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<br />04:4ZPM <br /> <br />FROM-DEMPSEY ROOFING <br /> <br />T-757 <br /> <br />P.03/03 <br /> <br />F-403 <br /> <br />w.Y:-ZZ-03 <br /> <br />1-863-687-4Z74 <br /> <br />Th~ ~nde~s~gned unaQr~~an~ ~hat ~1~ pe=~t ~y be .UDj~~t to ~d.~ :esir~ct~ona" w~ch <br />~y b. ~~e reacr1cc~~ th~ ~~~y :equ~a~~o~s. The ~nd.=e~gn~ ~~8umee tespon3~b111tY for <br />comp~L&n=a w~th ~y app~~c~1c dQe~ ~est:~c~1ons. <br />B. UN~XCENsep CONT~~ORS AMP CONT~oa ~S~NS~B%L~T~:e I <br />X~ cne owner h.~ A~~ed a aQn~:.c~cr 0: con~~~cto~~ ~o unde~tahe wQrk, th~y may be =.~1red <br />~o be 1~eeng~4 1~ .ccg~.ftn~e w~th &~ace And loc.~ ~e9~~t1Dns. ~~ ~e ~~tr~c:or 1~ net <br />1~~n~ed .. :equ~~od by ~<<W. both ~~e ownQr ana QDn~ractor ma~ ~= ~~~~ for ~ ~a~qno~ <br />vial~t~on under stat. ~~w. If ~h. aWD.~ Dr ~nc.nded eontr~ctor a~~ uac=~ft~n aa ~o Kba~ <br />~ic~na~ng :.qu1r~n~. may apply ~o~ tb~ in~~ed work, tn.~ ~~ advia.dl~o contact the <br />C~ty o~ Z~hy~~~~. 5U1~q~g p.partmcntr a~3-'8s-6611. I <br />ru~chcr.rngrer L~ tb- own.: h.~ h+re4 ~ eo~tr5c~or 0: cont~aetora, h6 ~e ~,Vi3Cd ca 3~VC ~bp <br />aQn~~ctor(o) Q~9n pa~c~o~. o~ ~e ~eOD~ractor SectL~u~- of th~e 'Pp11ea ion :or wh~eb th~~ <br />w111 pe ~e.pons1blc- X~ you, as ~h. ownor B~9n= ~= the cont~.=~o~. yo~ ~. 1naicac~nq th~t <br />yo~. ra~h.: th~n the eOQ~~AC~O~, ~:e ~espon&1ble ~o~ th. wo:~. .f ~he Q ntractc~ w~~heo <br />Ya~ ~o B~g.n as oon:~$ctor tb.t ~~ b. aft 1~~oa~ign thQ~ bo is bo~ p~op. 1y 1~c.nQ8d ~n4 ~~ <br />not WftbL~~.d ~o pe~tt~nq pr~vi~egea Ln ch~ C1ty o~ Zephyrh1ll~- <br />c. '1'~s~OR:t'~::tON ~~i>A~'r Jr'IlES ANt) U'I':tX.XTY COI\1NJ:CT%ON F'EEa I <br />I). CON8TRUC'1'U:rON LJ:E:N I.A1It' (CW\.J!'T1!:~ 7:1.3, r.t.on~ ZTATU'l'l!:l!;, AS .llIlM:NDED) I <br />~ cert1ry th~t t, ths ~ppl~cant, have ~ecn p~ov~~~ ~~ a copy o~ ~~~or+d~'O Con$truc~~Qn <br />1ien Law - QO~CDwnQ~ID ~=ot-c~1on G~~aeN p~.p~=cd by the F~o~~da pepa~tm~nt o~ ~~~icu1ture <br />~nd con~~r ~~~~:D. Xf the ~pp~icant ~g eoneonc otbc~ ~hAc ~. "awner~. % ~er~ry thnt ~ <br />hsv. Obta1ne4 a copy or the abcv~ Q.Ecr~.