SFD (0311-102)55335 Medallist Dr
0311-102
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.
'&cense # Lic. Class Exp. Date
482086 B 0/02
.Date; %! Signature of Contractor- s '
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
_ .WORKERIS•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.
X,Uk7t FUND
(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' compensatiory/provisions of Section 3700 of the Labor
Code, I shall forthwith comply with tt osu-6basions.
'Date:/•• a Applicant:' J
Vt
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 above-mentioned property /r insVdtion purposes.
Signature (Owner/Agent)• Date i • "-
BUILDING PERMIT PERMIT#
DATE VALUATION LOT' 11- TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
UMMARTDOMOPKE .1'r
;~'HLWA cl-,.
l WO Ts. 1411:01ANT10"Fi3J IM
$ 3 =t,9951 A J: ? i;. <s r Ut• S r i
d2tIs2°!;> a FL. 3*477
d..1-.-,e4L`"Y1TA CA 42253
USE OF PERMIT
1•''ft i 7 R: •`. n +.Q .til' i}' t::'•' x. ;;'i -
SFD - WT TILAW 4C; Nf;J`,1" 01C<LUIX, DIA)ICK WALI-%' ..
V I&T(,3169 11W
MIN OF
'D COST OF co_441;=Ucl ATI ,TINT
X. 0;t%40_1. 0
y -t ,
S 1'r8.'G77la.,l" II J3':ato i7l.+L , AA%.eR:Y
CONSaI t1CTIO, YZE 1011 •,tiW'-41€ -000 51,448,90
PLM R"H ,-''I:rF
1► efs' EI.E4; '(s,r. .flit afJ' aUt?(•9<4•, Z•'C< fl 1ti },9a -
.
Y.ISC;"fICIC...4:;1., f friv 2t3.a. G.ri""x d w. i1-i}Q % 1223-94
Iai.LtMBir O „ .v l Qi' 0(? ] ✓nC1Utl S 3. A :
,
STRONOMOT IMI :YFE R ,lb 903 -00%4A l.'000 13i.10
OL YP•.•"IG Y E:; `. rtdi'T' .t"':' i:%;• ° . $$,+ii➢3.€ 0
ART IT! PUT F2C cEJCIt itaj„ilt t3p -f fJ:r 4i'3 '13$ ::
5.93446
DEC 17 2003'
CITY OF LA QUINTA
PIONF.-F
PERTBY
DATEFINALED:
INSPECTOR'
INSPECTION RECORD
,' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
i
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
/ d
F.A.U.
Framing
3
Compressor
Insulation
3 p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
d -
Drywall - Int. Lath
Z6 6
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 APPROVAL
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
All
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
i
D6"rt
ENERGY
s�1'- A o E
Sefvices
P0. Box 621
Rancho Mirage, CA 92270
Ph/Fax (760) 564-2044 ;
Cell: (7601250-1852
Email: DESNRG MAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) cF-4R
GREG NORMAN ESTATES PH 1 DATE TESTED 11-04
Project Title Date
55-335 r—MED-ALLIST-DRfVE—L—A--o—UN—T—A—C—A—.-92-25-3--I EHLINE CO.
LEVZA
Builder Contact
. ALAN WEAVER
HERS Rater
Certifying Signature
Firm: DESERT ENERGY SERVICES LLC
Street Address: P.O. BOX 621
Copies to: ' Builder, HERS Provider
760-578=4301 Builder Name
PLAN 4 3 UNITS
Telephone Plan Number
760-880-5504 GROUP 1
Telephone Sample Group Number
11-09-04 LOT 4 1 OF 3.
Date Sample Lot Number
HERS Provider: CHEERS
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. .
® The installer has provided a copy of CF -6R (Installation Certificate.
I
® 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 38
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) = 05
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass Fail
® THERMOSTATIC EXPANSION VALVE (TXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection _ ' ® ❑
•
t
4 '
D"O,t
ENERGY, '- A o E
emces
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (760] 250-1852 "
Email: DESNRG (a1AOL.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
55-335 MEDALLIST DRIVE LA QUNTA CA. 92253 EHLINE CO. -
Project ress Builder Name
GILBERT LEVZA 760-578-4301 PLAN 4 3 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP '1
HERa Rater Telephone Sample Group Number
#CCNAW183266 11-09-04 LOT 4 2 OF 3 r
Certifying Signature T 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 partof 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)
a Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values -
Test Leakage Flow in CFM 78
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 r
Leakage Percentage (100 x Test Leakage/Fan Flow)'= 4.875 '
Check Box for Pass or Fail (Pass=6% or less) ® ❑ ,
Pass Fail
` ® THERMOSTATIC EXPANSION VALVE.(TXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is y ti
provided for inspection r ® ❑ '
ss
!ti
1 ,
b
_ Desen- =
ENERGY 5,1-- C A 0 E
Semi -
P0. Box 621 Ph/Fax (760) 564-2044
Rancho Mirage, CA 92270 Cell: (7601250-1852
Email: DESNRG AAOL.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
55-335 MEDALLIST DRIVE LA QUNTA CA. 92253 EHLINE CO.
Project Address 760-578-4301 Builder Name
GILBERT LEVZA PLAN 4 3 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504' GROUP 1
HERS ater Telephone Sample Group Number
#CCNAW183266 11-09-04 LOT 4 3 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: KANCMU MIIKAGt, GA. UZZIU
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 corinections. '
® 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 , 71
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) = 3.55
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is. ® ❑
provided for inspection
is u^i uiiatoe. MNYMUNU I- RHMUIE 760 636 OB56 ti p.4
6 F STRUCTURAL CONSULTANTS, INC.
44.1 CO MONTEREY AVE. SUITE 201-C;,.PALM OESERT, CA. 98260
PHONE (760) 836-1000 FAX (760) 338.01656
EMAIL R.FRANQIEQVERl2QN.N@T
R
I
APRIL 8, 2004
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.: 40$2, PLAN 4
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.
WITH THE EXCEPTION OF THE REQUESTED CORRECTIONS, WE BELIEVE TRAT
THE AS -BUILT CONSTRUCTION AT THE MME OF OUR VISIT IS IN GENERAL
CONFORMANCE WITH OUR STRUCTURAL PLAITS 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
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING &SAFETY DEPARTMENT
78-495 CALLS TAMPICO (760) 777-7012.
LA QUINTA, CALIFORNIA 92253. FAX (760) 777-7011
December 28, 2005
Ms. Esther Sanchez
Riverside County Assessor's Office
3255 E. Tahquitz Canyon Way', Suite 114
Palm Springs, CA 92262-6962
RE: APN #767=510-005
Dear Ms. Sanchez:
Please be advised of an address change for the following permit #0402-063. The pool
was incorrectly issued to a non =existing address of 55-5.15 Medallist Drive, La Quinta.
The correct address is 55-375 Medallist Drive, La Quinta, (APN 767-510-005).
I have enclosed a copy of the permit for your files.
Please make the appropriate changes. If I may be of further assistance, you may contact
me directly at (760) 777-7074.
Sincerely,
Therese Vella-Finorio
Senior Secretary
Attachment