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Home My WebLink About2020-4310 (1)City of Palm Springs BUILDING PERMIT 4 Building Address: 250 Burton Way Date 12131/2020 Case Nz: Permit Angela LaFrance Submitted Technician Owner Address Prone Michael Ricks 250 Burton Way 760 409 1669 Palm Springs CA Contractor Address Phone Lic Number Frassica Inc. 580 Malloy Ct 951 8175252 987860 Corona CA Architect Address Phone Engineer Address Phone Lot# Block# Traci Para I Number 86 ENCHANTHOME3 5D2.092-013 Lot Size Zone Occupancy 10400 Building Sq,Ft, GaragerCarparl Rooled Patio/Porch Remodeled Area New Use of buddwg Permil Typi, Const.Type Fixture Units SFD GastWaterRe-pipe Fire Sprinkler Units Valuation Penrit Fees Paid 4000.00 179.89 Descr be w,.,,rk in detail: Gas repipe from meter to point on entry into house. Special Conditions. 00 N)- CONCEAL OR COVER ANY CONSTRUCTION UNTIL. THE WORK IS INSPECTED IMPORTANT The issuance of this perm I shall not be held to be an approval of the violation of any provisions of any city or county ordinance or state law. Inspections of work are sub.ec',to an approved set of plans being on the job Changes to plans are not to be made without permission of the Building andSafetyDivisions The owner and/or contractor is responsib!e for establishing all property lines All utilil es must be underground This permit will expire if work is not started n 180 days or if more than 180 days siapses between inspections I certify that I am familiar with all requirements of the City of Palm Springs as they apply to this permit and understand that these requirements must be completed prior to fin inspectionection and that no certification of occupancy will be issued until such hrne as th quirenrients are met. I certify that I have Ir rrereadthisapplicatistatetheinformationistrueandc4rectj Ow TJG' TOR/AGENT 41 tcokgODATEIS —D BY Fioaled Thi Is bui in mit when proper y filled out,signed and validated,and is not transif rabfe, PERMIT NUMBER 2020-4310 4aLMS4 INSPECTION INFORMATION No work shall be concealed without a signature by the inspector. t^ rf°0' .. The approved plans and this card must always be available to the inspector. Preserve this record. Every permit issused shall become invalid after 180 JOB CARD days unless a required inspection has been approved. Furthermore, permits expire when more than 180 days has elapsed from the date of the last approved Project address: 250 Burton Way required inspection. Permit #: 2020-4310 Inspection hours 8AM -4PM Monday -Thursday CONSTRUCTION HOURS Inspection request line(760)323-8243 Building Department(760)323-8242 Weekdays 7am to 7pm Building Department Fax(760)322-8342 Saturdays 8am to 5pm Sundays & Holidays Not Permitted GAS&WATER REPIPE INSPECT NS JOB NOTES:Gas pressure test Rough/Bonding Repipefinal CITY OF PALM SPRINGS BUILDING PERMIT APPLICATION Date : 12/23/2020 Plan Check Deposit Fees: Building:Fire: Project Address 250 N Burton Way Assessor's Parcel # Owner's Name Michael Ricks Phone #760-409-1669 Owner's Address 250 N Burton Way, Palm Springs, Ca, 92262 Contractor's NameFrassica Inc. Phone #951-817-5252 Llc# 987860 Contractor's Address580 Malloy Ct, Corona, Ca, 92878 Architect's Name Phone#Lic.# Architect's Address CONTACT PERSON James Gardner, Frassica Inc Address 580 Malloy Cy, Corona, Ca, 92878 PHONE951-906-4270 FAX EMAILjim.frassica@outlook.com Business License. #20024388 Exp. Date10/31/21 Lot Size (sf.) Building Use Residence Type of Const.Plkumbing Occupancy Group(s) Sprinkled Project SQ Ft:Building Garage Carport Patio (type) Project Description Replace Gas Line to the home.Total Value of Work$4,000 All submittals of New Construction (Single Family Residence), and Additions (including Casitas) are subject to Public Works and Engineering Conditions of Approval. All required Conditions of Approval for the project must be submitted and/or addressed directly to Engineering and Public Works by the Applicant for review, approval and issuance of all grading and encroachment permits. WHERE INDICATED BY A CHECK, SUBMIT 4 SETS Minimum size of plans *18 x 24" Minimum scale '/4" =1';Maximum size of plans 40" x 36") Complete Application Mech. Plan / Duct Schematic, Equipment Location Plot Plan with lot square footage.Fireplace Specifications, if applicable Drainage Plan: show lot corner elevations. Planning / Fire approval / Engineering Approval Structural Calculations, if applicable Fire Sprinkler plans (required at time of submittal) wet-stamped and signed) FloorPlan, dimensioned. Door & Window Schedule Submit the following directly to the Engineering Framing Plan with sections and elevations Department: Truss Calculations and layout as applicable ENGINEERING SERVICES: Min Requirements, wet-stamped and signed) proiect maybe subject to additional