9710-094 (RC)LICENSED CONTRACTOR DECLARATION
;;^he.,gby 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
Professionals Code, and my License is in full force and effect.
License # It. Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
I, as owner of the property, or my employees with wages as their sole
co . pensation, will do the work, and the structure is not intended or offered for
Sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
( ) I am exempt under Section , B&P.C�/. for this reason
Date Oe 1 ', , �`-'1 Signature of Owner L t, Ve-
1
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one. of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
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 & policy 6o. are:
Carrier Policy No.
Qhis section need not be completed if the permit valuation is for $100.00 or less).
(�,)? 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`. `- F " "" Applicant It -
1 h
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his I
application. -
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
[Certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
tsignature
he above-mentioned property for inspection purposes.
(Owner/Agent) Date -wit
PERMIT°°"TRDL#
BUILDING PERMIT
�►��
6126
DATE JJ�12 i{'P, VALUATION S51000.0f) LOT TRACT
JOB SITE
ADDRESS 7S-4.11 HIGHWAY III
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
tlxnr�Zr r r:ce+rr.
0.. 1 4 1 1 , L.II.aA .. 0.'I't.
�I�er�rr,r� r r�r�:+ ;)�r:» -
II -1\.
i.I♦Y 111wl1 I 1.II A% 11.41
79411 NiGk9WAV III
LA C.4091"A CA 021.53
f`fii,fl
USE OF PERMIT
`iF.1vAW MIILOVIE tT:NT IrORKki t'r4�1. ClOYM S li,3
4 A4,1M111 t D N i,l4 li,ilu 1.3
i.•31 41111 /.4.173 \:' f• t L
d'gy 5
�,RM i 1 3�,�.:+tjR'�MAR 0.r
PLAN FIiF. 101-00-439-318 StIi.�3lt
:i'►'it.t:�PJir hG:J'1'te:1N t-fik: - C�,lt�1�f 1 GU-iriW•2�I1-V1ft� Sk.fT,ti
"�
SI 11:10TAI, C-' �t`;)jtNS"i'tOY,"i'Ir, N ANY'.) Pi,AN 011- ;[K
x,1111 i5
U -SS
Fit H
'#'t'aTAI, ilWl:l CAV
$141J5
OCT z 1 1997
`
DATE-"" " e tt J
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
a
761
'IP71Y lb
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14,4L JID12-0
PROJECT
DESCRIPTION
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DESCRIPTION
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DATE:
| | i
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' ' r I
i I I
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103roHd
l Gemini
200 -.900 Series
Ceiling and Wall Blowers
CAPACITIES FOR GEMINI 200-900 SERIES
Model
Watts
RPM
0.0
SP
0.100 SP
0.125 SP
0.250 SP
0.375 SP
0.500 SP
0.625 SP
0.750 SP 0.875 SP
No.
MaxJBHP
9-3/4
CFM
Sones
CFM
Sones
CFM
Sones
CFM
Sones
CFM
Sones
CFM
Sones
CFM
Sones
CFM Sones CFM Sones
GC -220
41
1050
120
1.2
107
1.2
104
1.1
74
1.3
720,740 10-1/2 4-3/4
36
820, 840, 860 20 6
27
1 141/2
141/2
31-3/8
GC -240
65
1200
147
2.2
130
1.9
127
1.9
100
1.5
15-1/4
86
GC -320
77
1365
213
3.4
201
3.3
198
3.3
184
3.5
165
3.8
GC -340
135,
1610
257
4.9
236
4.5
1232
4.4
212 1
4.3
188 1
4.1
GC -420
170
1145
327
5.3
294
4.2
287
4.0
260 1
3.4
237
2.9
204
2.7
GC -520
172
1205
356
5.9
346
5.7
344
5.7
332
5.5
318
5.0
300
4.6
280
4.3
253 4.0
GC -620
233
960
451
3.7
433
3.3
429
3.3
400
3.3
359
-3.3
296
3.6
__
�rGC-640
351
1075
559
4.6
516
4.3
509
4.3
480
41
424?
