS SUBJECT TO ALL THE TERMS. ElCCI.USIONS AND CONDITIONS OF SUCH POLICIES. I.lMITS SHOWN MAY HAVE BeEN REDUCED BY PAlO ClAIMS. CO TYPE OF INSuRANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMrrs LTR DATE (MUIClD/VV) DATE (MWODIVY) GEIIlERALLIABILITY GENERAL AGGRGGATE S 2000000 I-- 03/0B/OB $1000000- A ~ COMMERCIAL GENERA~ LIABII.1TY 062312-20680616-08 03/08/09 PRODUCTS. COMPtOP AGG ~ CLAIMS MADE ~ OCCUR PEftSONAL & ADv INJURY $1000000 OwNER'S & CONTRACTOR'S PROT EACH OCCURRENCE S 1000000 - - FIRE DAMAGE (Ally One ro",) $ 50000 MED EXP (Ally OI'le peI'!#1) $ 5000 AUTOMOBILE LIABILITY $ 1000000 - 95-434-022-00 03/08/08 03/08/09 COMBINED SINGLE UM/T A ....!.. NoN AUTO --~-. ALL OWNED AUTOS BODILY INJuRY -- $ SCkEDULED AUTOS (Pcf pOl$OI1) - ....!. HIRED AUTOS BODILY INJURY (per aCCident) $ ..!. NON-DWNED AUTOS - ~ PROPERTY OAMAGE $ GARAGE LIABILITY AUTO ONLY - eA ACCIOENT S; f-- ANY AUTO OTHeR THAN AUTO ONLY, f-- EACH ACCIDENT S "-- .- AGGREGATE S excess ~IAel~ITY EACH OCCURRENCE S R .lJMBREl.LA FORLl AGGRGGATE S OTHER THAN UMBRELLA FORM $ WORKERS COMPENSAYION AND fcfR~Ttl.Ws IOl~' EMPLOvERS LIA8IL/T'( a EACH ACCIDENT $ THE PROPRIETOR! R INCL El DISEASE. POLICY LIMIT S PARTNERSIEXECUTIVE OFFICERS ARe: EXCL EL DISEASE. EA iMPLOYEE S OTkER DESCRIPTION OF OPERATIONSlLOCATIONSNEHICL.ESfSPECIAl. ITEMS CERTIFICATE HOLDER CANCELLATION ZE~HYRH SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL EIIIDEAVOR TO MAIL City of Zephyrh~l.l.s Bl.dg. Dspt ~ DAYS WRITTEN NOTICE TO THE CERT'FICA pe.~OLDER NAMEo TO THE LEFT, ( BUT FAlL TO MAILid~OTlce Sl;lol LL1rosl N ~OBLIGATION OR LIABILITY 5335 8th Stree~ .... Zephy~hil15 FL 33542 01' ANY IONO UtlON 'I'ri - P.r. r ' n.a PRESENTArrves. A~~AEP~~V# W ~vt/. .A J lo..lAf ~ - '- ~ ~'- ACORD 25-$ (1/95) ___ - ORD CORPORATION 1988 {- - .. · 7/ 6/912008 10:54 Lion Insurance Lion Insurance Company-+-Apple Sign & Awning, LLC 1/1 :. . - .- . CERTIFICATE OF LIABILITY INSURANCE Date .11 6/912008 ,Jroducer: Lion Insurance Company This Certificate Is Issued as a matter of Information only and confers no rights 2739 U.S. Highway 19 N. upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Holiday, FL 34691 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, Inc. Insurer A: lion Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer c: Insurer 0: Insurer E: Coverages The poliCies Of Insurance listed below have been Issued to the Insured named above for the pOlicy penod indicated. Notwlthstandlng any requirement, term or condibon of any contract or ott.lr document...th 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 condiborr:; of such policies. Aggregate limits shown may have been reduced by paid claims. INSR ADDL Type of Insurance Policy Number Policy Effective Policy Expiration Date Limits LTR INSRD Dale (MMIDDIYY) (MMIDDIYY) GENERAL LIABILITY Each Occurrence $ - Commercial General Liability Damage to rented premises (EA :: :J Claims Made 0 Occur occurrence) $ t- Med Exp $ I- Personal Adv Inpry $ General aggregate limit applies per: :J Policy o Project 0 General Aggregate $ LaC Products - ComplOp Agg $ AUTOMOBILE LIABILITY Combined Single Limit - (EA Accident) $ Any Auto ~ All Owned Autos Bodily Injury - (Per Person) $ Scheduled Autos ~ Hired Autos Bodi Iy InjUry ~ Non-Owned Autos (Per Accident) $ - Property Damage (Per Accident) $ EXCESS/UMBRELLA LIABILITY Each Occurrence i Occ~ o Claims Made Aggregate Deducbble A Workers Compensation and WC 71949 01/0112008 01/0 112009 X I we Statu- I 10TH- Employers' Liability tory Limits ER Any proprietorlpartner/executive officer/member E.L. Each Accident $1 ,000.000 excluded? E.L. Disease - Ea Employee $1,000,000 If Yes, describe under special provisions below. E.L. Disease - Policy Lim~s $1,000,000 other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions ofOperatlons/LocatlonsNehlcles/Excluslons added by EndorsemenUSpeclal Provisions: Client 10: 29-66-299 Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. that are leased to the following "Client Company": Apple Sign" Awning, LLC Coverage only applies to inj.J1ies incurred by South East Personnel Leasing, Inc. active employee(s) , while working in Florida. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or CIly other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. FAX: 813-948-2403 & 813-780-0021/ISSUE 06-09-08 (TO) RE>nln Date 11 /22/2007 CERTIFICATE HOLDER CANCELLATION CITY OF ZEPHYRHILLS BUILDING DEPARTMENT Should any of the above described policies be cancelled before the expirabon date thereof. the issuing insurer will endeavor to mall 30 days written nODce to the certificate holder named to the len, but failure to do so shall impose no obllgabon or lIablily of an,' kind upon the insurer, Its agents or representabves 5335 8TH STREET JZ4 .../~ ZEPHYRHILLS FL 33542 ,~