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Home My WebLink AboutELPU18-0066CJ City of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department ELPU18-0066 73510 Fred Waring Drive 9117120i8 Palm Desert, CA 92260 Permit Type: ELECTRICAL PANEL Appl. Date: 9/1312018 UPGRADE Permit Appr. Date: 911312018 Subtype: Exp. Date: 311612019 Job Valuation: $2,000.00 Project Address: 45585 ABRONIA TRL Project Description: APNITract/Lot No: Owner: Contractor: Applicant: 625193003 RICHARD A KAIN ASSOCIATE ELECTRIC ASSOCIATE ELECTRIC PANORAMA RANCH 45585 ABRONIA TRL 2616 GRIFFITH AVE 2616 GRIFFITH AVE 63 PALM DESERT, CA 92260 LOS ANGELES, CA 90011 LOS ANGELES, CA 90011 (323)872-4515 (323)872-4515 Licensed Contractor Declaration Fee Summary I hereby affirm under penalty_of pedury that I am licensed under proysions of Chapter 9 ARCHIVE FEE-8.5X11 UP TO 11X17 GL-110D000-3411600 $0.14 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ELECTRICAL PANEL UPGRADE GL-1100000-3221105 $159.0D - Initial GREEN BLDG FEE 5131473 GL-610G000-2281000 $1.00 PERM IT ISSUANCE FEE GL-1100000-34114CO $105.0D owner -Builder Declaration I hereby affirm under penalty of perjury that I am exempt from the Contractors' State Total Fees Paid: $265,14 I hereby afflirm under the penalty of paduryfhat there is a construction fending agency for the 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 performance of the work for which this permit Is issued (Sec 3097, Civil Code) county which requires a permit to construct, alter, improve, demolish, or repair any fenders Name and address structure, prior to issuance, also requires the applicant for the permit to file a signed statement that he or she is Iicensed pursuant to the proAsions of the Contractors' State Asbestos Declaration 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 Written asbestos notification pursuant 10 Pan 61 of Title 40 of the Code of Federal Regulations is required applicant to a civil penalty of not more than five hundred dollars ($500).) when asbestos e"Is in buildings, or portions thereof, undergoing demolition. I hereby declare that 1, as owner of the property, or my employees with wages as their sole compensation, demolition authorized by this permit Is from construction that does or does not contain asbestos, or that no demolition is authorized by this permit. 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 NOTICE: You may protest any of the fees for this permit in accordance with CA Gov Code Sec. 66020 an owner of property who builds or improves the property, provided that the (a). The protest must satisfy the requirements of Gov. Code Sec.66020(a) and must be filed within 90 improvements are not intended or offered for sale. If, however, the building or days of the date of this notice. In addition, you must tender payment of the protested fees at the lime of improvement. is sold within one year of completion, the Owner -Builder will has the the payment or provide evidence of arrangements to pay the protested fees or exacliens at the time they burden of proving that it was not buiR or improved for the purpose of sale,) are due if they are not already due. I, as owner of the property, am exclusively contracting with licensed contractors 10 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; DatelSignature of property owner or agent Workers' 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 ($100,0001, IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 3704 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under the Penalty of oortury ONE of the following declarations: I have and wlll maintain a certificate of consent to selfAnsure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit issued. Initial Policy No. I ave and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: _ initial Carrier & Policy Number Expiration Date I certify that in the performance of the work for which this permit is issued, I shall not a employ any person in any manner so as to become jeI to the workers' compensation Taws of Calilomis a ree that if I s o ld becomme subject to the workers' compensa 'on provision of S ction 370 1 e a or Code, 1 shall forthwith m I with those rovtsfons. Date Initial Applicant City of Palm Desert Department of Building and Safety Buildinq Permit Application (For Office Use Only) JOB ID: , 006 C PLANS FILED: Project Address:`-1-� _ 1 1J� lG i E Spite # Total Value of work: $ Note: Plan Review Fees may be adjusted after Plan Review r Co tractor Business Name V Property Owner Narrie \ Y Address qJ 67:%kh, Address, f 6 city Zip I ` city o I c Zip 1(P Phone f S ` Phone —,D�o—►I- C16 Fax Fax E-mail / 1 l�LlcenS - E-mail Vo) Iq la go mat - Contractor !,N No ❑Architect 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 Date -�/)\Aww Nmky 17U,4 ) Contact Teleph ne N mbe E-Mail 23 `Z - Sl ' C PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 • (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org