SFD (0309-201)55455 Medallist Dr
0309-201
LICENSED CONTRACTOR DECLARATION
I hereby.affirrri under penalty of perjury that I am licensed under provisions of .
F Chapter 9 (commencing with Section 7060) of Division 3 of the Business and
C14
W Professionals Code, and my License is in full force and effect.
C:) =) M License # Lic. Class Exp. Date
LU
Z r Date r `, ig t Signature of Contractor
0.
I.— C) OWNER -BUILDER DECLARATION .
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z ( )• • 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)• s r,
C0 O I am exempt under Section ` B&P.C. for this reason
LO
O. N Date Signature of Owner
0),
E Q WORKER'S COMPENSATION DECLARATION•
,p IM I hereby affirm under penalty of perjury one'of the fo(lowing.declaratlons:
,;r O O 1 have and will maintain a certificate of consent to self -insure for workers'
LLfJ , compensation, as provided for by Section 3700 of the' Labor Code for the
Q performance of the work for which this permit is issued.
I, have and will maintain workers' compensation insurance, as required by .
.p,0 UA Q Sdction 3700 of the Labor Code, for the performance of the work for which'this
#,d .u.) H permit is issued: My workers' compensation insurance carrier,& policy no. are'.
Cartier Policy No.`..
O "T. T
(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',
a 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 l should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with thoseprovisidins.
Dater , :a Applicant ,r' t
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'Latior 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 pursuantto
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.
I 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) ' ►9.f4 . r _ Date .. • y
BUILDING PERMIT PERMIT" " • ' :'
DATE VALUATION -.LOT pij •..af• TRACT
JOB SITE
ADDRESS ryy, •._ ii -A_ ppS yyye rtyq_y"dry
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OWNER
CONTRACTOR/17 NEER ,
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S-A, QuAyrrA-, CA !V21 2 S
ICA 921111,53
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USE OF PERMIT .•
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POOL, SF .011 URI4,'P +A,*,'',A.Pi'ROACH
7V.00 SF
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fASC.A`itlIVAL1Y.RX ).RIt .000 V.200
' MIuL; 'ItIC,AI; i;: t t,81. t9+."4 e vG Omit $,'i9 34
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.1' :6Lf F. dJ a.•
•
OCT '2003
j
CITY.OF.UINTAFINANEPT
RECEIPT
DATE
BY
DATE F%SIA /D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Return Air
Slab Grade
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
p
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
Pool Cover
Sewer Connection
QLD
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
gg
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
ENERGY S ' -- CADEC
Smit -
PO. Box 62
Rancho Mir4ge, w. uL i V wall. , w GJV 1 VJL
Email: DESNRG (WAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
GREG NORMAN ESTATES PH -1 & MODELS
Project Title
55-455 MEDALLIST DRIVE'AA QUNTA CA. 92253
Nrolect Adoress
GILBERT LEVZA 760-578-4301
Builder Contact Telephone
ALAN WEAVER 760-880-5504
HERS f0tter Telephone
#CCNAW183266
Certifying Signature Date
Firm: DESERT ENERGY SERVICES LLC
Street Address: P.O. BOX 621
Copies to: Builder, HERS Provider
-,
Date
EHLINE CO.
Builder Name
PLAN 3 3 UNITS'
Plan Number
GROUP 2
Sample Group Number
LOT 7 3 OF 3
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.
® 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 41
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) = 5.125
Check Box for Pass or Fail (Pass=6% or less)
® THERMOSTATIC EXPANSION VALVE
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
® ❑
Pass Fail
K
INSU6ATI®N CERTIFICATE '
This is to certify that insulation has been installed In conformance with the current energy
regulation, California Administrative Code, Title.24, State of California, in the building at
55-455 MEDALLIST DRIVE LOT 7, LA QUINTA CA
CEILINGS:
TYPE; BATTS MAUNFACTURER: Certaintsed THICKNESS: R-38
WALLS:
TYPE: 'BATTS MANUFACTURER: Certainteed THICKNESS: R-19
GENERAL CONTRACTOR: EHLINE CO BUILDERS 4ICENSE #
BY: TITLE'
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 '
BY: TITLE, ACCOUNT REPRESENTIVE ` DATE 2 3 (%
._.._....•.... .......... ...._.. . r.. r:. ...•.l'•.. .•+.. ..._...... ✓.'rfr:.:i.i. rail. ..... •'iFI%ir.'w. ':'. .'r.. re. r..rr. r...... ..... .i. r.....i .
INSULATION CERTIFICATE
This Is to rtify that insulation has been installed in conformance with the current e —
regulation, ornia Administrative Code, Title 24, State of California, i n Ilocatad at
CEILINGS:
TYPE: BATTS MAU CTURE ertainteed THICKNESS: R-38
WALLS: -
TYPE: BATTS / M UNFACTURER: C Inteed THICKNESS: R-19
GENERAL CQ ACTOR: EHLINE CO BUILDER LICENSE #
8Y: TITLE..
PARA30 SCHMID BUILDING PRODUCTS A MASCQ Compan ICENSE # 221517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
60/90 3E)Vd 90Z QIWHOS N0E)V6Vd 080T@b 09L ov'Ej tpooz!0E/60
i . Cert fica-...Ce of 30ccu anc
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of . # ' -Building & Safety Department l
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.This Certificate is_issuedpursuant to `the `requirements. of Section 109 of the California Building
S.
Code, certifying• that, at the : time of issuance, this structure was in,Ncdmpliance.. with the
'provisioris of the Building' Code an&th e various, ordinances of the City regulating'. building
,
'construction and/or use.
1 I
`BUILDING ADDRESS:'55-455:MEDALL•ISTD^RIVEu x - •' f
CERTIFICATE -MODEL HOME
,,,TEMPORARY
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71
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Use classification: SINGLE FAMILY DWELLING^~, , W= f Buildmg;Permit No :0309-201+
Occupancy Group: R-3 -Type of ConstrU6tion: VN. c} -{ 'Larid^Use Zone: RL -
Jt
LOwnerof Building.,NORMAN,ESTATES II LLC - Address- 81 -140 NATIONAL DRIVE
LA ,
City, ST, ZIP: QUINTX, CA. 92253
.fBy: GARY: HARTMAN
Date: 6-25-2004..' a
,Building Official
3 - -POST INA CONSPICUOUS PLACE