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Home My WebLink AboutPLUM18-0005City of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department PLUM18-0005 73510 Fred Waring Drive Palm Desert, CA 92260 Permit Type: PLUMBING Appl. Date: 1/29/2018 Permit NEW GAS PIPE Appr, Date: Subtype: Jab Valuation: S800.00 Exp. Date: Project Address: 667 ARROWHEAD DR Project Description: FIRE PIT APN1TractlLot No: Owner: Contractor: Applicant: 632710002 ELLIOT AXELBAND R B C BUILDERS ING TR 28227 5109 VELVET LN 354 S INDIAN CANYON B 2 CULVER CITY CA, 90230 PALM SPRINGS, CA 92262 (760)325-7677 Licensed Contractor Declaration Fee Summary d hereby aihrm under Denaily of Dedury that I am licensed under provisions of Chapter 9 (commencing ,pre 7000) of Division 3 of the Business and Professions Code, and my license is In full farce and effect. ARCHIVE FEE - 8,5X11 UP TO 11X17 GL-1100000.3411600 $0.28 GREEN BLDG FEE SB1473 GL-6100000-2281000 $4.00 Initial MINIMUM INSPECTION FEE GL-1100000-3221100 $159.00 PERMIT ISSUANCE FEE GL-1100000-3411400 $105.00 Owner -Builder Declaration Fl I hereby affirm under penalty of Dedury that I am exempt from the Contractors' State Total Fees Paid: $268.28 f hereby affirm under the penalty or pedury that there is a construction lending agency for the 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 performance of the work for which this permit is issued (Sec 3097, Civil Code) county which requires a permit to construct, alter, improve, demolish, or repair any Lenders Name and address 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 Declaration License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt and the basis for the alleged exemption. Anyviolation of Section 7031,5 by anyapplicant for a permit subjects the Written asbestos notification p u o P'0-s f Title 40 of the Cade of Federal Regulations is required 'ng applicant to a civ l penalty of not more than five hundred dollars ($500).) when asbestos e>dsts in p ieof, undergoing demolition. I hereby declare that I. as owner of the properly, or my employees with wages as their sole compensation, demolition authorized by i e is f in construction that does or does not contain asbestos, or that a is authorized by this permit. will do the work, and the structure is not Intended or offered for sale {Sec. 7044, Business and Professions Cede: The Contractors' State License Law does not apply to NOTICE: Y test f the fees for this permit in accordance with CA Gov Code Sec. 66020 an owner of property who builds or improves the property, provided that the (a). The p st s tis a requirements of Gov. Code Sec.66020(a) and must be filed within 90 improvements are not Intended or offered for sale. If, however, the building or days of the d his ice. In addition, you must tender payment of the protested fees at the time of improvement is sold within one year of completion, the Owner -Builder will have the the p t vi o a once of arrangements to pay the protested fees or exactions at the time they burden of proving that it was not built or improved forthe purpose of sale.) are e a not already due. nI, as owner of the property, am exclusively contracting with licensed contractors 10 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.) LJI am exempt from Licensure under the Contractors' State License Law for the following reason: Date/Signature of property owner or agent workers' Compensation Declaration WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PERALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATrORNEY's FEES. I hereby affirm under the penalty of pedury ONE of the f*IIpMdno declarations: t 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. 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Coda, for the performance of the work for which this permit Is issued. My workers' Compensation insurance carrier and policy number are: Carrier $. Polley Number Initial 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 Callfomi and agree that if I should become subject to the - workers' compensation provision of Section 3700 of the Labor Code hall o�ith compl with those provisions. _ Initial Date Z/ Applica r- City of Palm Desert Department of Building and Safety Buildinq Permit Application (For Office Use Only) JOB ID: PL—UM I.S- _ U(7C1S PLANS FILED: Project Address: �- `�'�'ti-UUf R EPA �� Suite # rr��lG Total Value of work: $ �0V Note. Plan Review Fees may be adjusted after Plan Review Project Description (be specific): (�o "(5-'T I J JC— -FkCNL pw L J1. AC —to y I t L O C1'<'/ o L Contractor Business Name k. o lw Property Owner Name gipc.U^s Address g J114 1NPIAnj w Address 6-1 h �� j 2tVL City fp iP oL 2 2 �Y� City zip Phone y L 1r r `-� "! 91t i -1 Phone -� ! � L6 6 S Fax Fax E-mail IapC 110e6t 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. Applicant Name R&Yw Signature � Date Z� ov )OW -k6---�� ` ZU t Contact Telephone Number Mail 0 OND Cl SO Qk& �-f�CGUtU;*, r L - PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 • (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org 6 7 .fj.� �f= Mr-O OOM m m i 354 B South Indian Canyon Palm Springs, Ca. 92262 Ca Lic n 855629 951 - 443-8424 760-325-7675 fax March 20, 2012 To Whom it May Concern: I Robert Barckley of RBC Builders, Inc. Lic # 885629 give Jorge Mayorga permission to pull permits, business license and pay any fees on behalf of RBC Builders, inc. no expiration Sincerely, k4)W 4Ke' Robert Barckley