conditions of Foundation Plan approval (Submit 1 copy of the following ). Electrical Plan/Load Calculations 0 Site Plan with the following Finish Floor Elevations Health Department approval of: Existing, Proposed and Immediate Adjacent Homes Waste, Drain & Vent Isometric J Title report or Grant Deed with a Tax Bill showing Gas/Water Piping Isometric (dimensioned layout) current ownership Details showing compliance with accessibility 2 RIFA (Red Imported Fire Ant Certificate)for any requirements export of soil from the site Site Plan showing parking for persons with Z PM-10 (Dust Control) for projects of more than 5000 disabilities and path of travel to building entrance square feet of soil disturbance Title 24 (Energy)—2 sets/ Lighting Compliance Forms 0 Tribal Clearance Letter for all New Construction Manufacture's brochure for HVAC equipment not required for additions or Casitas) Bldg. Plan Check# urePlanningCase# Signat i A 07103/CERTIFICATE OF LIABILITY INSURANCE DATDIYVYY) 7/03/20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Aon Risk Services,Inc of Ronda NAME: Aon Risk Services,Inc of Florida 1 00 1 Brickell Bay Drive,Suite#1100 PHONE FAX Miami,FL 33131-4937 A/C,No Ext:800-743-8130 A/C No):800-522-7514 EMAIL ADDRESS: ADP.COI.Center Aon.com INSURER(S)AFFORDING COVERAGE NAICJ INSURER A: New Hampshire Ins Cc 23841 INSURED INSURER B: ADP TotalSource DE IV,Inc. 10200 Sunset Drive INSURER C: Miami,FL 33173 ALTERNATE EMPLOYER INSURER D: Frassica,Inc. INSURER E: 580 Malloy Ct Corona,CA 92880 INSURER F: COVERAGES CERTIFICATE NUMBER:2987624 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDIYYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE 7 OCCUR PREMISES(Ea occurrence) $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT 71 LOC PRODUCTS-COMP/OP AGG $ OTHER OMBINED TIN LE LIMI AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEC I I RETENTION$ WORKERS COMPENSATION X PER OTH- A AND EMPLOYERS'LIABILITY YIN WC 027115079 TN 07/01/20 07/01/21 STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT 2,000,000 Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) All worksite employees working for FRASSICA,INC.,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy. FRASSICA,INC.is an alternate employer under this policy. CERTIFICATE HOLDER CANCELLATION Frassica,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 580 Malloy Ct THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Corona,CA 92880 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0"701i AL6A(jd tv1ee_4, qnc of(fIo cicla 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Frassica, Inc. Facility Support Contractor Li cense#987860 To Whom it May Concern: I Kenneth McCarthy hereby authorize the following person Lim Gardner to act as an agent to apply for,sign, and file the documents necessary to pull building permiit/s for Frassica Inc.I declare under penalty of perjury that I am the authorized owner/officer of the above referenced contractor license number and certify to the accuracy of this authorization form. if you have any questions or concerns, please contact me at the office. Thank you, Signature: Printed Name: Kenneth McCarthy 4/17/20 951-817-5252 Service.frassica@outlook.corn F 3 J J t S80 Malloy Ct Corona CA 92880 OWNER/BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason(Section 70 31.5, Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any Structure prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law Chapter 9 commencing with Sec.7000 of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom 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).) Please 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 of the Business and Profession Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvementPgpovement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for the purpose of sale.) I,as owner of the property, am exclusively contracting with licensed contractors to construct the project(Sec. 7044 of the 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 contractor(s)licensed pursuant to the Contractor's License Law.) I am exempt under Sec. of the Business and Professions Code for this reason: Owner Signature: Date: LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that I am licensed under the 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.The following applies to B contractors only: I understand the limitations of Section 7057 related to my ability to take prime contracts or subcontracts involving specialty trades. License Class: C36 State Lic. No.: 987860 City Bus. Lic. No. 20024388 Print Name on License: Frassica Inc Phone: 951-817-5252 Address: 580 Malloy Ct, Corona, Ca, 928787 Every county or city which requires the issuance of a permit as a condition precedent to the