SFD (04-4063)55380 Medallist Dr
04-4063
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
QF 9 D 7$F495 CE --T- a- ': ICo FAX (760) 777-7011
GGA==,,—Q` F) RNIA 92253 INSPECTION REQUESTS (760) 777-7153
JUL 0 6 2004 BUILDING PERMIT .
CITY OF LA U0VTq
Flan I,, -cmc
Apple a on i be"'. . . . 4-60.D_04.063 ;Date,; _ 5/12/04
Property Address . . . . . 55380 MEDALLIST DR-
APN: 767-600-001- - =
Application description DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 274539
Owner
NORMAN ESTATES II
C/O MEDALLIST GOLF DEVELOPMENT
501 NORTH AlA
JUPITER FL 33477
Contractor
EHLINE COMPANY
55375 MEDALLIST DR
LA QUINTA CA 92253
(760) 771-8130
WCC:. STATE FUND
WC: 2290006783
01/01/05
CSLB: 482086
11/30/05
CCC: B
-=------------------------
Structure Information --------------=---_-------
Construction Type
TYPE V - NON RATED
.,Occupancy Type . . .
. . . DWELLG/LODGING/CONG <=10
Flood Zone . . . . .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION 2001 CRC
# BEDROOMS
3.60
FIRE SPRINKLERS NO
GARAGE. SQ FTG-
733.00
PATIO SQ FTG
911.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG
'3070.00
------------------=.-----------------------------------------------------i---
Permit . . . . . .
BUILDING PERMIT
.Additional desc
Permit Fee
1252:00 Plan Check, Fee
813:80
Issue Date . . . .
Valuation . . . .
274539
Expiration Date
5/12/05
Qty Unit Charge
Per
Extension
BASE FEE
639.50
175.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
612.50
Permit . . . . . ..
ELEC-NEW RESIDENTIAL
Additional desc
Permit Fee
137.11 Plan Check Fee
30.61
Issue Date
Valuation . . . .
0
N
P.O. Box 1504 ' �/i •
w VOICE (760) 777-701
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 3 Date:
Applicant: chitect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
r
Ic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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 {{ m full force and effect.
___Ueease Class 7 Li en se No.
/Date• /�'�"'��---Contractor �Ll nl
V
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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
s�surd My �workers' compensation ance carrier and olicMumber re:
�rier iAT� i-.)..7� Policy Number carrier and
8
_ 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 provisip6s)
Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a constriction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced within 160 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 informati co . I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to ente on a above-mentioned property for inspection purposes.
ti
ate –4v -c Sig(Applicant or Agent):
Page
2
Application Number
04-00004063.
Date
5/12/04
Expiration Date
5/12/05
Qty. Unit
Charge
Per
Extension
BASE
FEE
15.00
3070.00-
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
107.45
733.00
0200
ELEC
GARAGE OR NON-RESIDENTIAL
14.66
Permit . .
----------------------------------------------------
. .
GRADING PERMIT
Additional desc
Permit Fee
15..00
Plan Check 'Fee
.00
A Issue Date
Valuation
0
Expiration Date
5/12/05
Qty Unit
Charge
Per
t
Extension
BASE
FEE
'15.00
Permit . . .
. .
MECHANICAL
Additional desc
Permit -Fee
127.50
Plan Check Fee
31.88
Issue Date
Valuation
0
Expiration Date
5/12/05
Qty Unit
Charge
Per.
Extension
BASE
FEE
15.00'
3.00 .9.0000.EA
MECH
FURNACE <=100K
27.00
3..0.0-,
9.0000
EA MECH
'B/C <=3HP/100K BTU
.27.00
8.00
6.500.0
EA MECH
VENT FAN
52.00
1.00
6.5000
EA MECH
EXHAUST HOOD
6.50
Permit . .
. .
PLUMBING
----------------
Additional desc
..Permit Fee
173.25
Plan Check Fee
43.31
Issue Date
Valuation .'
0
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00"
17.00
6.0000
EA PLB
FIXTURE
102.00
1.00 15.0000
EA- PLB
BUILDING SEWER
15.00
' 1.00
7.5000
EA PLB .WATER
HEATER/VENT.
7.50
1.00
3.0000
EA PLB
WATER,INST/ALT/REP
3..00
1.00
9.0000
EA PLB
LAWN SPRINKLER'SYSTEM
9.00,
9.00
.7500
EA PLB
GAS PIPE >=5
6.75
r
Page
3
Application Number .
. . . .
04.-00004063 Date
5/12%04
.Qty Unit Charge
Per
Extension
1.00 15.0000
----------------------------------------------------------------------------
EA PLB GAS METER
15.00
Special Notes and Comments
SFD - TR 29800,. LOT 1.
PLAN 1CR. PERMIT
DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA
OR DRIVEWAY APPROACH.
Other Fees
. . . .
ART IN PUBLIC PLACES -RES
186.34,
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
81.38
DIF FIRE PROTECTION -RES
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF. PARK MAINT. FAC - RES
5.00
DIF PARKS/.REC - RES
502.00
STRONG MOTION (SMI) - RES
27.45
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total
1704.86
..00 .00
1704.86
Plan Check Total
919.60
.00 .00
919.60
Other Fee Total
2700.17
.00 .00
2700.17
Grand Total
5324.63
..00 .00
5324.63
CAOE
ENERGY '-
emces
PO. Box 62'
Rancho Mir- w., r pctiv vcu. ki wJ
Email: DESNRG L@AOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
GREG NORMAN ESTATES PH -2 DATE TESTED 3-21-05
Project Title Date
55-380 MEDALLIST DRIVE LA QUNTA CA. 92253 EHLINE CO.
Project Address Builder Name
GILBERT LEVZA 760-578-4301 PLAN 1 3 UNITS
Builder Contact Telephone Plan Number
RICHARD KROWN 760-250-1852 GROUP 3
HERS Rater Vim"`- Telephone Sample Group Number
#CCNRK613292 03-21-05 LOT 58 1 OF 1
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.
❑ 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
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow)
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 0
provided for inspection
I
0 - 0
Certificate of* Occupancy
T4&t 4 #gum
'iit/
r I.xaavoc Tm
OF w Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of -the City regulating building
construction and/or use.
Use classification: SFD
Occupancy Group: R-3
BUILDING ADDRESS: 55-380 MEDALLIST DR.
Type.of Construction: V -N
Owner of Building: MEDALLIST DEVELOPMENT
Building Official
IN A CON
Building Permit No.: 04-4063
Land Use Zone: RL
Address: 1070 E. INDIANTOWN RD.
City, ST, ZIP: JUPITER, FL 33477
By: STEVE TRAXEL
Date: 03-28-2005