HomeMy WebLinkAboutHVRC18-0274City of Palm Desert
PERMIT NUMBER:
ISSUED DATE:
Building and Safety Department
- 73590 Fred Waring Drive
HVRC1B-0274
5181201812:00:00AM
Palm Desert, CA 92260
Permit Type: HVAC CHANGE OUT
Appl. Date: 5/8/2018
RESIDENTIAL
Appr. Date: 5/6/2018
Permit TIER 1-LESS 15 SEER
Subtype:
Exp. Date: 111412018
Job Valuation: $1,255.00
Project Address: 341 ARROWHEAD DR
Project Description:
APNITract/l_ot No:
Owner:
Contractor:
Applicant:
632512022
DANIEL E GREEN
PREC H & A INC
PREC H & A INC
INT IN COMMON LOT 4
341 ARROWHEAD DR
P 0 BOX 10991
P 0 BOX 10991
OF MB 2431033 TR
PALM DESERT, CA 92211
PALM DESERT, CA 92255
PALM DESERT, CA 92255
26123-2
(760)776-1550
(760)776-1550
S118
Licensed ContractorDerIpC@tion
Fee Summary
I hereby affirm under penalty of Dedury that I am licensed under provisions of Chapter 9
(commencing with Section 700D) 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-11 DOD003411600 $D.21
GREEN BLDG FEE SB1473 GL-6100000-22610DO
Initial
RESIDENTIAL HVAC CHANGE OUT GL-110000032211DO $159.00
Total Fees Paid: $160.21
Owner -Builder Declaration
I hereby affirm under Penalty of nedury that 1 am exempt from the Contractors' State
License Law for the reason(s) Indicated below by the checkmark(s) 1 have placed next
to the applicable items) 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 Law(Chapter 9(c10mmencing with Section 7000) of Division 3 of the Business
Print Name.
and Professions Cade) or that he or she Is exempt and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the
applicant to a civil penalty of not more than rive hundred dollars ($500).)
I, as owner of the property, or my employees with wages as their sole compensation,
Signatureof Applicant or Agent:
will do the work, and the structure is not intended or offered for sale (Sec. 7044.
Business and Professions Cade: The Contractors' 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 or
improvement is sold within one year of completion, the Owner -Builder will have the
Date.,
burden of proving that it was not built or improved for the purpose of sale.)
I, 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 exempt from Licensure under the Contractors' State License Law for the
following reason:
Date/Signature of property owner or agent
Wgiftre' Compensation Declaration
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFULAND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS j$100.0001, IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
SECTION 1706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I horeby affirm under the penalty of perfury ONE of the following declarations
I have and will maintain a certificate of consent to seINnsure for workers'
compensation, issued by the Director of Industrial Relations as provided far by Section
Initial
3700 of the Labor Code, for the performance of the work for which this permit issued.
Policy No.
I have and will maintain workers' compensation insurance, as required by Section
3 OD of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance Cartier and policy number are;
Initial
Carder a Policy Number
Expiration Date
I certify that in the perfermanco 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' come subject t
workers' co pe olio rovisians of 'on 3 0 of the La r Code I forthwith
T
comply wi h e 'sions.
e Applicant
City of Palm Desert
Department of Building and Safety
Building Permit Application
(For �Of ice Use Only)
JOB ID: � � s,'C PR- Ua74
PLANS FILED:
Project Address: ,?�Lf /�7"/OLC1 /1�crd ,U / 4/,/,)aScSuite ##
Total Value of work: $. Note: Plan Review Fees may be adjusted after Plan Review
Project Description (be specific):
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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.cityofpaimdesert.org
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