construction,alteration,improvement,demolition or repair of any building or structure shall require that each applicant for the permit sign a declaration under penalty of perjury verifying workers'compensation coverage or exemption from coverage as required by Section 19825 of the Health and Safety Code.I,hereby affirm under penalty of perjury one of the following declarations: 1 HAVE AND WILL MAINTAIN A CERTIFICATE TO SELF INSURE for worker's compensation as provided for 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: Carrier: American Home Assurance Co Policy No. 027119620 I CERTIFY that in the performance of work for which this permit is issued, I SHALL NOT EMPLOY ANY PERSON, in any manner so as to become subject to the worker's compensation laws of California, and agree that if I should become subject to the worker's compensation provisio of Section 3700 of the Labor Code, I shall for with comply with those provisions. Contractor or Agents Signature: Date: I 3 a Disclosure Form Ci alm Springs, CA Page 1 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California Countt y of t On v_. L, ___,— before me, Date // p Here Insert Name and Title of the Officer personally appeared r j 1 MC C6, M% Namg(s) of Signer(s) who proved to me on the basis of satisfactory evidence to bet erson whose name( is are Ccribed to the within instrument and ackno dged to me that he she/thej`executed the same in hi ser/their authorized capacity(ies), and that b hi her/their signatur on the instrument the person or the entity upon behalf of which the personNacted, executed the instrument. I certify under PENALTY OF PERJURY under the laws Will,i l 1,., of the State of California that the foregoing paragraph V.\521g7.,jj . is true and correct. F?°`a.YoPlidtiy j YWITNESSm hand and official seal. VYM 4 V y Signa re. Signat e of Notary Public cMa'I Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name:Signer's Name: y; Corporate Officer — Title(s): .....___......._...____._...___.. a Corporate Officer — Title(s): 11 Partner — _1 Limited LI General 7 Partner — -1 Limited C1 General 1-1 Individual D Attorney in Fact 11 Individual I__!Attorney in Fact 1 Trustee 1 I Guardian or Conservator I_'Trustee i;Guardian or Conservator J Other:I_ Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 4 07/03/2 YYYY) CERTIFICATE OF LIABILITY INSURANCE DATE( 03/20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Aon Risk Services,Inc of Florida NAME: Aon Risk Services,Inc of Florida 1001 Brickell Bay Drive,Suite#1100 PHONE FAX Miami,FL 33131-4937 AIC,No,E:t:800-743-8130 A/c No):800-522-7514 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: American Home Assurance Co. 19380 INSURED INSURER B: ADP TolalSource DE IV,Inc. 10200 Sunset Drive INSURER C: Miami,FL 33173 UC/F INSURER D: Frassica,Inc. 580 Malloy Ct INSURER E Corona,CA 92880 INSURER F: COVERAGES CERTIFICATE NUMBER:2950172 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO IENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 71 PROJECT LOC PRODUCTS-COMP/OP AGG $ OTHER OMBINEDSINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEC I I RETENTION$ WORKERS COMPENSATION X I PER OTH- A AND EMPLOYERS'LIABILITY YIN WC 027119620 CA 07/01/20 07/01/21 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT 2,000,000 Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 21000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) All worksite employees working for FRASSICA,INC.,paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION Frassica,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 580 Malloy Ct THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Corona,CA 92880 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / Aon p7 L3k(JG't:ivtee3, Q.nC o Iflog ida 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD tb i-s C'. "'7" *0, Replace gas line with same size T e- WA e. on exterior only. No changes to ip tee_ Cj C,&,.,,O b0 ,Q k existing BTU demands. i ro C C)oe 4roVkA4,Q. APPROVED By Angela LaFrance at 11:33 am, Jan 04, 2021 FD--JCoviN saS Yn t. Z V 7-0 kAowf— ol 1/13/2021 City of Palm Springs I Online Receipt ALM ity ,,,f Palm 1 I" pririgs 3200 E. Tah uitz Canyon Way Jacob Azar,Audit&Rev Supervisor Palm Spj ings,-Qafifornia (QA)-22262 1 760-323-8249 Jacob.Azar(@r)almsp *ingaca.ggy Invoice Number: 20204310 Item 1 179.89 I................. I.......I... - ... Subtotal 179.89 Total Taxes 0.00 Total 17989 I.............. ............. .......... PAYMENT ID: PNSMGFlJKN176 Hide Details Card: MASTERCARD 8771 D1 January 13,2021, 1:26 PM Method: INTERNET TRANSACTION Auth ID: 50019Q Reference ID: 101300510494 Authorizing Network: MASTERCARD I.................. DATE MASTERCARD January 13,2021 1:26 pm 8771 View the Privacy Policies for Clover https://www.clover.com/tx/p/PNSMGFlJKN176 1/2