05-4697 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
t.05-00004697'
55569 SOUTHERN HILLS
775-200-012- - -
STRUCTURES OTHER THAN BUILDINGS
LOW DENSITY RESIDENTIAL
200
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Owner:
GOELLNER THEODORE C
.55569 SOUTHERN HILLS
LA QUINTA, CA 92253
VOICE. (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/19/05
I]
Contractor:
Applicant:_ Architect or Engineer:
BRYAN INVESTMENTS GROUP;. INC.
®
WCC: GRANITE STATE F
/�oo�
WC: 1518726 03/29/06
C1, �,
CSLB: 552140 06/30/06
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION. '
-'� I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commen ' with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.: - -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Vetf+� Contrac (/✓ ' `�
- �( 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: -
I hereby affirm under penalty of per r that I am exempt from the Contractor's State License Law for the • -
Carrier B C53 - . -Policy Number ---------------
--------------following
following reason (Sec. 7031.5, Business and Professions Code: Any -city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
- ' 3700 of the Labor Cod I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
//O� /r>< -
any applicant for a permit subjects the applicant to a civil'penalty of not more than five hundred dollars ($500).:
Da pplicant:
(_) 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
WARNING: FAILURE TO SECURE 0 CERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
- -Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRI N L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITIO TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ,.
- -- improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
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.).
APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property; am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
- 7044, Business and Professions Code: The Contractors' State License Law does•not apply to an owner of ,
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
- 1. Each person upon whose behalf this application is made, each person at whose request and for
- pursuant to the Contractors' State License Law.).
- whose benefit work is performed under or pursuant to any permit issued as a result of this application,
- (_) I am exempt under Sec. , B.&P.C. for this reason
- the owner; and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
- -
of La Quints, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
Date:' Owner:
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
- .. • CONSTRUCTION LENDING AGENCY
- permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above,information is correct. I agree to complywithall
work for which this permit is issued (Sec. 3097, Civ. C.). _
city and county ordinances and state laws relating to building onstruction,and hereby authorize resentatives
this nspection
ra Lender's Name:
of ou`nty to enter upon the above-mentioned property purposes.
//4
Ddt-e: aD 1105ignature (Applicant or Agent): ✓�'
Lender's Address:
'
LQPERMIT
,
I]
Application Number
05-00004697
Permit . .
BUILDINd PERMIT''
- Additional- desc= .
Permit Fee
15.00 Plan Check Fee
9.75
Issue Date
Valuation
200
-Expiration Date..
4/17/06
Qty Unit. Charge
Per.
Extension
BASE• FEE
15.00
Permit
PLUMBING
Additional desc .
Permit Fee
18.00 Plan Check Fee
4•.50
-Issue Date
Valuation . . .
0
Expiration Date ..
4/17/06
Qty Unit Charge
-,,Per.
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
------------------------------------- --------------------------------------
Special Notes and Comments
REMODEL EXISTING BARBEQUE, ADD FIREPIT.
"
Other'Fees . . . . .
. . . . ENERGY REVIEW FEE
.98
Fee summary Charged Paid Credited.
Due
Permit Fee Total
33.00 .00 .00
33.00
Plan Check .Total
14.25 .00 .00
14.25
Other Fee Total-
.98 .00 .00
.98
Grand Total'.
48.23 .00- .00
48.23
LQPERMIT
G- LO
GAS-FIRED HE.ATw N, Y.
L��cStyk'Produ�ctS
C ®L us
LISTED
INST
IMPORTANTI Read all instructions carefully before
starting installation. Failure to follow these installa-
tion instructions may result in a possible fire hazard
and will void.the.warranty. :.,.. .
Do not store or use gasoline or other flammable
vapors and liquids in the vicinity of this or any other
fireplace.
What to do if yousmell gas ,
• Do not try to light any appliance.
Do not touch any electrical, switch; do not use
-any phone in your building.
• Immediately call your gas supplier from a
neighbor's phone. Follow the gas supplier's
instructions.
If you cannot reach your gas supplier, call,the fire
department
Installation and service must be performed by a
qualified installer, service agency or the gas supplier.
This manual must be used for installation and retained by the homeown
future, er for operation and maintenance: Save this manual for
reference)
If you have questions"or concerns, please contact the Technical Services Dept., Hearth 8 Home Technologies Inc., 1-800-927-6841
.or 1-888-427-3.M. +
This product is covered by one or more of the following patents: (United States) 4,112,913; 4,408,594; 4,422,426; 4,424,792;,4,520,791; 4,793,322; .
