0012-297 (PLBG)1:
LICENSED CONTRACTOR DECLARATION
lih;�,eby 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.
LiceAse# Lic.'Class'. Exp.Dat6
41 U
Date SignatLIre'bf.Contractor
OWNER -BUILDER DECLARATION_
I hereby affirm under penalty of perjury that I am exempt frorri the Contractor's
License Law for the following reason:
-( ), 1; as,,owner of the property, or my employees with wages as their sole
compensation, will. do the work, and the structure . isnot intended or offered for
Sale (Sec. 7044, Business & Professionals Code).
1; as 6Wh6r of the property, am exclusively contracting wiih licensed
contractors to construct' the Project (Sec. -7044, Business & Professionals
Code).'
O. I am exempt under Section B&P.C: for this reason
Date Signature, of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury.one ,of 'th6 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.
(J 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 no. are:
Carrier Policy No.
AM, 9I.tICAN ALTH)UR
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 1 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 ' th kers' compensation provisions of S tion 3700 of the'Labor
Co'de'•
I sh I IfowrtEith comply with those pro_Vis'i'on`s./
Qatia:.' Applicant—
Warning:- Failure to secure WorkersCompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines 6p to $100,'000, in
addition to the cost of compensaflon, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Applicati6n is here -by made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set,- forth on* his
application.
1. Each person upon whose behalf this application it made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees -to, & shall, indemnify
& hold harmless the City of 'La 06inta, its officers, agents and employees.
2. Any permit issued as a, result of this application becomes null and- void if
work is not commenced within,180 days4rom date ; of, issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that.1 have read this application and state - that the above information, is
c6rrect. I agree to comply With all City, and State laws relating to the building.
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes..
Signature (Owner/Agent) Date T
Y
BUILDING PERMIT# PERMIT'
DATE VALUATION LOT TRACT
JOB SITE
,ADDRESS
APN
47-44
OWNER
CONTRACTOR/DESIGNER/EN INEER
CAMAINAY &COWANY
CKMA6AY &C'OM' PA.14Y
7400,K I 7TH UL 41015
17480 X 171.11,0L 4106
TUT124 ("A 92780
TORM 0A 9 27 SM
(714)5m--4440 (IBL$ 4-1,�
USE OF PERMIT
RAW -PONVa
15k.r.F. CM.1 LIN? TO 1qZ CONMEZ712n TO UL LISTED A.PKAANCF, ONLY
AS XJFA APPROVED PLANS'� ONLY,
NVALUATMN 2MOO US
xamixam cWr Or, COMMMIMIMON
PRRMT FRE 99MWARY
PKA111muffic FEE 01 -000-4145'-0014
xr S.
t $0,00.
lxga, IYErgm. rITIE1.9 DUE NOW
MOM.,
RECEIPT
DATE 1hiI
BY
DIL D
I Z 1%
I.
I INSPECTOR
f
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 2 $ =p J �-
Drywall - Int. Lath
_ /l
Final 13_L Q/ 6E�
BLOCKWAL.L i_PROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
S •r
LOT ,#124
• 1 � w
• 1
BLS WALL
-
0 4 � EDF 21:88' 66.
2h.64'
R=316 50' I
0=
CONCRETE
2)595-00
5
g5• pp sS• FFL-31.64' IDRE�Y REA 426.
r= L'VINGAA
0541 Ji ARE(PGARAG'
N
6D�3D �
10'LQ
0
Z h ' cnI 42��
#123 N a
LOT
W
o I 0.5' EpF
lel o -
;r I ;n BL OCK .•YALL
2 N 89-39'52- E 111.50' '
LOT ,#122
I ..
To fsr x2l�x4
ciOF. LA QUiNrA
DE
BUILDING & SAFETY PT.
APPROVED
FOR CONSTRUC JOB ADDRESS,.
N
4 7 : 440- 1/lA' `FL'OR£NCE - —
WE I'?- BY LAKEyL 9 CJUlN=TA �La �.QUINTA,_�C� A�92253
LAND 1910 S. ARCHIBALD AVE.. STE. N
ONTARIO, CA 91761.
