SFD (0311-101)55295 Medallist Dr
0311-101
LICENSED CONTRACTOR DECLARATION
Uj I herby affirm under penalty of perjury that I am licensed under provisions of
1 - K: Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Cn
C14LU Professionals Code, and my License is in full force and effect.
O =) ch license # Lic. Class Exp. Date .
r_CYL
4820236 B
oZ Date Signature of Contractor
to O O r'fF ✓'tf
OWNER -BUILDER DECLARATION
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U License Law for the following reason:
Z_ ( ) 1, 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).
C'') () I am exempt under Section' B&P.C. for this reason
LO
N Date Signature of Owner
O
a- Q WORKER'S COMPENSATION DECLARATION
2 Z I hereby affirm under.•,penalty of perjury one of the following declarations:
n O () 1 have and will maintain a certificate of consent to self -insure for workers'
K LU = compensation, as provided for by Section 3700 of the Labor Code, for the
D J Q performance of the work for which this permit is issued.
Q U (.) I have and will maintain workers' compensation insurance, as required by
j U Q S ction 3700 of the Labor Code, for the performance of the work for which this
L rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
ano 0
d S A R,, WAD 00 2aSfi b7 ?.y
Q (This section need not be completed.if the permit valuation is for $100.00 or less)'
J ( ) 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
3 Code, I,shall forthwith comply with those provisions.
Date: Applicant
r 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 asa 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 fo .insp ct on purposes.
Signature (Owner/Agent),:XDate r'► _ +-g. t'z•
BUILDING PERMIT PERMIT#
DATE VALUATION LOT .. .. i h .`3, TRACT
JOB SITE
APN
ADDRESS
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irQ ••,:' 1. -A'G .
OWNER
CONTRACTOR / DESIGNER / EN (NEER
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USE OF PERMIT
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IS
03 PRE -PAID TEM
.TO'I•AIT'RM.1
FTES' DVE HOW
Im
DEC 17 2003
CITY OF LA QUINTA .
FINANCE DEPT:
RECEIPT
DATE t'.
By
DATE FINALED
INSPECTOR
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
0. K. to Wrap 0
F.A.U.
Framing a
Compressor
Insulation $ //
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath Z!
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
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 J
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Y._
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Street Address: P.O. BOX 621 City/State2ip: RANCHO MIRAGE, CA. 92270
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: ® Tested ❑ Approved as part of sample testing but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
The installer has provided a copy of CF -6R (Installation Certificate.
® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaks at duct connections.
® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) -
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 35
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 800
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4375
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
N Yes ❑ No Thermostatic Expansion. Valve is installed and Access is
provided for inspection N ❑
i
r Deseft`
ENERGY
Sem`
—
P0. Box 621
Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270
Cell: (760] 250-1852
Email: DESNRG OAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND
DIAGNOSTIC TESTING (Page I of 7) CF -4R
GREG NORMAN ESTATES
PHI DATE TESTED 11-8-04
Project Title
Date
T`55-_295 MEDALLIST DRIVE LA.QUNTA CA. 92253 EHLINE CO,
Project -Address _
GILBERT LEVZA
760-578-4301 Builder Name
PLAN 3 3 UNITS
Builder Contact
Telephone Plan Number
ALAN WEAVER
760-880-5504 GROUP 1
HER;er
Telephone Sample Group Number
" #CCNAW183266
11-09-04 LOT 3 1 OF 3
Certifying Signature
Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC
HERS Provider: CHEERS
Street Address: P.O. BOX 621 City/State2ip: RANCHO MIRAGE, CA. 92270
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEMENT
The house was: ® Tested ❑ Approved as part of sample testing but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
The installer has provided a copy of CF -6R (Installation Certificate.
® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaks at duct connections.
® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) -
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 35
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 800
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4375
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
N Yes ❑ No Thermostatic Expansion. Valve is installed and Access is
provided for inspection N ❑
i
I
Desen
ENERGY -- A a E
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760] 250-1852
Email: DESNRG MAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
GREG NORMAN ESTATES PH 1 DATE TESTED 11-8-04
Project Title Date
55-295 MEDALLIST DRIVE LA QUNTA CA. 92253 EHLINE CO.
