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PMT17-01268 City of Menifee Permit No.: PMT17-01268 29714 HAUN RD. Type: Residential Re-Roof �CCK:A_�. MENIFEE,CA 92586 sAv MENIFEE Date Issued: 0 4/2 412 01 7 PERMIT Site Address: 28446 PEBBLE BEACH DR, MENIFEE, Parcel Number: 337-193-007 CA 92586 Construction Cost: $4,130.00 Existing Use: Proposed Use: Description of RE-ROOF 1400 SO FOOT HOUSE AND GARAGE Work: CRRC 0890-0011 ANTIQUE SILVER Owner Contractor GARY&SHELLY DUMA ADVANCED ROOFING SYSTEMS INC 617 COUNTRY CLUB DR SIMI VALLEY, CA 93065 Applicant Phone:2138800778 MENIFEE, CA License Number: 1018039 Phone:8184593839 Fee Description g}y Amount f$1 Building Permit Issuance 1 27.00 Inspections not specified 98 98.00 GREEN FEE 1 1.00 General Plan Maintenance Fee-Building 1 4.90 $130.90 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications or from preventing builiding operations tieing carried on thereunder when in violation of the Building Code or of any other ordinance of City of Menifee.Except as otherwise stated,a permit for construction under which no work is commenced within six months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA Bldg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects with a licensed contractor(s)pursuantto the Contractors State License Law). I hereby affirm under penalty of perjury that I am under provisions of Chapter9(commencing with section 700D)of Division 3 of the Business and o I am exempt from licensure under the Contractor's State License Law for Professions Code and my license is in full force and effect. (�., the following reason: License Class� License No. 'd 1 D 0 By my signature below I acknowledge that,except for my personal residence Expires q_-�wk Signature in which I must have resided for at least one year prior to completion of improvements covered by this permit.I cannot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by ❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,issued by the Director of Industrial Relations as provided for this application is submitted or at the following website: by Section 3700 of the Labor Code,for the performance of work for which www.leginfo.ca.gov/calaw.html. this permit is issued. Policy k Date PROPERTY OWNER OR AUTHORIZED AGENT cave and will maintain worker's compensation insurance,as required by section 3700 of the labor Code,forthe performance of the work for which ❑By my signature below I certify to each of the following:I am the property this permit is issued.My worker's compensation insurance carrier and policy owner or authorized to act on the property owner's behalf.I have read this number are: application and the information I have provided is correct.I agree to comply 1_1„,„r,0 �S k^ *��V�. �j1J11Z all applicable city and county ordinances and state laws relating to Carrier LQ�.yC{.L"'HI,(.rxr� ���lll building construction.l authorize representatives of this city or countyto Policy tt !E I SS-00-1 tExpires enter the above identified property for inspection purposes. (This section need not to be completed is the permit is for one-hundred Date dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT certify that in the performance of the work for which this permit is issued, I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE R worker's compensation laws of California,and agree that if I should become HAZARDOUS MATERIAL DECLARATION subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall foRa compl with thos provisions. ( Will the applicant or future building occupant handle hazardous material or a Applica Date '(�?