3.9:,,r
3474
x,3.8
244
4.1
GC -720
301
1375
709
6.7
690
6.5
684
6.5
1654
6.5
618 1
6.4
578`-6-2-
536
5.9
480 5.7 385 5.4
GC -740
374
1625
852
8.6
826
8.3
818
8.3
776
7.9
726
7.5
672
7.0
615
6.3
1552 5.6 463 5.0
GC -820
287/.162
780
972
5.4
923
5.4
891
5.9
853
6.4
782
7.2
680
8.0
GC -840
373/.224
900
1188
7.0
T13168.8
1129
7.1
1066
7.1
995
7.5
909
7.7
795
8.3
GC -860
430/.333
10701395
9.2
1297
8.8
1205
.8.3
11115
8.0
10231
7.8
904
8.1
718 8.4
GC -92Q
430/.282
925
1471
7.6
14071
7.3
11395
7.3
13481
7.5
12931
7.7
1191
8.0
1019
8.4
GC -940
494/.383
10401653
9.1
115711
0
11554
8.7
1483
8.6
1406
8.4
1291
8.6
1100
8.7
GC -960
564/.476
11121807
10.2
117161
9.7
11694
9.6
1589
9.1
1495
8.7
1385
8.6
111971
8.5
The sound ratings shown are loudness values in fan sones at 5 ft. (1.5 m) in a hemispherical free field calculated per AMCA Standard 301. Values shown are for
Installation Type B: free inlet fan sone levels. Performance shown is for Installation Type B: free inlet, ducted outlet. Performance ratings include the effects of inlet
grill, backdraft damper and outlet duct in the airstream. Speed (RPM) shown is nominal. Performance is based on.actual speed of test.
All motors are 115 volt, I C� A
single phase, 60 cycle.
O --- �- -- r--'
AIRFLOW_
B
Back panel of housing is ' I I II;,5-. '1I I I
interchangeable for air- t i i I [ ] c ] Fi
flow requirements: verti- c: c i,
I I Z� I I
cal or horizontal dis-
charge.
DIMENSION CHART 200 - 900 SERIES
Model No. Outlet
GC A B
Housing
Standard Grille
Deluxe Aluminum Grille
Approx.
Shipping Wt. Lbs.
L
W
H
J
K
J
K
220,240 8 6
12-3/8
9-3/4
9-3/4
16 3/8
13 5/8
13-1/4
10-1/4
22
320,340 8 6
12-3/8
10-3/4
10-3/4
13-1/4
11-1/4
25
420 8 6
17
11-7/8
11-7/8
21
14-1/4
17-3/4
12-3/4
30
520
81/2
32
620?640 10- 4 3/4
35
720,740 10-1/2 4-3/4
36
820, 840, 860 20 6
27
1 141/2
141/2
31-3/8
17-1/8
27-3/4
15-1/4
74
920, 940, 960 24-1/4 6
31
1 141/2
1 141/2
35-1/8
17.1/8
1 31-3/4
15-1/4
86
All dimensions in inches.
2
0.50
0.45
3 0.40
c 0.35
rr 0.30
D
ID 0.25
W
Er 0.20
p 0.15
0.10
0.05
0 30 60 90 120 150
AIRFLOW (CFM)
GC -500 SERIES
GC -800 SERIES
1.00
_ 0.90
0 0.80
3
c 0.70
¢ 0.60
D
� 0.50
W
a 0.40
EL
00.30 d
0.20
0.10
d
0
0 280 560 840 1120 140(
AIRFLOW (CFM)
,
Gemini
200 - 900 Series
Ceiling and Wall Blowers
4 �r
GC -300 SERIES
1.00-
0.90
3 0.80
c 0.70
Q 0.60
D
U) 0.50
a 0.40 C
0.30
G�
0.20
0
0.10
0
0 55 110 165 220 27
AIRFLOW (CFM)
1.00
0.90
�? 0.80
3
0.70
¢ 0.60
U) 0.50
W
M 0.40
H 0.30
0.20
0.10
0
0 120 240 360 480 600
AIRFLOW (CFM)
GC -900 SERIES
5
GC -400 SERIES
1.00
0.90
0 0.80
c 0.70
W ¢ 0.60
7
U) 0.50
d 0.40
v
0.30
0.20
0.10
0
0
70 140 210 280 350
AIRFLOW (CFM)
GC -700 SERIES
1.25
1.12
0 1.00
3
0.88
We 0.75
7)
u) 0.62
a 0.50
y
O
V 0.38
ao
0.25
0.12
0
0
180 360 540 720 900
AIRFLOW (CFM)
1.00
_ 0.90
00.80
3
c 0.70 Gi
0.60
D �o
U) 0.50
W
a 0.40
H 0.30
(F- 0.20 N
0.10
0
0 370 740 1110 1480 1850
AIRFLOW (CFM)
7
GEMINI
L'
DATE: p` Ceiling and Wall Blowers
e
PROJECT: Ls 200-900 Series
LOCATION:
�A�
1910 12 1 "1
W
T —Air Flow' -,
B -
/.1 ham-- K
Grille
r ---1I Ir---�
I lurc3-C]231n1 1
I •� LIC]I� I
I Ic]c](a�l I H
I I Inc31 1 I
I 1 I
L ---J L ---J
Double blower unit Is shown.
Model No.
