Loading...
HomeMy WebLinkAbout09-8869 CITY OF ZEPHYRHILLS 5335-8TH STREET (813)780-0020 8869 BUILDING PERMIT Permit Number: 8869 Address: 6015 9TH ST Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL. Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: Improv. Cost: 2,300.00 It Date Issued: Name: GRAY, ARRON Total Fees: 67.50 Address: 6015 9TH ST Amount Paid: ZEPHYRHILLS, FL. 33542 Date Paid: Phone: (813)782-0757 Work Desc: REPLACE SLIDING GLASS DOOR W/FRENCH DOOR SIZE TO SIZE HOME SAFE LLC BUILDING FEE 67.50 �4M 1k FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING FOOTER BOND DUCTS INSULATED SEWER MISC. ROUGH ELECTRIC LINTEL MISC MISC. 1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC. DUCTS INSTALLED WATER MISC DRIVEWAY PRE-SLAB SHEATHING MISC. MISC. CONSTRUCTION POLE FRAME MISC. MISC. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection trips are necessary due to any one 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. The payment of inspection fees shall be made before any further permits will be issued to the person owning same "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 r ing your noti of commenceme " T CTOR SIGNATURE PERMIT OFFI R 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 Fax-813-780-0021 • Building Department Date Received �—�S�o Phone Contact for Permitting 4 U -- w v 1 I/v Owner's Name LP. Irq Owner P ne Number13 78Q 075 7- Owner's Address I (o /c /Ll/r I Owner Phone Number I Fee Simple Titleholder Name 5/ Owner Phone Number Fee Simple Titleholder Address ,� JOB ADDRESS TV \ T7orrkIS LOT# I SUBDIVISION I PARCEL ID# I (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CONSTR ADD/ALT SIGN Q MOVE Q DEMOLISH INSTALL REPAIR PROPOSED USE SFR Q COMM Q OTHER I TYPE OF CONSTRUCTION BLOCK FRAME STEEL fl OTHER I � c' DESCRIPTION OF WORK e SS U 1*h ors& M5i` /s 2 BUILDING SIZE SO FOOTAGE I HEIGHT BUILDING VALUATION OF TOTAL CONSTRUCTI ON ELECTRICAL $ AMP SERVICE PROGRESS ENERGY W.R.E. PLUMBING MECHANICAL $ VALUATION OF MECHANICAL INSTALLATIONO Cep 17S 1111 GAS Q ROOFING � SPECIALTY fl OTHER ?/ FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA =YES =NO BUILDER COMPANY Iccci . —(� c_ SIGNATURE REGISTERED Y/ N FEE CURRENT IY/N Address % C • ' License# I C rC8 ELECTRICIAN COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N Address License# r � PLUMBER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N Address License# r � MECHANICAL COMPANY SIGNATURE REGISTERED I Y/ N FEE CURRENT I Y/N Address License# F_ OTHER COMPANY SIGNATURE REGISTERED I Y/ N I FEE CURRENT I Y/N N Address 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)working 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 COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-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 SIGN PERMIT Attach(2)sets of Engineered Plans. •"PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. Owner&Contractor sign back of application,notarized If over$2500,a Notice of Commencement is required. (A/C upgrades over$5000) ** 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 A/C 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—Homeowner's 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,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. 