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- - - Fort Pierce,Florida 34982 M Q R 1 9 18
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OWNERBUILDER AFFIDAVIT DISCLOSURE STATEMEN
ST. Lucie County, Permitting
F.S.489.103(7)EXEMPTIONS
State law requires construction to be done by licensed contractors. You have applied for a permit under an
exemption to that law. The exemption allows you,as the owner of your property,to act as your own contractor even
though you do not have a license. You must provide direct, on-site supervision of the construction yourself. You
may build or improve farm outbuildings, a one-family or two-family residence for your use and occupancy. You
may also build or improve a commercial building at a cost not exceeding $75,000.00 as long as it is for your own
use or occupancy. You may not build or improve said structures for the purposes of selling or leasing that building.
If you sell or lease a building you have built or improved within one year after construction is complete, then a
presumption is created that it was built or improved for sale or lease,which is a violation of this exemption. You
may not hire an unlicensed person to act as your contractor or to supervise people working on your building; it is
your responsibility to make sure that people employed by you have licenses required by state law and by county or
municipal licensing ordinances. You may not delegate the responsibility for supervising work to a licensed
contractor who is not licensed to perform the work being done. Your construction must comply with all appli able
laws,ordinances,building codes,and zoning regulations. Initial , �
I understand that the building official and inspectors are not there to design or give advice on how toret
the minimum code. Initial q-_
—
I understand that as an owner-builder that any contract disputes with sub-contractors and I must be handled
in a civil court with the advice of an attorney. This department will not mitigate any contract disputes.
Initial 7
I understand that if I compensate any person or company for work performed they are required to be
licensed in this jurisdiction. If for some reason they do not possess a license,I maybe responsible and liable fort the
cost of the license. Initial
I understand that if any person that is unlicensed and uninsured gets injured on my construction project-
they may be entitled to workmen's compensation. I could be held liable for all doctor, lawyer and related me4icaI
cost,which could include loss of wages during recovery from their injury. Initial 1
To qualify for this exemption under this subsection,an owner must personally appear and sign the building
permit application and initial the above.
I hereby acknowledge that I have read and understand the above disclosure statement and that I further
understand that any violation of the terms of the owner/builder exemption shall be reported by the Building and
Zo mg Department to the F orida Stat epartment of Professional Regulation. Signed and acknowledged on this
day of k of 20 —
ElrcC l
Owner/Builder Signature
STATE OF FLORIDA
COUNTY OF SIt. L
The foregoing instrument was acknowledged before me this \4. day of Vim►{ ,20
by t•`vZ d.b•.a %KN1 •ky%4r-e who is personally known to me,or who has
produced ipt as identification.
V`./9_-�C = .F °b DEANNA MARIE GIVENS
MY COMMITS�S_IO,,N��#GG 022023
Signature of Notar Type or Print Name of Notary EXPIRES: ber 16,2020
Title:Notary Public Commission Number rtq S ,` Bonded Thru Notary Public Urderwrte
SLCPDSD Revised 05/15/2014
iv -- -
P.
MAR 19118 M. IIAMIMI MIAMI-DADE COUNTY
is:i'1iitL1 ucie County, Permitting
PRODUCT CONTROL SECTION
DEPARTMENT OF PERMITTING,ENVIRONMENT,AND REGULATORY 11805 SW 26 Street,Room 208
AFFAIRS(PERA) Miami,Florida 33175-2474
BOARD AND CODE ADMINISTRATION DIVISION T(786)315-2590 F(786)31525-99
NOTICE OF ACCEPTANCE (NOA) w"ww.miamidade.goy/vera
R. M. Lucas Co.
3211 S.Wood Street
Chicago,IL 60608 FT� ,77, v
SCOPE:
This NOA is being issued under the applicable rules and regulations governing the use of construction
materials. The documentation submitted has been reviewed and accepted by Miami-Dade County PERA
- Product Control Section to be used in Miami Dade County and other areas where allowed by the
Authority Having Jurisdiction(AHJ).
This NOA shall not be valid after the expiration date stated below. The Miami-Dade County
Product Control Section (In Miami Dade County) and/or the AHJ (in areas other than Miami Dade
County) reserve the right to have this product or material tested for quality assurance purposes. If
this product or material fails to perform in the accepted manner, the manufacturer will incur the
expense of such testing and the AHJ may immediately revoke, modify, or suspend the use of such
product or material within their jurisdiction. PERA reserves the right to revoke this acceptance, if it
is determined by Miami-Dade County Product Control Section that this product or material fails to
meet the requirements of the applicable building code.
