HomeMy WebLinkAboutHVRC18-0415City of Palm Desert
PERMIT NUMBER:
ISSUE DATE:
Building and Safety Department
73590 Fred Waring Drive
HVRC18-0415
716I2018
Palm Desert, CA 92260
Permit Type: HVAC CHANGE OUT
Appl. Date: 7/6/2018
_
RESIDENTIAL
Permit TIER 1-LESS 15 SEER
Appr. Date: 7/6/2018
Subtype:
Exp. Date: 1/2/2019
Job Valuation: $29,500.00
Project Address: 91 APPIAN WAY
Project Description:
APNITract/Lot No:
Owner:
Contractor:
Applicant:
632450048
SUSAN K TAPPAN
ALL KNIGHT HEATING & AIR
ALL KNIGHT HEATING & AIR
TR 25711
91 APPIAN WAY
CONDITIONING INC
CONDITIONING INC
69
PALM DESERT, CA 92211
P O BOX 5232
P O BOX 5232
LA QUINTA, CA 92248
LA QUINTA, CA 92248
(760)772-4947
(760)772-4947
Licensed Contractor Declaration
Fee Summary
I hereby affirm under penally of Aedury That I am licensed under provisions of Chapter 9
ARCHIVE FEE-8.5X11 UP TO 11X17 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-6100000-2281000 $2,00
Initial
RESIDENTIAL HVAC CHANGE OUT GL-1100000-3221100 $159.00
Total Fees Paid: $561.28
Owner -Builder Declaration
1 hereby affirm under Penalty of oedury that I am exempt from the Contractors' State
l hereby amrm under the penaffyof perjury that there is a construction lending agencyfor the
License Law for the reason(s) indicated below by the checkmark(s) I have placed next
Performance of 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
structure, prior to issuance, also requires the applicant for the permit to file a signed
Asbestos Declaration
sta lament that he or she is licensed pursuant to the provskms of the Contractors' Slate
License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business
Written asbestos notification pursuant to Part 61 of Title 4D of the Code of Federal Regulations is required
and Professions Coda) 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 to a civil penalty of not more than five hundred dollars ($500).)
asbestos, or that no demolition is autharized by this permit.
I, as owner of the property, or my employees with wages as their sale compersation,
NOTICE: You may protest any of the fees for this permit In accordance with CA Gov Code Sec. 65020
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.56020(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 {f they are not already due.
improvement is sold within one year of completion, the Owner -Builder will have the
burden of proving that i1 was not built or improved for the purpose of safe,)
El1,
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 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 Licensure under the Contractors' State License Law for the
following reason:
Date/Signature of property owner or agent
Workers' Cornoensation 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 ($100.000). IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
'
1 heroby affirm under the penalty of perlury ONE of the followna declarations:
I have and will maintain a certficale of consent to self -insure 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 have and will maintain workers' compensation insurance, as required by Section
13
3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation Insurance carder and policy number are:
Initial
Carder & 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 became subject to th0wo ens'
compensation laws of California and at if I should become ject to the
workers' compensation provisio f ection 370 Labor Co., I shall forthwith
campl with hose provisions.
r, �—'
�f
Initial
Date Applicant
City of Palm Desert
Department of Building and Safety
Building Permit Application
(For Office Use Only) _
JOB 1D:4r1:\/Y-Ll�
PLANS FILED:
I It
Project Address: Suite #
D6
Total Value of work: $ Q 0 . Note: Plan Review Fees may be adjusted after Plan Review
Applicant Name
� c� Vi3r►\
Contact Telephone Number
.-1(oo=1 -1a-yqu`7
Signature _
E-Mail
v ac.
Date
- �- \�g
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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