HomeMy WebLinkAboutWTRH18-0030City of Palm Desert
PERMIT NUMBER:
ISSUEDDATE:
Building and Safety Department
WTRH18-0030
312012018 12:00:00 AM
73510 Fred Waring Drive
Palm Desert, CA 92260
Appl. Date: 312012018
Permit Type: WATER HEATER
Permit STANDARD CHANGE
Appr. Date: 3/20/2018
Subtype: OUT
Exp. Dale: 9/1612018
,tot? Valuation: $800.00
Project Address: 72856 ARBOLEDA DR
Project Description:
APN/Tract/Lot No:
Owner:
Contractor:
Applicant:
640062005
STEVEN A MCI LROY
ALL STAR WATER HEATERS INC
ALL STAR WATER HEATERS INC
PALM DELL ESTATES
72856 ARBOLEDA DR
30300 PUERTO VALLARTA WAY
30300 PUERTO VALLARTA WAY
59
PALM DESERT, CA 92260
MENIFEE, CA 92584
MENI>=EE, CA 92584
(951)301-0067
(951)301-0067
Licensed Contractor Declaration
Fee Summary
I hereby affirm under penalty of penury that I am licensed under provisions of Chapter 8
(commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license Is In full force and effect-
ARCHIVE FEE - 8.5X11 UP TO 11X17 GL-1100000-3411600 $0.28
GREEN BLDG FEE SB1473 GL-6100000-2281000 $1.00
Initlal
WATER HEATER CHANGE OUT GL-1100000-3221100 $46.00
Total Fees Paid: $47.28
Owner -Builder Declaration
I hereby affirm under penalty of Penury that I am exempt from the Contractors' State
License Law for the reason(s) indicated below by the checkmark(s) I have placed next
to the applicable Item(s) Section 7031.5 Business and Professions Code: Any city or
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
statement that he or she is licensed pursuant to the provisions of the Contractors'State
License Low(Chapter 9(commencing with Section 7000) of Division 3 of the Business
Print Name: 111
and Professions Code) or that he or she is exempt and the basis for the alleged
exemption. Any vioEation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than five hundred dollars ($500),)
I, as owner of the property, or my employees with wages as their sole compensation,
Signaturoef Appikant or Agent :
Will do the work, and the structure Is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contraclors' State License Law does not apply to
an owner of property who builds or improves the property, provided that the
improvements are not intended or offered for sale. If, however, the building or7
Improvement is sold within one year of completion, the Owner -Builder will have the
Date: L
burden of proving that it was not built or improved for the purpose of sale.)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7D44, 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 exempt from Llcensure under the Contractors' State License Law for the
following reason:
Date/Signature of property owner or agent
Workers' Compensation Dggl,aEation
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE }KINDRED THOUSAND
DOLLARS ($100,000), INADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under the Penalty of Pedury ONE of the following declarations:
I have and will maintain a csnificate of consent to selfinsure 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 forwhich this permit issued.
Policy No -
I have and will maintain workers' compensation Insurance, as required by Section
3700 of the Labor Code, forthe performance of the work for which this permit is
issued. My workers' compensation insurance carder and policy number are:
-
Initial
Carrier & Policy Number
Expiration Date
I certify that In the performance of the work forwhich this permit is issued, I shall not
I
employ any person in any manner so as to become subject 10 the
compensation laws of California and agree that if I should b subject to
workers' compensation provisions of Section 3700 aborCoca
co: with Ihose visions.
D co:Applica
-
Initial
City of Palm Desert
Department of Building and Safety
Building Permit Application
(Fo
r Office
Use Only) `'ice
JOB ID: _ 1q — 1
PLANS FILED:
Project Address: a A 1 Q 1,0, G DR- Suite #
Total Value of work: $ 200, 00 Note: Plan Review Fees may be adjusted after Plan Review
Contractor Busi ess Name
Property Owner Nam
)mil a
Address
_ r
(�f
Address
city
Zip
city
-- Zip
Phone
V
Phan
Fax
Fax
E-mail
E-mail
Contractor License No.
❑Architect Name
❑Designer Name
Engineer Name
Address
Address
City
Zip
city Zip
Phone
Phone
Fax
Fax
E-mail
E-mail
License No.
License No.
AoDlicant Name
'
ture
Date
K\'� : i 5 L_ C' K(-
4E-M
Contact Telephone Number
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PLEASE COMPLETE THE REVERSE SIDE
73-510 Fred Waring Drive, Palm Desert, CA 92260 • (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org