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HomeMy WebLinkAboutHVRC17-0002 PERMIT EXPIREDCity of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department 73510 Fred Waring Drive6 HVRc17-Dooz Palm Desert, CA 92260 Permit Type: HVAC CHANGE OUT Appl. Date: 10123/2017 RESIDENTIAL Permit TIER 3-18 OR MORE Appr. Date: Subtype: SEER Exp. Date: Job Valuation: $12,675,00 Project Address: 17 ACAPULCO DR Project Description: APNITract/Lot No: Owner: Contractor: Applicant: 624021028 EARL J AURELIUS HYDE'S HYDE'S TR 14032-1 1NT IN 2659 TRAILSIDE CIR 42949 MADIO ST 42949 MADIO ST COMMON AREAS PLEASANTON CA, 94588 INDIO, CA 92201 IND10, CA 92201 28 (760)360-2202 (760)360-2202 Licensed Contractor Declaration a Summary V18,5X1 t hereby affirm under oenaity of oeriury 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, 1 UP TO 11X17 GL-1100000-3411600 $0.42 N OG FEE SB1473 GL-6100000-2281aw $1.00 Initial E TIAL HVAC CHANGE OUT GL-1100000-3221100 $111.30 I Fees Paid: $112.72 Qwner-Builder Declaration rs 1 hereby affirm under penalty of oeriury that I am exempt from the Coe3usil rebyafRrm under the penalty of par]urythat there Is a construction lending agencyfor the License Law for the reason(s) indicated below by the checkmark(s) la n erformanae of the work for whkh this permit Is Issued (Sec 3097, CMI Code) to the applicable item(s) Section 7031,5 Business and Professions ny ceders Name and address county which requires a permit to construct, alter, improve, demoliss' n structure, prior to issuance, also requires the applicant for the permia Asbestos Declaration statement that he or she Is licensed pursuant to the provisions of thc License Law(Chapter 9(commencing with Section 7000) of Division usl s Written asbestos notification pursuant to Part 61 of Title40 of the Code of Federal Regulations is required and Professions Code) or that he or she is exempt and the basis fored when asbestos exists in bu€ldings, or portions thereof, undergoing demolition. I hereby declare that exemption. Any violation of Section 7031.5 by any applicant for a peje the applicant to a civil penalty of not more than five hundred dollars ($50asbestos, demolition authorized by this permit is from construction that does or does not contain or that no demolition Is authorized by this permit. 1, as owner of the property, or my employees with wages as their sosation, will do the work, and the structure is not intended or offered for sale (sec. 7044, NOTICE: You may protest any of the fees for this permit in accordance with CA Gov Code Sec. 66020 Business and Professions Code: The Contractors' State License Law does not apply to (a). The protest must satisfy the requirements of Gov. Code Sec.66020(a) and must be filed within 90 an owner of property who builds or improves the property, provided that the improvements days of the date of this notice, In addition, you must tender payment of the protested tees at the time of the payment or provide evidence of arrangements to pay the protested fees or exactions at the time they are not intended or offered for sale. If, however, the building or are due if they are not already due. 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' Stale License Law,) I am exempt from Llconsure under the Contractors' State License Law for the following reason: Date/Signature of property owner or agent Workers' Connoen5atiOn Declaration WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFULAND SHALL SUBJECTAN 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. Lbwbeafrrrm under the penalty of penury ONE ofwe folloWjnp declarations: - I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of industrial Relations as provided for by Section Initial 3700 of the Labor Code, for the performance of the work for which this permit issued. Policy No. 1 have and will maintain workers' compensation Insurance, as required by Section OD 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: lnitlal Carrier & Policy Number Expiration Date 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 the workers' compensation laws of California and agree that if I should become subject to the workers' compensation provisions of Sect5p 3700 0 Labor Code, I shall forthwith comps o^ste rovislons. Initial �wryith Date q ] Applicant City of Palm Desert Department of Building and Safety Building Permit Application; (For Office Use Only) JOB ID: 1HV C17-000a. PLAINS FILED: Project Address: Suite # Total Value of work: $ 9 .Rio Note: Plan Review Fees m I y be adjusted after Plan Review Project Description (be specific): Ac, \ Ni FMlAd;}a VA *Uln Uv Contractor Business Name Property Owner Name t Address E Address ( CCU ` c city } Zip Ci [ l Zip Phone Phone ' s_ Fax } Fax E-mat[ E-mail Contractor License Not t r ❑Architect Name ©Designer Name Engineer Name i Address i Address I City Zip City i i Zip Phone i Phonel Fax ! Fax i E-mail E-mail i License No. License No. I Applicant,Na6e Signature Date 14�� -7 6:;� Contact ephone dmber E-Mail PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Palm Desert, CA 92260 • (760) 776-6420 • (760) 776-6392 fax 9 www.c4ofpalmdeseit.org In A A 0 rD =r, 'O cmG 3 0 '* ¢i C m C ra p O D v rDN a m f N rn rb 0 G1 ro m d CD CL 2 N m O N N � V 0 CL O C lD � N � 9 iv n m O ti Q a p0 L O rt n an y z CD f�ii FO+ ab fb 3 O O. r � O 3 OQ R H fi n n � y CL ro N N a y .c O• � T a Ln m w y ov nm 0 y y y CL yr m y rF (b .n+ m m 3 0. 3 1n Z, m n n O n _ - LA (D 0 � � rD ?, 7 tRl VI� :3 rt Ei y O = O to ,yy tD T a f1 f�D 3 [D " O = Z O M .y+ et O 41 LA A w O c = n _ rt Z y m ,C al O O �. = t10 1 O oQ N fD n K � y W h ZIA N O ro C l00 mt b:3 .y S n 2 o ro d n 't m ro m a7 a] a5 as o n T a T T m > n O n N m •o a o -ri�ro ni n m o v v w (DD G .n-r rn+ NJ N f° o o = 0 qnj �, 0 o m m = �. a r3+ O @ 3 N O wn 3 n S C Q != .6 ro CD v� Ln N oai V v rn 3 n D C n Q q fu w n rD y o C zs C .r 0 rD o o CL o v S M m ao m n O 3 C 2 T 7• 6J 7• Oc7 H O O O O rD O 00 A N a �* n z S O -�+ v v c QQ O r{{ m m O Q m m 0=u ro o n aq m - •- �, 0 ac as 7 = yl 00 = = �� 'o ply N C C j/1 CD r :i rr Z ro ro = n m O b, m HaL C 3 y Q- R ro � A V j• O Y D W C rD C E 3 n LOO C 0 C y' 0 O' { rD ro R O n C 3 rD M fD Q. 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