HomeMy WebLinkAboutWTRH18-0059Project Address: 40900 AVENIDA CALAFIA Project Description:
APN/Tract/Lot
No:
Owner:
Contractor: Applicant:
622330012
BEVERLY J THOMPSON
HARRISON ENTERPRISES INC HARRISON ENTERPRISES INC
TR 24603
40900 AVENIDA CALAFIA
31170 RESERVE DRIVE 31170 RESERVE DRIVE
12
PALM DESERT, CA 92260
THOUSAND PALMS, C THOUSAND PALMS, CA 92276
(760)343-7488 (760)343-7488
Fee Summary
Licensed Contractor Declaration
I hereby affirm under penally,of perlury that I am licensed under provisions of Chapter 9
1 TO 11X17 GL-11COD003411600 $D-07
(commencing with Section 70DO) of Division 3 of the Business and Professions Code,
Initial
and my license is in full force and offect.
EE 1473 GL-6100000-2281000 $1.00
OAA
RCHANGE OUT GL-11000003221100 $56.00
id: $57.07
Owner -Builder Declaration
0
I hereby affirm under penally of pe je ' a that I am exempt from the Contractors' State
raby affirm under the penalty of perjury that there is a construction lending agencyfor the
License Law for the reaspn(s) indicaled below by the checkmark(s) I have placed next
performance of the work for which this permit is issued (Sec 3097, Civil Code)
to the applicable item{s) Section 7031.5 Business and Professions Code: Any city or
Lenders Name 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(Chapter 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. Anyviolation of Section 7031.5 by any applicant for a penult subjects the
demolition authorized by this permit is from construction that does oi does not contain
applicant to a civil penally of not more than five hundred dollars ($500).)
asbestos, or that no demolition is authorized by this permit,
ElI,
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 accordanca with CA Gov Code Sec. 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' Stale License Law does not apply to
days of the dale of this notice, in addition, you must tender 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
improvemerts 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,)
1, as owner of the property, 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' 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' 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 i00,000), 1N ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
1 hereby affirm under the penalty of Dedury ONE of the following declarations:
I have and will maintain a certificate of consent to selMnsure 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
olicy No.
have and will maintain workers' compensation insurance, as required by Section
'
3700 of the Labor Code, for the performance of the work (or which this permit is
issued. My workers' compensation insurance caner and policy number are:
_
Initial
Carrier & Policy Number
E)piration 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 Ca;ifomia and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Cade, I shall forthwith
comply with those provisions.
_
Initial
Date Applicant
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❑Architect Nalme. ClDesigner.Name
Engineer Name
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City
Zip
Phone
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E-mail
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License No,
License No.