HomeMy WebLinkAboutHVRC19-0438City of Palm Desert
PERMIT NUMBER:
ISSUE DATE:
Building and Safety Department
yVRC19-0438
73510 Fred Waring Drive
Palm Desert, CA 92260
Permit Type: HVAC CHANGE OUT
Appl. Date: 7/312019
RESIDENTIAL
Permit TIER 2-16 TO 17 SEER
Appr. Date:
Subtype:
Exp. Date:
Job Valuation: $8,000.00
Project Address: 47362 AVENUE JADIDA
Project Description: REPLACE 4TON CONDENSER AND 3TON CONDENSER
APN1Tract/Lot No:
Owner:
Contractor:
Applicant:
630360020
KIMBERLIE JOAN BONSALL
A#1 SERVICES HEATING & AIR
TR 5904
47362 AVENUE JADIDA
CONDITIONING
20
PALM DESERT, CA 92260
78206 VARNER RD #D-189
PALM DESERT, CA 92211
(760)565-2691
Licenseo Contractor Declaration
Fee Summary
�5
I hereby affirm under penalty of oedury that I am licensed under provisions of Chapter 9
ARCHIVE FEE - 8,5X11 UP TO J 1X17 GL-11000DO-3411600 $0,35
(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
IRiYial
RESIDENTIAL HVAC CHANGE OUT GL-1100000-3221100 $135.15
Total Fees Paid: $136.50
Owner -Builder, Dpolaration
I hereby affirm under penalty of Pedury that I am exempt from the Contractors' Stale
i herebyWiirm under the penahyof perjury that there is a construction lending agency for the
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, Civif Code)
to the applicable item(s) Section 7031.5 Business and Professions Code: Any city or
Lenders Name and address
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(commencing with Section 700D) 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 construction that does or does not certain
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 Code Sec. 66020
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
(a). The protest must satisfy the requirements of Gov, Code Sec.66020(a) and must be filed within 90
days of the date of this notice. In lender
an owner of property who builds or improves the property, provided that the
addition, you must payment of the protested fees at the time of
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 iicensed 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 Licensure under the Contractors' Slate License Lew for the
following reason:
DatelSignature of property owner or agent
WtZkers' 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
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under the penalty of pedury ONE of the followina declarations:
I have and will maintain a certificate of consent to selfuinsure for workers'
cam pensation, Issued by the Director of Industrial Relations as provided for by Section
3700 of the Labor Code, for the performance of the work for which this permit issued.
im4tial
Policy No.
I have and will maintain workers' compensation insurance, as required by Section
5,
3700 of the Labor Code, for the performance of the work far which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier & 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 become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, t shall forthwith
comply wi h those pro visions.
Date -3 / Applicant ��—
_
lmitlal
Total Value of work: $ 8,000.00
(For Office Use Only) f
JOB ID: �`I
PLANS FILED:
Suite #
Note: Plan Review Fees may be adjusted after Plan Review
Project Description (be specific): Replace 4 ton 148,000 BTU complete HVAC system, replace 3 ton / 36,000 BTU complete HVAC system
Contractor Business Name
A#1 Services Heating & A/C
Property Owner Name
Kim Bonsall
Address
78206 Varner Road #D-189
Address
47362 Jadida Avenue
city Zip
Palm Desert, CA 92211
City Zip
Palm Desert, CA 92260
Phone
760-565-2691
Phone
760-340-4959
Fax
Fax
E-mail
E-mail
Contractor License No.
977333
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.
Al2plicant Name
Signature
Date
`
Steven Schnierer�
July 3, 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 a (760) 776-6420 a (760) 776-6392 fax a www.cityofpalmdesert.org
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