CC-18-3676CC 18- 366
f
J
y\
Certificate of Completion
Miami Shores Village
10050 N.E. 2nd Ave, Miami Shores, Florida 33138
Tel: 305-795-2204 Fax: 305-756-8972
Building Inspection Department
This certificate issued pursuant to the requirements of the Florida Building Code 106.1.2 certifying that at the time of issuance this
structure was in compliance with the various ordinances of the jurisdiction regulating building construction or use. For the following:
Description: ADD LOW PARTITION WALL AS SHOWN ON THE DRAWINGS.
BUSINESS NAME: BEST CHOICE PUBLIC ADJUSTERS
UNIT: 9703
Permit Type Building (Commercial) Bldg. Permit No.
Owner COCHRAN MIAMI SHORES LLC Go Fitzgerald Property Mgmt Contractor
Subdivision/Project
Construction Type V -B
Square Footage
Location
9705 NE 2ND AVE 9703
Miami Shores, FL 33138
CC -12-18-3676
RANDOLPH ROBINSON CEO INC
Date Issued 08/08/2019
Occupancy B Office, 12 Occupants
Type
1,258.00 Flood Zone X
If the building is located in a special flood hazard area documentation of the as -built lowest floor
elevation or lowest horizontal structural member has been provided and is retained in the records of
Miami Shores Village.
This certificate issued pursuant to the requirements of the Florida Building Code certifying that at the
time of issuance this structure was in compliance with the various ordinances of the jurisdiction
regulating building construction or use.
C
Building Officials Approval
Not Transferable
Ismael Naranjo, CBO
oRes
ZKQtt
fin..
i
ORig4`
N?Iiami Shores Village
Building Department
10050 NE 2 Ave
Miami Shores FL 33138
Pgnj* NC
Issue Date: 6/14/2019 Expires: 12117/2019
INSPECTION REQUESTS: (305)762-4949 or log on at https://bidg.msvfl.gov/energov—prod/selfservice
Requests must be received by 3:30pm
WORK IS ALLOWED: MONDAY THROUGH FRIDAY, 8:OOAM - 7:OOPM
SATURDAY 8:OOAM - 6:OOPM.
NO WORK IS ALLOWED ON SUNDAY OR HOLIDAYS
BUILDINGAND ROOFING INSPECTIONSARE DONE MONDAYTHROUGH FRIDAY.
NO INSPECTION WILL BE MADE UNLESS THE PERMIT CARD IS DISPLAYED AND HAS BEEN APPROVED . PLANS ARE
READILY AVAILABLE. IT IS THE PERMIT APPLICANTS RESPdNSIBILITY TO ENSURE THAT WORK IS ACCESSIBLE AND
EXPOSED FOR INSPECTION PURPOSES. NEITHER THE BUILDING OFFICIAL NOR THE CITY SHALL BE LIABLE FOR
EXPENSE ENTAILED IN THE REMOVAL OR REPLACEMENT OF ANY MATERIAL REQUIRED TO ALLOW INSPECTION
POST ON SITE
1132060134230
Owner's Name: COCHRAN MIAMI SHORES LLC c/o Fitzgerald Property Mc Owner's Phone: (954)760-4360
Job Address: 9705 NE 2ND AVE Total Square Feet: 200
Miami Shores, FL 33138
dotal Job Valuation: $ 1,500.00
Contractor(s) Phone Address
RANDOLPH ROBINSON CEO INC (561)578-3040 3702 TERRAPIN LN APT 1715, CORAL SPRINGS, FL 330E
Description: ADD LOW PARTITION WALLAS SHOWN ON THE'DRAWINGS .
BUSINESS NAME: BEST CHOICE PUBLIC ADJUSTERS
74
Pati. a--$- -r 1 Y,— P, &j--
iL 27f J
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 COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
Page 1 of 1
INSPECTION RECORD
STRUCTURAL
INSPECTION DATE INSP
Foundation
Stemwall
Slab
Columns (1st Lift)
Columns (2nd Lift)
Tie Beam
Truss/Rafters
Roof Sheathing .
Bucks
Interior Framing
Insulation
Ceiling Grid
Drywall
Firewall
Wire Lath
Pool Steel
Pool Deck
Final Pool
Final Fence
Screen Enclosure
Driveway
Driveway Base
Tin Cap
In -Progress
Roof Installation
Roofing Final
Shutters Attachment
Final Shutters
Rails and Guardrails
ADA compliance
DOCUMENT
Soil Bearing Cert
Soil Treatment Cert
Floor Elevation Survey
Reinf Unit Mas Cert
Insulation Certificate
Spot Survey
Final Survey
Truss Certification
STRUCTURAL COMMENTS
WINDOWS:....
