Loading...
PL-17-994Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Permit NO. PL -4-11-9 4 Permit Type: Pturting;- Resident'_ / dditionlAlteration it Status: APPROVED Parcel Number 26/2017 Expiration: 10/23/2017 Applicant 897 NE 91 Terrace Miami Shores, FL 33138 - Owner Information 1132060050300 Block: Lot: TIMOTHY JAMES MARSH JAME TIMOTHY JAMES MARSH JAMES • Address 3250 NE 1 Avenue MIAMI FL 33137- 3250 NE 1 Avenue MIAMI FL 33137- Contractor(s) Phone DREMCON CONSTRUCTION CORP (305)903-6282 UNIVERSAL PLUMBING CORP (305)887-3131 CeII Phone Phone Valuation: Total Sq Feet: Type of Work: BATHROOM AND KITCHEN REMODEL Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $1.80 $3.38 $3.38 $0.60 $225.00 $9.00 $2.40 $245.56 Pay Date Pay Type Invoice # PL -4-17-63651 04/26/2017 Credit Card Amt Paid Amt Due $ 245.56 $ 0.00 Cell 0 Available Inspections: Inspection Type: Top Out Final Review Plumbing Underground In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is ac rate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-O,a -d con - for to do the work stated. OC.� tt April 26, 2017 Authorized Signature: Owner / Applicant / ctor / Agent Building Department Copy Date April 26, 2017 1 BUILDING PERMIT APPLICATION Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 k l FBC 20 Ll Master Permit No. R C 1 7- 91 t Sub Permit No. PLA 9 9 Li ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: i3 1 V\1 8 q' -f .Q \r,,,,.. D City: Miami Shores County: Miami Dade Zip: - 8 i �, Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: a Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): T /NCYKL4 ,'kI! (,\\ Phone#: t - Address: t N 4- V C2 IA , a � f t City: N &1.O.PA t State: Zip: 3 13G Tenant/Lessee Name: Phone#: Email: CONTRACTOR:: Company Name: Address: £ 41 lib -Jai Phone#: 3/2S-- fa c5-YdY City: tate: Qualifier Name: � 1 a l�� � ' A Phone#: (ft State Certification or Registration #: I yJt2'1 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: �n Value of Work for this Permit: $ 00 Square/Linear Footage of Work: Ji))4 /i Zip: Type of Work: ❑ AdditiontI Alteration ❑ New ElRepair/Replace Description of Work: 1.�nt`A { 00 ❑ Demolition Specify color of color thru tile: Submittal Fee $5 O ` Permit Fee $ 22-3 CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 195 • 'evised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "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 YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature I% OWNER or AGENT I C' The foregoing instrument was acknowledged before me this I c� _`dayof ArA-A1 ,20 1 �— ,by TvrA0A \\.15 w.r,N\ who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Seal: APPROVED BY (Revised02/24/2014) TRACTOR The foregoing instrumen + was ac owledged before me this d • y of � , 20 n , by , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUB Sign: 1 Print: Seal: (407) 398-0153 MY COMMISSION #FF009167 EXPIRES April 17, 2017 Flo rldallotaryService.com ********* *****4********** ********kph********* ******** *** (1-17/7 Plans Examiner Structural Review Zoning Clerk RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 GARCIA, MICHEL UNIVERSAL PLUMBING, CORP 141 E 60 ST HIALEAH FL 33013 ISSUED 090112016 DISPLAY AS REOIJIRED BY LAW RICK SCOTT, GOVERNOR SEQ # L1609010002701 KEN LAWSON. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER CMC1250146 The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31. 