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Home My WebLink AboutWTRH19-0087City of Palm Desert PERMIT NUMBER: ISSUE DATE: Building and Safety Department WTRH19-0087 73510 Fred Waring Drive 8126/2019 Palm Desert, CA 92260 Permit Type: WATER HEATER Appl. Date: 8/26/2019 Permit STANDARD CHANGE" Appr. Date: 812612019 Subtype: OUT Job Valuation: $2,300.00 Exp. Date: 2/22/2020 Project Address: 40755 AVENIDA ROSARIO Project Description: APN/Tract/Lot No: Owner: Contractor: Applicant: 622340033 RONALD D BACKER HARRISON ENTERPRISES INC HARRISON ENTERPRISES INC TR 24773 40755 AVENIDA ROSARIO 31170 RESERVE DRIVE 31170 RESERVE DRIVE 16 PALM DESERT, CA 92260 THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 (760)343-7488 (760)343-7488 Licensed Contractor Declaration Fee Summary I hereby affirm under penalty of oeriury that I am licensed under provisions of Chapter ARCHIVE FEE- B,5X11 UP TO 11 X1 7 GL-1100DOO-3411600 $0.14 ommending with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. GREEN BLOG FEE SB1473 GL,6100000-2281000 $1.00 Initial WATER HEATER CHANGE CUT GL-1100000-3221100 $56,00 Total Fees Paid: $57.14 Owner -Builder Declaration I hereby affirm under the penattyof perjury that there is a construction fending agency for the 1 hereby affirm under penalty of oeriury that I am exempt from the Contractors' Stale License Law for the reason(s) indicated 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 andaddress 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(commenc'mg 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 constructlon 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 sole compensation, NOTICE: You may protest any of the fees for this permit in accordance with CA Gov Cade 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 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. 7D44, 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 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 CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001, IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 1706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES. - I_herebv affirm under the Penalty of aoriury ONE of the following declarations: I have and will maintain a certificate of consent to self4nsure 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 forwhich this permit issued. Initial Policy No. I have and will maintain workers' compensation Insurance, as required by Section �70D 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 Cartier ti Policy Number CYPRESS INSURANCE COMPANY HAW0012965 Expiration Date 5/112020 1 certify that in the performance of the wont forwhich this permit Is Issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith Comply lth those provmons. v 7 _ Initial Date 8 —;o � i � Applicant City of Palm Desert Department of Building and Safety Building Permit Application (For Office Use Only) JOB ID: PLANS FILED: Project Address: 40755 Avenida Rosario Suite #r' Total Value of work: $ 2,300.00 Note: Plan Review Fees may be adjusted after Plan Review Project Description (be specific): Replace 50 gallon gas water heater, UEF .63 Contractor Business Name General Air Conditioning Property Owner Name Ronald Backer Address 31170 Reserve Drive Address 40755 Avenida Rosario City Zip Thousand Palms, CA 92276 City Zip Palm Desert, CA 92260 Phone 760-343-7488 Phone 760-636-0404 Fax Fax E-mail E-mail Contractor License No. 686310 El 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 Date Steven Schnierer August 26, 2019 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