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334 Hidden Lake Dr - BR18-002769 - REROOFD CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: / / C i0? Documented Construction Value: S g--=p-S so' — Job Address: 334 Hidden Lake Dr. Sanford, FL 32773 Historic District: Yes No Parcel ID: 11-20-30-5FU-0000-1870 Residential© Commercial Type of Work: New Addition Alteration Repair Q Demo Change of Use Move Description of Work: Re -Roof of Shingles Plan Review Contact Person: Renier Fernandez Title: Phone: 321-229-8657 Fax: 407-814-8169 Email: Renier(M-castle[g.com Property Owner Information Name Troast Mark J & Deborah M Street: 334 Hidden Lake Dr Phone: Resident of property? : City, State Zip: Sanford, FL 32773 Contractor Information Name Castle Roofing Group, LLC Phone: 407-477-2823 Street: 505 Suggs Rd. Ste. 200 Fax: 407-814-8169 City, State Zip: Apopka, FL 32703 State License No.: CCC1329942 Architect/Engineer Information Name: Street: City, St, Zip: Bonding Company: Address: Phone: Fax: E-mail: Mortgage Lender: Address: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc. FBC 105.3 Shall be inscribed with the date ofapplication and the code in effect as of that date: 51° Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application 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 districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ignature of Owner/Agent ate FAme P s•, JEFFREY RANDALL WILLIS Notary Public - State of Florida Commission # FF 940998 My Comm. Expires Dec 3. 2019 Bonded through National Notary Assn, f, I - 1) ) - Signature of Contractor/Agent Datc Carlos Fernandez Print Contractor/Agent's Name e o ida Date YOLYMAR JIMENEZ Notary Public - State of Florida Commission a GG 210824 My Comm. Expires Apr 24, 2022 ed through National Notary Assn. Owner/Agent is 'Persoof y n M r Me or Contractor g n t n to Me or Produced ID Type of ID Dl. Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing Gas[] Roof Construction Type: Occupancy Use: Total Sq Ft of Bldg: Min. Occupancy Load: Flood Zone: of Stories: New Construction: Electric - # of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: Yes No # of Heads APPROVALS: ZONING: UTILITIES: ENGINEERING: FIRE: COMMENTS: Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 30, 2015 Permit Application r ON Certified Roofing Contractor CCC1329942 um, LC www.CastleRG.com IBBB.,- R O O F I N G G R O U P Estimator: 505 Suggs Rd Ste 200 — Apopka FL 32703 Date v .Office: 40T-477-2823 Fax:•407-814-8169 Direct PROPOSAL AND AUTHORIZATION TO DO WORK CUSTOMER: S Home/Cell#: — 3jq. ajj J*jo bg Email: 3 c;1`773 GENERAL ITEMS: (Unless otherwise indicated all the following items apply) Provide all necessary permitsIDuecaretakentoprotecthome exterior, shrubs and landscaping Provide dump trailer or dumpster for debris as needed Remove existing roofing material, 1 layer. (concealed layers will create an additional cost) I Renail existing roofdeck as required per current code, with 8d ring shank nails Replace any accessible damaged/deteriorated'declting and fascia as required. (Additional charges will apply, see below) Replace existing drip edge with.galvanized, 26 gage, pre -finished in select colors. Repiace.ridge vents and/or offridge vents with new - Install Self -Adhered valley lining complying with ASTM D 1970 Replace all lead stacks / boots and gooseneck ventilations (existing gas related vents to be reused) INail all roof metals, flashings and shingles with I 'A" galvanized roofing nails Provide starter shingle and ridge cap as needed. Magnetically sweep jobsite at completion, remove debris, cleanout existing gutters ofdebris jExisting gutters, soffit and fascia on existing home to remain MATERIAL SELECTIONS SHINGLE ROOF SPECIFICATIONS Layers: l Limited Lifetime Product Warranty V'Limited 10 Year Worlananship Warranty