4852,548; 4,875,464, 5,000,162; 5,016,609; 5,076,254; 5,191,877;5,218,953; 5,328,356; 5,429,495; 5,452,708; 5,542,407; 5,613,487; (Australia)
543790; 586383; (Canada) 1,123,296; 11297,746; 2,195,264; (Mexico) 97-0457; (New Zealand) 200265; or other U.S. and foreign patents pending.
08/04 4004-001 Rev C
1
J
HEAT N -CfLJY
L feStylc Products PATIO CAMPFIRE INSTALLATION INSTRUCTIONS
CONTENTS
AIntroduction.................................................................................................................................................................. 2
B. Safety Information......................................................................................................................................................... 3
C. Components and Installation........................................................................:.............................................................. 4
D. Operating Instructions.................................................................................................................................................. 8
E. Maintenance Instructions............................................................................................................................................. 9
F. High Elevation Installation............................................................................................................................................. 9
GReplacement Parts.................................................................................................................................................... 10
Warranty...................................................................................................................................................................... 12
A. INTRODUCTION
This appliance is a Decorative Gas Log Set for OUTDOOR USE ONLY and MUST NOT be used for cooking.
Place this appliance on a flat and stable surface in an outdoor location such as a patio or deck. This location must'be adjacent to the
gas supply line or LP gas supply cylinder. DO NOT locate the appliance where it can get excessively wet or submerged in water.
The following clearances to combustibles must be maintained:
Bottom - 0 in., Sides/Walls (all around) - 24 in. (610 mm), and Top - 8 ft (2.4 m).
A decorative surround can be made from noncombustible material (such as bricks, landscape blocks, rocks, etc.) or two models of
fabricated surrounds are available (see below).
Rock Ring
Mesa
Always keep the appliance area clear and free from combustible materials, gasoline and any other flammable vapors and liquids.
4004-001 Rev C
08/04
HEAT N-G�LU
PATIO CAMPFIRE INSTALLATION INSTRUCTIONS LifeStyle Products
B. SAFETY INFORMATION
The Patio Campfire has been tested in accordance with IAS US
requirements for Outdoor Gas Fireplaces, Draft4-96 and ANSI
221.58-1995/CGA 1.6-M96 for Canada and has been listed by
Underwriters Laboratory (UL) for installation and operation as
described in these installation and operating instructions.
The installation must conform with local codes or, in the absence
of local codes, with the National Fuel Gas Code ANSI 2223.1 or
CAN/CGA-B149.1, National Gas Installation Code or CAN/CGA-
B149.2, Propane Installation Code.
IMPORTANT: Installation of natural gas should be done by a
qualified installer, service agency or gas supplier.
The appliance and its manual shutoff valve must be disconnected
from the gas supply piping system during any pressure testing
of the system at test pressures in excess of 1/2 psig (3.5kPa).
This appliance must be isolated from the gas supply piping
system by closing its manual shutoff valve during any pressure
testing of the gas supply piping system at test pressures equal
to or less than 1/2 psig (3.5kPa).
Note: All new LP cylinders (and in many cases used cylinders)
may contain water, air or other contaminants. It is essential
that these substances be released before filling the cylinder
and placing into service. Water vapor present in the gas vapor
may cause the regulator to "freeze up" and cause an
interruption to the gas flow. This, interruption will cause the
appliance to shut down. To prevent this from occurring, it is
essential that a qualified individual always purge a new tank
thoroughly before placing it into service. It is recommended
that cylinders that have not been used for extended periods of
time also be purged before use.
• Children and adults should be alerted to the hazards of high
surface temperatures and should stay away to avoid bums
or clothing ignition.
• Clothing or other flammable. materials should not be placed
on or near the appliance.
Any guard or other protective device removed for servicing
the appliance must be replaced prior to operating the
appliance.
• Installation and repair should be done by a qualified service
person. The appliance should be inspected before use and
at least annually by a qualified service person. More frequent
cleaning may be required as necessary. It is imperative that
the control compartment, burners and circulating air
passageways of the appliance be kept clean.
• Inspect the fuel supply connection (including the hose for
LP models) before each use of the appliance.,
• If it is evident there is excessive abrasion or wear, or the -
hose is cut, it must be replaced prior to the appliance being
put into operation.