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"V"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 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 YO OTICE OF COMMENCEMENT. FLORIDA JURAT(F.S.117.03)O _p``�`` + SubsR OR cribed b d ands sworn to(or affirmed)before me this Spbscr/R�eO annd sw to( r affirmed)before meR is \\\ `QV •..s E • '/,''/'//// by ?!Z5/O b., 'flSt �v . .Q4.#<C• ,1SSI0�/ •;�S.i C •• Who is/are personally known to me or has/have produced o is/ar p o me or has/have produced � • P� 0)3&7 as identification, as identification. ` --- ���ZZpp''• tDD 710524 Notary Public Notary oeli4 • ^� i •%l�bd1dS Commission No. Commission No. D,0 /I0 S2 :•�( /��rq r/Gis E - ,' 9/Pl e'/ IHN� '�'� Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped - g12i4 1 tI 1 I ov rJ 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—Homeowner's 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,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. 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"V"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 NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT IN H YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FRIDAJURAT(F.S.117.03) ER OR AGENT 'I_k� CONTRACTOR /S c, ed and sworn to(or affirmed)before me this Subscribed and sworn to(or affirmed)before me this �iV�by c by o is re personally known to m�aroduced who is/are personally known to me or has/have produced as identification. �- s4.,i1lr t G--r'.1G(oof`IVI -4 — Notary Public _Notary Public Commission No. ,GV11''/ Commission No. ary ty V • Name of Notary typed,printed or stamped �• *t �00 * EXP11 S:J*29,2012 �T�j+ BaMMd1b l NdrySIr II City of Zephyrhills BUILDING PLAN REVIEW COMMENTS Contractor/Homeowner: Vm, f-L Date Received: 2- 15-0 9 Site: (, o l Permit Type: Q E c.S' i9fSal Approved w/no comments: Approved w/the below comments: El Denied w/the below comments: ❑ This co ent eet shall be e with the permit and/or plans. Kal in Switzer—Plan Ex iner Date Contractor and/or Homeowner (Required when comments are present) -2/25/2009 1 of 1 `I-Iom¢ e5af¢ ��111ttlrr f� 5914)vt Port Industrial lvd. � ^ Tampa, fk 3363 813 890-9909 Licenses: QB20996/CGC057678 Leo Gray 6015 9th St Zephyrhills, FL 33542 permitting Job#: 08-0392 Phone: 813-782-0757 or 813-312-1958 Proposal November 11, 2008 General description: Home Modifications -Replace sliding glass door with french doors - FL Product approval info attached Ref. No. Scope of Work 1 Sliding Glass Doors Remove existing 60"wide by 79" high sliding glass doors -door is stuck and will not open -frame opening to accommodate a set of metal French exterior doors with 1 way reflective film and insulated glass - provide and install a new brass lock set with lever handle -finish,paint and trim to match existing area as close as possible 