HomeMy WebLinkAboutHVRC19-0259APN/Tract/Lot No: Owner: Contractor: Applicant:
622066005 JUSTIN R LNERSIDGE HARRISON ENTERPRISES INC HARRISON ENTERPRISES WC
WT IN COMMON TR 299 AVENIDA DEL SOL 31170 RESERVE DRIVE 31170 RESERVE DRIVE
11454 MB 97I82 & PM PALM DESERT, CA 92260 THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276
74143 (760)343-7488 (760)343-7488
5
Licensed Contrac[orDeclaration Fee Summary
I�ereDyaftirmuntleroenalNofoeriurvihatlamlicenseounaerprotisionso(Chapler9 qRCNIVEFEE-flSXiil1PT011X1] GLdW00003411600 SOA2
��� and myefcense ishin fulll(or e�aotl etfeclsion 3 of iM1e Bvsiness antl Pm�essions Code, GREEN BL�G FEE 3 GL-fi10000�-228�400 $1.00
Initial RESIDENTIALHVA� ANG UT GL-11000003221100 51590�
Owner-Builtler Declaretion Total Fees P tl: 916042
�I hereby afiirm untler oenalN of oenury ihat I am exempt from the Contac�ors' Sta�e � eby fi itler fh panel oiperjury fhaf fhere is a conslmclion lentling agenry ior fhe
License Law for IM1e reason(sJ Intlicatetl below by the checkmaM(s) I ha�e placetl neA P manc Me orklor which fhis permd is issuetl(Sec 309I, Civil Code)
�o �he applicable item(s) Section ]03L5 Business antl Pmfessions Cotle�. Any city or � tl rs N� antl tltlress
coun�y w�ich reqvires a pemtll to consUuct, alter, Impmve, demolish, ar repair any
sVucWre.pnortolssuance,alsorequiresmeapplicantrormepermittoale Iqne AsbestosDeclaration
statemen� roa� he or she Is Ilcensetl pursuant to �he pmvisions of �he Con(r c� ' S te
License Law(Chap�er 9(commencing with Section ]000) o( DiNsion 3 of Ih Bu -ne Wnl� asbes�os noti(icalion pursuant to Patl 61 olTitle 40 o(�he Code of Federal Regulalions is requireE
ana Professians Cotle) or ihat M1e or she Is exempl np lM1e basis for e al e when asbeslos ersts in Guildings, or portions Ihereof, undergoing demolition. I hereby declare ihat
exemp�ion Any Holation of Sectlon ]03t5 by an epplmant for e pa i su �s �he tlemolltion aWhonzetl by this permlt Is from constmction that tloes o�_ tloes nol conteln
epplicenl lo e citil penelty of not more Ihan Ava unared dollers (350 ).J asbestos, or Ihet _ no demolilion Is euthonzad by this permi�.
� I, as owner of tlte pmpetly, or my employees Hh w qes as 1 ompen tiory NOTICE�. Vou may pmtesl any of tM1e fees tor Ihis permil in accortlance wilM1 CA Gov Cotle Sec. fifi�20
will tlo the work, antl the stmcWre Is no� Inte etl o Rere or sal (Sec. ]04q (a). The pro�est must satisly ihe feqwrements of Go¢ Cotle Sec 6fio20�aJ antl must be fletl wi�hin 90
Business antl Pmfessions Cotle�. The ConVac ate ' ense L does not apply to days of Ne date of �his notice. In atltlition, you mwt Ientler payment of ihe pmtesletl fees at t�e lime of
an owner oi pmpehy who builtls or impmves the pr pert , provitletl at tM1e �p¢ payment or proNtle evitlence of arrangemenis lo pay the pmtested fees ar exactions al ihe time tM1ey
impmveman�s are not Intendetl orofferea for sele. , h eeer tha bailtling or ere tlue if they ara nat elreetly tlue.
improvementissoltlwRM1inoneyearofcompletioq Owner-Bwlderwillhavzthe
burtlen of pmhng Ihat It was no� buil� or improvetl fo� Ihe purpose ot sale.)