• The pressure regulator and hose assembly supplied with
LP models must be used. Replacement pressure regulators
and hose assemblies must be those specified in this
manual
• The LP gas supply cylinder used with LP models must be
constructed and marked in accordance with the.
specifications for LP gas cylinders of the U.S. Department of
Transportation (DOT).
Cylinders must be stored outdoors in a.well ventilated area
out of the reach of children. Disconnected cylinders must
have threaded valve plugs tightly installed and must not be
stored in a building, garage or any other enclosed area.
• Storage of this appliance indoors is permissible only if it
has been disconnected from its fuel supply (natural gas line
or LP gas cylinder).
• The LP gas cylinder supply system must be arranged for
vapor withdrawal.
• The LP gas cylinder used must include a collar to protect the
cylindervalve.
Young'children should be carefully supervised when they ' When an LP model is not in use, the LP gas must be turned
are in the area of the appliance. off at the supply cylinder.
Never leave the appliance unattended during operation.
Note: Do not use this appliance if any part has been under
water. Immediately call a qualified service technician to
inspect the appliance and to replace any part of the control
system and any gas control which .has been under water.
08/04 4004-001 Rev C
HEAT=N=GLa
L feStyle Producrf '> PATIO CAMPFIRE INSTALLATION INSTRUCTIONS
C. COMPONENTS AND 'INSTALLATION
The burner assembly and log assembly are packaged individually and shipped in one Icarton. See illustrations below.
Natural Gas Propane
`BumerAssembly Locating Button Burner Assembly
(Align with dimple on bottom of log base)
Heat Shield
�1 �l Regulator Hose .
Flex be / (Propane only)
ON/OFF valve
Burner Assemblies
Log #1
4
Log #4
Log,
#2
Locating
"ON/OFF" Button
Valve \\
Check fittings Heat Shield
for leaks y
Figure 1
Natural Gas Bumer Assembly
a s wi a commerc ally available, non -corrosive
leak check solution. Be sure to rinse off the solution
when done' leak testing. If a leak is found, tum the
tank valve off and do not use the appliance until
-repairs can be made. , `
"O WOFF" Burner
Gas Valve Locating Assembly.
Flex . Button
Connector ,
Check fittings -Propane for leaks Heat Si
held
Regulator Hose
Figure 2.
Propane Burner Assembly',
'r
•
PATIO CAMPFIRE INSTALLATION INSTRUCTIONS
HEAT-N-,G�L��
Lifestyle Products
1. Burner Assembly
c. LP Gas Models
a. All Models
1)
Make -sure the tank valve is turned completely off
1) Remove the burner assembly -and check for'
(clockwise).•
damage. Do not use damaged components.
2)
Ensure the tank valve has the proper external mating
2) Position the burner assembly in the desired
threads (tank valve marked "USE WITHTYPE 1").
location.
3)
Inspect the hose shipped with the appliance for
This location must be adjacent to the gas supply
any damage. Do not use if there is evidence of
line.
damage.
You must have easy access to the gas valve control
r 4)
Connect the end of the hose onto the ON/OFF gas
knob after it is installed and connected the gas
valve of the appliance. Make sure it is secured tightly.
supply because the ON/OFF gas valve is used to
5)
Connect the regulator assembly to the tank valve.,
turn the burner on and off. -
Hand tighten only (clockwise). Do, not use a wrench
b. Natural Gas Models `
to tighten! Use of a wrench may damage the. quick
1) Connect the ON/OFF gas valve of the appliance to
closing nut and result in a hazardous condition.
the incoming gas supply line. See Figure:1. Make
See Figure 2.
certain all gas connections are tight.
6)
Position the hose•out of pathways where people
2) Tum the ON/OFF valve at the appliance slowly to •
"ON"
might trip over it or in areas where the hose might
be subject to accidental damage
the position. All connections must be tightened
and checked for leaks with .a• commercially
7)
Open the tank valve fully (counterclockwise). Tum '
available, non -corrosive leak check solution. Be
the ON/OFF valve slowly to the„"ON" position. All
sure to rinse off the solution when done leak testing.
connections must be tightened and checked for
le k •th
Locating
"ON/OFF" Button
Valve \\
Check fittings Heat Shield
for leaks y
Figure 1
Natural Gas Bumer Assembly
a s wi a commerc ally available, non -corrosive
leak check solution. Be sure to rinse off the solution
when done' leak testing. If a leak is found, tum the
tank valve off and do not use the appliance until
-repairs can be made. , `
"O WOFF" Burner
Gas Valve Locating Assembly.