2018 GARCIA. MICHEL UNIVERSAL PLUMBING. CORP 141 E 60 ST HIALEAH FL 33013 ISSUED 09/01/2016 D►SPLAY AS REQUIRED BY LAW SEQ # L1609010003804 Local Busi ness Tax Faecei pt Miami -Dade County, State of Florida THIS IS NOTA BILL DO NOT PAY 6808779 BUSINESS NA M E/LOCATION UNIVERSAL PLUMBING CORP 141 E 60 ST HIALEAH, FL 33013 OWNER UNIVERSAL PLUMBING CORP Worker(s) RECEIPT NO RENEWAL 7082282 SEC TYPE OF BUSINESS 196 PLUMBING CONTRACTOR 3 CFC1428421 1113.1t EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art, 9 & 10 PAYM ENT RECEIVED BY TAX COLLECTOR 45.00 09/28/2016 0224-16-006101 This Local Business Tax Receipt only con"rrrs payment of the Local Business Tax, The Receipt is not a license, permit, or a certi "cation of the holder's qual i "cations, to do business. Holder trust comply with any governmental or nongovernrrental regulatory Iaws and requi renentswhich apply to the business. The FB PT NO above trust be displayed on ail commercial vehicles - Miami -Dade Code Sec 8a-278. M IAMt For more information, visit www.miemj_d e.gov/taxceilector Notice to Owner Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: I . The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Florida County of Miami -Dade The foregoing was acknowledge before me this 20 day of •(g Iry , 20 /-7-. Owner By /• i Cv S who is personally known to me or has produced 1940/e4/1 /11/0" Ceigeas identification. Notary: SEAL: New Construction Remodeling and Repair Licensed & Insured State certified plumbing contractor Back Flow Preventer certification Medical Gas Certification PLUMBING & MECHANICAL CFC -1428421 CMC -1250146 RESIDENTIAL ® COMMERCIAL* INDUSTRIAL Tel 305-824-3131 Fax 305-824-3134 universalpms@gmail.com State of Florida. County of Miami Dade. FROM: Universal Plumbing Corp. Date: 04/18/2017 Before me this day personally appeared Sergio Izquierdo who, being duly sworn, deposes and says: That he or she will be the only person working on the project located at 897 NE 91 ST MIAMI SHORES. Sworn to (or affirmed) and subscribed before me this 2'0 day of ler 6 r(a rC . 20 0-7by fer('1 o �'�c Vier‘ Personally know Or Produced Identification Type of Identification Produced Print, Type or Stamp Name of Not BUILDING PERMIT APPLICATION BUILDING f 1 ELECTRIC PLUMBING MECHANICAL JOB ADDRESS: q T moi; 9/ City: Miami Shores Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 RECEIVED OCT 092015 FBC 20)Y Master Permit No.JLtj — A13, Sub Permit Noll lc--2"-- ROOFING 5---2"--ROOFING ;"/;❑ REVISION EXTENSION RENEWAL PUBLIC WORKS ❑ CHANGE OF CANCELLATION SHOP CONTRACTOR DRAWINGS 't'/t County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Address: Yrt>'t ' 4-130 j Phone#: )F rci rj E k 1515/ City: State: r fk Tenant/Lessee Name: Phone#: 9e In 56 c i T15/ Email: zip: 33,31 CONTRACTOR: Company Name: / o Phone#:(3,PDI/—cc ' Address: 141 / C� ► f r City: i /• ,'./. State: J�L� a12i3 Zip: 3 Qualifier Name: (4) < 'al/ VAR Phone#3/(o q S 9' V State Certification or Registration #: i,i C 1)2-gi/ 21 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ��m o Square/Linear Footage of Work: /YOd Type of Work: ❑ Addition ❑ Alteration New Description of Work: ' 4'f ri to lut k Cri, r, c [r] Repair/Replace Demolition Specify color of color thru tile: 3 t-ii5Imo) y Submittal Fee $ Permit Fee $ 2'15 '-y CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ 0- J ' (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "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 YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspectio which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not bt apprpv d and a reinspection fee will be charged. Signature Signature CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument.acowledged before me this `! -- day of (!- ,20 i'ti .4 .#whp-ispers no ally known me or who has Rroduced - as identific.tion ard who did ISI ►clhi e Q` ••; g\ON EX/S. 611 44V1, 20,i,> t. dos :>O �.0 • o= • ct; , by 12 / day of f '�T , 20 /6- , by JL'3"'/r !' &6/1/41 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: NOTARY Sign: Print: Seal: •1/4.� and (:)$' UU Sign: Print: Seal: ******************************************************************** APPROVED BY 7c) -(j /5 Plans Examiner (Revised02/24/2014) Structural Review EXPIRES April 17, 2017 Zoning Clerk i STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS Expiration date AUG 31 2016 GARCIA MICHEL UNIVERSAL PLUMBING CORP 141 E 60 ST HIALEAH FL 33013 ISSUED 08/31/2014 DISPLAY AS REQUIRED BY LAW LICENSE NUMBER SEO # L1408310003913 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS Expiration date AUG 31 2016 GARCIA, MICHEL UNIVERSAL PLUMBING, CORP 141 E 60 ST HIALEAH FL 33013 ISSUED 08/31/2014 DISPLAY AS REQUIRED BY LAW SEQ aK L14081000580: y �i i Lora, Bags4les Tax Recept v4?:„du. al Baa c'ao Vv'is `eZ �'/i Slate of Fk4 Ft,L ate%" r L — �.