INSPECTION DATE INSP
Attachment
PUBLICWORKS
INSPECTION DATE INSP
Excavation
ELECTRICAL
INSPECTION DATE INSP
Temporary Pole
30 Day Temporary
Pool Bonding
Pool Deck Bonding
Pool Wet Niche
Underground
Footer Ground
Slab
Wall Rough
Ceiling Rough
Rough
Telephone Rough
Telephone Final
TV Rough
TV Final
Cable Rough
Cable final
Intercom Rough
Intercom Final
Alarm Rough
Alarm Final
Fire Alarm Rough
Fire Alarm Final
Service Work With,
191
ELECTRICAL COM ENTS ,.
i
INSPECTION DATE INSP
Rough
Water Service _
2nd Rough
Top Out
Fire Sprinklers
Septic Tank
Sewer Hook-up
Roof Drains
Gas
LP Tank
Well
Lawn Sprinklers
Main Drain
Pool Piping
Backflow Preventor
Interceptor
Catch Basins
Condensate Drains
HRS Final
PLUMBING COMMENTS
INSPECTION DATE INSP
Underground Pipe
Rough
Ventilation Rough
food Rough:
Pressure Test
Final Hood
Final Ventilation
Final Pool Heater
Final Vacuum
MECHANICAL' COMMENTS ,
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Permit No.: CC -12-18-3676
Permit Type: Building (Commercial)
Work Classification: Alteration
Permit Status: Approved
Issue Date: t6/14/2019 Expiration: 12/17/2019
Location Address Parcel Number
9705 NE 2ND AVE, Miami Shores, FL 33138 1132060134230
Contacts
Re
Description: ADD LOW PARTITION WALL AS SHOWN ON THE Valuation: $ 1,500.00
nests: Ins pectionsett nRe
DRAWINGS.
49
BUSINESS NAME: BEST CHOICE PUBLIC ADJUSTERS Total Sq Feet: 200.00
Fees
COCHRAN MIAMI SHORES LLC c/o Owner
Fitzgerald Property Mgmt
1800 ELLER DR 212, FT. LAUDERDALE, FL 33316
Other: 9547604360
RANDOLPH ROBINSON CEO INC Contractor
RANDOLPH ROBINSON
3702 TERRAPIN LN APT 1715, CORAL SPRINGS, FL 33067
Business: 5615783046
1.20
Commercial Application Fee 50.00
DBPR Fee
Re
Description: ADD LOW PARTITION WALL AS SHOWN ON THE Valuation: $ 1,500.00
nests: Ins pectionsett nRe
DRAWINGS.
49
BUSINESS NAME: BEST CHOICE PUBLIC ADJUSTERS Total Sq Feet: 200.00
Fees Amount
CCF 1.20
Commercial Application Fee 50.00
DBPR Fee 2.00
DCA Fee 2.00
Education Surcharge 0.40
Permit Fee 50.00
Planning and Zoning Review Fee 50.00
Scanning Fee 9.00
Structural Review ($90) 90.00
Technology Fee 2.50
Work Without Permit 1st Offense 100.00
Work Without Permit 1st Offense 100.00
Total: 457.10
Payments Date Paid Amt Paid
Total Fees 457.10
Cash 12/12/2018 $50.00
Check # 115 06/20/2019 $407.10
Amount Due: 0.00
Building Department Copy
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores
Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate
permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Futhermore, I authorize the above named contractor to do the work stated,
Authorized Signature: Owner / Applicant / Contractor / /Ant Date
June 20, 2019 Page 2 of 2
i msV
o C?
Miami
ON,
BUILDING
Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
C 13 2018
Tel: (305) 795-2204 Fax: (305) 756-8972 —1 '
INSPECTION LINE PHONE NUMBER: (305) 762-4949 1r,
FBC 20 (_:'
Master Permit No. on_ (9 ` 30__:)
PERMIT APPLICATION Sub Permit No.
OBUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING MECHANICAL E] PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR / `
r
DRAWINGS
JOB ADDRESS: `i ?0 3 NE Z nd V 9 M M N I y NE 2- 'I'\ V 0
City: Miami Shores County: Miami Dade Zip: "3,513
Folio/Parcel#: I - 5Zub - o 13 - Lf 23-0 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Coons/truucttion Type: /
A i
jFll0000dd.
Z one:` B FEE:
J 'j J
FFE: !
OWNER: Name (FeeeSimple
TiTittlleeholder):
CQCf KNi j "r'I,y
q
S r S. t i C,Phone#:—1 5 1 " t W4 - q3W
Address: 6 ` ( 1y'TzCs (.D 06rrAr*5 2-14. 2.
City: T Mu> _) L State: F1 _ „ ip:
Tenant/Lessee Name: nj. 1 A/I aiPhoned:
Email: M
CONTRACTOR: Company Name: rbc 1°HgirtSpl! Phone#: %1!5'z2 zn
Address: 374z T$i49Z Iouq LkA7/S
City: GaAAL XAIAI&,5 State: r'G, Zip: 1306?