Flex . Button
Connector ,
Check fittings -Propane for leaks Heat Si
held
Regulator Hose
Figure 2.
Propane Burner Assembly',
Oct 14 05 01:40p Ted GoeIfne'r 7GO-771-5599 p:1r, ,
PGA WEST H RESIDENTIAL ASSOCIATION, INC.
42-600 CAROLINE COURT, SUITE '101
* -PALM DESERT, CALIFORNIA 92211 ,
PHONE (760),776-5100 • FAX (760)
October 13, 2005
. Mr. and Mrs. Ted Goellner
55-569 Southern Hills '
Southern Hills, CA 92253,
Reference: 55-5.69 Southim Kills, La Quirda '
Architectural Change Request — Pool, spa, patio decking; BBQ, firepit
Dear Mr. and Mrs. dbeliner:
The Architectural Committee reviewed and approved your. architectural change request.
Please note the following:
• The committee recommends that you review the: enclosed specifications for the
PGA West concrete mix .for consideration prior to the installation of your patio
decking. ,
• Barbecue -height of countertop cannot exceed 36"; total height induding y
countertop, cannot exceed 54"
• "Quiet" pumps shall be utilized for all pool and spa installations and shall meet
the minimum requirement of the industry's "quiet" pump standards. -
• The contractor shall ensure that the make-up water for the automatic water feed
device be tapped ahead of the main dwelling shutoff: Existing hose bibs cannot'
4 be used for this purpose:
• Please be reminded that once a homeowner installs custom concrete surfaces,
the Association has no responsibility for maintenance or, repairs,for such
modifications. Per the Architectural Guidelinesjeference page 7, Section 6 '
. ,. Patio Decking & Patio Extensions, ......."any damage or change to the
aforementioned shall be at the Owner's expense." - t
Per fhe Architectural Rules and Application for Change'(revised 7/01/04), 'All
ovtrlaor fireplaces shall be natural gas and shall meet Gty of Ca Qulnta .cudLes
: and rules:' '
• This application is approved with the understanding that` there will be no -
additional landscaping.
Review AX the r4mm i eg iS ' only for veneral conforrnanmwrit me.
anChft+QctYtral g4nde/i ,It& ththe M@ortgMitY of CM owner to- _f dIr
understand and cwfim W the arithftec tua/ acritfelfnes erfa whetfier or
mt a// dernymcies ane noted &-&W newew. A is also &k owner's ful/
t6 ne ve 'fir all existiQar vondita[o �Trie Co+ttmfKaee's de�tiision '
with rmand t,,R ernnect desibn wd/fie tlna/ Please refer m Rlie'Ardiitut! a
• Rules for a/! reauinad subntitrd/ss - • �
u ..
Oat 14 05 101:40p Ted Goe1Tner 760-771-5599
p'u2•.
Mr: and Mrs. Ted Goellner
October 13, 2005. _
Page Two
a
P
Approvals given by the Architectural Committee are good for onty six months from
the date on the approval letter. if construction has not commenced within six months ,
the approval date; a riew'appiication must be submitted.,
after project
• please contact Luis'Umana. Sunshine Landscape at 7601346-3999 andJCarol Fuller, the
'change.
• Association Manager, prior to. arrY irrigation modifications associated with this
flowers and turf Is the responsibility of
Damage to tfhe_ landscaping,. i.e.; shrubs; trees,
The landscaping must be brought back to its original condition •
~'
the contractor. original
when the project Is'completed-
Although your, drawing does not meet the required 5' setback tole (reference the
Architectural Rules' and Application -for Change"` revised 7/01/04, page 3) _which
states...."S' from pmpwty line on golf cnwse side for pants, Som,W,9thr features,
hwrdscape, tear walls, etc....." per Dean Miller and lim Oliver, the Pool Setback
R
Exception Agreement is not required for your installation.
Upon compidon of your project, please complete and return The Notice of Completion
of ArcWfEklnral Change.
if you have any questions, please do not hesitate to contact Carol Fuller, ~Assoctiation
Manager, at 760M6-5100, 'Ext. 320, or Cathy Clark, Assistant Manager, Ext. 318,
Sincerely,
PGA WESTI.I RESIDENTIAL ASSOCIATION
For Architectural Committee
Carol Fuller, CCAM
Association Manager
_
' oc:. Board Of,Directors
"
Unit - 011e
f
. - r
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