This product is approved as described herein,and has been designed to comply with the Florida Building
Code including the High Velocity Hurricane Zone of the Florida Building Code.
DESCRIPTION: : Lucas#6000,#5000,#1000,#776,#771,#779,#777,#775,#774,#764,
#758,#728,#316,#315,#734,#754
LABELING: Each unit shall bear a permanent label with the manufacturer's name or logo,city,state
and following statement: "Miami-Dade County Product Control Approved", unless otherwise noted
herein.
RENEWAL of this NOA shall be considered after a renewal application has been filed and there has
been no change in the applicable building code negatively affecting the performance of this product.
TERMINATION of this NOA will occur after the expiration date or if there has been a revision or
change in the materials, use,and/or manufacture of the product or process. Misuse of this NOA as an
endorsement of any product,for sales, advertising or any other purposes shall automatically terminate
this NOA. Failure to comply with any section of this NOA shall be cause for termination and removal of
NOA.
ADVERTISEMENT: The NOA number preceded by the words Miami-Dade County, Florida, and
followed by the expiration date may be displayed in advertising literature. If any portion of the NOA is
displayed,then it shall be done in its entirety.
INSPECTION: A copy of this entire NOA shall be provided to the user by the manufacturer or its
distributors and shall be available for inspection at the job site at the request of the Building Official.
This revises NOA No. 09-0811.15 and consists of pages 1 through 6.
The submitted documentation was reviewed by Jorge L. Acebo.
NOA No.: 11-0707.02
MAM OM E COUNTY Expiration Date: 10/07/14
• Approval Date: 10/27/11
Page 1 of 6
_?
ROOFING COMPONENT APPROVAL
Category Roofing
Sub-Category: Cement-Adhesive-Coatings
Material: Elastomeric, Asphalt
SCOPE:
This approves"Lucas #6000,#5000,#1000,#776,#771,#779,#777,#775,#774,#764,#758,
#728,#316,#315,#734, #754"as roof coatings,cements and adhesives as manufactured by R. M.
Lucas Co.,as described in this Notice of Acceptance. These product have been designed to comply
with the Florida Building Code, including the High Velocity Hurricane Zone of the Florida Building
Code.
EVIDENCE SUMITTED:
Test Agency Test Identifier Test Name/Report Date
PRI Construction Materials Technologies RMLC-012-02-02 ASTM D 6083 06/09/09
RMLC-011-02-01 ASTM D 6083 12/17/08
RMLC-013-02-01 ASTM D 4586 06/10/09
RMLC-014-02-01 ASTM D 4586 07/14/09
RMLC-004-02-01 ASTM D 6083 07/26/07
RMLC-004-02-02 ASTM D 6083 07/26/07
RMLC-021-02-01 ASTM D 2824 05/09/11
RMLC-023-02-01 ASTM D 4586 06/07/11
RMLC-022-02-01 ASTM D 41 05/09/11
RMLC-024-02-01 ASTM D 3019 05/09/11
Underwriters Laboratories Inc. 09CA14148 UL790 06/23/09
MANUFACTURING LOCATION:
1. Chicago, IL.
PHYSICAL PROPERTIES OF COMPONENTS:
Trade name: Lucas#6000
Substrates: Galvanized Metal Roofs, EPDM, PVC, Concrete, TPO, BUR, and SBS
Granule Surface.
Application Rate: Apply a Base Coat at a minimum rate of 1.25 to 1.5 gallons per 100 square
feet. Apply a Top Coat at a minimum rate of 1.25 to 1.5 gallons per 100
square feet.
Specifications: ASTM D 6083
Description: A solvent based elastomeric coating membrane applied to Galvanized Metal
Roofs, EPDM, PVC,Concrete, TPO, BUR,and SBS Granule Surface.
Container Size: 5, 55 gallons. Note all cautions on container label.
Systems Approvals: Methods of application and quantities shall comply with the specific Roof
Assembly System's Product Control Notice of Acceptance where it exceeds
standards of this NOA.
NOA No.: 11-0707.02
MIAMFDADECO1 Expiration Date: 10/07/14
. • p Approval Date: 10/27/11
Page 2 of 6
Trade name: Lucas#5000
Substrates: Galvanized Metal Roofs and USG Securock.
Application Rate: Apply a Base Coat at a minimum rate of 1 to 1.5 gallons per 100 square feet.
Apply a Top Coat at a minimum rate of 1 to 1.5 gallons per 100 square feet.
Specifications: ASTM D 6083
Description: A solvent based elastomeric coating membrane applied to Galvanized Metal
Roofs and USG Securock.
