HomeMy WebLinkAboutHVRC18-0309City of Palm Desert
PERMIT NUMBER:
ISSUE DATE:
Building and Safety Department
73510 Fred Waring Drive
HVRC1B-0309
5123/2018
Palm Desert, CA 92260
Permit Type: HVAC CHANGE OUT
Appl. Date: 5/23/2018
RESIDENTIAL
Permit TIER 3-18 OR MORE
Appr. Date: 5/23/2018
Subtype: SEER
Exp. Date: 11/19/2018
Job Valuation: $5,194.00
Project Address: 40785 AVENIDA ROSARIO
Project Description: NEW MINI SPLIT FOR EXISTING CASITA
APN/Tract/Lot No:
Owner:
Contractor:
Applicant:
622340032
KEVIN KIRK
HARRISON ENTERPRISES INC
HARRISON ENTERPRISES INC
TR 24773
40785 AVENIDA ROSARIO
31170 RESERVE DRIVE
31170 RESERVE DRIVE
15
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 oe(ua that I am licensed under provisions of Chapter 9
ARCHIVE FEE - 6.5X11 UP TO 11X17 GL-1100000-341160D $0.21
(commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my license is in full force and effect.
GREEN BLDG FEE SB1473 GL-6100000-2281000 $1.00
Initial
RESIDENTIAL HVAC CHANGE OUT GL-1100000-3221100 $111.30
Total Fees Paid: $112.51
Owner -Builder Declaration
! herebyaffirm under the penaltyofiaw1uryfhaf there is a construction lending agencyror Me
i hereby affirm under penalty of penury that I am exempt from the Contractors' State
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)
Lenders Name and address
to the applicable item(s) Section 7031.5 Business and Professions Code: Any city or
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' State
License Law(Chapter 9(commencing with Section 7000) of DIV s!Dn 3 of the Business
Written asbestos notification pursuant to Pan 61 of Title 4D 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 civi penally 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 Sec. 6602D
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. Code Sec.56020(a) and must be Tiled within 9D
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 already due.
improvement is sold within one year of completion, the Owner -Builder will have the
burden of proving that i1 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 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 Llcensure under the Contractors' State License Law for the
following reasom
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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
SEVIRON 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under the penalty of perlury ONE of the following declarations:
I have and will maintain a certificate of consent to self -insure forworkers'
compensation, issued by the Director of Industrial Relations as provided for by Section
3700 Of the Labor Cade, for the performance of the work for which this peril issued.
Initial
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
Issued. My workers' compensation insurance carrier and policy number are:
Garner& Policy Number
_
Initial
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 I should became subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply Ith th a provislons.
_
Initial
Date Applicant
City of Palm Desert
Department of Building and Safety
Building Permit Application
(For Office Use Only) �
JOB ID: Mfus- () 301
1
PLANS FILED:
Project Address: L10785 vc asar:o Suite #
Total Value of work: $. S., 1 -14 . as Note: Plan Review Fees may be adjusted after Plan Review
Project Description (be specific):,T-, �ss fin;„m
Contractor Business Name
Property Owner Name
Address
3117t7 l��scrv� l�r~
Address
-7$5 vchuQ osaryo
C' Zip
�n 0.A R"L2�
City Zip
ct C'� ciZZlpp
Phone
'7tAc 3 L1-_5- 42E
Phone
'70`7-315 - 1 3cY
Fax
Fax
E-mail
E-mail
Contractor License No.
fo8�310
❑Architect Name El 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
5
Contact Telephone Number
E-Mail
PLEASE COMPLETE THE REVERSE SIDE
73-510 Fred Waring Drive, Palm Desert, CA 92260 • (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org
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