2 Clean-up and dispose of debris 3 Permits, if required Thank you for calling Home Safe. ALL WORK SHALL COMPLY WITH ALL z PREVAILING CODES,FLORIDA BUILDING REVIEW DATE ✓ CODE,NATIONAL ELECTRIC CODE AND CITY OF ZEPHYRHILLS CITY OFZEPHYRHILLS ORDINANCES PLANS EXAMINER__ f Prices quoted are estimates based on our observations at the time and are valid for 30 days from the date of this estimate. Florida Building Code Online Page 1 of 1 BCIS Home Log In User Registration Hot Topics Submit Surcharge Stats&Facts Publications FBC Staff BCIS Site Map Links Search Product Approval USER:� User Product Approval Menu>Product or Application Search>Application List Search Criteria Refine Search Code Version 2007 FL# 9542.2 Application Type ALL Product Manufacturer ALL Category ALL Subcategory ALL Application Status ALL Compliance Method ALL Quality Assurance Entity ALL Quality Assurance Entity Contract Expired ALL Product Model, Number or Name ALL Product Description ALL Approved for use in HVHZ ALL Approved for use outside HVHZ ALL Impact Resistant ALL Design Pressure ALL Other ALL Search Results-Applications FL# Type Manufacturer Validated Status BY FL9542- Revision Taylor Building Products L.F. Schmidt, Approved R1 FL#: FL9542.2 P.E. History Model: b. Steel Edge Door-Glazed (813)926- Description: Insulated Steel Edge Glazed Steel Door- Single with 6537 Sidelite(XO or OX)Configuration Outswing or Inswing up to 6'8 in Height Category: Exterior Doors Subcategory: Swinging Exterior Door Assemblies DCA Administration Department of Community Affairs Florida Building Code Online Codes and Standards 2555 Shumard Oak Boulevard Tallahassee,Florida 32399-2100 (850)487-1824,Fax(850)414-8436 ©2000-2005 The State of Florida.All rights reserved.Copyright and Disclaimer Product Approval Accepts: V� sad rpBOE16y! so a FkFr http://www.floridabuilding.org/pr/pr_app_lst.aspx 2/25/2009 'OWL eiNr.flneNOO ofiailne'M'N BODE 9L11 '•N 3'd M II•Cu•M SNOISIA38 S31ON 1VN3N39 �' S32lSS3dd AO/�' '• NOIS30 SNOLLVA313 lv3IdA1 A9 31V0 ON o = N ICI 0126 'ON uo uzuo4v,v CO•iwyR'0 AlBW3SSV 210 12Nd .•u eu3 In I...CO,d To woos opl' d o vN N Z II L6L6' L9'CT8 '•N •084d L6LCC -Id oolLlon OCZ •08 'O'd4� 8000 3003 1331S o ll 'ONI 'siNVnnsNoo ONIDIIne S8000 801AV1 + g puodud .3u.0 aaao I ,I,3naoad 3 S v 8 I— CD w U- 00 ti m ≥ 0 0 0 a r o u) ¢ D_ U- D Z W N O a ≥ 0 0 z ( 0 0 � O O o Nw o SW 0 w 0� z z a o - = z O:2 ul o in o ¢ - � QZ NX IA NX O J W XO_W • I I (O O O N w II � o co n CO 3 N II 0 II W IC.JM� �Z CD 0 Q W ID Z Z 1 3 N Cl) Q O Z O } O O O o N w M ly HlOHS32iH1 ON-XVV ,, 1H913H 3WV2l3YO 'XVW „OS'08 030HS321H1 ONIMSNI 1H013H 3WVHA YO 'XVW „00.28 w 0 NC NCC) Z 00 Cm O'O VL 3 „ G 2ViO O C Z J O ° ` c W¢ OCR y „ a , . " � �o 00 maw 7E wo wZ ~ 0s 0 � �- WW �� oo „ CV p,D mU VI� V) ��nn vN - O Z CL 0 of X03— Go „a o zlv'-z - O N u 'D NC a 0o y w W r z z Z o O' :: o cu c3 (CC o WZ0000 n� �•d ��01 111(��vJ0 ' a0i 0 0 o Wt Odvwi��2 OO0�2 O oo C/1 U y w C (0 FU'''Z N Q 7 O „ C Q-C 2, « O COm QQ LL °tL UV6)Zmav cUj �a h � NC Z¢�U00�W w ��t raw0 ova CO o a_wru�C) 