~ ~eumant .n4 p~~ae in 9D~1~31Ch ~o qe11V.~ <br />~t e~ ~b- ~QWn~~N p~~or to eommcnc~C. <br />E. CON'1'1UU::~QII.' S/ow.NE'R'. AFnDAVIT <br />% certi~y th~~ =1~ ~b. ~nrO~t~Qn ~n ~h~5 ap~~~e.~~o~ ~S aOOUraee and ~ ~~ n~~ _a~k w11~ <br />be ~onc ~n e~1~~o. w~~b a~1 ~pl~c~1c 1aw. ~.~lat1ng aenGtrYc~~O~, onin9r &ft. ~~nQ <br />d.."el.opment- <br />~p~~c_tian 1e hc~eby ~d. ~o Ob~a~n a ~e~c ~o do wo~k ."~ ~nsta11ati as ~ndic~tcd. ! <br />c.~cify that no work or ~nAe.1~.tion has c~nce~ pr~o~ to ~~~~nc. of ~ ~er=1t anQ tb~t <br />a11 wo:~ W~41 ~e pe~ror.med to ~.c ~~~ndards or _~l ~aW8 rQgu~Q~~n9 ~onF~ruc~iDD, C1ty <br />code*r ~on~nq re9U~.:~Ons, ~nd l.And ee~~Qpm.n~ regu1_~~on2 ~n ~bo jU~~a~ict~gn. % _1&0 <br />c~~t1f~ th~t X undar.t4Ud tn~~ the regula~~oa5 of other qov.=nment~l. aqe~~e. ~y app1y ~o <br />tho ~n~ended ~=k, and tha: ~~ 16 my r~.pon~~b~11ty to ~4en~1fy Wb~t ~ct'Qn. % ~$t ~a~a t< <br />~e 1n comp1~.ncc- S~~h a9~c~.a incl.~4o but a~e no~ 1.1~~ed to: TDGpar~ ont of <br />~"1ro~nea1 RQ~acLo~-Cypress sayheaaa, Wct~~n~ A:ca~ 'na ~n~~Qnmen~ 1~y Scn~~t~vc <br />Landa, Wa~e~/W~atQW.tc~ T~.atmen~ <br />-SQuchwe$~ ~lD~1da WQto~ M4Aa9~~ D~s~r~o~~wa~.ar C~rc36 B.yhc.Q~. <br />~~.r1ng Watergg~~e~c <br />-~y ~C~9 c~ &n~1nee~s-5eQ~1~3, Pcc~" N~v~9ab~e Wat.rwa~D <br />.De~art~~~ of Hea1LA & R~~~~t~tive S.:v~=oa, Env1~o~nta~ He~~th U '~-w.1~~, <br />WQatcwa~.: ~~.atment. s~e~c Tanke <br />*U.S- 2nv1~~nt~~ ~:c:ect~On Aaeng~-~beotoa abat~n~ , <br />I a1QQ C.~~ey that. ~e ~~11 mate~_.1 ~s ~c ~e ~OQ~ ~n F~~~ ZQ~~ ~AN g~ ~A,e~c.-, ~t ~g <br />un4.:.e~od chat ~ 4~e~na~e p1an _~Q:~as~ng a "Qompen~~ting volu..* w~41 b~ a~tt~d w~eh <br />~a p~e~arGd by . prcfcss~on.~ cngin~er re~~~~8:ed ~n the State of F~Q.~~ pr1cr ~o ~e~~~ <br />~~a~~nce. , I <br />A p.~t ~s~ued cha1~ be conzt=uod ~o be a 1~=cn~~ to procae4 w1~h :~e Wb~~ QQ~ ~O~ a5 <br />.Uthar~ty to v~~~~t~. ~ang... a~t.r, 0: ~c~ ~~1de a~y p=o~~~ona ot the ~.dbn~g~1 codca, <br />;Qat abaJ.). 