07-3050 (SOTB)`0
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Tity/ 4 4 Q"
07-00003050
79583 POMO
772-180-063- - -
STRUCTURES OTHER THAN BUILDINGS
LOW DENSITY RESIDENTIAL
5000
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
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 Professionals Code, and my License is in full force and effect.
LicenseC/lass: C27 LicenseNo.: 379421
Date: /" "r%� Contractor:
+ OWNER -BUILDER DECLARATION -
I hereby affirm under pe of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its 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 Contractor's 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 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 1$5001.:
(_ I 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 thereon,
and who does the work himself or herself through his or her own employees, 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 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, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERn1IT
Owner:
HUFFMAN RESIDENCE
79583 POMO
LA QUINTA, CA 92253
Contractor:
ARTISTIC LANDSCAPE INC.
78206 VARNER RD, #D PMD:
PALM DESERT, CA 92211
(760)360-1395
Lic- No.: 379421
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/29/07
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 and policy number are:
Carrier SIRIUS AMERICA Policy Number 01KDRM11000546
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: -z��z Applicant: ' ��
WARNING: FAILURE TO RE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOY:40 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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and -employees for any act or omission related to the work being
performed under or following issuance of this permit.
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.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
ofthis county tto`enter upon the above-mentioned property for inspecti n purposes.
Date: Signature (Applicant or Agent)
Application Number . . . . . 07-00003050
L�
Permit . . .
BUILDING PERMIT
Additional desc . .
r4 Permit Fee
72.00
Plan Check Fee
46.80
Issue Date . . . .
Valuation . . .
. 5000
Expiration Date
5/27/08
Qty Unit Charge
Per
Extension
BASE FEE
45.00
3.00 9.0000
-----------=---------=----------------------------
THOU BLDG 2,001-25,000
--------------------------
27.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
17.25
Plan Check Fee
4.31
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
5/27/08.
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3.00 .7500
-------------------------------------------------------------------=--------
PER ELEC.DEVICE/FIXTURE
1ST 20
2.25
Permit . . .
PLUMBING INV FEE
Additional desc .
Permit Fee . . . .
36.00
Plan Check Fee
4.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
5/27/08
Qty Unit Charge
Per
Extension
BASE FEE
30.00
1.00 6.0000
EA PLB GAS PIPE
1-4 OUTLETS
6.00
-------------------------------7------------------------------------
Special Notes and Comments
BBQ & FIRE PIT "ONLY"
--------------------------------
Other Fees. . .. . .
--------------------------------------------
. . . . ENERGY
REVIEW FEE
4.68
Fee summary Charged
Paid
Credited
Due
Permit Fee Total
125.25
--- --- ----------
.00 .00
125.25
Plan Check Total
55.61
.00 .00
55.61
Other Fee Total
4.68
.00 .00
4.68
Grand Total
185.54
.00 .00
185.54
LQPERMIT
Bin #
City of La. Quinta
Building ex Safety Division
P.O. Box 1504; -78-49.5 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit. Application and Tracldng Sheet
Permit #
Project Address: -7
Owner's Name:
A. P. Number.
Address: 6c
Legal Description:
C'ty, ST, Z'P: Z-, Cs—
Contractor.
Telephone:
Address:#• ZqqProject
Description:
City, ST, Zip: e CGt tivl
�� l r
Telephone i�o, 6
City Lic. #: p
State Lic. # : Z
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:`
State Lic #:
Name of Contact Person: ��
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#'Stories: _
# Units:
Telephone # of Contact Person _..
Estimated Value.of Project: 6 o O
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed TRAdMG .
PERMIT FEES
Plan Sets
Pian Check submitted
i l
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Cheek Deposit
Truss Calcs.
Called Contact Person
Plan Cheek Balance
Energy Caics.
Plans picked up
Construction
07' 8
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2' Review, ready for correetionsrkwue
Electrical
`
IX7
Sabcontaetor ISst
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:-
ew, rea fo
Developer Impact Fee
Planning Approval
UCion
MMM PT.
A I.I'.P.