'o WZ .0 , NE �O „ „ E :S (Joz--I¢ dL, W O 2= L 053 U Q J O D U O fL L m O C W N .. E. C „ U u w 00O O -0 .00 j u .0'C O v `o 00 ¢ ai m �v aW U �j L U C X-0 >�� >•C CN mow. NO v 0 = „o ≥ - DC „ Q � '-NM•t NCON W „ O N 0 CV o 4 u) Z'Zbs6-ld'6Mp'S-I'Zbs6-ld\S6u!MeJa JLMb'O\ELEI dd\OC T-IOE-,rod\s.CapIod pa[ad\oalod- ONI aLNvlln.noo ONI01JflU ML 9008 99tis ON 3' 'M IIopo.M 1(V134 9NIZV19 SN0ISIA3a �n' SiN3N0dW00 S1IV130 13NVd �9 31V0 ON £185 'ON u ozPo41 10 o;000e+q N 3 w•wl6u3 to I0olO P.0°9Id 10 nuB oPNald h _Al8W3SSV b0 12Nd F N - LBL 6fl9'£LB ON -uo4d M Z NI sss££ �NIGA o£z 008 .0.d�1/ a000 3003 1331S o S y J 3NI 'slNvilnsN00 0N10vne QQ7 saooa aouvi e paodud gwwnoop :13(1002Jd b a M � O a „o0S'9 L „0SL'Z T o L() m � U II I J ^I�„69b z 1 N N N N O O O O O O N c� LO O1 M O• O 1 O O I II J . F- w p a a W - Z w a o LL w ♦ N N W (n N O cam (n U U O g o Y ( L. �g (D Z 1 — o = 0 N O ? ¢� J N O Lf1 O aD N M N N O F- M C.7 m 41 O O Z ZO LO tn� M 00 ®p N (j � N N N rN1 m M R9'L Lto n o Mtis'o zVo a o99'o „sz'F sz'oL 00 .,scZL 00 M O QJp C�� al �z N�a3 na n ---1H0I3H -0.1.0 -XVW „00' 9-] 41i IH0I3H 13NVd XVYV ,SZ'6L N � N N nv,'6Mo'n,0E-iu\s6uIMLun ngMM n\ci rr 4A\nnbr-r nrr(wA\slaolo-I na(ou\saa(OJd-M:>t 7NI a nn BNOo o IO IflB'M'N Boaz w919 ON 3'�-WO1414O1191O11MAViso SNOISIA32fSNOLLO3S SS080 T+INOZIdOHA8 31V0 ON moCM 'oN u..ul6u3 I ol.uyo,d to woog oPI-1.1 1835S/210 12Nd N Z m Ga a6s9'£le 'oN .uoNd MI sas££ - ool+IOA o£z •0e •o•d)g'1!' dOOG 3003 1331S o '3NI 'sLVVnnsNoo ONlallne Z2 S000 NOIANi �f L. p. do .O..wnxa I0n0021d Z^ ('du) ('du) ('dA1) ('du) 3003 A2lNOSVW 3003 A2JNOSVW 'm 3003 A2INOSVW 3003 ANNOSVW�� 10213 'NIW L 10213 NM L T WON3 NM Z/L—Z 10213 'NIW „Z/L—Z zmQ Y Fad , e U UAW V) O mO0 Z^ 1 (/1 I N 1UiC ya In m�3 IQ- \v W ^ Z ^U Vl a w O a r OZU� \Sv Y N N (/J Fw- •t M U Z � W w W O p z N Z w W _ �U N O p ? VUW U Q Q IQ— (L o� Z J L Q N O z OO O Q 2 O N N M O (n N M Z N W 0O [// A Ef1XD Y D orb w0 cnz N u) XU O / •t � Q Q� N F" m M u7 \=v O N N (/I N N U J z 2 o N O N d = M � z (du) I (au) 3003 ANNOSVW 3003 ANNOSVW 10213 NM 0L W021J NIW „t M I uj w nxc'6Mo•lbcF-,.As6urMexn'IeMN,n\c,cl 4a\nnar-,ncr(ola\Mooio-na(oia\sva(o,a-M:u ONI G1NVJfln SN00 ONIOlIIIE MN 8000 BL Lis ON 3d II.V..M SNOISIA3N -/_- SNOLL33S SSONO IVOLL83A AG 1VO ON o = N nl £EBB 'oN u sNo43ml 10 .ivaLL13+.J VI N w.uieul �o u.1o.d Io p.00e ovVold Al8V43SSV NO ISVd N 1' S t o L6 ,ess•£Le 'ON •OO 1d `*I ses££ .� ooNion o£z .oe 'Odjy).,'v0 80O0 3003 1331S o S 9 J row •SINV1lnSNOO MUMS Q�9 SNOW NOlAV1 :.(e paod.�d .lu.Onooa 13802 1d ( u) '8W3 v) 'NIW , /L-L FwQ Fad a OW _• hHi; 4m�W •. 'y V) }FN v eCN ♦• P •wW W W (au) A :• a at V 1 ZL30VdS WI-IS °. Z (au) •9W3 N NI W „b/L-L Y � m 1 J U OW 1 0O T`o p W_ 00 o� OW QQ [Y Q Q ��♦ W� N ::: r W W O` a 1VOIdAl o • I L33VdS �{ SINS-2110 N. 00 • _ -i WIHSSl O XdW „b/L ('au) '8W3 (au) '8W3 NIW ., /L-1 'NM „b/L-L O0'6Mp•S-T•Zt,S6-ld\s6u!MOJa 8MN'a\FEET dd\000-TOT(ad\sapIod ha(o,d\sha(old-V\:N �NI filHvllns NOQ flNiCllfl9 M'tl BOOL 99 L* ON ' 'd M II•PO•M I SNOISIA3N S1N3NOdI 03 �P �p lE SIVIN3IVW JO 1118 