HomeMy WebLinkAboutHVRC18-0287City of Palm Desert
PERMIT NUMBER:
ISSUE DATE:
Building and Safety Department
73510 Fred Waring Drive
HVRC18-0287
5l1512018
Palm Desert, CA 92260
Permit Type: HVAC CHANGE OUT
Appl. Date: 5/15/2018
RESIDENTIAL
Permit TIER 1-LESS 15 SEER
Appr. Date: 5/15/2018
Subtype:
Exp. Date: 11/11/2018
Job Valuation: $10,067.00
Project Address: 73660 AGAVE LN
Project Description:
APN1Tract/Lot No:
Owner:
Contractor:
Applicant:
655100025
ROBERT HUNT ZIEGLER
HARRISON ENTERPRISES INC
HARRISON ENTERPRISES INC
TR 5553
7366D AGAVE LN
31170 RESERVE DRIVE
31170 RESERVE DRIVE
52
PALM DESERT, CA 92260
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)343-7488
(760)343-7488
Lijr,arnsed 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 11X17 GL-1100000-3411600 $D.28
commencing with Section 700D) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
GREEN BLDG FEE SB1473 GLF100000-2281000 51.00
Initial
RESIDENTIAL HVAC CHANGE OUT GL-1100000-3221100 5159.00
Total Fees Paid: $160.28
Owner -Builder Declamation
i herebyaffirm under the penalty of perjury that there is a construction fending agency for the
1 hereby affirm under penalof per[ury that I am exempt from the Contraclors' Stale
License Law for the reason(s) Indicated below by the checkmark(s) I have placed next
performance of the work for whkh this permit is issued (Sec 3097, Civir Code)
to the applicable item(s) Section 7031.5 Business and Professions Code: Any city or
Lenders Name and address
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
Asbestos Declaration
statement that he or she is licensed pursuant to the provisions of the Gontractors' State
License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business
Written asbestos notification pursuant to Part fit of Title 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 buildings, or portions thereof, 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 permit is from construction that does or does not contain
applicant 1D a civil penalty of not more than five hundred dollars ($500).)
asbestos, or that no demolition is authorized by this permit.
I, as owner of the property, or my employees with wages as their sole compensation,
NOTICE: You may protest any of the fees for this permit in accordance with CA Gov Code Sec. 66020
will do the work, and the structure is not intended or offered for sale (Sec. 7044,
(a). The protest must satisfy the requirements of Gov. Code See.66020(a) and must be filed within 90
Business and Professions Code: The Contractors' State License Law does not apply to
days of the date Of this notice. In addition, you must tender payment of the protested fees at the time of
an owner of property who builds or improves the property, provided that the
the payment or provide evidence of arrangements to pay the protested fees or exactions at the time they
improvements 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.)
El1,
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 exam ptfrom Licensure under the Contractors' State License Law for the
following reason:
Date/Signature of property owner or agent
W rk rs' C m ensat)on Declaration
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 ATTORNEYS FEES.
I hereby affirm under the penalty of oerlury ONE of the follow!na declarations:
I have and will maintain a certificate of consent to self -insure forworkers'
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 have and will maintain workers' compensatlon insurance, as required by Section
3700 of the Labor Code, for the performance of the work forwhich 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
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 Section 3700 Of the Labor Code, I shall forthwith
comply wilt In tho a prows Eons.
r
Oale G Applicant
_
Initial
City of Palm Desert
Department of • and Safety
Building Permit Application
Project Address: 73660 Agave Lane
Total Value of work: $ 10,067.00
(For Office Use Only)
JOB ID: b!h ,C 1' S - 0097
PLAINS FILED:
Suite #
!Vote: Plan Review Fees may be adjusted after Plan Review
Project Description (be specific): Replace 4 ton / 75,000 BTU complete HVAC system
Contractor Business Name
General Air Conditioning
Property Owner Name
Robert Ziegler
Address
31170 Reserve Drive
Address
7 0 Agave Lane
City Zip
Thousand Palms, CA 92276
City Zip
Palm DesertCA 92260
Phone
Phone
Fax
Fax
E-mail
E-mail
Contractor License No.
686310
El Architect Name ❑Designer Name
Engineer Name
Address
Ad d ress
City Zip
City Zip
Phone
Phone
Fax
Fax
E-mail
E-mail
License No.
License No.
Applicant Name
Signature
Date
Steven Schnierer
May 15, 2018
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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