Pub. Wits. Appr
XI2
School Fees
e
nR CONSTRUCTION
Total Permit Fees
WARNING
HOTI DO NOT TOUCH.
SEVERE BURNS MAY RESULT
CLOTHING IGNITION MAY RESULT.
Glass and other surfaces are hot during
operation and cool down.
• Keep children away.
• CAREFULLY SUPERVISE children in same room as
appliance.
• Alert children and adults to hazards of high
temperatures.
• Keep clothing, furniture, draperies and other
combustibles away.
Installation and seance of this appliance should be performed
by qualified personnel Hearth &Home Technologies
suggests NFI certified or factory-trained d
�HSTIT�'- professionals, or technicians supervised
by an NFI certified professional.
STANDARD: IAS US requirements for Outdoor
Gas Fireplaces, Draft 4-96 and ANSI 221.58-19951
CGA 1.6 M96 C. High Altitude Installations
U.L. Listed gas appliances are tested and approved without
The Patio Campfire has been tested in accordance with requiring changes for elevations from 0 to 2000 feet in the
IAS US requirements for Outdoor Gas Fireplaces, U.SA and Canada.
Draft 4-96 and ANSI Z21.5849951CGA`1.6-M96 for Cana-
da and has been listed by Underwriters laboratory (UL) for When installing this appliance at an elevation above 2000 it,
installation and operation as described in these installation it may be necessary to decrease the input rating by chang-
and operating instructions. ing the existing burner orifice to a smaller size. Input rate
should be reduced by 4% for each 1000 It above a 2000 It
The installation must conform with local codes or. in the elevation in the U.S.A., or 10% for elevations between 2000
absence of local codes, with the National Fuel Gas Code and 4500 It in Canada. If the heating value of the gas has
ANSI Z223.1I or CANICGA-B149.1, National Gas Instal- been reduced, these rules do not apply: To Identify the prop-
lation Code or CANICGA-81149,2, PropaneInstallation er orifice size, check with the local gas utility.
Code.
If installing this appliance at an elevation above 4500 It (n
Canada), check with local authorities.
I
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4 Heat-N-Glo L festytes - Patio Campfire • 4004-001 Rev 0.07105
-- — —17T- i
Max input
Model
B't`OH
Orifice Size
PCF-HNG
75,000
#27/.144
PCFL-HNG
60,000
#44/.086
STANDARD: IAS US requirements for Outdoor
Gas Fireplaces, Draft 4-96 and ANSI 221.58-19951
CGA 1.6 M96 C. High Altitude Installations
U.L. Listed gas appliances are tested and approved without
The Patio Campfire has been tested in accordance with requiring changes for elevations from 0 to 2000 feet in the
IAS US requirements for Outdoor Gas Fireplaces, U.SA and Canada.
Draft 4-96 and ANSI Z21.5849951CGA`1.6-M96 for Cana-
da and has been listed by Underwriters laboratory (UL) for When installing this appliance at an elevation above 2000 it,
installation and operation as described in these installation it may be necessary to decrease the input rating by chang-
and operating instructions. ing the existing burner orifice to a smaller size. Input rate
should be reduced by 4% for each 1000 It above a 2000 It
The installation must conform with local codes or. in the elevation in the U.S.A., or 10% for elevations between 2000
absence of local codes, with the National Fuel Gas Code and 4500 It in Canada. If the heating value of the gas has
ANSI Z223.1I or CANICGA-B149.1, National Gas Instal- been reduced, these rules do not apply: To Identify the prop-
lation Code or CANICGA-81149,2, PropaneInstallation er orifice size, check with the local gas utility.
Code.
If installing this appliance at an elevation above 4500 It (n
Canada), check with local authorities.
I
i
i
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i
i
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4 Heat-N-Glo L festytes - Patio Campfire • 4004-001 Rev 0.07105
-- — —17T- i
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OF LA QUINTA
CITY
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ZOF 1A
FETY DEPT.
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j $ IF f d APPROVED BY SCALE I e ." F+ DftAN/A[ F3Y zf
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BATE � � REVISED
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-. DRAWING .HUMBER -
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RAFTING FORM NO. 101.63 -
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