A9 Stlb0 31V0 ON f L96 'ON 9o:uovinv io •iooulN•o 12Nd N u•w16u3 1 ol•wCold io Ploog OPI.uld AIOW35 z 'C O L6L6699T19 :'oN •uoyd M Z 969cc '� •>I1I•n O Z ••e •'o'a 44 ?1000 3003 1331S o 'ON1 'survnnsNoo 0NI0llne Q�9 S?1000 NOIAVi yy u(e Puod•,d •iu•wn000 .LOn00Nd S v 06L'0 „t6l'L iL_ „00£'L „Ozz-L - 0 0 7 0 m x x m II 0 m _ a (V x (0 yI ~ O Z Lm w1J Z Z N U Jazz o0 I L I I ,Sz'L F�- •) M D M J O 0 2 2 WII I � � x ,696'0 ¢ N __II Z LNo Z * Z o Lo 3 Ln 3�7 ri 3 m m1(1(11111 o S 0 O 0 0 IA ° ° ON D —I„06z'L w W LAI Z Z 0 0 0 O 0 1W Q m W J J 0 0 0 m 0 0 J J J J o O J J 1 W O O J J J J = J p O J Z } J J 0 0 0 O O J O J J m W W W W O0 W W m O O w w w w rj w o o Q w 0 w w w w w w w 0 a w 3 3 3 z 3 } . } w W w W w w w w I w (� w W W w w w W O O w I z z w r r r o o �' �' U o o r r r r m r 0 0 > O r - I- - r r r r r r m r x ¢ (n U U U 3 3 U U 3 3 U U Ln U } U 3 3 w U J U U U U U U U W U m Z n > > U U OJ CL J J o 0 Q Q Q Q Q < -- --a x 0 J M 0 QOQ Q lI I- C O U N O U CD �O - N Q U U) U 00 N J 0 O UU W II (n j 0 o � II �� m A 0 m a J a J U X A O r (n Y Y m 0 O< U II m LY w 0 } m } U U Z 0 J 1'10 _ N 0 01 z OU r W Z 1. ^ d' ?i () m r m m O m 0000 ZOUO Z_Z 000 (rn0 I (Onm U (r U (C 1U (nU 2a J 3 I W I O wQ- U UUU Z_ 0 0 Jj 00 } (n0 O w Ln } Inr � Fa �� aarL �+ w ¢ o (n 0 W m � 00000 mm LJ ww ¢ m QQ ¢ Yli az � 0 0 Li (� (n )- > LUO D0CCDd W (]_ p Qr a rrrF NZLLJ 3 QU3 JOU ODDDOmdm QU J J J J NQN JUOw W N� oFN � � � ZUOU � Ha UZ � 20000 Jw J (anQ fA } z 0) II N O W (Y O a m d W U W r d O D U U U O 3 O O W fn W U W a ^YA O U d 0 d= Ll Y = } }• O W W W W O Q O = M O N 1 0 N fY d' d m m w a' QQ d J U O Ll= = W r w d m W W Z K ( U M M O (n 17 ^ ^ L� Y (.J F Y U a O D U U O N I I m M N M U, fl I M Q OU 0 2 fl o O J } Y Y Y O J Z W I M N r J W M } W (? (7 (.J (7 O r (n III d W O W N J U U (n U m LI_ m W N r N U O O J U (7 Z Z Z 2 C7 m O O M � cQQ� cQQ� 6o � Dxx zp 00xxx = z xx = m ? xOwxOz_ 3333 ? zz UJwJJJ We me OJmmc - K � (� Ym } r¢¢ x ¢gx U0 = d UUUU w X U) U Q U Q x Q O X X d d 00 O ? O ¢ O 0! W L10 L], n L J, O d FW-- O > ≥ ≥ U p U U Ln O UIII III } U } ^ N ^ ^ S N ^ ^ 0 w = J fl r 3 U g O ^ = W Q m U (.7 2 - Y J Z d r ^ N M at ¢ N M 01 O M Ln m r f10 Of N r m m LO r m N N N OHS RLNV1ln.NOO ONlOllne MU BODE 995 ' N '3 d ' 'M II•P'•M OH SNOISIA3a oNlaonn A9 31V0 ON o x N nl £(98 '�N oRosN•41 10 .3oaLLILq �} 1- p w..Ie�3 �olo.�o,d �O wove W11OIA -A1BW3SSV 40 1Wd N z o In L 8BC9•£l9 'oN .-o4d r7 I 4JI sesc£ 1 OoSI A OE :Oe o d4/, x000 3003 1331S o 'ONI 's-NviinSN03 ONIOIIne Saooa aouvl L. :AS p.Od.id quown*oa :LOnOO8d O O� Z N z SZL'6£ p O O �i f..09'S `� cYigo vg m¢Z Y mQ U1 \N W O \N Z �ZN xI O Q F N N N U � ; O ; Q ¢ N O N Z Z N - N = ..SZ'6f--1--- .,5Z'L£ I „SZ'L£--� z rn a31N30 NO `� °I oywN n ..9 �'XVW OQ r Yz YZ 6.