Qualifier Name: AAQneL•Pfl Pe:)I&i=! Phone#:
State Certification or Registration #: G f3G I? l Z j ? _ Certificate of Competency #:
DESIGNER: Architect/Engineer:
I
f'
Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $_ 1,500 Square/Linear Footage of work: 'WO S. F.
Type of Work: Addition EE' -Alteration New Repair/Replace Demolition
Specify color of color thru tile:
Submittal Fee $ C—D 60
Permit Fee $
Scanning Fee $ 'YRadon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $.
Revised02/24/2014)
cr3i
CCF $
4a;1!<& ii ,,i3.00 CC $ > i >• =i. .
DBPR $
Double Fee $ 10Q 'r
Bond $
TOTAL FEE NOW DUE $ 9 1 • ( Q
V. 4..y...... .-^f r••y^ I
1 11,
Bonding Company's Name (if applicable)
Bonding Company's Address
City State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
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 O'er Signature
OWNER or AG CONTRACTOR
The foregoing instr ent was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 i9' by day ofm 20 1S by
B&.0 c14'd who is personally known to n(1 c O,Dirl -RDiott15of1, who is personally known to
me or who has produced as me or who has produced V ti _- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: 4, L P Sign:_
Print: j -&i in, L` I r l Print:
Zip
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 O'er Signature
OWNER or AG CONTRACTOR
The foregoing instr ent was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 20 i9' by day ofm 20 1S by
B&.0 c14'd who is personally known to n(1 c O,Dirl -RDiott15of1, who is personally known to
me or who has produced as me or who has produced V ti _- as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: 4, L P Sign:_
Print: j -&i in, L` I r l Print:
CARLA RIVERA
Notary Public - State of Florida
GeFRFRI99le FF 907456
Seal: Seal:-.;.Fzy;., My Comm. Expires Aug 6, 2019
Bonded through National Notary Assn.
REBNIA L. MALLI
Notuy FVW - $wo of ibrNe
t ef *Ff U 4
sh, ,fir My Comm. xpres Wt.
Banded ttwo* Ndidd NoWy Asan.
APPR Plans Examiner Zoning
Structural Review Clerk
Revised02/24/2014)
Property Search Application - Miami -Dade County Page 1 of 1
OFFICE APPARAISER
Summary Report
Property Information
Folio: 11-3206-013-4230
Property Address:
9705 NE 2 AVE
Miami Shores, FL 33138-2310
Owner COCHRAN MIAMI SHORES LLC
Mailing Address
1800 ELLER DR STE 212
FT LAUDERDALE, FL 33316
PA Primary Zone 6400 COMMERCIAL - CENTRAL
Primary Land Use
1209 MIXED USE -
STORE/RESIDENTIAL : MIXED USE
RESIDENTIAL
Beds / Baths / Half 0/0/0
Floors 1
Living Units 0
Actual Area Sq.Ft
Living Area Sq.Ft
Adjusted Area 15,885 Sq.Ft
Lot Size 13,000 Sq.Ft
Year Built 1926
Assessment Information
Year 2018 20171 2016
Land Value 338,000 338,000 338,000
Building Value 596,368 596,368! 567,970
XF Value 10,663 10,789 10,915
Market Value 945,031 945,157 916,885
Assessed Value 945,031 915,018< 831,835
Benefits Information
Benefit Type 2018 2017 2016
Non -Homestead Cap Assessment Reduction 30,139 85,050
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
1 5341 6 53 42
MIAMI SHORES SEC 1 AMD PB 10-70
LOTS 13 & 14 BLK 31
LOT SIZE 100.000 X 130
OR 17224-2398 1295 5
Generated On : 12/12/2018
Taxable Value Information
20181 2016
County
Exemption Value $0 0 0
Taxable Value $945,031 915,018 831,835
School Board
Exemption Value ! $0 0 0
Taxable Value $945,031 945,157 916,885
City
Exemption Value $0 0 0
Taxable Value$945,031 $915,018 $831,835
T..- ... ---- ............................. .W._.... ....... _..................._... ................ _.__........ .....---..._........ _........... _.... _®_ _
Regional
Exemption Value I $0 0 0
Taxable Value $945,031 915,018 831,835
Sales Information
Previous OR Book -
Price Description
Sale
26354- Sales which are disqualified as a result of
03/01/2008 0
0686 examination of the deed
00000- Sales which are disqualified as a result of
12/01/1995 0
00000 examination of the deed
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