Project Address 760-578 301 Builder Name
GILBERT LEVZA PLAN 3 3 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 1
HER terTelephone Sample Group Number
#CCNAW183266 11-09-04 LOT 3 2 OF 3
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS
Street Address: P.O. BOX 621 City/State/Zip: RANCHO MIRAGE, CA. 92270
Copies to: Builder, HERS Provider
HERS.RATER COMPLIANCE STATEMENT
The house was: ® Tested ❑ Approved as part of sample testing but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
® The installer has provided a copy of CF -6R (Installation Certificate.
® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with. cloth
backed, rubber adhesive duct tape to seal leaks at duct connections.
® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
F.
Duct Pressurization Test Results (CFM @ 25 Pa)
values
Test Leakage Flow in CFM 88
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 1600
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _ .5.5
Check Box for Pass or Fail (Pass=6% or less) ' ® ❑
Pass Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
0 Yes ❑ No Thermostatic Expansion Valve is installed and Access is ® El for inspection
` "
ENERGY '1-- ° E
Semi —
P0. Box 621
Rancho Mirage, CA 92270
Email: DESNRG MAOL.COM
Ph/Fax (760) 564-2044
Cell: (760) 250-1852
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
GREG NORMAN ESTATES PH 1
Project Title
55-295 MEDALLIST DRIVE LA QUNTA CA. 92253
Project Address 760-578-4301
GILBERT LEVZA
DATE TESTED 11-8-04
Date
EHLINE CO.
Builder Name
PLAN 3 3 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 1
HERS a& Telephone Sample Group Number
lx #CCNAW183266 11-09-04 LOT 3 3 OF 3
Certifying Signature Date Sample Lot Number
Firm: DESERT ENERGY SERVICES LLC HERS Provider: CHEERS
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
City/State/Zip: RANCHO MIRAGE, CA. 92270
HERS RATER COMPLIANCE STATEMENT
The house was: ® Tested ❑ Approved as part of sample testing but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply
with the diagnostic tested compliance requirements as checked on this form.
N The installer has provided a copy of CF -6R (Installation Certificate.
® Distribution system is fully ducted(i.e., does not use building cavities as plenums or platform returns in lieu of ducts)
® Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth
backed, rubber adhesive duct tape to seal leaks at duct connections.
® MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 112
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 2000
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 5.6
Check Box for Pass or Fail (Pass=6% or less) 0 El
Pass Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is ® ❑
provided for inspection
• 4
nNr ,c u-► u/:-rae KHTMUNIJ h.KHN( It 760 836 0856 p.3
R F STRUCTURAL CONSULTANTS. IN.C.
✓a
44-100 MONTEREY AVE. SUITE 901-0,,PALM DESERT, CA. 92260
PHONE (760) 836-1000 FAX (760) 836.0666
E-MAIL R.F*RANGIE®VERIZON.NET
i
APRIL 8, 2,004
EHLINE COMP. DUILDERS AND DEVELOPERS
81-480 NATIONAL DRIVE
' LA QUINTA, CA. 92253
Attn.: MR. LARRY NELSON
Re.: MEDALLIST DEVELOPMENT
THE NORMAN ESTATES AT PGA WEST
LA QUINTA, CA.
FOLLOW-UP TO WALK THROUGH
JOB NO, : 4082, PLAN 3 ..1
DEAR LARRY
THIS LETTER ADVISES THAT WE HAVE OBSERVED THE STRUCTURAL
REQUIREMENTS THAT ARE VISIBLE DURING CONSTRUCTION AT THE TIME OF
OUR SITE VISIT. A LIST OF REQUESTED CORRECTIONS WAS PROVIDED TO THE
OWNER'S REPRESENTATIVE.
I
WITH THE EXCEPTION OF THE REQUESTED CORRECT IONS, WE BELIEVE THAT
THE AS -BUILT CONSTRUCTION AT THE TIME OF OUR VISIT IS IN GENERAL
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.).
i
RESPECTFULLY SUBNGTTED
NICHOLAS F. ABOU: FADEL, PE
NICHOLAS R 9
I ABnU•FADEL
NO 50588
EXP
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