SFD (0307-087)55375 Medallist Dr
0307-087
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
DatSignature 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).
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. '
(N)• 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.
37, TE KAUlv ra 3-03
(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 ryovlslonj of Section 3700 of the Labor
Code, I shall forthwith comply with tho. e, Vr, ''Cisons.
Date: <y4+' • ram Applicant ,_:5:!!Z%L A'L,
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.issliance 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 author ieirepresentatives of this City to enter upon
the above-mentioned property fojinspection purposes.
.'
Signature (Owner/Agent);; %f f .t..• Date R^
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
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JOB SITE
APN
ADDRESS
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OWNER
CONTRACTOR /DESIGNER / EN INEER
'Mirli"1114F, cc).
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CA 9211 s
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USE OF PERMIT
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iit.,t .,*i;S► t b;F''.' •Zi i-iJtv`t,)• -"; •-3ji3 $I,r10i.1 '!
M.I!:1 HFrN1C -0, W?, $150.0
M.>XTEU. , fr;"M 0.00 $1i37.t?. .
nUmi?Tk4arE;r.
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ART R "P t1FLIC'.1'lACES - 1TVIK 210 -`00o,445 -00o .. s164.09
101-000439-318. 4750-00
A
' 'C1W .. e'_(ifI'_/i'1` YKES NO, NOW
OCT 27 -2003'-
2003'CITY OF.LA GUINTA"
CITY
FINANCE b
RECEIPT
DATEa
BY
DATE IN 'ED
INSPECyeR .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
_Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel 4 y
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
InsulationZ 6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath o
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL A PROVALS
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 A
Pool Cover
Sewer Connection
Encapsulation
Gas Piping D
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)
F
ICK
ENERGY CADEC
PO. Box 62'
Services
Rancho Mirage, lr/1 ALL/ V �.cll. I W� GJV- 1 UJL
Email: DESNRG CDAOL.COM
/
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
GREG NORMAN ESTATES 'PH -1 & MODELS DATE TESTED 11-19-04
Project Title Date
55-375 MEDALLIST DRIVE LA-QUNTA CA. 92253 EHLINE CO. "
rolec ress�—�' 760�78�301 Builder Name
GILBERT LEVZA PLAN 1 3 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 2
HERS Rater Telephone Sample Group Number -
#CCNAW183266 12-17-04 LOT g 3 OF 3
Certity� ture 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
Duct Pressurization Test. Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 42
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) _ 5.25
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
provided for inspection ti ® ❑
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l` -
IULATInN 4--PRTFI s
This is to certify that insulation has been instal
" led in conFpmlance with the current energy
'regulation, California Administrative Code, Title 24, State of t;alifornia, in the building at
r
55-375 MEDALLIST DRIVE LAT 5, LA QUINTA CA
s
CEILINGS: s
TYPE: BAITS . MAUNFACTURER: Certainteed THICKNESS: R-38 F
WALLS:
TYPE: BAITS MANUFACTURER: Certairiteed THICKNESS: R-19
i
GENERAL CONTRACTOR: EHLINE Co BUILDERS LICENSE # R
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Com
-pany LICENSE # 221517
t TITLE: ACCOUNT REPRESENTIVE DA
iE: �� b
s
INSULATION npa- FICATE
This is to certify.that insulation has been installed in conformance with the current energy
regulation, California Administrative Cade, Title 24, State of California, in the building located at
9ELLNGS: 55-415 MEDALLIST DRIVE LOT 6, LA QUINTA, CA
+
TYPE; BAITS , MAUNFACTURER: Certalhteed THICKNESS: R-38
WALLS:
TYRE: BATTS 'MAUNFACTURER: Certainteed'
• THICKNESS; R-19
GENERAL CONTRACTOR: EHLINE CO BUILDERS LICENSE
8Y: _�. TITLE:
PARAGON SCHMID BUIL ING PRODUCTS A MASCO Company LICENSE # 2221517
BY: / 1 TITLE: ACCOUNT REPRESENTIVE DATF-:
60/SO 39Vd
9OZ QIWHOS N09V6Vd
0
1V
0801OP609L Oti:F.T. b00G/OE/E0
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that 1 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
482086 B 11/30/0:
Date 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).
( ) '1, 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.
STATE FUND 000229-6783-03
(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 above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0307-087 TRACT
$265,636.10 5 29657
JOB SITE
APN
ADDRESS
55-375 MEDALLIST DRIVE
767-510-005
OWNER "
CONTRACTOR / DESIGNER / EN (NEER
NORMAN ESTATES 11, LLC
E19 -INE CO.
81-140 NATIONAL DRIVE
81-095 NATIONAL DRIVE
LAQUINTA CA 92253
LAQUINTA CA 92253
(760)777-8770 CBL#
USE OF PERMIT
SINGLEFAMIIsY DWELLING
SFD - LOT 5, PLAN 1. PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA OR DRIVEWAY APPROACH
CUSTOM CONSTRUCTION 3,070.00 SF
PORCH/PATIO 911.00 SF
GARAGE/CARPORT 733.00 SF
ESI`IMATED COST OF CONSTRUCTION
265,636.10
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $1,220.50
PLAN CHECK FEE 101-000-439-318 $1,001.87
MECHANICAL FEE 101.000-421-000 $150.00
ELECTRICAL FEE 101-000-420-000 $197.11
PLUMBING FEE 101-000-419-000 $169.75
STRONG MOTION FEE - RESID 101-000-241-000 $26.56
(GRADING FEE 101-000-423-000 $15.00
DEVELOPER IMPACT FEE $2,405.00
ART IN PUBLIC PLACES - RESIL 270.000-445-000 $164.09
FEE DEPOSIT 101-000-439-318 -$750.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$5,349.88
LESS PRE -PAID FEES
-$750.00
TOTAL PERMIT FEES DUE NOW
$4,599.88
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
�- ertiricaae bf Occupancy,.,
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J� .!{' INCgePO➢A7FD�� a a f r e �- r F „ ��l
K & Safety epart e t ° °•°
OF Bu�ld�ng
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- ..
This.Certificate is issued pursuantlo the requirements of Section` 109 of the California' Buildings
.,Code; certifying that, :`at: the time of issuance, this strucfure;4as' in ,. compliance 'with the
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{ provis ons , "of the Building Code' and the, -various , ordinances of the,;City regulating building
construction.and/or-use "'
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y BUILDING ADDRESS: 55=375'MEDALL'IST DRIVE}
TEMPORARY°.CERTIFICATE°,=_MODEL,HOME;� :f,•
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Use classification SINGLE'FAMILY DWELLING- _'4-11 'rY Building Permit N6::,0307-087
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nd Us RL
Occupancy Group: R-3, `:; r ';' -Type"of Construction: VN" ' L yZone
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,Owner of Building: NORMAN'ESTATES II LLC "° - Address: '81 140 NATIONAL DRIVE
f _Yr QTY . City,•ST; ZIP: LA QUINTA, CA. 92253
4 . '{ By: GARY HARTMAN
Date: 6-25-2004
_-. Building-Offida' l
-
` " ' -POST IN A CONSPICUOUS PLACE