DEVEL OPMENT (909) 930-1468
QES/GN FAX (909) 930-1468
f CORPORA TION PLANNING • CIVIL - SURVEYING
SCA LE: l--20' DATE: SCALE: SHEET: JOB NO.
04/04/00 1 320' 1 3065 - LOT 123
The RD -A wood -burning fireplace system provides
the benefits of dependable radiant heat at a very comfort-
able price.
It features quick zero clearance construction, thanks to Superior's
proven two -wall, air-cooled chimney system.
The RD -A also has a clean -face design yAth no exposed grilles. This
allows you to bring surround materials right up to the front opening, thus
creating the appearance of a large, conventional masonry -built fireplace.
A look that's further enhanced by our realistic, rounded refractory and
disappearing smoke shield damper.
You have a choice of decorator doors in a variety of beautiful styles and
finishes. There's an optional outside combustion air kit. And the RD=A is
available in three screen opening sizes; 33': 38", and 43`:
In short, the RD -A is a great way to offer homeowners the beautiful
warmth.of a masonry -like, wood -burning fireplace with the. economical
efficiency of radiant heating.
Complete, one piece
chimney top. Storm collar.
Firestop spacer -secures
chimney in ceiling or
between floors. rr� -
'7/. �i Roof flashing.
06-s /
All -metal Thru-Flow
t+'
(8" or 10") chimney
p,
;Ystern. Easy Jinstall-
r,.�-
no tools required;
II
straps togeW,er.
�-.. r l
Mitumum clearance
face construction
to combustible
materials.- Frame with
Wood right up to :1I-;: ;
fireplace.
Realistic rounded
`; r ,-4
refractory interior.
Easy gas line
i
access with acces-
x
sible knockout.
smoke shield
Optional outside
;,
air kit.
Standard me(al-
safety strip.
Optional glass
doors ay."able,
your choice of
firth
Distribute by:
WS 0406h RE,: U 7192
TO 39tid
Fan (C .
Front
33-12'/x"D
38.12-A"D
A---r,-4/-'t �—
PAW 33-331/:'
--•--- 38-38" N/te"I
8 21 43.42'/." 8 341/i'
g 8
7"
33-35r/w'
43.451/11"
Left
Side
Right
II �
t.. Side
Top
H Q a NOTE: Diagrams and illustrations are not to scale and should not be used for framing purposes - consult installation
instructions. Product designs, materials, dimensions, specifi•
cations, colors and prices tubject to change or discontinuance
WA�f1DGk� without notice.
v 1 — i O 3? Consult your distributor f)r local fireplace code infnrmatirr
fie Fireplace company
4325 Artesia Ave., Fullerton. CA 92633, (714) 521-7302
Printed in U.S. A- 01992 by Superior Fireplace Company. Plants in Fullerton, CA; Union City, TN.
All Superior wood burning fireplaces include a.25 -year limited warranty and are listed Py natinnaily recognized listing agencies.
3>1830W ANV8_1 806908660E ii -E0 0001/90/ZT
T T
,:ambustion i
air inlet. 7. V••
38„ 341h"
I T �..
RIS,• Line
[ Acce66•
J._ A.
�--- ll'ii'-----�
33.24'/."
— 38-291/x, • =
4333'/,"
1 I
'21'G1"
i
41&D
Frvnine nim.ns;nne
model I
Widt
Smooth exterior.
p,
3301 a
front face.
3T
n V. •
Special narrow side
�-.. r l
;,
face construction
7
for easy installation.
I "
Disappearing
smoke shield
;,
damper.
Construction
anchors secure
1
fireplace to floor.
Standard
heavy-duty,
fuel grate. ;
Hearth extension -
secure to platform
or, floor. No special
foundation required.
Top
H Q a NOTE: Diagrams and illustrations are not to scale and should not be used for framing purposes - consult installation
instructions. Product designs, materials, dimensions, specifi•
cations, colors and prices tubject to change or discontinuance
WA�f1DGk� without notice.
v 1 — i O 3? Consult your distributor f)r local fireplace code infnrmatirr
fie Fireplace company
4325 Artesia Ave., Fullerton. CA 92633, (714) 521-7302
Printed in U.S. A- 01992 by Superior Fireplace Company. Plants in Fullerton, CA; Union City, TN.
