HomeMy WebLinkAboutDeclaration with Smoke CarbonPALM DESERT PERMIT CENTER
73-510 Fred Waring Drive, Palm Desert, California
(760)776-6435 permitcenter@cityofpalmdesert.org
DECLARATION
CONTRACTOR DECLARATION – CONTRACTOR LIC#: PERMIT#:
I Hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code, and my license is in full force and effect.
Worker’s 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 penalty of perjury ONE of the following declarations (MUST CHECK ONE OF THE FOLLOWING):
I have and will maintain a certificate of consent to self-insure for workers’ compensation, as provided for by the Director of Industrial Relations as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain workers’ compensation insurance, as required by Section 3700 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:
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 with those provisions.
Date: Print Name: Signature:
OWNER BUILDER DECLARATION – PERMIT#:
I 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 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) 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 is licensed pursuant to the provisions of the Contractors' State License Law(Chapter
9(commencing with Section 7000) of Division 3 of the Business 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).)
I hereby affirm under penalty of perjury ONE of the following declarations (MUST CHECK ONE OF THE FOLLOWING):
I, as owner of the property, or my employees with wages as their sole compensation, 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 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-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. 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' State License Law for the following reason:
Date: Print Name: Signature:
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CITY OF PALM DESERT PERMIT #_____________
Building & Safety Department
73-510 Fred Waring, Palm Desert, CA (760) 776-6420
SMOKE & CARBON MONOXIDE ALARM RETROFIT
2019 California Residential Code sections R314.8 and R315.2
W here a permit is required for alterations, repairs or additions exceeding $1,000, including exterior work, i.e. roofing,
HVAC change-outs, electrical panel upgrades, windows, etc. existing dwelling or sleeping units that have attached
garages or fuel burning appliances including fireplaces shall have a carbon monoxide alarm.
Smoke and Carbon monoxide alarms shall be installed in the following manner:
•In each sleeping room (only require Smoke Alarms unless bedrooms contain a gas appliance then a carbon
m onoxide alarm is required as well)
•Outside each separate sleeping area in the immediate vicinity of the bedrooms. (require Smoke and Carbon
Monoxide Alarms)
•In each story level of the dwelling, including basements and habitable attic rooms (require Smoke and Carbon
Monoxide Alarms)
•Smoke alarms and smoke detectors shall not be located where ambient conditions, including humidity and
temperature are outside the limits specified by the manufacturer’s published instructions
•Installation near bathrooms. Smoke alarms shall be installed not less than a 3 ft. horizontal distance from the door
or opening of a bathroom that contains a bathtub or shower unless this would prevent placement of a smoke alarm
required by other sections of the code
•Smoke alarms and smoke detectors shall not be installed within 36 in. horizontal path from the supply registers of a
forced air heating or cooling system and shall be installed outside of the direct airflow from those registers
•Smoke alarms and smoke detectors shall not be installed within a 36 in. horizontal path from the tip of the blade of
a ceiling-suspended (paddle) fan
•Smoke Detectors shall be within 10 years of manufacture marked date and/or replaced if such date does not exist
•Conventional Ionization smoke alarms must be installed with a ten year battery
Interconnection:
Where more than one carbon monoxide alarm is required to be installed within the dwelling unit or within a sleeping unit
the alarm shall be interconnected in a manner that activation of one alarm shall activate all of the alarms. Exception:
Interconnection is not required in existing dwelling units where repairs do not result in the removal of wall and ceiling
fini shes, or there is no access by means of attic, basement or crawl space.
The Building Inspector will verify the installation of the smoke and carbon monoxide alarms during the inspection
process or the owner can complete and sign under the penalty of perjury the following:
I understand the above requirements and certify that we now have smoke alarms and carbon monoxide alarms
installed that comply. I agree to comply with the CRC in regards to smoke alarms and carbon monoxide alarms.
I, ________________________________ and I, ______________________________ who own and/or live in the
(Property Owner’s name) (Tenant’s name/same)
Dwelling located at: ____________________________________________________________________________
_____________________________________________ _______________________________________________
Signature of Owner Date Signature of Tenant Date
*This is a voluntary smoke and carbon monoxide alarm verification procedure. If you prefer a building inspector to
perform the verification, you must arrange to have an adult present at the time of inspection.
*Note, this verification is only used when normal access to the interior of the dwelling is not achieved during the course
of project construction. It is normally used for projects such as re-roofing, re-siding, patio covers or swimming pools.
1/31/2020