-o UO UO x z mg mg as ¢ x� � 0 \(n • O 3z 3z 31'133 N0_____ O XVW „00 b 1 t--„9 aorNFz �cWiv�v Q D()—' Z O�OF¢ =K O—O (nF Y HI N U lili z Z N m z U w O O m m z N AZ X ? \(n\(nwF. . ow a0 w w � UOU¢ZZ Z ZI''I yy N �W �¢F=~Z_Z ~OW OO �UW�V N((nZco U m s i1 i m((n3n O�Z� Z6�(n(nz QOQQ O41aw ti= O h0¢O Y d m OZ z ((nnw Q Z�OW QWW x Qa m¢WWOF-= zfnV(n- N �O WUW�O~ ce(tz2 U Z Q-Fc Ozo-O - = m UL �OOQ� a31N3O NOLiii . Xt/W „ti6'8L 0zQ �ow o�x¢Qow -�— LLJ cr a o�z—z Z ~rxor wWwo�-IQ-(n O�WWtiw w` wmU-wm < O O cOLJ 00 a.Z za0¢ UUE-~mwz mOZw QO O=�mZ�Om o ZI- ___________ z F- ¢ O U W illQ ozwz¢� 3z¢ozWO r�r wc, wZ wfm xz ao w�zo zo�az� voo�co�o?� o� UF�Zz� �Q3�oz� m N XOI OW �-zp�UZ OOVIZ s xN <O owMOOO U >-t w w =¢U¢W OUZ I— `v �-p w�U sl•In ZO w�(n (V 0X9'6MP'Zt,S6-1d\S6tIMejO DNM'd•O\ELET Jd\00b1-TOEI(ad\SIaPIOJ 7 OJd\ST3a[OJd-V\:N 051 G.Luw.n 1CNPO NNIGIIl19 M'L 9OO0 HS/YS oN 3' 'M IL.P' M SNOISIA38 Sd l2"� SN01103S SS0d0 1VLL1a3A A9 31V0 ON 00I I j f J96 ON nozyoy, b no°L4M O :,k SSV 210 J.UVd wl6u3 ol.plo.d 10 Prooe oPyold N Z z L6L6'699'fLH :'ON .unyd hl 6sef '1 ooyIon 0fz •0e 'o'd 'd/' 8000 3903 1331S o 10I.I ONI •siNVllnSN00 05101108 (12 S≥J000 ?IOIAVl � S L. :J Pu.dud . .v..oa i3naoad ('duL) 9W3 'NIW „V/t—t wo zo a cn z x ~a� P ry I=NOy Ow p� N z�^ n O UAW N O • V) mN33V' N O F Ln \Q �• IInn 310�lL6 zv. \Q N N w R) XfUn^O vv N 1 D_ V ZKO� O Q a In , z In "Q -F- --z --i L 30VdS WINS N �Q I 'XVW „b/L I N N ('du) aw3 'NW J,/L—L L- wL0 zow O InZ IY J W W J l W W 01- M O U Z QLn w U pZ O Z WI- G 1 H LLL III,,,,,,��� LU<<- -- o 2 r 0 0 cO-- !n f-J!n!n Y w Y :i1TIn w TTT 0_• Ln LD W (� Z 11 ^ N •- h li 0 z lV01dJ L ° z w zo ° HNS-a O s a x L30VdS WIHS XVW „-0/L ('dkL) 9W3 (au) 8W3 'NIW „b/L-L 'NIW , /L-L OXS'6Mp'S-i'ZYS6-u\56u!meJ0 DRMN'O\£L£T jd\0061-IO£i fold\S 0PI0j PJIoJd\s}Da(0Jd-V\8 forn¢ Saf r, L LC 5914 J4zt Port Industrial 31vd. �.,tlltflrr,,f{ `Camp , ?J 33634 Ci ji 813 890-8809 Feb 9, 2009 To Whom it may concern: This letter is to verify that Denise A. Isensee is authorized to register, sign, and pull permits under License #CGC057678. Sincerely, Edward J. Serralle Home Safe, LLC STATE OF FLORIDA COUNTY OF __ Sworn to(or affirmed)and subscribed before me this 9th day of Feb ,2009,by Edward J. Serralles. Signature Of Notary public -State of Florida..... ersonally Known. ..X..... Or Produced cation......... ```���t111111111//�/// #C0710624 g e l c b ACORD CERTIFICATE OF LIABILITY INSURANCE 2/24/20091 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION hmalz Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sc 3c4 Tampa Insurance Suite y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Road, e ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oldsmar, FL 34677 813-855-6639 INSURERS AFFORDING COVERAGE NAIC# INSURED Home Safe,LLC. INSURER A. Mount Raw ley nyuraT1oe Company Edward Serralles/Lic#: CGCO57678 INSURER a. Business First Ins. Co. $914 Jetport Industrial Blvd. INSURER C CNA Surety Tampa, FL 33634 INSURER D INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED SIELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT', I SIAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TPIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL'I'HE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1,461 CFFGCI'IVE POucYExPIRArIoLIMITS u'li NnRo 1'YP' :'I POLICY NUMBER PAF I M IDDIYY OATE(MM/ODIYYI