LOW SLOPE ROOF SPECIFICATIONS Man cturer/MModel: CERTAINTEED / FLINTASTIC SA Product. Color: Insulatibn: (if required): Warranties: mited 12 Year Product Warran Limited 5 Year Workmanship Warranty Edge Size: [''/:" 1 '/2" e. Color:.S10V ,1/ (Sid Colors: White,,Brown, Black, Beige, Grey) Vents and Accessories Color. Aeytd (Std Colors: White, Brown, Black) SF1*GLE ROOF PRIC I Additional Work/Comments: Price for work described above: $ Payment due in full upon completion. WOOD WORK: Inspect all wood, decking and fascia material, etc for deterioration. Replacement of any damaged wood will be an additional.charge at the following rages: Pscia bard @ S. LFT, _Decking Board Qa $ (/• per LIFT, Plywood Q S per 4'x8'sheet. Other: JW aS —J$Zg!eZM GENERAL CONDITIONS Contractor shall carry worker's compensation, automobile liability, commercial general. liability, and any other Insurance required by law. * Contractor shallshall not -be responsible for damages to electrical lines,.water lines, refrigerant lines or other mechanical components that have been Improperly installed near roof decking and may be damaged while performing the installation of roofing materials. Contractor may need to disconnect TV Antennas and/or satellite dishes that are mounted within the work area. Owner must make arrangements to have the equipment're-installed/aligned by their service provider. Loss of signal may occur during work duration. Wind.Mkigation Inspections (if included In contract) must be coordinated after project completion with a third party certified licensed inspection company. A pending wind mitigation inspection shall not be used a reason for delay in final payment. Devices, screens and/or sealants around vents, soffits and/or accessories installed for critter control purposes may need to be iemoved/disturbed in, order to properly complete the roof replacement. If applicable; replacement / re -install of these items must be completed by others•at owners expense. Contractor shall exercise care as to not cause any unnecessary wear to driveways and landscaping. Normal operations requite -access to driveway during the delivery of materials and/or removal of the work -related debris. Unless negligence is shown, contractor will not be responsible for damages to walkways, driveways and/or landscaping. 1 HAVE READ AND UNDERSTAND THIS PROPOSAL, THE TERMS AND CONDITIONS ON THE FRONT AND BACK OF C O7tA AND ALL DOCUMENTS REFERENCED THEREIN.AND AGREE TO BE BOUND BY THEIR TERMS. 6 p MsegGrouomerfiat THIS INSTRUMENT PREPARED BY: GRANT MALOY SEMINOLE COUNTYName: Yolymar Jimenez /Castle Roofing Group LLC Address: 505 Suggs Rd., Ste. 200 CLERK OF CIRCUIT COURT & COMPTROLLER Apopka,FL 32703 BK 9151 Ps 741 (1P9s) CLERK'S T 2018066923 RECORDED 06/12/2018 02s20:!1'6M. NOTICE OF COMMENCEMENT RECORDED RECORDINGBYEhdevES uve00 Permit Number. QR Parcel ID Number. 11-20-30-5FU-0000-1870 The undersigned hereby gives notice that Improvement will be made to certain real property, and In accordance w%12(d te ; FI t es. thefollowingInformationIsprovidedinthisNoticeofCommencement _, O _Q' 1. DESCRIPTION OF PROPERTY: (Legal description or the property and street address if LOT 187 / 334 HIDDEN LAKE DR SANF014n 2. GENERAL DESCRIPTION OF IMPROVEMENT: Re -Roof 3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT: Name and address: TROAST MARK J & DEBORAH M / 334 HIDDEN LAKE DR SANFORD FL 32773-5581 Interest in property: Fee Simple Title Holder rd other than owner listed above) Name: Address: 4. CONTRACTOR: Name: Castle Roofing Group, LLC Phone Number: 407477-2823 Address: 505 Suggs Rd., Ste. 200, Apopka, FL 32703 S. SURETY (If applicable, a copy of the payment bond Is attached): Name: Address: Amount of Bond: 8. LENDER: Name: Phone Number: Address: 7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as provided by