https://www.miamidade.gov/propertysearch/ 12/12/2018
Detail by Entity Name
ori6a Deoart'n:ent of State
f
Ge artirrer;t of State / Division- of Coroo ations / Search Records / Detaii By oc{ime t Number /
Detail by Entity Name
Florida Limited Liability Company
COCHRAN MIAMI SHORES, LLC
Filing Information
Document Number L08000034368
FEI/EIN Number NONE
Date Filed 04/03/2008
Effective Date 04/03/2008
State FL
Status ACTIVE
Last Event LC AMENDMENT
Event Date Filed 02/14/2018
Event Effective Date NONE
Principal Address
1800 ELLER DRIVE, SUITE 212
FT. LAUDERDALE, FL 33316
Changed: 01/24/2014
Mailing Address
1800 ELLER DRIVE, SUITE 212
FT. LAUDERDALE, FL 33316
Changed: 01/24/2014
Registered Agent Name & Address
FITZGERALD PROPERTY MANAGEMENT
1800 ELLER DRIVE, SUITE 212
FT. LAUDERDALE, FL 33316
Name Changed: 02/16/2011
Address Changed: 01/24/2014
Authorized Person(s) Detail
Name & Address
Title MGMR
COCHRAN, JOHN C
135 BELLAIRE STREET
DENVER, CO 80220
Page 1 of 2
DI".,,io.: .. ",..r. _...,.. rns
http://search.sunbiz.org/Inquiry/CorporationSearchISearchResultDetail?inquirytype=Entit... 12/12/2018
Detail by Entity Name
Title MGRM
COCHRAN, SHELIA S, TRUSTEE
8205 KERRY ROAD
CHEVY CHASE, MD 20815
Annual Reports
Report Year Filed Date
2016 02/09/2016
2017 02/22/2017
2018 01/17/2018
Document Images
OLS 14 2Q18_L_C Arpendmeni.
01,•'112018 .ANNUAL REPORT
02!^_2,;2017 -- ANNUAL REPOR I
Ct2iM2015 -- ANNUAL REPORT
0':24!2014 -- REINS:FATEMENT
03,•'21;2012 -ANNUAL REPORT
0'1;10%2011 -- ANNUAL- REPOR I
04'( .........i`_f_N..l..r3E,_[ FF>RT
0_'!19!2009 -- ANNUAL REPORT
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Detail by Entity Name
Fiorlda Dep ail R --v nt of State'.
Department of State / Division of Crirp_2anon^. / Search Records / Detail By Document Number /
Detail by Entity Name
Florida Profit Corporation
FITZGERALD PROPERTY MANAGEMENT INC.
Filinq Information
Document Number P98000104349
FEI/EIN Number 65-0910418
Date Filed 12/14/1998
State FL
Status ACTIVE
Principal Address
1800 ELLER DRIVE
SUITE 212
FT. LAUDERDALE, FL 33316
Changed: 11/05/2013
Mailing Address
1800 ELLER DRIVE
SUITE 212
FT. LAUDERDALE, FL 33316
Changed: 11/05/2013
Reqistered Agent Name & Address
FITZGERALD, BRADFORD W
1800 ELLER DRIVE
SUITE 212
FT. LAUDERDALE, FL 33316
Address Changed: 04/03/2014
Officer/Director Detail
Name & Address
Title P
FITZGERALD, BRADFORD W
1800 ELLER DRIVE
SUITE 212
FT. LAUDERDALE, FL 33316
Annual Reports
Page 1 of 2
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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:
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;
The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
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. A 14
Signature
State of Fl
County of Miami -Dade
The foregoing was acknowledge before me this day of K2j. , 20.
By Y - Cc t A—o is personally known to me or as produced
as identification.
I
Notary: G,q
SEAL:
REGINA L. MASCIARELLI
Commission N FF 928544
My Comm. Expires Feb 10, 2020
Bonded through National Notary Asan,
Randolph Robinson C.E.O.,INC.
3702 Terrapin in # 1715
Coral Springs, Florida 33067
Phones: (561) 578-3046
F.-mail: rrobin35641daol.com
Residential & Commercial Contractor's
License # CBC1251292 & PX2381
Date:: i 21Z -7 //,S
State of : Ftiox 114
County: M 1 &m t - 040f -
Before me this day personally appeared R/[l.02zv0A ge)vIkAgow who being duly sworn,
deposes and says:
That he or she will be the only person workingon the projectlocated at:
eCA")
I-es, Fz 7 3/ -37
nt actor Aignature
Sworn to for (or affirmed) and subscribed before me this day of 20 18
by
1—N,-: SINMA ALVAREZ
MY COMMISSION # GG 238273
EXPIRES: September 3, 2022
Bondad ThiU WWW Na Urift iters
Personally know
r/
OR Produced Identification
Type of Identification Produced 'i C- t)Q,( U&2_ .t 1 ,t
Print, Type of Stamp Name of Notary