1.I3Ieu.c:l.nce oo~ .. ;p=laIU.t preven~ the a~1~cu.b9 O:ff'i.c:.:i.o.1 f~Dm th.r.. ' ~e~ ~equ.ir.t.ng ~ <br />corrQ~~~gn o~ crror~ ~n ~1.~~, con.t:uc:~on, or v~ol~~~Qn~ of any ~oa.. Ev~ry pe~t <br />1ssua4 8ha1~ beo~ 1nvQ1~d ~1.s. ch~ wo~k autho:~=e4 by =u~h pe~~ ~ ~nQ.4 W~tn1n <br />~~x =on:hs o~ 1..~ance, or if vo~k $~tha~~h.a by tb6 pe~t ~= ~Uo~end O~ aD_ndoa.a ~O~ <br />p=:L~d Q~ ~~x mon:hs a~ter the t~ tho wo~k ~a Q~no~Q. ~D 90 4~y tcno:i.on o~ ~1__ <br />~y be 8~~o__d %or the pe~t w~~h ree e~arge of 815_00. ~he ~:~ene~on .h.~~ bc rcqucGtoQ <br />~n w~.t.tin9 to ~ke a~~~n9 o~~~~a~. An ap~rg~cd inGpectLan ~~t DP. ~o g04 Qur1ng e~cb =~; <br />~n~h PQ~~Od, e~ tbe p~oj.c~ w~~~ b~ eons~de~ed Qb~n4gned. <br />WARlf:UfG TO OWNER. YOUrt. E'JU:1..UEUi; TO ru:COJU) A NQT.CIi OJ' C <br />l"A'r%Il'!;; "rWJ:CE: 1t01t :tMI'ROVEMBNTS '1'0 YOUR .l?P-01"EIt1'Y. :tt' YOU <br />WZ~a: TOUR t.~DI!:J{ O~ ll.N ~'l"l'O'ANEY ~l!l!'OM St.ECOWING' ~OUR N <br />$2,500 :l:N VALUJ: DO NOT NSlitl TO RECOM ANti POST A "'NOT:!: <br /> <br /> <br />.C::J~~ <br /> <br /> <br />~anCl. AlCoOla:li, <br /> <br />-- <br /> <br /> <br />'%' ~y :;;ux:r xx ~Q'Op. <br />OBT~ ~xHANCINQ, CONSU~ <br />C~T. JOBS UNDER <br />B:,MJI;Ji"l.... <br /> <br />STA'2:'t: 0" ~,'" <br />ocu.NTY O~~I <br />Tn.. f'cregO:Lnq 1 .'l:~t WQC ~c:::know1edg~...". <br />.c~ ~ th~a da~ ot , 20~ <br />by <br />.~ ( of p.~. acboWJ..4~ed) <br />~who'~G pe~.oAa11y ~nQwn :0 mer o~ <br /> <br />o wno h;a.. J:lrDducec:l <br />(~ype o~ ~dcnt~~~=.t~an) <br />~.a wboCJ d.t.d Od:Ld not t:ilke;'Ul. OQ.t;h_ <br /> <br />a'1:ATI!: O~ <br />COUNTY at <br />'I'he> fore <br />It..:l;o;s:.- <br />b:v <br />.-./ (n__ 0= pe~aCln ~~OW~ecL9...d) <br />~ho .~ pe:DQna11y kD~l~ ~o me, c~ <br /> <br />o ~o bas produced. <br />(~YP ~~ idcnt1~1~Qt1o~ <br />~d n ~ ~ake ~n a~t~ <br /> <br />w~o.-rnQW~edZlte:~ <br />'I: ,_ <br /> <br /> <br />.ci <br />l"'~ "v ., <br />0"" ~~ ~~ <br /> <br />~W~ <br />'" ~ ~4o COMMISSION NUMBER . <br />- 'C DD1 <br />"" ~ 447~ <br />~ 0 o~ Ioly COM/.4IS$lON lOllPlRES <br />F F I. AuG. 26.2006 <br /> <br /> <br />CU'le who Ddic:l <br />