Section713.13(1)(a)7., Florida Statutes. Name: Phone Number: Address: In addition, Owner designates of to receive a copy of the Llenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number: 9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFORECOMMENCINGWORKORRECORDINGYOURNOTICEOFCOMMENCEMENT. Under penaltiesof perjury, ) declare that I have read the foregoing and that the facts stated In it are true to the best of my knowledge andbelief. X(siryudre M owner or Lane. or Owners at Lessee's Aue xWOnlaeq 49CWdPertrr Manager) (Print Name and Provide Signatory'sTitldOlnre) State of _i-,62.y Q A County of O-aA/VW The foregoing Instrument was acknowledged before me this day of Jy 2 le A - - i by who has produced Identification type of Identification produced: u . JEFFREY RANDALL WILLIS Notary PubliC Ala a of Florida , ICommission # F 940998 13, My Comm. Expires Dec 3.2019 fo;,;,`X" Bonded through National Notary Assn. Who is personally known to me O OR CITY OF SANFORD FIRE DEPARTMENT PERMIT NO. /0 CONTRACTOR: JOB ADDRESS: 3 3 C. TYPE OF WORK: , Building & Fire Prevention Division Re -Roof Permit Card ISSUE DATE: A C 17 aaA,- L4 tOTECT FROM WEATHER Post this Permit and all required documents in a conspicuous place outside Digital Photographs are required - please follow re -roof policy and procedures guide All trash, debris and dumpsters must be removed from job site at final inspection Permit expires six (6) months from date of issue ROOF INSPECTION TYPE APPROVED REJECTED INSPECTOR FINAL ROOF FAILURE TO FOLLOW THE RESIDENTIAL RE -ROOF POLICY & PROCEDURES WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AND MAY REQUIRE AN AFFIDAVIT, SIGNED AND SEALED, FROM A REGISTERED FLORIDA DESIGN PROFESSIONAL WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: IN ADDITION TO THE REOUIREMENTS OF THIS PERMIT, THERE MAY BE ADDITIONAL RESTRICTIONS APPLICABLE TO THIS PROPERTY THAT MAY BE FOUND IN THE PUBLICRECORDSOFTHISCOUNTY, AND THERE MAY BE ADDITIONAL PERMITS REOUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. FBC 105.3.3 REVISED: 4-17 Inspection Line 407.792.6069 or 855.541.2122 TO SCHEDULE AN INSPECTION: Dial 407.792.6069 or 855.541.2112 Provide the items requested during the message The type of inspection requested must be scheduled under the appropriate permit type Follow the prompts PLEASE NOTE: Inspections scheduled by 5:00 p.m. will be conducted the next business day.' If you experience difficulty, please call 407.688.5150 Monday - Thursday 7:30 am - 5:30 pm for assistance. AUTOMATED INSPECTION SYSTEM CODES Final Roof Inspection Code 111 Inspection Policy & Procedures A Final Roof Inspection is the only inspection required for Residential Single Family, Townhouse, Mobile Home, Apartment and/or Condominium) Re -Roof Permits. The Following is required to be provide on the job site: Permit Card, posted in a conspicuous and weatherproof location Completed Residential Re -Roof Scope of Work Completed and Notarized Inspection Affidavit All Florida Product Approval and Corresponding Installation Instructions Product Approval shall match what is on the scope of work) Digital Photographs (must include the permit number or address in each picture) o Each plane of the roof, showing the underlayment installed o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler) o Roof Deck Nails used (including a measuring device or ruler showing size of nails) o Underlayment Pattern & Spacing (including a measuring device or ruler) o Drip Edge & Valley Attachment (including a measuring device or ruler) o Shingles installed, nail pattern and location of nails Skylights (if applicable) o Digital photographs showing all installation components, per.FL Product Approval ' o Digital photographs showing all required flashing, per FL Product Approval Failure to follow these specific guidelines will result in