9803-067 (MISC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter"omfiiencmg with Section 7000) of Division 3 of the Business and
Prh;fessionals Code, and my License is in full force and effect.
' License # Lic. Class Exp. Date
Signature of Contractor�f
P
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
compensation, 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
Code).
( ) 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 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 no. are:
Carrier Policy No.
(This 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: Applicant
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
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.
I 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
the ave -mentioned property for inspection purposes.
Signature (Owner/Agent) 3
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 9803-067 TRACT 8636
3/13/98 5800.011
JOB SITE
APN
ADDRESS
47-815 VIA. `1'RI1i:ST'E
=QANER
CONTRACTOR / DESIGNER / ENGINEER
DAVM L. WAGNER,
OWNERIBUILDER
47-81.5 VIA TMEST'F
LA. QUINTA CA 92253
CBL#
USE OF PERMIT
Hf t ll'Oitic:
'LMEE
50 L.F. 1/2" OAS & 70 L.F. i3.E'CTRIC LINF-3
MAR
1 3 1998
VAL1 XF(ON WO.00 1.S
c#Ti( OF
LA QUINTA
U, STIAIATED CO.S'T OF CONSTRIJL fION
8ild1illf
PFRNUT FEE SUMMARY
1rLECTRICAJ FEE 101 -000 -420 -Wo $2.25
PLUA1131NO FEE 101-004-419-000 $3.00
PLAN, C HFICK. FEE 1.01-000439-3113 $13.65
CONSTRUCT ION FEE 101-M418-000 121.00
SUB -TOTAL L CONSTRUCTION AND PLAID CMCK
$39.90
LESS .PPE -PAID FELS
Ul.()U
TOTAL PERMIT FEES DITE NOW
$39."
RECEIPT
DATEb r�
BY
DATE FINALED
INSPECTOR
�t
INSPECTION RECORD
r OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
...'et Backs
MECHANICAL APPROVALS
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
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
S ion
Encapsulation
as Piping _/
Gas Test '
P
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole Q
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
i
Final ���bl—� �
Utility Notice (Perm)
COMMENTS:
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;o • ", �� j ACQEPTED, FOR CO
$QWEQT TO 'INSTALLATIQN,AS PER.
r.,�ND'ALL APPLiCQ L QQD2,
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GAS BARBECUES GAS FIREPLACE
SALES, SERVICE & LOG SETS
INSTALLPTu3IN OUTDOOR HEATERS
ALL E`k ORtPRANDS
PATIO
OF PALM DESERT SHOP
74-053 HIGHWAY I I I • PALM DFSERT, CA 92260
(760) 568-5009 RICHARD MARCKS
COOKING CENTERS
GRILL
CASTINGS
1 SMOKER PAN .
INFRA -BROIL SYSTEM
burner systems and enclosures are / ROTISSERIE SET
produced from commercial quality series COOKING GRIDS
304 stainless steel. All PGS stainless steel
SIDE BURNER
components are warranted for 10 years. SEALED BURNER
YSTEMS
• All PGS units that include our unique
Infra -Broil system include a basting pan, _
smoker tray, rotisserie set, and high
quality meat probe thermometer for FLARE GUARD
perfect rotissing results every time! GRIDSBURNER
_
• All PGS masonry grills feature our "Sure SYSTEMS
Start" continuous spark electronic
ignition for safe and efficient lighting. "SURE START" o
CONTINUOUS SPARK
• All Side Burner systems feature high IGNITION =
output "Sealed" burner systems with STAINLESS STEEL
continuous spark ignition and stainless ENCLOSURES CONTROL PANELS
steel enclosures.
• Proudly produced in the USA.
Our warranty does not cover normal discoloration of aluminum or stainless steel components or
scratches in finish. Warranty not applicable to commercial installations. Please see Owners Manual
for detailed information.
OUR WARRANTY: Castings Lifetime MADE IN
Stainless Steel Parts Ten Years
All Other Components One Year
Our warranty does not cover normal discoloration of aluminum or stainless steel components or
scratches in finish. Warranty not applicab mmercial installations. Please see Owners Manual /��
for detailed informal' N
CUT -O
D ENSI NS .
QUIRED FOR MASON
UNITS
K-40/NNIS K
-40 DELUX
ULTRA K-60
SIDE BURNER
� DOORS
WIDTH 28"
28"
423/4" 46'/2"
10'/4 "
27'/2"
DEPTH 18"
18"
18" 18"'
18"
r'
HEIGHT 10'/z"
10/4
12" 10/4"
10'/z" '
163/4"
CLEARANCE 8"
8"
8" 8"
8�
For lid to rear en lid open
9
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11
PLEASE BE SURE TO CEAVEAREA BE SURE TO PROVIDE ADEQUATE �ENTINGOIN E)ICLOSURE.G UNIT P EE INSTRUCTIONS EN FOR PROPER OFOR D AND COMBUST PL
_ PACIFIC GAS SPECIALTIES, CORPORATION 1
2641 DU BRIDGE AVE. ■ IRVINE, CA 92606-5001 ,
(714) 757-7723 0 FAX (714) 474-5559 "
G�
I r%A A-lamr-MA-% w � J-%,
THE ULTIMATE IN
OUTDOOR COOKING
CENTERS
K-40 ULTRA
with Side Burner and
Infro Broil Burner'
err —7
2� i
K-60 with
Infro broil Burner and -
Optional Side Burner-
. . . . . . . ......
K-40 Delux with
Infra Broil Burner
ling,
501
err —7
2� i
K-60 with
Infro broil Burner and -
Optional Side Burner-
ULTRA, DELUX K-60 6 STANDARD shown with all Stainless Steel Access Doors.
. . . . . . . ......
K-40 Delux with
Infra Broil Burner
ULTRA, DELUX K-60 6 STANDARD shown with all Stainless Steel Access Doors.