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Home My WebLink AboutELPU18-0024City of Palm Desert Building Safety Department PERMIT NUMBER: ISSUED DATE: /""-- and 73510 Fred Waring Drive ELPU18-0024 412512018 12:00:00 AM Palm Desert, CA 92260 Appl. Date: 412512018 Permit Type: ELECTRICAL PANEL UPGRADE Appr, Date: 4/25/2018 Permit Subtype: Job Valuation: $1,500.00 Exp. Date: 10/22/2018 Project Address: 76923 ASCALON AVE Project Description: 100amp to 100amp APN/Tract/Lot No: Owner: Contractor: Applicant: 634171055 LINDA C GULLETTE BRADLEY ELECTRIC INC BRADLEY ELECTRIC INC INT IN COM LOTS 1 2414 223RD PL NE 41570 SPARKEY WAY 41570 SPAR KEY WAY THRU 5 TR 23322-3 MB SAMMAMISH WA, 98074 BERMUDA DUNES, CA 92203 BERMUDA DUNES, CA 92203 207163 (760)360-0944 (760)360-0944 27 /0 Licensed Contractor Declaration Fee Summary ( hereby affirm under penalty of periurx that I am licensed under provisions of Chapter g (commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is In full force and effect. ARCHIVE FEE - &5X11 UP TO 11X17 GL-1100000-UI1600 $D.07 ELECTRICAL PANEL UPGRADE GL-1100000.3221100 $159,00 initial GREEN BLDG FEE SB1473 GL-610DOOD-22810DO $1.00 PERMIT ISSUANCE FEE GL-1100000-3411400 $105.00 Owner -Bulkier Declaration I hereby affirm under penalty of perjury that I am exempt from the Contractors' State Total Fees Paid: $265.07 License Law for the reason(s) indicated betow 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 slatement that he or she is licensed pursuant to the provisions of the Contractors' State License Law(Chapier 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 Print Name: exemption. Any violation 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).) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Profess Eons Code: The Contractors' State License Law does not apply to Signatureof Applicant or Agent: 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 burden of proving that it was not built or improved for the purpose of sale.) Date: i, as owner of the property, am excEusively contracting with licensed contractors to construct the project (Sec. 7C44, 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.) 0 I am exempt from Licensure under the Contractors' State License Law for the following reason: Date/Signature of property owner or agent YWpirkers' C_omoensation Declaration WARNING: FAILURE TO SECURE WORKERS' cOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES LP TO ONE HUNDRED THOUSAND DOLLARS (1100,0001. IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION $706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under the penalty of perjury ONE of the following declarations: i have and will maintain a Certificate of consent to self -insure forwarkers' 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 for which this permit Issued. Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work forwNch this permit is - issued. My workers' compensation insurance carrier and policy number are: Initial Carrier& Policy Number Expiration Date I certify that In the performance of the work for whic this permit is Issued, I'shall not employ any person in any manner so as to become bject to the workers'! compensation laws of California and agree that if I sh td become subject to the workers' comps sation provisions of tion 37D oftLabor Code, all forth comply ithtthhh 'ons. 1 Date f FI(ppfirant City of Palm Desert Department of Building and Safety Building Permit Application (For Office Use Only) JOB ID: l G( f 0�-G 0��+ PLANS FILED: Project Address: 0/ AJ AL—d�ueSuite # Total Value of work: $_ �,� - Note: Plan Review Fees may be adjusted after Plan Review Contractor Bus"n ss Name Property Owner Name A d ss 1 A dress laity ,�44 ip C� city Zip Phone�� .p Phone Fax � � j Fax E- d -mail ezK ��raCtOr LICe Se NO. ❑Architect Name ❑Designer Name Engineer Name Address Address city Zip City Zip Phone Phone Fax Fax E-mail E-mail License No. Lic nse n.1. Applicant Name Sign Lure Date ontact Te[ephone Number E- I PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 - (760) 776-6420 - (760) 776-6392 fax - www.cityofpalmdesert.org