an affidavit provided by a Florida Design Professional (Architect or Engineer), certifying FBC code compliance by personal inspection REVISED: 04-17 Inspection Line: 407.792.6069 or 855.541.2112 City of Sanford Building Division Residential Re -Roof Inspection Policy & Procedures PERMITTING REQUIREMENTS —No PLAN REVIEW REQUIRED This document (signed) along with an accurate and completed Residential Re -Roof Scope of Work are required to be submitted as part of your permit application. The Scope of Work must include all applicable Florida Product Approval numbers for all roofcomponents that will be installed on the project. A permit will not be issued without these documents. Copies will be made to post on the job site. Projects located in the Sanford Historic District will require plan review and approval by the SanfordHistoricPreservationBoard INSPECTION POLICY & PROCEDURES A Final Roof Inspection is the only inspection required for Residential (Single Family, Townhouse, Mobile Home, Apartment and/or Condominium) Re -Roof Permits, The Following is required to be provide on the job site: Permit Card, posted in a conspicuous and weatherproof location Completed Residential Re -Roof Scope of Work Completed and Notarized Inspection Affidavit All Florida Product Approval and Corresponding Installation Instructions Product Approval shall match what is on the scope of work) Digital Photographs (must include the permit number or address in each picture) o Each plane of the roof, showing the underlayment installed o Roof Deck Nailing Pattern & Spacing (including a measuring device or ruler) o Roof Deck.Nails used (including a measuring device or ruler showing size ofnails) o Underlayment Pattern & Spacing (including a measuring device or ruler) o Drip Edge & Valley Attachment (including a measuring device or ruler) o Shingles installed, nail pattern and location ofnails Skylights(ifapplicable)_— o Digital photographs showing all installation components, per FL Product Approval — o Digital photographs showing all required flashing, per FL Product Approval Failure to follow these specific guidelines will result in an affidavit provided by a Florida Design Professional (architect or engineer), certifying FBC code compliance by personal inspection. CONTRACTOR (OR OWMBRMUILDER) SIGNATURE: DATE: b PERMIT # City of Sanford Building Division Residential Re -Roof Scope of Work JOB ADDRESS: 334 Hidden Lake Dr. Sanford, FL 32773 STRUCTURE TYPE: ® SINGLE FAMILY RFSIDENCErrOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM RE-RooF TYPE: 0 REPLACEMENT (TEAR OFF EJQSTDJG ROOF AND REPLACE Wmi NEW COMPONENTS) O RE-COVER (NEW ROOF INSTALLED OVER EXISTING ROOF) DECK TYPE (PLEASE SPECIFY): 1 /2" Plywood PLEASE NOTE: ONLY700 SQUARE FEET OF THE EX1STINGDECK rSPMWnTED TO BEREPLACED** ROOF VENTILATION: O OFF -RIDGE 9RIDGE OSOFFrr OPOWERED VENT OTURBINES SKYLIGHTS: O YES ® NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #: MAIN ROOF AREA ROOF SLOPE: O LESS THAN 2:12 O 2:12 -4:12 bS14:12 OR GREATER TYPE OF ROOF MANUFACTURER(] FLORH)APRODUCT OAPPROVAL M HGLEQ {(y • F t' UCT FL# ' 5 O METAL FL# O MODIFIEDBITUMEN FL# OTORCH DOWN FL# OINSULATED FL# OT1LE FL# OOTHER: FL# ROOF EXTENSIONS (PORCHES. PATIOS. ETC.) **IFAPPL1CA8LE** ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER TYPE OF ROOF MANUFACTURER FLORIDA PRODUCT APPROVAL O SHINGLEFL# O METAL FL# QMODIFIED' BITUMEN _-- FL# O TORCH DOWN FL# OINSULATED FL# O TILE FL# OOTHER: FL# FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING INSPECTIONS 300,N PARK AVE 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 Page 2 Application Number . . . . 18-00002769 Date 6/20/18 Property Address . . . . . 334 HIDDEN LAKE DR Parcel Number . . . . . . . 