GENERAL LIABILITY H OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMI B Ew occuron co 6 50[000 CLAIMBMADE C OCCUR MLOEX (MYUrp.IIoIaU/d 6 5,000 A MGLO150720 03-08-0 03-08-09 PERSO L&AOVINJURY x 1,000,000 GENE IL AGGREGATE S 2,000000 GEN'L AGGREGATE LIMIT APPLIES PER, PR UCTS•COMPIOPAGG $ 1 000,000______________________ X POLICY n JhF191 .. LOC AUTOMOBILE LIABILITY COMaINED SINGLE LIMIT ANYAU T O (Ea accidnn%) ALL OWNEU AV I'O$ BODILY INJURY SCHEDULED AUTOS (Par person) HIRED AUTOS BODILY INJURY NON•OWNEDAUTOB (Par�ccldenl) PR01'ER'FY DAMAGE (Perecclu*AI) GARAGE LIABILITY AUTO ONLY•EA ACCIDENT Y ANYAUIO OTHER THAN EAACC S AUTO ONLY AGES — — EXCESS/UMBRELLA LIAOILITY EACH OCCURRENCE S OCCUR CI CLAIM6MADE AGGREGATE S OEOUCTISLE S RETENTION S S WORKERSCOMPENSATIONANO X I'ORYLIMI'TS ER 10TH- EMPLOYERS LIAAILITY 0521000470000 9-3-08 9-3-09 E.L.EACHACCIOEN'r S 100 r000 AN !L•KL•CVfIVL' B Oi,ICLWMGMl1LR L%CLUDL'U1 EL.DISEASE-EAEMPLOYE S 100,000 If[ue EcaUILewM , SPCCIAL PROVISIONS boIow EL DISEASE•POLICY LIMIT 3 500,000 CTI IEk $250,000- per claim C Professional PL- 909270 07-29-08 07-29-09 $1,000,000- occ. Liability a DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES I EXCLUSIONS ROBED BYENDORSEMENT I SPECIAL PROVISIONS General Contractor: Edward .7oseph Serralles, CGC 057678 CERTIFICATE HOLDER CANCELLATION City of Zephryhills SHOULD ANY OF T14E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 5335 8th Street DATE THEREOF. THC ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Zephryhills, EL 33542 NOTICE TO THE CEHTIPICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 0050 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, I'r$AGENY6 OR RIEPRESSN'rA'rIVES. AUTHORIZED REPI I . ACORD 25(2001/08) ®A R CORPORATION 1988 10/t0 3EH d 33NtidfSNI 21VMHDS 9bZTS58Et8 b5:TT 600Z/EZ/Z0 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET SERRALLES, EDWARD JOSEPH HOME SAFE LLC 2324 N HIGHLAND AVE TAMPA FL 33602 STATEOFFLORIDA AC# 3896325 Congratulations! With this license you become one of the nearly one million DEPARTMENT OF BUSINESS AND Floridians licensed by the Department of Business and Professional Regulation. PROFESSIONAL REGULATION Our professionals and businesses range from architects to yacht brokers,from boxers to barbeque restaurants, and they keep Florida's economy strong. CGC0 5 7 6 7 8 08/06/08 080008769 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.myfloridalicense.com. CERTIFIED GENERAL CONTRACTOR There you can find more information about our divisions and the regulations that SERRALLES, EDWARD JOSEPH. impact you, subscribe to department newsletters and learn more about the HOME SAFE LLC 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. IS CERTIFIED under the provisions of ch.489 FS Thank you for doing business in Florida,and congratulations on your new license! s:piration data AUG 31, 2010 L08080602109 DETACH HERE AC! 3896325 $TT9FFI..QRIDA DEPARTMENT 'OF PROFESSIONAL REGULATION Sr LICENSING BOARD SEQ#L08080602109 18/O6/20O8 080008769 66CGC069QL . The GENERAL CONTRACTOR . . , � Named below IS CERTIFIED r+7r Under the provisions of Chat Expiration date: AUG 31 . i 1riT SERRALLES, EDWARD JOSEPH HOME SAFE LLC . 