`� `till; t✓.i�r a' ;Flit,1 R:1 `@..ZW.724'�tii`„ ls; i v t RStF; 't:'LLIiViii;NG CORP L j..3✓1.3 l'deV ib LkS �2CAMt kill P` u5- motel taiwati on. visit evytti.iiim ii i ie.8l•.➢.lf@lsfl9ifelpF EXPIRES SEPTEMBER 30. 2016 Mies' he tti slli.iypr9 ;}' 5-;l;' , _ PUFSIAciiii i6 C;IUFI;d C;):} A.t. 9 5 i, SEC. 'TYPE OF CL9Sl.sl.CCS '95 !'LIJF�°,i�'!":.'� PAYMENT RECEtVFO ©NTie6,CTt7 t N It CC:.LEC as:i ;;CC1128479U3;2Gi2Cii3 u20226-15-0, 5662 9Fos Lot j'i oe i11 Tal fl '6FPjrt S f pave is` $ lire Local Business Tall. nip Receipt is not © license. the holder's q,_alet c ale's , ua va_i::e t:Cdct; u :cii Sy ita goeara tacaf u n Iry ceoi rape t c 5-g lava; and vugniei'tpeali iaaich apply to tiac Inisiaotz. Itoill? el T ra0. ,;,ory i<: st ite ein;iayad ala an caannercial vottaSlo5 -Miami-Dade Code SFie F.a-2BS. cal ess Tax ecelp State aaf F orlda VPARAErt li3 AT,T9iL' ui` ;ia+ r=LatGver�iiig iia'..1.11-:SAt P l!MP;F•;;_ iC7€ F i'ECEIP'r Tdo. REN EWA L EX:"HIES SEPTEMBER 30, 2016 ?se di:i t?iyed@ of place al /Visit!e ss "'lilJU.::7t ;i Courtly Art. EEC. 'TVPfc OF a'BASlS41ES;i' 196�7C1� GENERAL MECHANICAL (P AYMERTLECEIVED BY TAX CC'LLECT©r? CONTRACTOR CMCi2F0146 45 CO 33123;2015 0226-15-005802 Ta,<, a.ocdI eosiaosa 10A maw coltfiTtav> pay 1, of (flow Loca@ Business Tau. No ticceipl is aot a liceu: e. (17! tsf. ^s o i ..til; sliGtt c; fl 1 s faaider s gao@izaaatichl:: to ale business. Walder roust coati -Air with es ncntrp4:',',r a:aaital req.aatura lams and te,,8a;;si„t,eai@, ::AteP apply ly to the Gttsinos3. J nay 4oveero ea a�9 TTl3 a..@;1IPT EJ@P. i auda .rust he displayed on a@i 5-.cratpeecial vehicles -. tlia ni-9yada Cade See Ea -216. ✓:e5- MOW ia@tree3atian, visit bsyvvvApia,p_gg-gf yilaxiaiilh_zip1f JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW* CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 5/18/2015 PERSON: GARCIA FEIN: 264039076 BUSINESS NAME AND ADDRESS: UNIVERSAL PLUMBING CORP EXPIRATION DATE: MICHEL 141 E 60 ST HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: PLUMBING NOC AND DRIVERS 5/17/2017 Pursuant to Chapter 440 05(14). F S . an officer of a corporation who elects exemption from this chapter by filing a certrficate of elednn under this section may not recover benefits or compensation under this chapter Pursuant to Chapter 440 05112). F S Certificates of election to be exempt apply only within the scope of the business or trade listed on the notice of electron to be exempt Pursuant to Chapter 440 05113). F S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if. at any time after the filing of the notice or the issuance of the certificate. the person named on the notice or certificate no longer meets the requirements of this sedan tor issuance of a certificate The department shag revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING B LOW eU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: er State of F . rida County of Miami -Dade The foregoing was acknowledge before me this By�JO//eS % LAI Notary: :.../d/ l r 1 SEAL: day of (' ,20 7 Cr - o si personally known -to me or has produced as identifi cI t a •%, EWOTSOfO • MY COMMISSION # FF 922126 EXPIRES: September 27, 2019 Boded Thru Budget Notary oF� UNIVERSAL PLUMBING CORP October 7, 2015 STATE OF FLORIDA COUNTY OF MIAMI DADE BEFORE ME THIS DAY PERSONALLY APPEARED MICHEL GARCIA WHO, BEING DULY SWORN DEPOSES AND SAYS THAT HE WILL BE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: 897 NE 91 TERRACE MIAMI SHORES SWORN TOO AFFIRMED ANJD SUBSCRIBED BEFORE ME THIS 2' DAY OF O 20j PERSONALLY KNOW PRODUCED ID