Container Size: 1, 5, 55 gallons. Note all cautions on container label.
Systems Approvals: Methods of application and quantities shall comply with the specific Roof
Assembly System's Product Control Notice of Acceptance where it exceeds
standards of this NOA.
Trade name: Lucas#1000
Substrates: Galvanized Metal Roofs, PVC,Concrete.
Application Rate: Apply a Coat at a minimum rate of 1.25 gallons per 100 square feet.
Specifications: ASTM D 6083
Description: An elastomeric top coating membrane applied to Galvanized Metal Roofs,
PVC, Concrete.
Container Size: 5, 55,250 gallons. Note all cautions on container label.
Systems Approvals: Methods of application and quantities shall comply with the specific Roof
Assembly System's Product Control Notice of Acceptance where it exceeds
standards of this NOA.
Trade name: Lucas#776 Elite Flashing Cement
Application Rate: This material is applied by trowel at a minimum rate of —'/4"thick. For
systems approvals,refer to specific Roof Assembly, Product Control Notice
of Acceptance.
Specifications: ASTM D 4586
Description: Flashing cement that is used on wet/dry roof surfaces.
Container Size: 3 gallon pails and 10 oz.tubes. Note all cautions on container label.
Trade name: Lucas#779 Asphalt Mastic Roof Cement
Application Rate: This material is applied by trowel at a minimum rate of/8"-'/a"thick. For
systems approvals,refer to specific Roof Assembly, Product Control Notice
of Acceptance.
Specifications: ASTM D 4586
Description: Flashing cement that is used on wet/dry or underwater roof surfaces and
flashings.
Container Size: 1, 3.5, 5, 55 gallon pails and 10 oz.tubes. Note all cautions on container
label.
NOA No.: 11-0707.02
MIAW ADEC2= Expiration Date: 10/07/14
• Approval Date: 10/27/11
Page 3 of 6
Trade name: Lucas#771 Asphalt Mastic Roof Cement
Application Rate: This material is applied by trowel at a minimum rate of/8"-'/4 thick. For
systems approvals,refer to specific Roof Assembly,Product Control Notice
of Acceptance.
Specifications: ASTM D 4586
Description: Flashing cement that is used on wet/dry or underwater roof surfaces and
flashings.
Container Size: 1, 3.5, 5,55 gallon pails. Note all cautions on container label.
Trade name: Lucas#774 Asphalt Flashing Cement
Application Rate: This material is applied by trowel at a minimum rate of/s"-'/4"thick. For
systems approvals, refer to specific Roof Assembly,Product Control Notice
of Acceptance.
Specifications: ASTM D 4586
Description: Flashing cement that is used on wet/dry or underwater roof surfaces and
flashings.
Container Size: 1,3, 5, 55 gallon pails. Note all cautions on container label.
Trade name: Lucas#775 All-Weather Roof Cement
Application Rate: This material is applied by trowel at a minimum rate of/s"-'/4"thick. For
systems approvals,refer to specific Roof Assembly, Product Control Notice
of Acceptance.
Specifications: ASTM D 4586
Description: Flashing cement that is used on wet/dry or underwater roof surfaces and
flashings.
Container Size: 1,3,5, 55 gallon pails. Note all cautions on container label.
Trade name: Lucas#764 Mod-Bit Cement
Application Rate: This material is applied by trowel at a minimum rate of/s"-'/4"thick. For
systems approvals, refer to specific Roof Assembly, Product Control Notice
of Acceptance.
Specifications: ASTM D 4586
Description: Flashing cement that is used on wet/dry or underwater roof surfaces and
flashings.
Container Size: 1,3, 5, 55 gallon pails. Note all cautions on container label.
Trade name: Lucas#777 Flashing Cement
Application Rate: This material is applied by trowel at a minimum rate of 1/8"-'/4"thick. For
systems approvals,refer to specific Roof Assembly,Product Control Notice
of Acceptance.
Specifications: ASTM D 4586
Description: Flashing cement that is used on wet/dry or underwater roof surfaces and
flashings.
Container Size: 3, 5 gallon pails. Note all cautions on container label.
NOA No.: 11-0707.02
MIAMFDADECOUNTY Expiration Date: 10/07/14
• Approval Date: 10/27/11
Page 4 of 6
Trade name: Lucas#734 Mod-Bit Adhesive
Application Rate: This material is applied by brush at a minimum rate of 1.5 gallons per 100
square feet.. For systems approvals, refer to specific Roof Assembly, Product
Control Notice of Acceptance.
