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Home My WebLink About11-12027 � CITY OF ZEPHYRHILLS 5335 - 8TH STREET � (si3)�so-oozo 12027 BUILDING PERMIT Permit Number: 12027 Address: 6438 BRENTWOOD DR Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section: Square Feet: Subdivision: SILVER OAKS Est. Value: Parcel Number: 04-26-21-0030-OOD00-0020 Improv. Cost: 6,200.00 Date Issued: 6/21/2011 Name: BENEDINI ANNE & ROBERT Total Fees: 70.00 Address: 10821 HIGHVIEW DR Amount Paid: 70.00 DADE CITY FL 33525 Date Paid: 6/21/2011 Phone: (352)567-3492 Work Desc: REROOF SHINGLE 25 SQ �. r� � TAPE JOINT ROOF INSP FINAL �-�-/( 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 � 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 witl 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 �ecording your no 'ce of commencement." C j f , ,, • � f,-C � - -- CONT TOR SIGN E PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER Pasco County Parcel: 04-26-21-0030-OOD00-0020 001 Page 1 of 1 Data Current as Of: Weekly Archive - Saturday, )une 18, 2011 Parcel ID 04-26-21-0030-OOD00-0020 (Card: 001 of 001) Classification O1 - Single Family Mailing Address Property Value BENEDINI ANNE M& ROBERT J Ag Land �p 10821 HIGHVIEW DR Land $14,124 DADE CITY FL 33525-8569 Building $66,719 Physical Address Extra Features $605 6438 BRENTWOOD DR ZEPHYRHILLS FL 33542-0621 Market Value �81,448 Leaal Descrintion (First 4 Lines) Assessed (Non-School Amendment 1) $81,448 BRENTWOOD PB 29 PGS 86-89 LOT 2 TRACT D Taxable Value �81�448 OR 7050 PG 1537 Land Detail (Card: 001 of 001) Line Use Description Zoning Units Type Price Condition Value 1 0100 SFR OPUD 3,978.62 SF $3.55 1.00 $14,124 Additional Land Information Show Mineral Riahts - 5 Acres 0.09 Tax Area 30ZH FEMA Code � Residential Code SIVLGP2 Buildina Information - Use 07 - Single Family Villas (Card: 001 of 001) Year Built 1992 Stories 1.0 Exterior Wall i Concrete Block Stucco Exterior Wail 2 None Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle Interior Wall i Drywall Interior Wall 2 None Flooring 1 Cork or Vinyl Tile Flooring 2 Carpet Fuel Electric Heat Forced Air - Ducted A/C Central Baths 2,p Line Desc Sq. Feet � Repl. Cost New 1 � BAS � 1,216 $67,123 � �— FEP 120 $4,637 � 3 FOP � 66 $938 4 FGR 336 $7,397 Extra Features (Card: 001 of 001) � Line Description � Year —� Units Value 1 DWSWC 1992 343 $528 2 CON PTO 1992 50 � �77 Sales History Previous Owner BUCHANAN STEVEN L Year Month Book/Page Type Amount 2006 06 7050 / 1537 WD $165,000 2006 02 6855/0914 � �p � 2003 03 5302 / 1886 WD $105,800 http://appraiser.pascogov.com/search/parcel.aspx?sec=04&twn=26&rng=21 &sbb=0030&b... 6/21 /2011 s'3-'s°-°°z° City of Zephyrhills Permit Application Fax-813-780-0021 Building Department -� Date Received � ' I < � �� / � Phone Contact for Permittin j �� _(x7'j Owner's Name �� (lVl Y��;��t .� ,�i� py�ner Phone Number �S� ' S(q 7' Owner's Address 1 ��0�. ` °�•�t ►' l V �� L ; �} �� S` � � � ��" � ��CX � Owner Phone Number Fee Simple Titleholder Name Owner Phone Number Fee Simpte Titleholder Address JOB ADDRESS �—� Jc� �!'