SFD (0309-200)55415 Medallist Dr
0309-200
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
af'f
Date Lle, 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). I • ' `'
( ) 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. forthis 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, aspprovided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(}/1 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.
WrNTE FOR
(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' compensatiorl provision5;of Section 3700 of the Labor
Code,,l shall forthwith comply with those/pr islons.
Dates - Applicant .
Warning: Failure to secure Workers' Compensation coverage is unlawful'a'nd
shall subject an employer to criminal penalties and civil fines up to $1001000, 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 foy`inspection purposes.
Y.ps
Signature (Owner/Agent)rt 4° r.a„ • Date •--
BUILDING PERMIT PERMIT"
DATE VALUATION LOT' { {LAd.• (y . TRACT
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JOB SITE
APN
ADDRESS
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OWNER .k^
CONTRACTOR/DESIGNER/EN INFER
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33 _095 NATKIIZAIAT. DRIVE
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USE OF PERMIT '" i:•
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OF AFINAN
RECEIPT
DATE t
'BY
DATE I AL
INSPECT
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
O.K, to Wrap
FramingCompressor
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F.A.U.
Insulation 3 Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath d
Drywall - Int. Lath
Final
Final r
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Pool,Gover
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
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
ENERGY S =- A a E
PO. Box 62' S
Rancho Mirayc, i. vL ,v i cll. ,/W LJV-IUJL
Email: DESNRG C&AOL.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
-55-415 : — ;MEDALLISTIDRIV-E-'- LA QUNTA CA. 92253 EHLINE CO.
Project Address Builder Name
GILBERT LEVZA 760-578-4301 PLAN 2 3 UNITS
Builder Contact Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 2
HERS RatAr Telephone Sample Group Number
k)A ,,. _I-#CCNAW183266 12-17-04 LOT 6 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: 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 25
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) = 3.125
Check Box for Pass or Fail (Pass=6% or less) ® ❑
Pass Fail
® THERMOSTATIC EXPANSION VALVE JXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection 19 ❑
.
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This is to rerElfy' that insulation f ets been Installed in conformance vAth the current energy
regulation, Cai(tom!a AdmInWmfive Code, 'title 24,
$tett cel C-allforms, In the building at
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56406 MEDALLIST DRIVE LOT 8i, LA QUANTA CA
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TYPE: BAITS MAUNFACTURER: is®rtalnted THICKNESS: R•38
TYPE:I ArfS MANUFACTURER: C oftinbied THICKNESS- R-15
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GENERAL CONTRACTOR: EMME Co BUILDERS LICENSE
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BY
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PARAGON
AGON SC HMID bUILDIN PRODUM A MASCO Company LIC EAlSE 221617
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TPTLE: ACCOUW R ESENTIV DATE:
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65499 MEDALLIST ORM LOT 6,
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TYPE: SATTS MAU NFACTURER:.0srWntsmd THICKNESS: R-38
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TMICICIdESS: R-49
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PARAGON SCHIVIlf) EtJIL 1NG PRObUCiS i4 MASCO Coat y
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TITLE: ACCOUNT REPRESENTIvE DATE:
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This C_ ertificate is issued pursuant` to ,the requirements of`Section.J09 of the california:'Building
Code,, certifjring °,,that, at3the ' time of issuance, this structure was in compliance with the
provisions of the Building Code and the `various ,ordinances `of; the city ;regulating building
_'Co construction and/or,use.
: t .,6 ,`? tT. J .. '. 7 f • .. _ ] a ' may.
- - BUILDING ADDRESS: 55-415 MEDAL -LIST DRIVE- °• - .., , f
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CERTIFICATE ^ MODEL "HOME r
.TEMPORARY
Use classification: SINGLE FAMILY --'DWELLING, _ ' ; µ Building Permit No.:' 0309-200
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. Occupancy Group R-3 ' ` Type of `Construction VN:R ' Land Use Zone:, RIL
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Owner of Building: NORMANrESTATES 11 LLC ;,' ,:`v Address: 81-140 NATIONAL DRIVE,
J' ti , ,' • City, ST, ZIP: LA QUINTA,'CA. 92253 .
By: GARY HARTMAN • -
*..
- _ f Date: 6-25-2004
u•t° Building Official
' ,' POST IN A CONSPICUOUS PLACE `ti