11.20.30.SFU-0000-1870 Application description . . ROOFING APPLICATION Subdivision Name . . . . . Property Zoning . . . . . . SINGLE FAMILY Permit . . . . . . RESIDENTIAL ROOFING PERMIT Additional desc . . Phone Access Code 1058957 Permit pin number 1058957 Required Inspections Phone Insp Seq Insp# Code Description Initials Date 1000 111 BL03 FINAL ROOF _/_/_ r . % City of Sanford Building and Fire Prevention RESIDENTIAL. RE -ROOF INSPECTION AFFIDAVIT NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS PERMIT#: 9-- ! R— :2 74q ADDRtSS: 334 Hidden Lake Drive Sanford, FL 32773 I Carlos Femandez . AS A(N) GENERAL. BUILDING, RESIDENTIAL, OR ROOFING CONTRACTOR, ENGINEFR, ARCHITCCT, OF F.S. CHAT" 408 BUILDING INSPr:Cm)R. 1 HERFRY AFFMI. THAT ALL OF THE FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFRCG COMPONT•T`TS LISTED ON THE SCOPE OF WORK AT THE. ABOVE REFERENCED ADDRESS HAVE BFFN INSTALLED IN ACCORDANCE WITH THEIR PROULICI' APPROVALS AND ALI, APPLICABLE COVE REQUIREMENTS— SPECIFICALLY FLARIDA BuiwmG CODr:, Exm'17Nf BUU.DING. IN ADDITION I QRTIFY THE INSTALLATION MEP. -IS AIJ. REQUIREMENTS FOR SECONDARY WATER BARRU{R AND NAILING OF 171E ROOF DECK, IN ACCORDANCI: wn H TILL•' IIURRGCANE RU ROFIT MANUAL REQUIREMENTS (BASED ON F.S. CHAPTI: R 553.844). Llcwsii a: CCC1329942 COMPANY / CONTRACTOR: Castle Roofing Group, LLC CONTRACTOR Siowm9m.: __ DA n.: MUST Rli SIGNED BY LICENSE. HOLDER ER) A FINAL. ROOF INSPECTION IS REQUIRED: THIS SIGNED A,ND Nuukizw AYF H)AVI'r MUST BE PROVIDED AT THE JOB SITE. AT THE. TIME OF THE FINAL. ROOF IN%"..LTION, ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DurAIL ALI. COMPONENTS (DECKING. L'NDERI.AY.MKNT, FLASHING, DRIP EDGE ATTACHMPAT) WITH THE. PERMIT NUMBER OR ADDRESS CLEARIM NARKED ON THE DECK FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE. A RULER OR MEASURING DEVICE TOCONFIRM ALI. NAIL SPACING AND OVERLAPS, INCLMING DRIP EDGE AND VAU.FV FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE PAPERWORK FOR FURTHER EXPLANATION OFAIJ, RRQUIRFMF.NTS. FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS. STATE. OF FLORIDA COUNTY OF Orange Sworn to and S4ribed before me tbb11 day or JULY 20 _JJL by: Fernandez . Wbo b jt Personally Known to me or bas ._: Produced (type or atat e% drn' Public or FlJuaRe Printrr tam Na e a NotaryPu as identification. of Notary Public Seats of Florida Juan Rodriguez p „ d My Commission FF 177883 Expires 11/1912018 n, fyn.. .,-. r a. }y.t I...+U•l: .:"•1'.:RP . J,.T^..1'•r ZN: .f.. ._.. Iv ,r.N.wr_ •`.CQ.A ..-e-r. , .. r..... N CITY OF SANFORD BUILDING SERVICES Residential Re -Roof Hurricane Mitigation Inspection Affidavit Permit #: 18-2769 I, Carlos Fernandez hereby acknowledge that I personally inspected 12 Roof deck nailing and/or J Secondary water barrier work at 334 Hidden Lake Drive Sanford FL 32773 and have determined that the work Job Site Address) was done according to the Hurricane Mitigation Retrofit Manual. (based on 553.844 F.S.) I certify that my statements herein are true and accurate to the best of my belief and that I fully understand that making any false statements in writing with the intent to mislead a public servant in the performance of his or her official duty shall constitute a misdemeanor of the second degree pursuant to Section 837.06 F.S. Signature of Contractor Carlos Fernandez Printed Name of Contractor 1 I Date CCC1329942 License # License Type: 0 General D Building 0 Residential X Roofing Contractor 0 or any individual certified in accordance with F.S. 468 to make such an inspection. STATt btF FLORIDA COUNTY OF Orane S rn 01 r affirmed) and subscribed before me this day of JULY , 2018 by C s "er aez ,who is 33( Personal Known to me or has D Produced (type of ident c ) as identification. SEAL) Signa= Fli tary Public State ju nKoa g e PrintX ype/ Name .,**IN Notary Public State of Florida JuanRodriguezofNotaPu ' ®• My commission FF 177883 7or, o' Expires 11/18/2018 3