L
Housing
W
H
Outlet
A
B
Standard Grille
J I K
Deluxe
Aluminum Grille
J I K
Wp WL
220,240
12-3/8
9-3/4
9-3%4
8
6
16-3/8113-5/8
13-1/4110-1/2
22
320,340
12-3/8
10-3/4
10-3/4
8
6
16-3/8
13-5/8
13-1/4111-1/2
25
420 1
17
11-7/8
11-7/8
8
6
21
14-1/4
17-3/4112-3/4
30
520
17
11-7/8.11-7/8
8—
6
_21
14-1/4
17-3/4112-3/4
_32
620,640
-1T
111-7/8.11-7/8
10-1/2
4-3/4
21
14-1/4
17-3/4
12-3/4
35'
720,740
17
11-7/8
11-7/8- 10=1%2 4-3/4
21
14-1/4
17-3/4
12-3/4
36
820,840,860
27
14-1/2
14-1/2
20
6
31-3/8_1
-1/8
27-3/4
15-1/4
74 '
920,940,960
31
14-1/2
14-1/2
24-1/4
6 135-1/8117-
i/-8
31-3/4
15-1/4
86
STANDARD CONSTRUCTION FEATURES:
Forward curved galvanized steel fan wheels — Corrosion resistant
galvanized steel fan housing Acoustically insulated housing —
Aluminum bockdraft damper with solid aluminum hinge rod mounted in
brass bushings — Permanently lubricated motor with built—in thermal
overload protection — Interchangeable panels with removable fasteners
allows the discharge to be easily changed — Internal .wiring box and
receptacle — Powder—pointed white steel grille.
ACCESSORIES
1.. FAN SPEED CONTROL (FSC)
2. ROOF JACK
3. ROOF CAP
4. WALL CAP
5. EAVE ELBOW
6. DELUXE ALUMINUM GRILLE
7. FILTER
8. BRICK VENT
9. CEILING RADIATION. DAMPER
10. HANGING VIBRATION ISOLATOR
11. TIME DELAY SWITCH
12. 277 VOLT TRANSFORMER
CATALOG NUMBER DEFINITION:
GC -220
Series: 220,240,320...
TTYPE: GC '= Ceiling & Wall (includes Grille)
QTY
MARK
CATALOG
NUMBER
(see above)
FAN INFORMATION
MOTOR INFORMATION
ACCESSORIES
CFM
SP
RPM.
HP
VOLTS
HZ
PH
TYPE
MU I UH I YPE: ODP (OPEN DRIP—PROOF); TENV (TOTALLY ENCLOSED NON—VENTILATING).
GM011 R04
)VO -r E
�ii2 LioND/T`oN/i✓C SYSTEM
Roof Curb
Roof Curb Dimension Data
Roof Cap Dimension Data
Model No.
Type
Series
A
B
C
Throat Dia.
PR8
Curb Mount
Little Gem
& 200-900
18-1/4
8-5/8
18
8-19/32
PR8F Flat Base
18-1/4 6-5/8 18
8-19/32
PR20
Curb Mount
1000
2000
37-5/8
15-7/8
32
20-1/2
PR20F I Flat Base
1 37-5/8 13-7/8 32
20-1/2
All dimensions in inches.
\Zv
Model Number
Roof Cap
Roof Opening
A
B
Galvanized Aluminum
VCG -16 VCA -16
PR8
12-1/2 sq.
27-1/2
16-1/2
VCG -30 VCA -30
PR20
26-1/2 sq.
41-1/2
30-1/2
All dimensions in inches.
OCT J7, '9,7 _, 11:40 AN 2 Pose 1
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253
I TELEPHONE (780) 777-7012 FAX (760) 777-7011
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protcaion you should be aware that as "Owner/Builder" you arc the responsible party of record on such a
permit. Building permits are not required to be. signed by property owners unless they arc personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors arc required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They arc also required by law to put their license number on all permits for which they
apply. ,
If you plan to do your own work, with the exception of various trades that you plan to sobcontnct, you should be
aware of the following information for your benefit and protection:
If you employ of otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is =200.00 or more for the entire project, and such persons arc not licensed as contractors or
subcontractors, then you may be so employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes. worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks arc especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and. if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Deparemcnt of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors arc allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor. only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "OwocriBuilder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits arc not required to be signed by property owners unless they arc performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N: Sherr, Sacramento, California 91814.
Please complete and return the enclosed owner builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF IA QUINTA
DEPT. OF BUILDING AND SAFETY
78495 Calk Tampico
La Quina, CA 92233
(760)777-7012
FAX: 60) 77 -7011
fir• /
OWNER'S SI NATURE/DATE
PROPERTY ADDRESS
PERM ITNUMBER(s)