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Home My WebLink AboutSPIN18-0029City of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department SPIN18-0029 9125/2018 73510 Fred Waring Drive Palm Desert, CA 92260 Permit Type: SPECIAL INSPECTION Appl. Date: 9/25/2018 Permit Appr. Date: 9/25/2018 Subtype: Job Valuation: $100.00 Exp. Date: 3/24/2019 Project Address: 350 AUGUSTA DR Project Description. RENEW FOR FINAL 93-6825 APNITracVLot No: Owner: Contractor: Applicant: 626300023 TERRANCE DEAN WONG TERRANCE DEAN WONG TR 23724 350 AUGUSTA DR 350 AUGUSTA DR 23 PALM DESERT, CA 92211 PALM DESERT, CA 92211 Licensed Contractor Declaration Fee Summary I hereby affirm under penalty of nedury that I am licensed under provisions of Chapter 9 ARCHIVE FEE - 8.5X11 UP TO 11X17 GL-1100000-341160D $0.14 (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-6100000-2281COD $1.00 - Initial MINIMUM INSPECTION FEE GL-1100000-322110D 5159.00 PERMIT ISSUANCE FEE GL-1100000-3411400 $105.00 Owner -Builder Declaration I hereby affirm under penalty of pedury that I am exempt from the Contractors' State Total Fees Paid: $265.14 I herebyafFrm under the perralfyof perjury that there is a construction lending agencyfor the License Law for the reason(s) indicated below by the chockmark(s) I have placed next to the applicable items) 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' Slate Asbestos 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. Any violation of Section any applicant fora permit subjects the Written asbestos notification pursuant to Part 81 of Title 40 of the Cade of Federal Regulations is required applicant to a civil penalty of not morree than five hundred defiers {550{Y).) when asbestos exists in buildings, or portions thereof, undergoing demolition. I hereby declare that demolition authorized by this permit is from construction that does or does not contain I, as owner of the property, or my employees with wages as their sole compensation, asbestos, or that no demolition is authorized by this permit. will do the work, and the structure is not intended Dr offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to NOTICE: You may protest any of the fees for this permit in accordance with CA Gov Code Sec. 66D20 an owner of property who builds or improves the property, provided that the (a). The protest must satisfy the 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 date of this notice. 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 payment or provide evidence of arrangements to pay the protested fees or exactions at the time they b en of proving that it was not built or improved for the purpose of sale.) are due if they are not already due. t, 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' Slate License Law for the following reason: DatelSignature of property owner or agent Workers' Compensation 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 13OLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION OAMACES AS PROMDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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 for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 37DO 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 370D of the Labor Code, for the performance of the work forwhich 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 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 if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date Applicant _ Initial City of Palm Desert Department of Building and Safety Building Permit Application (For Office Use Only) JOB ID: S PIl V ! S-- 0021 PLANS FILED: Project Address: �v k�V�� '' � �`!� 2 0 "'e�`� Suite # Total Value of work: $ J�'r2/M12 _ Note: Plan Review Fees may be adjusted after Plan Review vroject uescription ipe speciric): �92�� 6!�4__9 Contractor Busi ess N me a Proper owner Name Address �I �� 0 G A _ `{ r Address S City �GlfM �7-Z('p L? /�n /� r ��77 Ci� -f14inn�A L�Ip' +i i Phone 2 � O y krD�•,�� Phone Fax Fax E-mail E-mail e+r,! W r fct vjceW A40(, s Contractor License No. ❑Architect Name ❑Designer Nance Engineer Name Address Address City Zip City Zip Phone Phone Fax Fax E-mail E-mail License No. License No. Applicant Name WrVAJ Signature Date � c Contact TellL,ephQo'ne Number E-Mail J PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 9 (760) 776-6420 • (760) 776-6392 fax a www.cityofpalmdesert.org W