��Y��`E,V�,rj� � . r �� S � �j �' � LOT # �� SUBDIVISION tT�YQv'�� ) , PARCEL ID# O"[ ��fl ��"' �� -- DO -- DOO� C� (OBTAINED FO pROPERTY T ricEl DEMOLISH WORK PROPOSED NEW CONSTR ADD/ALT SIGN INSTALL 8 REPAIR �pp'�' PROPOSED USE 0 SFR � COMM �� OTHER �+'� .Q � �, TYPE OF CONSTRUCTION � BLOCK Q FRAME [� STEEL Q DESCRIPTION OF WORK �� I�� V P�V��'� a S � hL �- S� � yj J,QS BUILDING SIZE �_ SQ FOOTAGE � S O O HEIGHT �BUILDING $ /' r) � t�J (/t VALUATION OF TOTAL CONSTRUCTION �ELECTRICAL $ AMP SERVICE � PROGRESS ENERGY Q W,R.E.C. �PLUMBING $ / � �� OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION � QGAS ,� ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO BUILDER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address ' License # ELECTRICIAN COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # PLUMBER COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N Address License # MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N � Address � License # OT R ,,- � COMPANY VYI�i'l \ '� y�� SIGNA , ,,�-'l� REGISTER ED / N FEE CURRE� / N Address S�— L- � License # G� C. � 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, Stormwate� 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 constructlon. ��.,��,��.,��.,�� .�� .0 i,� ia.0 � � i a�.u.i i i.i.0 r Directions. Fill out application compietely. Owner 8 Contractor sign back of application, notarized If over $2500, a Notice of Commencement ls required. (A/C upgrades over;7500) "' Agent (for the contracto�) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shingles Sewers Service Upgrades A/C Fences (PIoVSurveylFootage) 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 (ocal regulations. If the contractor is not licensed as requi�ed 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 "contracto� 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 nvt 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 WaterlSewer Impact fees a�e 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'SIOWNER'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. 1 certify that no work or instaNation 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 apptication. 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 F R IMPROVEMENTS TO YOUR PROPERTY. IF OU 1 TEND TO OBTAIN FINANCING, CONSULT WITH YOU LEN ER OR AN ATTO EY BEFORE RECOR ING U OTICE OF COM CEMENT. FLO DA ,IU (F. . 117.03) � - � 4 _ ��..�.,�... Q � N CONTRA Subscribed and rn to (or affi e before e t Subscribed and swom to (or af ed) before m b ' bY Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced as IdenUficatlon. as identification. Notary Public Notary Public Commission No. Commission No. Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped t ,,.-� ^ � -' � -� • S��J.f�� , � . . �.. � � ��1wr 'r�' :u� ADiv�saon of Ryntan Constructtoft, Lic. Proposal # �� 7� iNC. 36413 SR 54 • Zephyrhills, Florida 33541 Phone� 813-782-6094 • Fax: 813-788-6773 Estimate # License # CCC 1325505 Job # a i o '�� `� `��''+�`��'�'I�t��' Also, Serving the Central and East Coast of Florida (76�3) Customer • 1��. � _ o ,��;� � Date: / a�at�e�s: _ lo ti 3� Q�, �- L,�,�m �� 1��' c��: Zvp — _ �-��-��1 c z�p: �3Sy � Home #:�o� - �"�,�=�� q �_ Cell # Business #: E-niail Aciciress: _ ��Coniplete tear off of existing �;�e� l� � Additional Items: o �_Q�� LL l� �ecure all loose roof deckulg as needed according �\�,�,�,� {��_C�c ��,5 F - � S ,�.,�,,��1 n��,� / to Florida Building Codes L�1 Roof dr•ied in with �g��5 ��G1� �� R t� f n ��._ �ristall new ��lley rnetal with galvanized inetal n �"� �`t-�.lna �r' �L��S.