HomeMy WebLinkAboutHVRC18-0357 PERMIT EXPIREDCity of Palm Desert
PERMIT NUMBER:
ISSUE DATE:
Building and Safety Department
73510 Fred Waring Drive
HVRC18-o357
B11z1z078
Palm Desert, CA 92260
Permit Type: HVAC CHANGE OUT
Appl. Date: 6/12/2018
RESIDENTIAL
Permit TIER 1-LESS 15 SEER
Appr. Date: 6/12/2018
Subtype:
Exp. Date: 121912018
Job Valuation: $6,825.00
Project Address: 40750 AVENIDA ARCADA
Project Description:
APNITract/Lot No:
Owner:
Contractor:
Applicant:
622340001
MARIAMAH HOGANS
CERTIFIED COMFORT SYSTEMS
CERTIFIED COMFORT SYSTEMS
TR 24773-1
2055 PINE HURST LN
INC
INC
1
42-949 MADIO STREET
42-949 MADIO STREET
HAWTHORNE, CA 90250
INDIO, CA 92201Z14"V,
CA 92201
L en d Contractor Declaration
ekyMary
hereby affirm under penalty of nedury that I am licensed under provisions of Chapter 9
ARCHIVE FEE - 8.5X11 UP 1) GL-1100000-3411600 S0.28
(commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
GREEN BLDG St�3 GL-6100000-2281000 $1.00
Initial
RESIDEN L C G NG UT GL-1100000-3221100 $159.00
T $160.28
Owner -Builder Declaration
I hereby affirm under Denalty of Dedury that I am exempt from the Contractors' Stale
aI
! h!Jehy irm under the penalty of perjury that there is a construction fending agencyfor the
License Law for the reason(s) indicated below by the checkmark(s) I have placed next
p�►or a e of the work for which this permit is issued (Sec 3097, Civil Code)
to the applicable item(s) Section 7031.5 Business and Professions Cade: Any city or
s e and address
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
Asbestos Declaration
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 Business
Written asbestos notification pursuant to Part 61 of Title 40 of the Code of Federal Regulations is required
and Professions Code) or that he or she is exempt and the basis for the alleged
when asbestos exists in buildings, or portions thereof, undergoing demolition. I hereby declare that
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the
demolition authorized by this permit is from construction that does or does not contain
applicant to a chit penalty of not more than five hundred dollars ($500).)
asbestos, or that no demolition is authorized by this permit.
I, as owner of the property, or my employees with wages as their sole compensation,
NOTICE: You may protest any of the fees for this permit in accordance with CA Gov Code See. 66020
will do the work, and the structure is not intended or offered for sale (Sec. 7044,
(a). The protest must satisfy the requirements of Gov. Cade Sec,66020(a) and must be filed within 90
Business and Professions Code: The Contractors' State License Law does not apply to
days of the date of this notice. In addition, you must lender payment of the protested fees at the time of
an owner of property who builds or improves the property, provided that the
the payment or provide evidence of arrangements to pay the protested fees or exactions at the time they
improvements are not intended or offered for sale. If, however, the building or
are due if they are not already due.
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.)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code: -the Centraclofs
License Law does not apply 10 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
fallowing reason
Date/Signature of property owner or agent
Workers' Comoensation Declaration
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS tf100,D00), IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I horoby affirm under the Penalty of per ur ONE of the follpwin4 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
3700 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
37CO of the Labor Code, for the performance of the work forwhich 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 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 l should became subject to the
14
Porkers' corn ensalion provisions of 370 the Labor Code, I shall forthwith
comps with ?hose revisions,
sTion
Initial
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