SFD (0311-099)55215 Medallist Dr
0311-099
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
yChter 9 (commencing with Section 7000) of Division 3 of the.Business and
F'drAssionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date e, + -,Signature of Contractor-
r"
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). ;
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 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:
Cartier Policy No. ;
STATE I'PJND
(Ths section need not be completed if the permit valuation is for $100.00'or less):
( I)%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' compensationj. r6visions"of Section 3700 of the Labor
Code, I shall•forthwith comply with those prpi`s`ions.
D,ate''*: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 3746
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 upori'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 above-mentioned property forInspection purposes.
k fr
Signature (Owner/Agent)~.✓ "- . l,,==--- Date / . "'
_cam.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT..: A' TRACT' -
1. `•7 rJ1PY? Irt'f59-t r J 2`:5.
JOB SITE
APN
ADDRESS
,
'y.
1.' l•.r51Ur . . : A''a:iTn i. , ,. ,-.
r ivv. 4A10JXil.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1:9.r''V ",f, ':ti>,wLL+T:c
_.I0M. CX).
1M0rl 3?.4 YgTTf.'` f. T. a)i
R1QIi35Y' AIIOWALDITF'v:::.
ISL 33477
Lt.(; ffi1r''A Opk 92ZV,°'
i 6(j,,777 -8770 MW
USE OF PERMIT
, . .
31713 4 LDTJi PLAV:., l .il'1tM i.' DOJV:a'NOT, Max'=)A BIWc'ICK WX LV,
Pool, SPA OR DRATtT.YA,,Y APPROk:A.01H '
V .,
... . ; .,, , • TIOD TM CO,-,Fr0. ,F t' i 7I3 "I `F3E°:VIK-liq
',tet 5,CKMAT .
PEMWE V83 t73IMM:ARY
c iSTRUCTION R.` -E ''101400.416-00401 S.1,; a11,1n
,P]1PN t<HWK FEE " 1.01-000-43V"319 m"001-e.j!
iEC•klAMC.ALFEE 101CNJ :-.21-00e $3 u
iwi.i Ta'TCALITEW 1{1,M0• 320-000 $a + .17
S ":i 140 MOT.IUM Vii; a RM -11A011:. 00 4:11+-mlo :' $ ti. •fi
.
1VI-1,0YIER.IMPACT FZI ' Q5:,04f9Q
0- 00/" '.-445.-iV. .. 61
A7RX,,44 y1iyys PrAST8- kMJK 170-000-445-MV.1
.
4
r`tmrk "ItT'd lei ;+ n pLmf 0-f3ax
,8
PA,M 10413
sc of,
Ivy
A
DEC. 17 1003. , - : •
-
CITY OF LA,QUINTA'
RECEIPT _....:VA
E I r e
BY
°/Z
DF, FI ALED
INSPE O
L D
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
d
F.A.U.
Framing
Compressor
Insulation
7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
> VL
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 101,
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
it .. . . a n rv.. r.... .a,..r.ry.i'/• rl.•v.rNA I.I,i..r....r. .w. ..awn.u.'x•. r_ %1'....vN•I.r✓JI" rNYrirY f .ii(9sit4l,'n.'f(••vrJ...•s, i , .tie J,. : .-, ... .(..:,u... .: (:s r .w (. !'. :..,• .. r: w: ,,..1
INSULATION CERTIFICATE
r •
f This is to certify that insulation has been installed In conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building at
6E -215 -MEDALLIST -CRIME -LOT' 1,-# A-QUINTA.CA -
CEILING$'
TYPE: BATTS MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS;
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-19
GENERAL CONTRACTOR: EMLINE CO (BUILDERS LICENSE 9
BY: _ TITLE: :.
PARAGON SCHMID,BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY: / TITLE: ACCOUNT REPRESENTIVE DATE:+. / / d
....•✓•sa•.✓,.•,•.•: . : ,r.v,rir:rr: :e•(ir,r,- : .w/(r...1•wra,i,uvne..rs:r•w siw:•r.r.rv✓sr•slrir. a:a., v . :v, :.u>..;nauxrmr .w..>u::✓r .i✓s..ter fs.s:m:;n'.:.ay.r:•.r,x•.•: v:'a:•.r.: u.• :: .,. r.. e. .,.. '
wwjw
Rpr 12 04 07r44a RAYMOND FRANGIL fou coo
g.ULTAP4T6. INC.
- R F 6TRUCTURAL CON _! •
201-C?AIM OES ERT. CA. 922260 y
44-1 p0 ta®_tiTEREY AVE. -SUITE .
PHONe [7801 ®36• t 000 FAX •17601 gee -0!456
R.FRANGll*®VERI.ZQwr4F_T
E•MA.IL -
AFRIL S. 2004
EHLINE COMP. DUILDE S AND. DEVELOPERS
81-480 NATIONAL DRIVE
LA QULNTA, CA. 92253
Atter.: MR. LARRY NELSON -
Re.: MEDALLIST DEVELOPMENT .
THE NORMAN ESTATES AT TGA WEST
LA QUINTA, CA-
FOLLOW-UP
A.FOLLOWUP TO WALK. THROUGH
JOB NO, : 4082, PIAN 3
DEAR LARRY
THIS LETTER AD'V`ISES THAT WE•HAVE OBSERVED THE STRUCTURAL
REQUIREMENTS THAT ARE VISIBLE DURING CONSTRUCTION AT THE TIME OF
OUR SITE VISIT.,k LIST OF REQUESTtD.CORRECTIONS WAS PROVIDED TO THE
OWNER'S REPRESENTATIVE.
WITH.THE-EXCEPTION OF THE REQUESTED C - VISIT ISE BELIEVE IN GENERAL T
INGE .
THE AS -BUILT CONSTRUCTION AT THE T
CONFORMANCE WITH OUR STRUCTURAL. PLANS AND RELEVANT
CORRESPONDENCE ISSUED BY OUR OFFICE.
WE OBSERVED THE BUILDING IN ITS FRAMED CONDITION PRIOR TO
INSTALLATION OF DRYWALL AND STUCCO. WE OBSERVED THE VISUAL. AND
ACCESSIBLE STRUCTURAL REQUIREMENTS• ( EXCLUSIONS ARE ITEMS SUCH AS:
FOOTING SIZE AND REINFORCEMENT, TOP PLATE SPLICES, ROOF SHEATHING,
AND ANY STRAPS ABOVE THE ROOF SHEATHING.).
RESPECTFULLY SUBMITTED
NICHOLAS F. ABOU-FADEL, PE