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Home My WebLink AboutWTRH18-0016 PERMIT EXPIREDCity of Palm Desert PERMIT NUMBER: iISSUED DATE: ~—� Building and Safety Department AM 73510 Fred Waring Drive W TRH18-0016 21231241812;00:40 Palm Desert, CA 92260 App1. Date: 2/23/2018 Permit Type: WATER HEATER Permit STANDARD CHANGE Appr. Date: 2/23/2018 Subtype: OUT Exp. Date: 8/22/2018 Job Valuation: $2,584.00 Project Address: 103 AVELLINO CIR- Project Description: APNITract/Lot No: Owner: Contractor: Applicant: 626161085 BARBARA A MAYERS HARRISON ENTERPRISES INC HARRISON ENTERPRISES INC TR 15000-1 16428 MARTINCOIT RD 31170 RESERVE DRIVE 31170 RESERVE DRIVE 85 POWAY CA, 92064 THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 (760)343-7488 (760)343-7488 Licensed Contractor Declaration Fee Summary t hereby affirm under penalty of pedury that I am licensed under provisions of Chapter 0 (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 17 GL-1100000-3411600 $0.07 GREEN BLDG FEE S 7 GL-6100000-2281000 $4.00 - Initial WATER HF�,TER R E 0 GL-11DDDDD-322110D $56.00 Total Fee $60.07 Owner -Builder Declaration I hereby affirm under penalty of perfury 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 Law(Chapler 9(commencing with Section 7000) of Division 3 of the Busi e: and Professions Code) or that he or she Is exempt and the basis for the allege exemption. Any violation of Section 7031.5 by any applicant for a permit subje lh applicant to a civil penalty of not moro than five hundred dollars ($500).) ElI, as owner of the property, or my employees with wages as their sole comPcnsa Sfgnaturaof.4pplkant or Agent: will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: 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 properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, 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' Slate License Law.) I 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 PENALTIES AND CPAL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000l, IN ADDmON 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 certificate of consent to self -Insure 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 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 for which this permit is issued. My workers' compensation insurance carrier and policy number are: Initial Camor& 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 lith t ose provisions, Initial Date Applicant 4 -7 of Palm Desert Department of Building and Safety Building PermitApplication Project Address: 103 Avellino Circle #1 _. (For Office Use Only) JOB ID: Kq_R- i ts- DO[(�, PLANS FILED: Suite # Total Value of work: $ 2,584.00 Note: Plan Review Fees may be adjusted after Plan Review Project Description (be specific): Replace 50 gallon water heater - (03 Contractor Business Name General Air Conditioning Property Owner Name Barbara Mayers Address 31170 Reserve Drive Address 103 Avellino Circle #1 city Zip Thousand Palms, CA 92276 City Zip Palm Desert, CA 92211 Phone 760-343-7488 Phone 760-837-3631 Fax Fax E-mail E-mail Contractor License No. 686310 ❑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 Signature bate Steven Schnierer,,�� February 22, 2018 Contact Telephone Number E-Mail 818-735-7876 swschnierer@roadrunner.com PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 • (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org