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HomeMy WebLinkAboutHVRC18-0758City of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department 73510 Fred Waring HVRC18-0758 11121/2018 Palm Desert, CA 92260 60 Permit Type: HVAC CHANGE OUT Appl. Date: 11/21/2018 RESIDENTIAL Permit TIER 1-LESS 15 SEER Appr. Date: 11/21/2018 Subtype: Exp, Date: 5120/2019 Job Valuation: $2,048.00 Project Address: 264 AVENIDA DEL SOL Project Description: APN/Tract/Lot No: Owner: Contractor: Applicant: 622064032 SUSAN JANE DIAMOND ANTHEM MECHANICAL ANTHEM MECHANICAL INT IN COMMON LOTS SURREY BC 53800 POLK STREET 53800 POLK STREET 18 19 & 20 TR 11454 CANADA WA1J1, COACHELLA, CA 92236 COACHELLA, CA 92236 32 (760)895-2621 (760)895-2621 Licensed Contractor Declaration Fee Summary ' I hereby affirm under penalty of Pariury that I am Ifcensed under provisions of Chapter 9 ARCHIVE FEE - 8.5X11 UP TO 11X17 GL-11000OD-3411600 $0.42 (commencing with Section 7D00) of Division 3 of the Business and Professions Code, and my license is in full force and effect. GREEN BLDG FEE SB1473 GL-610006D-22810DO $1.00 Initl RESIDENTIAL HVAC CHANGE OUT (3L-1100D60-32211 DD $159.00 Total Fees Paid: $16D.42 wn r- ii r D l herebyaff rm under the penalty of perjury that there is a construction fending agencyfor the I hereby affirm under Density of oedury that I am exempt from the Contractors' State License Law for the roason(s) indicated below by the checkmark(s) I have placed next performance or 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 Asbestos Declaration 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' Stale License Law(Chapter 9(commencing with Section 7000) of Division 3 of the Business WrIften 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 wrists in buildings, or portions thereof, undergoing demolition. I hereby declare that exemption. Any viotation 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 civil 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 solo compensation, NOTICE: You may protest any of the fees for this permit in accordance with CA Gov Code Sec, 6602D will do the work, and the structure is not Intended or offered for sale (Sec. 7D44, (a). The protest must satisfy the requirements of Gov. Code See,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 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 improvements are not intended or offered for sale, If, however, the building or are due if they are not afready,due. improvement is sold within one year of completion, the Ownor-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 (See. 7D44, Business and Professions Code: The Contractors 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 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 DOLLARS ($100,0001, IN ADDITION 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 pepjyry Q fg 2f the f_el_ wtng_declatatlons: I have and will maintain a certificate of consent to selfAnsure for workers' [Inia compensation, issued by the Director of Industriat Relations as provided for by Section 370D 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 forwhich this permit is 4nitiissued. My workers' com pensation insurance carrier and policy num bar are: Carrier & Policy Number I Initi Expiration Date I cc" that in the performance of the work for which this permit Is issued, I shall not t employ any person in any manner so as to become subject l0 the workers' compensation laws of California and agree that if I sh0 b a su jecf to the wo Kars' moan ation provisions of Section 3 D of t La r Cod , I shall forthwith _ Initia mplyj th lho pro 'sions. t Datel f Applicant City of Palm Desert Department of Building and Safety Building Permit Application Project Address: (For �Office Use On! ) (\ S-{ JOB PLANS FILED: Total Value of work. $ V Note: Plan Review Fees maybe adjusted after Plan Review Description C tr or Busi a Pr erty Owner N e Add s r Address city Cityc Q�r_ Phone r, S Y (f Phon .p r S Fax Fax©t E ! E-mail C6rtrdcfbr License No. E]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 Dat/ -6 Ild )//J > 12V( Number E-Mail "Contact %}Tellephone 0 PLEASE COMPLETE THE REVERSE SIDE 73-SIO Fred Waring Drive, Palm Desert, CA 92260 • (760) 776-6420 , (760) 776-6392 fax • www.cityofpalmdesert.org .1 LA Ln rD n O 3 r1 O m _ O m O a ro n co N O A f9 0 rt n1 rD _ r9 rD C x m 0 Ob H { N C" O � N 2 N m � m [n � A C/� ELCD o0 LA m n +[ a7 N a I•� m o m b � � 7 0 Q. a' r � r to VQ Di `�° ,c o n C r Q , ro N a H mm m W o y o 3 rD W C) y e d NAQ 3. ro m ro mw m tz v A O . 3• ¢ :3;W Ul k _ m w CR rh � •y n LA O 3 CA ( ro CA 3 V A K z m u, -h v o` C cm H a Y ro C m . m ao 3 cA m LA 0 k` .. 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