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HomeMy WebLinkAboutHVRC19-0111lj City of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department HVRC19-0411 73510 Fred Waring Drive Palm Desert, CA 92260 Permit Type: HVAC CHANGE OUT Appl. Date: 2119/2019 RESIDENTIAL Permit TIER 1-LESS 15 SEER Appr. Date: 2/1912019 Subtype: Exp. Date: Job Valuation: $4,172.00 Project Address: 73660 AGAVE LN Project Description: APN1TractlLot No: Owner: Contractor: Applicant: 655100025 IRENE ZIEGLER HARRISON ENTERPRISES INC HARRISON ENTERPRISES INC TR 5553 73660 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 Licensed Contractor Declaration Fee Summary I hereby affrm under penalty of perjury that I am licensed under provisions of Chapter 9 ARCHIVE FEE - B.SX11 UP TO 11X17 GL-11000OD-3411500 $0.21 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is In full farce and effect. GREEN BLDG FEE SB1473 GL-61000OD-2281000 $1.OD Initial RESIDENTIAL HVAC CHANGE OUT GL-1100000.3221100 $159.00 Total Fees Paid: $160.21 Owner -Builder Declaration f herebyafrm under the penaffyofpodurythat there is a construction fending agencyfor the 1 hereby affirm under penalty of pal that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next performance or the work for which this permit is issued (Sec 3097, Civil 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 Asbestos Declaration 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' Stale License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business Written asbestos notification pursuant to Part 61 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 canstruction that does or does not contain applicant to 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 sale compensation, NOTICE; You may protest any of the fees for this permit in accordance with CA Gov Code Sec. 60020 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 Sec.66020(a) and must be filed within 90 Business and Professions Cade: The Contractors' State License Law does not apply to days of the date of this notice. In addition, you must lender payment of the protested fees at the Um 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.) I, as owner of the property, am exclusively wnbacting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: the Contractors. 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' Stale License Law for the following reason: DatelSlgnatu�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 RNES UP TO ONE HUNDRED THOUSAND DOLLARS (510e,eeet, IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I herobV affirm under the l of pedury PNE of the followIng declarations: I have and will maintain a cartificato of consent to selfinsure 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, e I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work forwhich this permit is issued. My wgrkers'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 riot employ any person in any manner so as to become subject to the workers' compensation laws of California and agree that if t should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, t shall forthwith comply w'th those provisions. _ Initial Date Applicant M1. City of Palm Desert m Department of Building and Safety 9 °Ep a° o-ae Building Permit Application Project Address: 73660 Agave Lane (For Office Use Only) JOB ID: _h V um _O l PLANS FILED: Suite # Total Value of work: $ 4,172.00 Note: Plan Review Pees may be adjusted after Plan Review Project Description (be specific): Replace 100,000 BTU furnace Contractor Business Name General Air Conditioning Property Owner Name Robert Ziegler Address 31170 Reserve Drive Address 73660 Agave Lane city Zip Thousand Palms, CA 92276 city Zip Palm Desert, CA 92260 Phone 760-343-7488 Phone 760-837-3994 Fax Fax E-mail E-mail Contractor License No. 686310 El Architect Name ClDesigner 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 Steven Schnierer February 19, 2019 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 6ao-:p@sapwledjohlla•nrmm . xel Z6£9-9LL (096 - OZ-�9-9LL (09L) - 09ZZ6 d: `:Pasaq wiled `aAlJq 6ulaeM PaJ� OTS-EL -Alup eouarala&.ior -anoge pa;e;s seal aq; to llo seal ;lcuaad inoAeseq;ou oa a6ed aad [ $ Gxq,g o} do aoloO a6ed aad 09,$ sueld 96ed jed LO'$ L �x 1 L o} do L i xq•g :aad aAIgOJy 00'13M :AjjnoH uoiloadsul 00'99LS :AlanoH Vago Ueld Sa2=1 veld u01Wn010 4 lseal le 'veld aooll pauopuawlp ( 'ueld ails l.-sloofoid leguap!sab ueld joog 6 'uol}enala !, 'ueld ails 6 '96ed all!} L -sloefoid lepawwoo :(6uigwnld PUe 'leolipal3 '}oo�d-a�J 'OVAH 'Ja;eaH JaIeM 'saauad/slleM aoj ideoxe) s;lwaad pe ao; faupollo} ayj j!wgns aseald :jossassy ❑ lenoAdvjo aalp-1 uol;eloossry s,aaum0 ewoH ❑ suol;eol;haft s,ialn;oe}nueW ❑ podw sfloe ❑ 6ulgwnld ❑ leoluegaaW ❑ le31113813 ❑ swaod N-jo ❑ suoi;elnoleo ssnjl ❑ suopelnale0 Maui — VZ aR!1 ❑ suoljelnole0 lemjonjIS ❑ :sluawnoop 6uiljoddns 6uLmollol ayi. 6ulpnloul 'SNVId d0 5135 313`idW00 Z ❑ (papinoid aAey noA ley} lie joego aseald) :aaniWsns JN13S 3NV SMil JNIM0110d 3Hl •sle:giwgns ueld ajid 6uipae6aa uoi;ewaolui aaulanl aol OLBV9ti£ (09L) Ilea aseald 's,'I'1 aol sueld to ;as (I,) euo saainbei am=1 •;uawpuda❑ acid ay; o; pa;;iwgns eq;snw sueld s;uawanoidwi lueual 6uipnioui `spo[Oo d IeloJewwoO pue lei;uepisoN `Aliwel-ijInW s;lun 6ulpamp;o 'ON jeAoo tioss000y swoap80 P 'ON Bulpline pjol syIe8 Jo 'oN 96eaojS/asnoy9aeM JanoC) kossaooy ilelab eaay a6eaeE) a0W0 easy 6ulAri easy Algwessy a e;ood aaerf S .Iel;uapisoN a e;oo,,1 oien S IelojawwoO awoq o; poppe ioufaq ane;ool aJenps n juo a;eafpur asea fa suol;rpp& /W;uaprsa& JOJ, ON ❑ S3Lk ❑ :slal)iuijdS aji.1 :aaylO n z'd £-Zi :a0440 sal6u14S alll :saylO SA VA :dnos0 RouednooO :OdA_L looN :adA.L uoi;ona;suoO :uoilu'LIIjojul einjonjis "r, LU ° O J C1 a m m o N IL. 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