All Superior wood burning fireplaces include a.25 -year limited warranty and are listed Py natinnaily recognized listing agencies.
3>1830W ANV8_1 806908660E ii -E0 0001/90/ZT
T T
,:ambustion i
air inlet. 7. V••
38„ 341h"
I T �..
RIS,• Line
[ Acce66•
J._ A.
�--- ll'ii'-----�
33.24'/."
— 38-291/x, • =
4333'/,"
1 I
'21'G1"
i
41&D
Frvnine nim.ns;nne
model I
Widt
I li6g ,
p,
3301 a
1 '.
3T
n V. •
3s11 A
40>
Z__
The RD -A wood -burning fireplace system provides Front
the benefits of dependable radiant heat at a very comfort- 33-121/2"D
able price.3B-12t!z"D
It features 4wck zero clearance construction, thanks to Superior's r 41/4'
proven two -wall, air-cooled chimney system. ev,
The RD -A also has a clean -face design with no exposed grilles. This
allows you to bring surround materials right up to the front opening, thus is/,A 33-33v.� hi,6
creating the appearance of a large, conventional masonry -built fireplace. , 38 38^
A look that's further enhanced by our • realistic, rounded refractory and 21" 43-429/4- 341/6'
disappearing smoke shield -damper.
You have a choice of decorator doors in a variety of beautiful styles and 8
finishes. There's an optional outside combustion air kit. And the RD -Ai 7•
available in three screen opening sizes: 33. 38", and 43"
In short, the RD A is a great way to offer homeowners the beautiful + 33-3sia"
warmth of a masonry -like, wood -burning fireplace with the economical F— - 38-45MA7 -- --
63.65 �iP'.
efficiency of radiant heating. left
-Side T
Complete. one piece Storm collar. Combustion
chimney top: 3Y au inlet. �- i
14WFirestop spacer -secures
chimney in ceiling or 9' Gu
between floors. rr
. ±. y / jr.7/ /��, .Roof Bashing. II �' I:4L lint
�(
-LACCQ6P
All -metal Thn,•Flow
(R" or 10') chimney ♦Jf%^ '
system. Easy to install,
no tools required: l y - I '� s• ),�� Right
snaps together.
ty Side
Minimum clearance �� Smooth exterior ^
to combustible „� front face.
materials. Frame with
wood right up to Special narrow sides/'.
face construction
fireplace.
I
; :' ; f, , �fT•, , for easy installation. 9"•-{
Realistic rounded
refractory interior ' ' r t' Disappearing
smoke shield
+
Easy gas line ; , � , ' , damper. r' /x
I---•- 21 �" --{
• � + „ 1.
access with acces , _ ; • ; ;,
sible knockout. ; ; ; . , , Construction TOP 33-2414"
ki' anchors secure 38 29V,a" —
Optional outside „ i" fireplace to floor..—� 43-33si." i
air kit. ''' i i' ' •' -
r2iil/i
Standard 9.heavy-dutyfuel grate. _ '
Standard metalsafety strip: Hearth extension a3 1 "secure to platform
f or Qoor. No special
foundation required..
av
l !a'F LA .Q r1tSl5htj9dRWY & apjiah iotn8s 1AT1 D33e05
+ ,f�ro�,:SAFETY DEPT .'
P 30S }9.
stylesAl® P
Di$tI'ibtl[efj by. ROVED NOTE: Diagrams and llustrations are not to scale and
FOR C O N S TR U should not be used for f -arcing purposes - consult installation
CT�ON instructions. Product designs, materials. dimensions, specifi•
cations, colors and paces subject to change or discontinuance
without notice.
DA TE' —_ Coll -suit your diatributo for local fireplace code infnrmatinr
BY
Rim
The Flrepiace Comport
4325 Artesia Ave., Petherton. CA 92633, (714) 521 7302
er.• „ �,a� Printed in U.S.A. 01992 by Superior Fireplace Company- Planu in Fullerton, CA; Union City, TN.
— — _ JN/7 VjVgj3S Noll n 1SN03 ----- --- ------
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