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HomeMy WebLinkAboutHVRC18-0177City of Palm Desert PERMIT NUMBER: ISSUED DATE: Building and Safety Department f 73510 Fred Waring Drive HVRC18-0177 4161201812:00:00 AM r Palm Desert, CA 92260 Permit Type: HVAC CHANGE OUT Appl. Date: 4/6/2018 RESIDENTIAL Appr, Dare: 416l2018 Permit TIER 3-18 OR MORE Subtype: SEER Exp. Date: 10/3/2018 Job Valuation: $3,932.00 Project Address: 40810 AVENIDA ROSARIO Project Description: APNlTract/Lot No: Owner: Contractor: Applicant: 622340020 JUDITH A BELLE TIMO'S AIR CONDITIONING & TIMO'S AIR CONDITIONING & TR 24773 40810 AVENIDA ROSARIO HEATING INC HEATING INC 3 PALM DESERT CA, 92260 72232 CORPORATE WAY 72232 CORPORATE WAY THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 (760)770-4357 (760)770-4357 Licensed ContagAor Declaration Fee Summary I hereby affirm under penally of Penury that t am licensed under provisions of Chaptor 9 (commencing with Section 7D00) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ARCHIVE FEE-8.5X11 UP TO 11X17 GL-1100D00-3411600 $0.42 GREEN BLDG FEE SB1473 GL-6100000-2281000 $1,00 — Initial RESIDENTIAL HVAC CHANGE OUT GL-1100000�3221100 $111.30 Total Fees Paid: $112.72 Owner -Builder Declaration 1 hereby affirm under penalty of Perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next 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 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 %commencing with Section 7000) of Division 3 of the Business Print Name: 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 applicant to a civil penalty of not more than five hundred dollars ($500),) 1, as owner of the property, or my employees with wages as their sole compensation, Signatureof Applicant or Agent will do the work, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Cade: The Contractors' Stale License Law does not apply to an owner of property who builds or improves the property, provided that the Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner-Bullderwill have the Data: burden of proving that It was not built or improved for the purpose of safe.) 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's 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 reason: Date/Signature of property owner or agent Workers' Compensatjgn Declaratlon WARNING: FAILURE To SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS I$1 ae,00a), IN ADDITION TO THE COST OF COMPENSATION DAMAGE$ AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under the Penalty of perjury ONE of the following decrarotlons: I have and wilt maintain a certificate of consent to selNnsure forworkers' compensation, issued by the Director of Industrial Relations as provided for by Section Initial 3700 of the Labor Code, for the performance of the wont for which this permit issued. Policy No. 1 have and will maintain workers' compensation insurance, as required by Section 700 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 Carrier S. Policy Number 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 become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply ith those provisions. e )nitlal 4 !g r Cale Applicant City of Palm Desert Department of Building and Safety Building Permit Application (For Office Use Only) t JOB ID: Ar)� (_ tISJ PLANS FILED: Project Address: 140 R%D Suite # Total Value of work: $ 3 , q 32.. CX:) Note: Plan Review Fees maybe adjusted after Plan Review Project Description (be specific): ce_ (A. -Ale_ss. S Contractor usiness Name i i , G '-iaa��r� Property Owner Name �eAl� Address � ` �23Z CC7 Y' e kJ Address A bs to A venue- a cit ' Zip 1 0.1<n CA °[Zz?cam City Zip VS. L1 �eset� CA 9z2�o Phone '76o--no- Phone 32.3 - koi- all? Fax Fax E-mail E-mail Contractor License No. a 2 04(cZ ❑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 Contact Telephone Number E-Mail 73.5- 78-%. PLEASE COMPLETE THE REVERSE SIDE 73-510 Fred Waring Drive, Palm Desert, CA 92260 - (760) 776-6420 - (760) 776-6392 fax - www.cityofpalmdesert•org iW M Q Q p O J� cc m 0 �i Y N sL u -c L m Q. 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