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HomeMy WebLinkAboutHVRC18-0762 PERMIT EXPIREDCity of Palm Desert „ PERMIT NUMBER: ISSUE DATE: Building and Safety Department HVRC18-0752 11l26I2018 73510 Fred Waring Drive Palm Desert, CA 92260 Permit Type: HVAC CHANGE OUT Appl. Date: 11/26/2018 RESIDENTIAL Permit TIER 1-LESS 15 SEER Appr. Date: 11/26/2018 Subtype: Exp. Date: 5/2512019 Job Valuation: $8,200.00 Project Address: 22 ACAPULCO DR Project Description: APN/Tract/Lot No: Owner: Contractor: Applicant: 524021030 DOUGLAS ALAN AVERILL PALM DESERT AIR PALM DESERT AIR TR 14032-1 INT IN 57 CONDOLEA TERRACE CONDITIONING CO INC CONDITIONING CO INC COMMON AREAS LAKE OSWEGO, OR 97035 42-081 BEACON HILL 42-081 BEACON HILL 30 PALM DESERT, CA 922211 PALM DESERT, CA 92211 (760)346-0677 (760)346-0677 Licensed Contractor Declaration Fee Summary I hereby affirm under penalty of Perjury that I am licensed under provisions of Chapter 9 ARCHIVE FEE - 8.5X11 UP TO 11 X1 7 GL-1100000-3411600 $0.28 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. GREEN BLDG FEE SB1473 GL-5100000-2281000 $1.00 Initial RESIDENTIAL HVAC CHANGE OUT G4-1100000.3221100 $159,00 Total Fees Paid: $160,25 Owner -Builder Declaration f herehyatTrrm under the penattyof perfurythat there is a construction tending agency for the Civil 1 hereby affirm under penally of perjury that I am exempt from the Contractors' State License Law for the resson(s) indicated below by the checkmark(s) I have placed next performance of fhe work for which this permit is issued (Sec 3097, Code) to the applicable item(s) Section 7031.5 Business and Professions Code: Any city or Lenders Name andaddress county which requires a permit to construct, alter, Improve, demolish, or repair any Asbestos Declaration structure, pder 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 Divslon 3 of the Business Written asbestos notification pursuen of Tills 40 of the Code of Federal Regulations Is required and Professions Code) or that he or she Is exempt and the basis for the alleged when asbestos exists in bulldings, o po I s undergoing demolition. I hereby declare That exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the demolition authorized by this pe s from nstru 'on that does or does not contain applicant to a civil penalty of not more than five hundred dollars ($50D).) asbestos, or that no da lido is au Dri d by this permit. I, as owner of the property, army employees with wages as their sole compensation, NOTICE: You may prat o ea: for s permit in accordance with CA Gov Cade Sec. 66020 will do the work, and the structure Is not intended or offered for sale (Sec. 7044, (a). The protest must as fly ulre ants of Gov. Code Sea.66020(a) and must be filed within 90 Business and Professions Coda: The Contractors' State License Law does not apply to an owner of property who builds or improves the property, provided that the days of the date of t4 no I n, you must tender payment of the protested fees at the time of iha payment 'A eve of arrangements to pay the prolested fees or exactions at the time they improvements are not intended or offered for sale. If, however, the building or era due if the are of a us. 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 Contractors License Law does not apply to an owner of properly 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 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 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. , I hereby affirint onclertngonalty-of-pedua QNE of the fol lowing declarations: I have and will maintain a certificate of consent to self4nsuro 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. I have 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 Cartier and policy number are: Carder & Policy Number Initial ExpIralion Date I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to became subject to thew ers' laws of California and agree that if I should becomeObject to the comply workers' compensation provisions of Section 37 of the aborC. a, hall forthwith �1 complylwit tho a rovsions. 4 , N Initial Date Applicant City of Palm Desert Department of Building and Safety Buildinq Permit Application (For Office Use Only) JOB ID: "12i �'J 0-7� PLANS FILED: Project Address: _ 2�, -A MA14,G0 AL!, .rf)E� i 4A , q]1V Suite # Total Value of work: $ S f 2Db Note: Plan Review Fees may be adjusted after Plan Review ect Description (be specifi 0 0 �D ontractor Business Name YALmr1)6i0C1 A!R LQA15TX09-F ( Property Owner Name U Address O� r Address Ad- n P VLW City Zip �l City 7�/� Zip � ro � P one q'f0_0 Phone <03 _ o f _ U'9 Pax /p Z Z' Zo D Fax yw E-mail 5 Ekwrt-, A EALAE� E-mail Contractor License ❑Architect Name 00esigner 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 �CV Contact Telephone Number A o - %- ob-?� E-Marl PM PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 9 (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org W w M c o J 00 a ; 0 N a N LL �" V aj O a IL a m G J E; u� Q U 2 a o: U T `m E E a 7• to G �C W U G Z J C a u O U C CL LL 0 O ra u_ o z LL ++ a pL LU V a a a C O a -o a C a E 7 U O 'O aJ N E 2 J C C0 a hCa w V1 m C ON in Q r-I r-I C m ar a m Q o ; 3 E E m Z a H E > c > +v e^ E to p _ 3 Q. 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