Specifications: ASTM D 3019
Description: Adhesive used to adhere modified bitumen rolled roofing, asphalt felts and
cap sheets.
Container Size: 5, 55 gallon pails. Note all cautions on container label.
Trade name: Lucas#754 Asphalt Lap Cement
Application Rate: This material is applied by brush at a minimum rate of 2 gallon per 100
square feet.. For systems approvals, refer to specific Roof Assembly, Product
Control Notice of Acceptance.
Specifications: ASTM D 3019
Description: Adhesive used to adhere modified bitumen rolled roofing, asphalt felts and
cap sheets.
Container Size: 5, 55 gallon pails. Note all cautions on container label.
Trade name: Lucas#315 Asphalt Primer
Application Rate: This material is applied by brush at a minimum rate of 1/2 gallon per 100
square feet.. For systems approvals, refer to specific Roof Assembly, Product
Control Notice of Acceptance.
Specifications: ASTM D 41
Description: Asphalt Primer used to prepare concrete,asphalt and wood surfaces for
application of asphalt roofing products
Container Size: 5, 55 gallon pails. Note all cautions on container label.
Trade name: Lucas#316 Asphalt Primer
Application Rate: This material is applied by brush at a minimum rate of 1/2 gallon per 100
square feet.. For systems approvals,refer to specific Roof Assembly,Product
Control Notice of Acceptance.
Specifications: ASTM D 41
Description: Asphalt Primer used to prepare concrete,asphalt and wood surfaces for
application of asphalt roofing products
Container Size: 5, 55 gallon pails. Note all cautions on container label.
Trade name: Lucas#728 Fibered Aluminum Coating
Application Rate: This material is applied by brush or roller at a minimum rate of 1 gallon per
100 square feet.. For systems approvals,refer to specific Roof Assembly,
Product Control Notice of Acceptance.
Specifications: ASTM D 2824
Description: Aluminum Roof Coating intended for application to asphalt,modified
bitumen and metal roofs as a protective coating.
Container Size: 5, 55 gallon pails. Note all cautions on container label.
NOA No.: 11-0707.02
CMAMMARMUNW Expiration Date: 10/07/14
"'• Approval Date: 10/27/11
Page 5 of 6
Trade name: Lucas#758 Aluminum Roof Coating Fibrated
Application Rate: This material is applied by brush or roller at a minimum rate of 1 gallon per
100 square feet.. For systems approvals,refer to specific Roof Assembly,
Product Control Notice of Acceptance.
Specifications: ASTM D 2824
Description: Aluminum Roof Coating intended for application to asphalt,modified
bitumen and metal roofs as a protective coating.
Container Size: 5, 55 gallon pails. Note all cautions on container label.
LIMITATIONS:
1. Fire classification is not part of this acceptance; refer to a current Approved Roofing Materials
Directory for fire rating of this product.
2. Lucas#6000,#5000,#1000,#776,#771,#779,#777,#775,#774,#764,#758,#728,#316,#315,
#734,#754 shall not be applied in inclement weather conditions.
3. The products listed herein are components of roof assemblies and are approved for use with roof
assemblies that list the products listed herein as part of their roof assemblies Notice of Acceptance.
4. All products listed herein shall have an unannounced follow-up quality control program from an
approved listing agency. Follow up test results shall be made available to Miami-Dade County
Product Control upon request.
5. Change in materials, use,or manufacture of any products listed herein shall be cause for termination
of this Notice of Acceptance.
6. Lucas#6000,#5000,#1000,#776,#771,#779, #777, #775,#774,4764,#758,#728,#316,#315,
#734,#754 shall be applied in accordance with manufacturer's published application instructions.
7. All products listed herein shall have a quality assurance audit in accordance with the Florida
Building Code and Rule 9B-72 of the Florida Administrative Code.
8. All approved products listed herein shall be labeled in compliance with TAS 121 and shall bear the
imprint or identifiable marking of the manufacturer's name or logo and following statement:
"Miami-Dade County Product Control Approved" or the Miami-Dade County Product Control Seal
as shown below.
MIAMNAADE COUNTY
�Fj...• �
BUILDING PERMIT REQUIREMENTS:
Application for building permit shall be accompanied by copies of the following:
1. This Notice of Acceptance
2. Any other documents required by the building official or the Applicable Building Code in order to
properly evaluate the installation of this system.
END OF THIS ACCEPTANCE
NOA No.: 11-0707,02
MIAWDADECOUNTY Expiration Date: 10/07/14
�ffjzdatrnu Approval Date: 10/27/11
Page 6 of 6