HomeMy WebLinkAboutWTRH21-0048 DECCITY OF PALM DESERT
Department of
Building & Safety 73-
510 Fred Waring
Drive
Palm Desert, CA 92260
TEL: 760-776-6420 EMAIL: building@cityofpalmdesert.org
CONTRACTOR DECLARATION CONTRACTOR LIC#: PERMIT#:
I Hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, and my license is in full force and effect.
Compensation Declaration:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under the penalty of perjury ONE of the following declarations (SELECT ONE):
OWNER BUILDER DECLARATION PERMIT#:
I have and will maintain a certificate of consent to self -the Director of Industrial
Relations as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
of the work
compensation insurance carrier and policy number are:
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become
subject to th California, compensation
provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DATE: PRINT NAME: SIGNATURE:
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the
checkmark(s) I have placed next to the applicable item(s) Section 7031.5 Business and Professions Code: Any city or county which requires
a permit to construct, alter, improve, demolish, or repair any structure, prior to issuance, also requires the applicant for the permit to file
a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law(Chapter 9(commencing with
Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt and the basis for the alleged exemption. Any
violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).)
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended
or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property
who builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or
improvement is sold within one year of completion, the Owner-Builder will have the burden of proving that it was not built or improved for
the purpose of sale.)
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and
Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts
for such projects with a licensed contractor pursuant to the Contractors' State License Law.)
I am exempt from Licensure under the Contractors' State License Law for the following reason:
DATE: PRINT NAME: SIGNATURE:
Page 1 of 1
CITY OF PALM DESERT PERMIT #_____________
Building & Safety Department
73-510 Fred Waring, Palm Desert, CA (760) 776-6420
SMOKE & CARBON MONOXIDE ALARM RETROFIT
2019 California Residential Code sections R314.8 and R315.2
Where a permit is required for alterations, repairs or additions exceeding $1,000, including exterior work, i.e. roofing,
HVAC change-outs, electrical panel upgrades, windows, etc. existing dwelling or sleeping units that have attached
garages or fuel burning appliances including fireplaces shall have a carbon monoxide alarm.
Smoke and Carbon monoxide alarms shall be installed in the following manner:
In each sleeping room (only require Smoke Alarms unless bedrooms contain a gas appliance then a carbon
monoxide alarm is required as well)
Outside each separate sleeping area in the immediate vicinity of the bedrooms. (require Smoke and Carbon
Monoxide Alarms)
In each story level of the dwelling, including basements and habitable attic rooms (require Smoke and Carbon
Monoxide Alarms)
Smoke alarms and smoke detectors shall not be located where ambient conditions, including humidity and
temperature are outside the limits specified by the manufacturer’s published instructions
Installation near bathrooms. Smoke alarms shall be installed not less than a 3 ft. horizontal distance from the door
or opening of a bathroom that contains a bathtub or shower unless this would prevent placement of a smoke alarm
required by other sections of the code
Smoke alarms and smoke detectors shall not be installed within 36 in. horizontal path from the supply registers of a
forced air heating or cooling system and shall be installed outside of the direct airflow from those registers
Smoke alarms and smoke detectors shall not be installed within a 36 in. horizontal path from the tip of the blade of
a ceiling-suspended (paddle) fan
Smoke Detectors shall be within 10 years of manufacture marked date and/or replaced if such date does not exist
Conventional Ionization smoke alarms must be installed with a ten year battery
Interconnection:
Where more than one carbon monoxide alarm is required to be installed within the dwelling unit or within a sleeping unit
the alarm shall be interconnected in a manner that activation of one alarm shall activate all of the alarms. Exception:
Interconnection is not required in existing dwelling units where repairs do not result in the removal of wall and ceiling
finishes, or there is no access by means of attic, basement or crawl space.
The Building Inspector will verify the installation of the smoke and carbon monoxide alarms during the inspection
process or the owner can complete and sign under the penalty of perjury the following:
I understand the above requirements and certify that we now have smoke alarms and carbon monoxide alarms
installed that comply. I agree to comply with the CRC in regards to smoke alarms and carbon monoxide alarms.
I, ________________________________ and I, ______________________________ who own and/or live in the
(Property Owner’s name) (Tenant’s name/same)
Dwelling located at: ____________________________________________________________________________
_____________________________________________ _______________________________________________
Signature of Owner Date Signature of Tenant Date
*This is a voluntary smoke and carbon monoxide alarm verification procedure. If you prefer a building inspector to
perform the verification, you must arrange to have an adult present at the time of inspection.
*Note, this verification is only used when normal access to the interior of the dwelling is not achieved during the course
of project construction. It is normally used for projects such as re-roofing, re-siding, patio covers or swimming pools.
1/31/2020