The URL can be used to link to this page

Home My WebLink AboutELEC18-0090City of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department ELEC18-0090 12/13/2018 73510 Fred Waring Drive Palm Desert, CA 92260 Permit Type: ELECTRICAL Appl. Date: 12113/2018 Permit RESIDENTIAL Appr. Date: 12113/2018 Subtype: Job Valuation: $2,500.00 Exp. Date: 6/11/2019 Project Address: t j Project Description: REPLACE PEDESTAL APN1Tract/Lot No: Owner: Contractor: Applicant: 622060002 AGC REALTY BRADLEY ELECTRIC INC BRADLEY ELECTRIC INC TR 11454 FOR CM'S 6080 CENTER DR NO 500 42215 WASHINGTON ST STE A 42215 WASHINGTON ST STE A SEE SUB INDEX BOOK LOS ANGELES, CA 90045 381 381 622 PALM DESERT, CA 92211 PALM DESERT, CA 92211 62 (760)360-0944 (760)360-0944 U00sed Contractor Declaration 1 hereby affirm antler Penalty of Perjury that I am licensed under provisions of Chapter 9 Fee Summary ARCHIVE FEE - 8.5X11 UP TO 11X17 GL-1100000-34116DO $0,14 (commencing with Section 7000) of Division 3 of the Business and Professions Code, Initial and my license is in full force and effect. GREEN BLDG FEE SB1473 GL-6100000-2261000 $1.00 MINIMUM INSPECTION FEE GL-1100D003221100 $159.00 PERM ITISSUANCE FEE GL-11000OD3411400 $105.00 Owner -Builder Declaration I hereby affirm kodeypenalty of penury that I am exempt from the Contractors' Slate Total Fees Paid: $265.14 f hereby affirm under the penalty of perjury that there 7s a construction lending agency for the License Law for the reason(s) indicated below by the cbeckmark(s) I have placed next to the applicable item(s) 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' State Asbestos Declaration License Law(Chapter 9(commencing with Section 7DOD) 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 7031.5 by any applicant for a permit subjects the Written asbestos notification pursuant to Part 61 of Title 40 of the Code of Federal Regulations is required applicant to a civil penalty of not more than five hundred dollars ($500).) when asbestos exists in buildings, or portions thereof, undergoing demolition. I hereby declare that ElI, as owner of the property, or my employees with wages as their sole compensatlon, demolition authorized by this permit is from construction that does or does not contain asbestos, or that no demolition is authorized by this permit. 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 NOTICE: You may protest any of the fees forthls permit in accordance with CA Gov Code Sec. 66020 an owner of property who builds or improves the property, provided that the (a). The protest must satisfy the requirements of Gov. Code Sec.65020(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 lender payment of the protested fees at the time of improvement is sold wllhln 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 burden of proving that it was not built or improved for the purpose of sale.) are due if they are not already due. I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Centraetors 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 following reason: Date/Signature of property owner or agent Workers' Compensation Declaration WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE lS UNLAWFULAND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS t5100,00(1), 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 penally of Penury ONE of the following declaratlons: 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 I tat 3700 of the Labor Coda, for the performance of the work for which this permit issued. 11 Policy No. I have and will maintain workers' compensation insurance, as required by Section 700 of the Labor Code, for the performance o e work for which this permit is issued. My workers' compensation Insurance c 'erand policy number are: Carrier & Policy Number _ Initial Expiration Date certify that in the performance t I shall not AI employ any person in a e a as to becom srkers' compensati s if- is a grey t t ifI s yart to the workers'co i revisions o ct o t, shall forthwith aper-mitued, comply '1 p ons. _ I f I Date Applicant .14 40 City of Palm Desert Department of Building and Safety Buildinq Permit Application .�i(For Office Use Only) r� JOB ID: PLANS FILED: Project Address: ;"�� %_ _` �" ' "�"` r"t l/V_W�! Suite # Total Value of work: Note: Plan Review Feesmaybe adjusted after -{Plan Review Proiect Description (be soecific):gP-r' p C�"`� P rsm1A UU A��ea:A 111Y Y1 nAZ Al 114 Contractor Sus .r Nam es `� Property Owner Name ss � dre Ci Zip city Zip Ph a Phone Fax .� ` qq Fax E-mA � J / E Co t7 � L'c No. []Architect Name ❑Designer Name Engineer Name Address Address City Zip city Zip Phone Phone Fax Fax E-mail E-mail License No. Lic ns-L- o. Applicant Name�� Signa Date Contact Telephone Nu ber E-M I NO 36a141+'� PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 • (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org