0312-234 (SOTB)LICENSED CONTRACTOR 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.
License # Lic. Class Exp. Date
?22925 B 5131 /04
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
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
bate 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 IU XRT 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.
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 f
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 e"4
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for'inspection purposes.01
t `
Signature (Owner/Agent)• �Q••Lt -" ' .fes F Date
BUILDING PERMIT PERMITN w
01_2-234
DATE .VALUATION $2 loj.o LOT TRACT
JOB SITE` �t�
ADDRESS 49-.587 AWMA l��X.d..A V iW A BO.1T,CE1s '••
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.rc-1UNG -
'V21010 WE.Ir a'J:MOD 1:t 40 & CONST
49-,597.1AVKb1TDA Vi9JALOMA
/3.195 GUAU.�:�'iik E AVE
I -A 0Y';;11gTA CA 92253
PALM DESIC,'Mr 'L-'4 €4. 92261
(750)3414102 CIBLIel 5812
USE OF PERMIT
C A"�I1r LAT ,%�O u
4,
INSTALL 2 aASS 01-ILY FIR.EPLAC]FA ONE FACING MIT E IOR AN-" ONE
FACING LOKUM11011 PA 10 AREA VMTERiOR. TO HAV '".0HKARTH OR
SUAR.OUNID ,
VALUATION 1.0,
911USEED �? �l? r`l� ' i3 ' CUNf Y f ;O ,"
2 � OO,()Q
L'ERN:i'i: FRS: Sa"TNWARV
PLAN Ci r CK FEE 101.000-4391,318 $35.10
CONSTRUCTION F981 $54.010
MEC"HA-MICALFFE 101-000,421-000
PLUMBING IYL1d 101-6p0-�tZS-Q{)0 X14.00
=7 "' 3Ai fist l�•CT:�aN'.�'sAlD PLAN CHFXK
$144,440
4.10
o c'Y
p IXESS PRE—V MMS
$0.00 .
pEC 3 2003., ..U, RaW F. R6 DUR NOW
$144.3.0
CJTY O" OV: LAtdU!NTA
F114ANCEDEPT. i
RECEIPT
DAA
By —:5'
D FINgk✓
INSPM
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
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
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)
u I Y Ur LA LIUINTA SUB -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a consbicuous place. Only persons appearing on this list'or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed b a li t "O F'I "
Trade Classification
Contractor
State Contractor's License
Y pp can . n i e is not an acceptable response.
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
ExO. Date
(xz/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
xx/xx/xxl
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
j+
CONCRETE (C-8)
i
FRAMING IC -51
{
STRUCT: STEEL (C-51)
{
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
S
DRYWALL (C-9)
HVAC IC -20)-
'T -»/ire r A -
Zo
3 Sz�(03q
2,20f -'?.'5
ELECTRICAL (C-10) ..
-
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
`
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
a
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
6x—
C,onl�wsTro�/ Hr
-r6RIog IJAI17—
CONSTRUCTIONHOURS
October 1st - April 30
Monday. - Friday: 7:00 a.m. to 5:30 p.m
Saturday: 8;00 a.m. to 5:00 p.m.
Sunday: None
Government Code Holidays: -None
May 1st - September 30th
Monday - Friday: 6:00 am. to 7:00 p�=
Saturday: 8:00 am. to 5-.00 pm.
Sunday: . ' None
Government Code Holidays: None
N1(77
Ji" udy
!Jay.
4 J.
eleran's Day
Tkanks0ing Day.
cluitli" Day
IvIi-I&A, I.Al
;'f I i �i i 1 - i,
-r4o-.7
FA
.-P
CON
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR 0 �TR
IDATE��1_00!:)"_
........... .
TeP
*LA)
7;4 F
-Ty
_f_�,
li
st
ruction is'NOT�PFR•
---- z0 GII, o the folio
wing Code, Holidays: i
µ� - -- •-- - -� __ �;� - : w Year's day
�
Dr Martin L
ufer King 1r, Day
President's Day
Alenloria" � - � off- � . �- ,,, •,, � ind Pends ay �
Tabor Daynce �ay ;
Veteran's
Thank ay `
sgiving Day
r 1 N ! Christmas DayOtA
103 C
` ; ►
n. c ` ;
Zy �
o 0 r
• Vii- � N � �+�'► p "� QO --o •,
`nom
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- -,
m
11
8=40
BBV -36
BABE MODEL SHOWN
X28-3116'—�.
4-518' m ED
14'
4'
-I ID
38' --�
TOP VIEW
T 7-114'
14' i
36 33•
20-1/4"
1'
T
6'
r• FRONTBVIEW 11
asy gas line access
0 convenient
nockouts on both
ides.
tinunum dearance to f171/
ombustible materials.
came with 1Na0d.
teal'Istic refractory
ltefior.
Standard metal
afety strip..
Iptional glass door
vailable, your choice
f finishes and Was.
Wall switch or
b)CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
P
pp—BBV-42
BABE MODEL SHOWN
B-40�40
417 B -VENT
Get all the ambiance of a traditional wood-buming fireplace with the convenience of a
gas flame at the flick of a wall switch or the cl ick of a remote control. The hearth is open,
so there is nothing between you and the glow of the fire.
If you prefer, operable glass doors in black,. brass or brushed stainless can be added.
The B40 has a black interior and uses econ 3mical 4' B -vent.
The BBV -36/42 models use 6' B -vent, have brick interior liners and utilize the same
framing dimensions as Superior's wood -burning models so you can mix'n match easily.
8-318'
13•J8'
Affd6-1114'
Combustion
Line Air Inlet
9-1/4'
kmd32. 33-112' 41 43'
80" -22-5116' 2'29-15 cress 2-1 2' 1 7.3/ 16'
�l.— 14'—'I 6-114' I
RIGHT VIEW LEFT VIEW
FRONT VIEW
Smooth exterior
tract face.
Durable powder
coat finish.
Standard fuel grate.
Hearth extension —
secure to platform a
floor. No special
foundation required.
DA BY
27-114'
r-
7-13/M.1
1'40'-
4r
\ TOP VIEW
BBV -4a
611 B -VENT
114'
43'
D
IQ. 12-718'
8 -Ila'
3 -
Gas line �ren�
Access Boa
RIGHT SIDE VIEW
611 B -VENT
s
FRONT VIEW
RIGHT SIDE VIEW
optional VY„QeIess
�®
remote ava8able. MODEL BTU/HR CHART.. FRAMING DIMENSIONS
EL
B 40 TH HEIGHT DEPTH
15,000 15000 8-40 38-1R' 33 3/4' 13-1R'
BBV -36 24,000 _ 24000 BBV -36 41-14 37-1R' 20-518,
BBV 42 �� 30,000 BBV 42 46 1/4' 43-1/2' 21-5/8'
NOTE Diagrams and inustrations are not to scale and should not be Lsed for framing purposes - consult installation instructions.
Product designs, materials, dimensions, specifications, colors and prices subject to change or discontinuance without notice..
Built to ANSI 221.50 standards and Warnock Hersey M S�TPEI2IORe10Cr` f
listed. (Report numbers: B-40 = J20006122, c � $ -
BBV -36142 = J99025850). Consult your distributor
for local fireplace code information. Vww.LernoxHearthProducts.com
All Rurwrinr aas-bumino fireolaces include a 20 -year limited warrarty and are listed by nationally recognized listing agencies.