SFD (04-4064)55420 Medallist Dr
04-4064
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
c `yOFTt 9 8-495LLEA - FAX (760) 777-7.011
Qu1 92253 INSPECTION REQUESTS (760) 777-7153
JUL 0 6 2004 B I DING PERMIT ''
CITY OF
LA T
Fro?ra C® I
Application er-- Pr.._ 04 00004064 Date 5/12/04
Property,Address . . . . . • 5-5420EM DALLIST DR•
APN: 767-510-020- -
Application description . . . DWELLING = SINGLE FAMILY DETACHED'
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . 274539
Owner Contractor
7 --
NORMAN -ESTATES II EHLINE COMPANY
C/O MEDALLIST GOLF DEVELOPMENT 55375 MEDALLIST DR
501`NORTH AlA LA QUINTA CA 92253
JUPITER FL 3347:7, (760) 771-8130
WCC:. STATE FUND
r WC: 2290.006783 01/01/05
CSLB: 482086 11/30/05
CCC: B
-------------------------- Structure Information --------------------
Construction Type . . . TYPE V NON RATED
Occupancy Type . . . . . . DWELLG/LODGING/LONG.<=10'.
Flood Zone . . NON -AO FLOOD ZONE
Other struct info . . . CODE EDITION 2001'CRC
# BEDROOMS 3.00
FIRE SPRINKLERS NO
GARAGE SQ. FTG 733 ."00
PATIO SQ FTG 911.00
NUMBER.OF UNITS 1.00
FIRST FLOOR SQ FTG 3070.00
Permit . . . BUILDING PERMIT
Additional desc
Permit Fee . . . . ..1252.00 ...Plan Check Fee 203.•45
Issue Date Valuation . . .. 274539
Qty Unit Charge Per Extension
BASE FEE' 639.50
175.00 3.50.00 THOU BLDG 100,001-500,00,0, 612:50
----------------------------------------------------------------------------
Permit ELEC-NEW RESIDENTIAL
Additional desc.
Permit Fee 13*7.11 Plan Check Fee 7.65
Issue Date Valuation . . . 0
Qty Unit Charge Per Extension
P.O. BOX 1504 • 'G��
78-495 CALLE TAMPICO 4
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant: chitect
Applicant's Mailing Address: Architect
A Al
t
,-[-tic. No.:
or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
or Engineer's Address:
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 ss Lice ngQ is in full force and effect. / ' (�A ZC>�
dense Class j_7 License No. `�j Zj
OWNER -BUILDER DECLARATION
I 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 t
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 Owner
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 ued. My w�se rs compensal iPA- Surance carrier and polic number are:
�G`arrier SIS% /—z�,JQ /policy Number _,_,6u
Z_f, 6c3-(6-7 K 3
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, anAagree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisj6r)✓;
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 construction 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 Quinta, 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 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 info tion is correct. 1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize re entatives of this county toe a pon the above-mentioned property for inspection purposes.
ate �.� "'�J Signature (Applicant or Agent):
r
Page
1
2
Application Number . . . . . 04-00004064 Date
r
5/12/04
Qty Unit
Charge Per
Extension
y
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
Issue Date . .
. . Valuation
0
Qty Unit
Charge Per
Extension
BASE FEE
15.00
Permit . . . .
. MECHANICAL i
Additional desc
Permit Fees
127.50 Plan Check Fee
7.97
issue Date
Valuation . .
0
Qty Unit
Charge Per
Extension
BASE.FEE
15.00
3.00
9.0000 EA MECH FURNACE <=1-00K
27.00
3.00
9.0000 EA MECH B/C <=3HP/100K BTU
27.00•
8.00
6:5000 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-
10.83
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
13.00
1.00
9.0000 EA PLB LAWN SPRINKLER SYSTEM
9.00
9.00
.7500 EA PLB GAS PIPE >=5
6.75
1.00 15.0000
EA PLB GAS METER
-
15.00
-
----------------------------------------------------------------
Special Notes and Comments
----------
SFD - TR 296571
LOT '5.7. PLAN 1B. PERMIT,
Page
3
Application Number
04-0000406.4 Date
5/12/04
Special Notes and
Comments
DOES NOT INCLUDE BLOCK
WALLS,
POOL, SPA
OR DRIVEWAY APPROACH.
75% PERMIT
FEE ;
REDUCTION APPLIED
FOR MULTIPLE.ISSUANCE
OF SAME PLAN TYPE.
-Other Fees:
ART IN PUBLIC ,PLACES -RES'
186.34
DIF COMMUNITY CENTERS -RES
97.00'
DIF CIVIC CENTER - RES
366.00 .
ENERGY REVIEW FEE
20.35
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
229.90
.00 .00
229:90..
Other Fee Total
2639.14-
.00 .00,
2639.14
Grand Total
4573.90
.00 .00
4573.90
Deseft,
C A D E C
ENERGY
s ces -
PO. Box 62'
Rancho Mir-ayw, acc i v
Email: DESNRG PIAOL.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
55-420 MEDALLIST DRIVE LA QUNTA CA. 92253 E
ProjectAddress 760-578-4301 Builldede NE r Name
GILBERT LEVZA PLAN 1 3 UNITS
Builder Contact Telephone Plan Number
RICHARD KROWN 760-250-1852 GROUP 3
HERS Rate - Telephone Sample Group Number
#CCNRK613292 03-21-05 LOT 57 1 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: 0 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.
x
® 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) = 4.375
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 r
1 0
Desem- =
ENERGY
PO. Box 62' S
Rancho Mirayc, - cGG i v cn. w GJv i oJG
Email: DESNRG OAOL.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
55-420 MEDALLIST DRIVE LA QUNTA CA. 92253 EHLINE CO.
-Froject 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 Telephone Sample Group Number
o L #CCNRK613292 03-21-05 LOT 57 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' -
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM 86
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) = 5.375
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 ® ❑
Deseft--
ENERGY C A D E C
PO. Box 62' Services
Rancho Wag., r w, GJV- I UJL
Email: DESNRG OIAOL.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
55-420 MEDALLIST DRIVE LA QUNTA CA. 92253 EHLINE CO.
-Project Address . . 760-578-4301 Builder Name
GILBERT LEVZA PLAN 1 3 UNITS
Builder Contact Telephone Plan Number,
RICHARD KROWN 760-250-1852 GROUP 3
HERS Rater !" Telephone Sample Group Number
#CCNRK613292 03-21-05 LOT 57 3 OF 3
Certifying Signature Date Sample Lot Number
ci , 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 72
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
value here 1200
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 6
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
Certificate of Occupancy
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: 55-420 MEDALLIST DR.
Type of Construction: V -N
y
Owner of Building: MEDALLIST DEVELOPMENT
Building Official
POST IN A CO
Building Permit No.: 04-4064
Land Use Zone: RL
Address: 1070 E. INDIANTOWN RD.
City, ST, ZIP: JUPITER, FL 33477
By: STEVE TRAXEL
Date: 03-28-2005
PLACE