5914 JET PORT =INDUSTRIAL!` BL r1 TAMPA FL 4 CHARLIE CRIST CHARLES W. DRAGO GOVERNOR = '' ' SECRETARY DISP.LAY ASAREQUIRED BY LAW D zr- 0 > > O C 0 H m mZr" O cn z cn O Z N W O 0 g o 0 o n o ci+ S ♦�9 • I Dcn= D�O N O o 0 r o V` >m,, > 9 z Oo m r�OT W • ZJ G) .Z7 O O m Z n ;, A = >< Z A m C tt 0 n 9 () O rn gym , NZ / D v ^ r- D n m 4 / 00 -1 m m •f�� N /n = 0 D m O m C -+<,m m D o m N x 4w m rz m m \J D m m o m m X z m 00 > m NJ 0- or') c 11 W co c W O f N 0C) -i _ O O� m m C CD O U'i CD O U' NJ _ N O OD o O O O O DATE(MMIOOIYYYY) ACORD,M CERTIFICATE OF LIABILITY INSURANCE 3/4/2009 PRODUCER • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Schmalz Insurance A enc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3894 h Tampa Road, SAiee B HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Oldsmar, FL 34677 813-855-6639 INSURERS AFFORDING COVERAGE NAIC# INSURED Home Safe,LLC. INSURER A: Mount aN ey iisur=60 Company Edward Serralles/Lic#: CGC057678 INSURER B: Business First Ins. Co. 5914 Jetport Industrial Blvd. INSURER C: CNA Surety Tampa, FL 33634 INSURER D: I INSURER E: COVERAGES 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'PO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I SR G'I. POLICY EFFECTIVEPQL�Y PT 1�nAr LTh Hf! TYPE OF INSURANCE POLICY NUMBER DATE MMIOD/YY DATE MM/DOIY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 X COMM@RCIAL GENERAL LIABILITY UAMAE FU KEN I PREMISES ES occurence 3 50 000 CLAIMSMAOE OCCUR MEDEXP(Anyonoporson) $ 55,000 A MGLO150720 03-08-09 03-08-10 PERSONALSADVINJURY s 1,000 000 GENERAL AGGREGATE 3 2 000 OOO GEN'L AGGREGATE LIMITAPPLIESPER: PRODUCTS-COMPIOPAGG $ 1,000,000 X POLICY jt9i LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (54.CC[dWit) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pra pereon) HIRED AUTOS SODILYINJURY G NON-OWNEDAUTOS (PoroccIdenII PROPERTY DAMAGE 3 (Peracc(dam) GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC S AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR u CLAIMS MADE AGGREGATE S DEDUCTIBLE $ RETENTION $ S WORKERS COMPENSATIONAND XI TORYLIMITO I ER. AYPROPRTCRIPARTN 0521000470000 9-3-08 9-3-09 E,L.EACHACCIDENT S 100,000 ANY PROPRIETONiPARTNER/EJ(ECUTIVE B OFFICERAAEMeER EXCLUDEW E.L DISEASE-EA EMPLOYE $ 100 000 Ifvar.d.cnb.undr E.L.DISEASE.POLICY LIMIT $ 500 000 SPECIAL PROVISIONS Dolow OTHER $250,000- per claim C Professional PL- 909270 07-29-08 07-29-09 $1,000,000- occ. Liability a DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS General Contractor: Edward Joseph Serralles, CGC 057678 CERTIFICATE HOLDER CANCELLATION City of Zephryhills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION 5335 8th Street DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Zephryhills, FL 33542 NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REP T E ACORO26(2001/08) ® O CORPORATION 1989 10/10 39 td 30NtidIIlSNI Z1VWHDS 9tZT998ET8 SS:ZT 6002/VO/EO