�• � mixture containing a hazardous material equal to or greater that the amounts�spfecs eI1.on the Hazardous Materials Information Guide? O WARNING:FAILURE TO SECURE W KER'S COMPENSATION COVERAGE 15 ❑Yes r" UNLAWFUL,AND SHALL SUIIECTAN EMPLOYERTO CRIMINAL PENALTIES Will the intended use ofthe building bythe applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occupant require a permit for the construction or modification from South ADDITIONTO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)7 See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,ANO ATTORNEYS FEES for guidelin C0NSTRUCr1ON LENDING AGENCY ❑Yes F1140 I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) ❑Yes ?ffo OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD 1 hereby affirm under penalty of perjury that I am exempt from the permitting checklist.I understand my requirements underthe State of California Health&Safety Code,Section 25505 and 25534 concerning Contractor's License Law forthe reason(s)indicated below by the hazardous m�a al r orting. checkmark(s)I have placed nextto the applicable items)(Section 7031.5 p -0 rO ��r"1 �� Business and Professions Code).Any city or county that requires a permit to Date 1 construct,alter,improve,demolish or repair any structure,prior to its PROPERV OWNER OR AUTFOIZED AGENT issuance,also requires the applicant forthe permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State EPA RENOVATION,REPAIRAND PAINTING IRRP) License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)orthat he or she is exempt from licensure receiving compensation for most work that disturbs paint In a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to he RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their ❑1,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit: compensation,will do( )all of or( )portion of the work,and the structure is www.eoa.gov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-BOD-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a �. nIlee ❑An EPA Lead-Safe Certified Re a P r�9 e for this project property who,through employees'or personal effort,builds or improves the )d(f19 $ 8sy property provided that the improvements are not intended or offered for Certified Firm Nam. -I sale.If,however,the building or improvement is sold within one year of irm Certification No.: AD" � completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. o EPA Lead-Safe Certified Firm is required for this project because: ❑I,as owner of the property am exclusively contracting with licensed p'Py pe P3 contractors to construct the project(Section 7D44,Business and Professions R1 ri V G Code:The Contractor's State License Law does not apply to an owner of a If your Project does not comply with EPA RAP rule please fill out the RAP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN APPLICATION • • . . d =r-„ ;Menifee DATE ' ZL I .��� PERMIT/PLAN CHECK NUMBER PMT h-bt !iu TYPE: ❑COMMERCIAL ❑✓ RESIDENTIAL ❑MULTI-FAMILY ❑MOBILEHOME ❑POOL/SPA ❑SIGN SUBTYPE: ❑ADDITION []ALTERATION []DEMOLITION []ELECTRICAL [:]MECHANICAL ❑NEW [-]PLUMBING ❑✓ RE-ROOF-NUMBER OF SQUARES 1400 DESCRIPTION OF WORK Re-roof house and garage, 1400 Sq ft PRch 3112 ovve4 15 G(7V V)1 04 G V rG D 0 l I A 1-i U C S i IV Z V- PROJECT ADDRESS 28446 Pebble Beach Dr Sun City 92586 I 1 ASSESSOR'S PARCEL NUMBER 3'��- jqb-O(7-1 LOT (-I H 2 TRACT CO PROPERTY OWNER'S NAME Gary&Shelly Duma ADDRESS 28446 Pebble Beach Or Sun City 92586 City of Manffap PHONE (714)290-3703 EMAIL Building & Safety Dept. APPLICANT NAME CA Permits/Rachel Naples APR 2 4 2017 ADDRESS 150 S Glenoaks Blvd.#9317, Burbank,CA 91502 PHONE (818)459-3839 EMAIL CONTRACTOR'S NAME Advanced Roofing Systems Inc. OWNER BUILDER? ❑YES NO BUSINESS NAME Advanced Roofing Systems Inc. ADDRESS 617 Country Club Or Simi Valley PHONE (213)550-0778 EMAIL CONTRACTOR'S STATE LIC NUMBER 1018039 LICENSE CLASSIFICATION B VALUATION $ $4,130.00 SOFT 1400 LSQFT APPLICANT'S SIGNATUR DATE -C' DEPARTMENT DISTRIBUTION +r/ CITY OFF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE I GREEN SMIP y AMOUINT I JO • PAIDAMOUNT OCASH OCHECK# OCREDITCARD VISA/MC PLAN CHECK FEES PAIDAMOUNT OCASH 0CHECK# OCREDITCARD VISA/MC OWNER BUILDER VERIFIED OYES O NO DL NUMBER NOTARIZED LETTER O YES O NO City of Menifee Building&Sajety Department 29714 HDun Rd. Menifee, CA 92586 951-672-6777 www.cityofinenffee.us Inspection Request Line 951-246-6213 N O F $, < z n _n m n in 'o f1 m y 'o m 0 n o y O A 3 m ry m Q m- O T No Om ad a v T .+ m m w a a mN0 R O C O n O r 9 D a O a m O O 6 N `T m ~ T D m D 0 3 M < S a o m M 9 m. m m Y < - Z l bm �O m c » s n o N ti m {�1 A (1 m = O a n n j m < O W 6 N O Am w a n o w ° y a .nr z °1. 