� I, as owner of�he pmpetly, am exeWslvely con�rdeting wiN licensea mntmerors �o
constmct t�e pmlect (Sec. ]044, Business and Pmtessons Code. The ConVaclofs
License Law tloes not apply lo an owner of pmpetly who builtls or Impro�es thereoq
antl who con�racts for such pmjects with a Ilcensetl con�ractor pu�suanl to IM1e
Contractors' Slale License Law)
� I am exempt from Licensure untlerthe Conhaclors' State License Law br tM1e
(ollowing reason:
�alelSlqnaWre of propetly owner or agenl
Worker5 Comoensation Oeclaretion
WARNING: FflILI1RE TO SECURE W ORNEFS' COMFENSFTION C�VEpFGE IS IINLAW f11L RN� $NALL
SOBJECT AN EMPLOVEN TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HIINOREO THOVSAN�
OOLLNNS (Et00,000�, IN AP�fiION TO THE COST OF COA1GENSATION DNMAGES p5 PRON�E� FOR IN
SECTION ]]O6 OF THE LPBOR COOE, INTEREST. PN� ATfORNEPS FEES,
I hcrebv aKrm untler the oenalN ot ocr'ury ONE of the follovnno tleclare[ions�.
I Iteve en0 will mein�eln e certiLce�e o( consent lo self+nsum tonvoMe�s'
— oompansa�ioq Issuad by �he puector of Indus�rial Relations as prontlatl for by SacOon
Initial yp00o(lbeLeborGoae,(orthapaRormenceoftheworkforw�mhthispermilissuetl.
Policy No
I ha�e ana wtll mainlain woMers' compensalion msurance, as requiretl by Sec�ion
-�".) 3]00 of Iho Labor Cotle, for�he pertormance of IM1e work [or which iM1is permlt is
" issvetl. My woBers' compensa�ion insurance camer and policy number are�.
INll31 Carti¢r8 POlicy Numbe�
E�rtaOon Date
I ceM1i(y Ihal in t�e peRormance of Ihe work for which this permlt Is Issueq I shall nol
employ any person in any manner sa as to bewme subjecl lo �Fe workers'
compensafion laws ot Callfarnla and agree ihat if I shoultl become subject to Ihe
workea' compensalion prodsions oi Section 3]0� ot the Labor Code, I shall Potlhwith
complywt�l osepmNsions.
Illlfi3l Oate �? � Applicanl �\.�>..+-�%7 �� '
Project Address: 299 AVENIDA DEL SOL Project Description: PACKAGE UNIT
,���, City of Palm Desert (FoiOfliceUseOnly)
�%���L� Department of Building and Safety },� iG� h
JOB ID:` ,��'` `—v�
� V.' .� Buildinq Permit Application PLANS FILED:
�
Project Address: 2g9 Avenida Del Sol Suite #
Total Value of work: $ 11,154.00 Note: Plan Review Fees may be adjusted after Plan Review
Project DeSCription (be Specific): Replace 5 ton package unit
Contraetor Business Name Property Owner Name
General Air Conditioning Justin Liveridge
Address Address
31170 Reserve Drive 299 Avenida Del Sol
City Zip City Zip
Thousand Palms, CA 92276 Palm Desert, CA 92260
Phone Phone
760-343-7488 760-797-5693
Fax Fax
E-mail E-mail
Contrector License No.
686310
❑Archi4ect Name ❑Designer Name Engineer Name
Address Address
City Zip City Zip
Phone Phone
Fax Fax
E-mail E-mail
License No. License No.
Applicant Name Signature Date
Steven Schnierer ,� tiw�� May 8, 2019
Contact Telephone Number E-Mail
818-735-7876 swschnierer@roadrunner.com
PLEASE COMPLETE THE REVERSE SIDE
73-510 Fred Waring Drive, Palm Desert, CA 92260 •(760) 776-6420 •(760) 776-6392 fax • www.cityofpalmdesert.org
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