HomeMy WebLinkAboutHVRC18-0240City of Palm Desert
Building Safety Department
PERMIT NUMBER:
ISSUED DATE:
and
73510 Fred Waring Drive
HVRCI8-0240
4/30/2018 12:00:00 AM
Palm Desert, CA 92260
Permit Type: HVAC CHANGE OUT
Appl. Date: 4/30/2018
RESIDENTIAL
Appr. Date: 4/30/2018
Permit TIER 1-LESS 15 SEER
Subtype:
Job Valuation: $10,000.00
Exp. Date: 10/27/2018
Project Address: 41733 AVENTINE CT
Project Description:
APN1Tract/Lot No:
Owner:
Contractor:
Applicant:
622051064
JAY O MOORE
ALL SEASONS A/C PLUMBING
ALL SEASONS A1C PLUMBING
TR 14079 & INT IN
8194 W DEER VALLEY RD
AND HEATING
AND HEATING
COMMON AREAS
PEORIA AZ, 85382
75450 GERALD FORD STE303
75450 GERALD FORD STE303
109
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)56B-2663
(760)568-2663
Licensed Contractor Dg,Jaratiom
hereby affirm undec penal!yof peurvthat I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Cade,
and my license is in full force and effect.
Fee Summary
ARCHIVE FEE - 8.5X11 UP TO 11X17 GL-1100000-341leOD $0.28
GREEN BLDG FEE SB1473 GL-5100000-2281000 $1.00
-
_
hillier
RESIDENTIAL HVAC CHANGE OUT GL-1100000-3221100 $15g.00
Total Fees Paid: $150,28
Owner -Builder Declaration
I hereby affirm under penalty of Dal that I am exempt from the Contractors' State
License Law for the reasol 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' Stale
License Law(Chapter 9(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 sale compensation,
SignafureofApplicant or Agent:
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
an owner of properly 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 -Builder will have the
pate:
burden of proving that it was not built or improved for the purpose of sale.)
ElI,
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 Licensure under the Contractors' Stale License Law for the
fallowing 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 CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($101),000), IN AODrTION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTDRNEY'S FEES,
I hereby affirm under the penalty of Parlury 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
Initial
3700 of the Labor Code, for the performance of the work for which this permit issued.
Policy No.
have and will maintain workers' compensation insurance, as required by Section
700 of the Labor Code, for the performance of the work forwhich this permit is
issued. My workers' compensation insurance carrier and policy number are;
Initial
Cartier & Policy Number
Expiralion 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 37CO of the Labor Cade, I shall forthwith
-
comply ith thus provisions.
y
Initial
Date �� g Applicant L ~�
City of Desert
Department -of Building and Safety
Building Permit Application
Project Address: 41733 Aventine Court
Total Value of work: $ 10,000.00
(For Office Use Only)
JOB ID: �VPTI?;--QJ40
PLANS FILED:
Suite #
Note: Plan Review Fees may be adjusted after Flan Review
Project Description (be specific): Replace 4 ton / 60,000 BTU complete HVAC system
m
Contractor Business Name
All Seasons A/C Plumbing & Heating
Property Owner Name
Joy Moore
Address
75-450 C;Prnld Ford Drive Suite 303
Address
4J733 Aventine Court
city Zip
Palm DesertCA 92211
City Zip
Palm Desert CA 92260
Phone
760-568-2663
Phone
760-567-8087
Fax
Fax
E-mail
E-mail
Contractor License No.
827420
❑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
�-�-4 - ---�_
April 30, 2018
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 9 (760) 776-6420 • (760) 776-6392 fax • www.cityofpalmdesert.org
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