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S m m a H a •+ O N M 'O-r O N m C A w M Z O O m d a m N 2 m ?MT rla, 012 tp e m n n z • o a m �E Z lO 3. T m3 3 3 'o '° » '" o' S 'o a 'm 'd T R o w D 3 3 3 " 'a 'o = W a 2 o c c o ^ N n n c c c n m m o m m m `� a m s O o 0 3 3 3 n o. m n n o. O a n A O a �n Z < O w A A .: N y O y n 9 m O UU T m D w F m m .. A N E p W A 0 O y d f1 m C W 'o :. a s _ y d y o. m N m A m t m Er �D � d _ o. p 3 c. n 10 0. `° � m � n � �. — o � 3 S' >• W � m '* Z no z A A » m W » N c T T m c y, WN H o d R 2 c d a J d a udi O y m L N n, O C M O^ C r N O m C O P S i 0 O 3 c 3 Q �; m i 'n C °. S '� A ;� o n m CO ° F in a d o m n ' n N A 7 w : R ro m a o o u m O a m e 0 c n A -'.. G. udi H •n JC s a a n d o » 61 a a w 3 m a n n y N 0 0 a y o o m o m 10.E w m °0 m N s �, y Kn ^. ar p < O O c r p A A m n K O O O D 9. °. C O j < 'm Z c c m v D 0 °' 01 °, '2 '° . m y a m � Z m m a s a £ a 0 O ^ rdi d N W � pp C d J p n (0 C p N p N m d m m p 3 m m a m o Q d T m an d ran ? O D W 0 0 M d a 3 S C O V O O n m a = ° c n w N 9 n a o c FT+ -°n W A "C m m M n A O n n 1D w d p d R d o a "_ 1 d m m d p > Im m N R N Fl O m O 6 Al S w D o n 3 mc W m w m n m 0 c m n c N O m m mm O Z n O n O N GI krT 1 V-44), voj cl rl Tw IMPORTANT:This Authorization shall be completed by the licensed qualifier and returned to the agency. This document must be notarized to be valid. Agent Authorization Form C 39 , I,Cat os ('wxttlo NJ\Arced grf na S IY)C.• (Name and License Number of Licensed Qualifier) (Company Name) do hereby authorize the following persons to act as my authorized agent(s) to represent, apply, file and submit permit applications and city business licenses in the State of California (excluding the Notice to Property Owner): �/� (1)Zara Simonyan ��/ (2)Gagik Harutyunyan (3) Rachel Naples (4)Vano Allahverdi _ (5)Vehik Allahverdi (6)Ani Azoyan I understand that each time my agent(s)submits an application or plans for electronic submittal,or signs any documents, that the individual must exhibit this authorization form to the permitting staff, upon request. I understand thatmy agent(s)shall receive copies of required documents and communications related to my projects, unless notified otherwise. �+ 1 understand that I am the licensed qualifier of records responsible for the application as submitted by myagent(s), as referenced above. This form shall only name the agents you expressly authorize to pull permits on your behalf. To make changes to this authorization,you must submit a new form. This authorization will supersede any previous authorization forms and the 41 information contained thereon. This authorization will remain in effect for-3—year from signing date. Gam' "" C6-1�' / �/1/o Licensed Qualifier Signature Date OttY of ellgate Y Dept � . „uat AP , 14101 �eCe��� CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California ) County of On /l O before me, ate Here Insert Name and Title of the Officer personally appeared Name(-of Signer(*— who proved to me on the basis of satisfactory evidence to be the person(sKwhose name(4 is/afg subscribed to the within instrument and acknowledged to me that he/she/tbeq executed the same in his/Fjsrftbefr authorized capacity(iesr and that by his/her/tbetr signature(s)on the instrument the person(s)! or the entity upon behalf of which the person(sracted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. MARK A.ESPINOZA WITNESS my hand and official seal. Notary Public.California i Ventura County i = Commissions A ' Signature'- M Comm.E fires Aug 8.B,2020 Signature qVy iFr Lc Building & Safety De;-C. APR 2 4 201 i Place Notary Seal Above OPTIONAL + �P Though this.section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document fp�jf� /1 Tittle or Type of Document:,Oi 2/ oA.(*IlaAelZ11Tl114Y Document Date: Number of Pages: j g �� Signer(s) Other Than Named Above: Capacity(ies) Clai ed by Signer s) Signer's Name: ��Qi�,Sa�hT/GCS Signer's Name: ❑Corporate Officer — Title(s): ❑Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑Limited ❑General ;Qndividual ❑Attorney in Fact ❑Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: ©2014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907