� ❑ Install a11 new " drip edge color � � lstall a11 new lead boots _�ist��ll all ne�vL__� year fungus-i•esistatrt shiiigles �.�'Shuigle bi•and/color•: �-,A•'F'/F �t-� T:�v � IC� yt�T' ��ppr WarrantyPackage. klAll roof relal.ed debils removed from job site �All materials, labor and pet•mits furnishecl , Tota1 bid price $�p ��C'� �� ct_ra �t�ad plywood replaced at a cost of $�.�-{,� per sq. ft. nl the roof field. A,ll other wood work/additional labor, such as, but not luiuted to, valley rebuild'uig, raftei• replacement, etc. will be a rate of $_�� per man hour plus the cost of materials. 'PHIS BEC011g:S A BINDING CONTRACT UPON ACCPPTANCE OF PROPOSAL. PURCHASER ACKNOWI.EDGES RECEIE'T OF A COPY OF THIS CONTRACT. l. AU uiateiial is guaranteed to t�e as spe��ified and �•ompletecl in a substaiitial worluua�ilike n�wer. ?. All agreements contiiigent upuii stiikes, accidents oi• delays beyond oiu conh�ol. Owner to cairy fire, hurricane and other necessary insurance upon above work. 3. I.aLor w<u•rzmty does not cover dazuage to i•ooTs caused by light�iuig, fiunicute, Lornado, l�ailstorm, nnpact ot foreign objects or other violent storm or casu�ilty damage to roofs due to settlentenl, distoition Y�tilure c�r crackuig of roqf de�k, walls oi• fuw�dation of a build'uig. 4. Workiu�u�'s compei�sation uid public liability n�sm�a�lce on above work to be taken out by RYMAN ROOF'ING, INC., a Division of Rynkm Coc�shvction, Inc., or it's subcontractors. 5. HYMAN ROOFING, INC., a llivisiun of Rymui Gonstrlutiun, Inc u not respoc�sible to provide any niateiials or to perforni ax�y work other than what is described above. Replacement of deterioiated deckuig oi• f��•ia bo<u•ds, is iiot included aiid will be ch:uged as an extra wiless otl�eiwise stated herein. ti. Ttiis coutract is subject to fuial appi•ovzil by KY11-IAN ROUFING, INC., x Division of Rynuui Consttuction, Inc. aitd is the entire ag•eement of the parties and no other written or other forius will recogiti�ed. 7 A ch�u•ge of 1.5% will be made on <ill tuipaid balances atter 30 days, plus ch�u•ges incurred for non-paynnent procedures, plus attomey's f'ees. b. A�l% processing fee will Ue added to all credit ru•d ordeis. Ryman RooYing, Inc., a Division of Rynuui Construction, Inc. will �iot be responsible for any damage to septic tanks, sod, s}u�ubbery, pau�t, satellite signal loss, sprinklers, concrete drives or atiy uudergro�uid piping. Yayment Schedule: Payiuent Method: �- Acceptance of Proposal .'�'AT 1TORY NOTI ,, R.�� auniNr ( NSTRiJ(`Ti[lN I NS• ACCORDING TO FLORIDA�S CONSTRUCTION LIEN LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS CLAIM IS KNOVVN AS A CONSTRUCTION LIEN. IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB-SUBCONTRACTORS, OR MATERIAL SUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVE ALREADY PAID YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAIN5T YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY YAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A`�NOTICE TO OWNER". FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX AND IT IS RECOMMENDED 1 HAT YOU CONSULT AN ATTOKNEY. I ACCEPT THI:i l��P SAL AN HEREBY CEKTIFY THAT I HAVE READ AND F[JI.I.Y UNDERSTAND THE PROVISIONS OF THIS CONTRACT. � f � Purchaser: � Date: �� T Purctiaser: Estimator� �'� �- � . _ . .. . ' iiiiii�iiiiiiiiiiiiu�iiiiiiiiiuiiiiuiiii�iu�iiiiiiiii�ii . ' 2013094769 �� NOTICE OF COMiVIENCEIVI�NT STATE OF FLARIDA COUNTY OF PG�� Tt� UNDExs[GxED heraby gives notice that improvament will ba made to certain real property, and in accordance with Chapter 713, Florida Statues, the following infoimation is pmvided in this Notice of Commoncement: 1. Descrip6on of Proparty: Parca o. - - �- fJ -QO 6�[3F3 13�, P(� otq �-S g- i�f-� �� o �o sp , P 6- � s � 3 ' l 2. General l,�eacriptiou of�inprovement: �i��. r�o•{� 3. Owner Information: Nama n _�. (�o �.. ' v, ' Address: $ i- ' City Stato - rL� Zip code 3`_�. � ' intecest in Proparty: c� c.UY"I.�YS Name of Foo Simple Tittloholdu: If other than owner: Address: '- � City State Zip Code 4. Cont�: 1'1't R00�\V1CD �+� • � ��j-��-(�OC.�� i Addr�s� � 3 S, .R 54. Z�vrhills. FI. 3�541 • ---- - ��RepL:1374048 Ree: 10.00 • ' 5,. Suroty: Nama � Phone DS: 0.00 IT: 0.00 i p�� 06/21/11 C. Cook, Dply Clsrk � City State Zip Coda _ ' Amount df Bond: $ ' (. Lender: Name 1�ILA Phona # • Address � CILY S'tg� ��pULA 5 0'NEfL,Ph D PPSCO CLERK L COMPTROLLER _ - 06/21/11 �8�� 1PGof' 1 _ 7. Persons within tha Stata of Florida designated by owner upon whom n.._ OR BK �w uw.uments may � sarved as provided by Section 713.13 (1) (a) ('n, Florida Statutes: � Nama I�1[A Phona #� ' Address � > C�ty Stato ' Zip Code 8. In addition to himsel� Ownor deaignates: � of Phone # to recoive a copy of tha Lienor's Notice as provided in section 713.13(1) (b), Florida Statutas. 9. Expiration date of Notica of Commoncament (the expiration data is one (1) year from.th� dato of recording uniess a different date is specified.) � i • ' � �JVARNINCi TO' OWNER: ANY PA�IVIENTS MADE BY THE OWNER AFTER THE EXPIRATION OF TFIE 1�TOTICE OF COMMENCF•MENT ARE CONSIDERED IlVIPROPER PAYM}.�IVTS UNDER CHAPTER'113, c� z v � � PART I, SECTION 713 • 13 • FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYINC� TWICE FOR �� MPROVBMENTS TO YOUR PROPERTY. A NOTICE OF COMIVILNCEN�ENT MUST BE RECORDED AND ci� z �� i- -' >- �OSTED ON THE JOB STTE BEFORE THE FIRST INSPECTION: IF YOU INTEND TO OBTAIN a� o= Q N� � �INANCINd, CONSULT WITH YOUR LENDER OR.AN ATTORNEY BEFORE COr�IIVIII�iCING WORK OR � w°� � a w �iECORDING YOUR NOTICE OF COMMENCEMENT. a p= Z -� � � . , - >-�.�.��Q O ��8� C�S�µ - �(� � � w � � � � �ignature of Owner. � Printed Name � i ✓l � z O O� � � ' : "L,�.... OQ�wO Y STATE OF FL A - � , A'�;:n,�r� � o �� COUNTYOF , ' ,. ' ;�-,�. � � C? ... 'lt � ,,, �.�� :' ;.:� q; �] � W � � lL '1'ha foregoing instrument wes.acicnowlodgod beforo me this �_ day of �'U�s_ y" •�''• 20�, Pamoflaliy know�, ;� �� Q Q W to ma or whn produced identificah'on, and who did/did not tako oatli (pYeasa circle which). '. . -:' . _� �i''��n � , 'i 1 ;�U��} n? i ,�. o`' '.; "b�4,�SPua, 'su� a �,•�;ae ,-;' ;9 ••c�.as� W�r',an � �r '�- O p � � � Notary Public: My Commission Expires: "`'� MY�.".""+� oors>e�o y �` , ,; ',lGJ �� w v�-�Q ^ � �,� _ Under alties of ' I declaro that I hsve read the foregoing Notice of Commancam�Y and t1i�t.Lho,facts• stated in itare '� � t- �~`` cn � z P� P�'J�'Y� ; �'s � " � i=� p�� I a m true to t he bos o f my k now le dga an d b e}ie f. ' y,. �� , v . �.. �. K�� (Signature of Owner igning Abova)