SFD (0309-202)55495 Medallist Dr
0309-202
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H -Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W
U) Professionals Code, and my License is in full force and effect.
O ch' . License # • Lic. Class Exp. Date
U)
LU
(1 T
Z Date 44!:a=4zIL ;Signature of Contractor
0
( OWNER -BUILDER DECLARATION
co
W w I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ N 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 'exclu`sively contracting, with licensed
contractors to construct the project (Sec. 7044, Business &' Professionals
Code).
C'') O, I am exempt under Section B&P.C. for this reason i
• LO
N Date Signature of Owner
,0.
E Q WORKER'S COMPENSATION DECLARATION .:
01 . I hereby affirm under.penalty of perjury one of the following declarationLO < Ccs:
0 O 1 have and will maintain a certificate of consent to self -insure for workers'
.'`X w compensation, as provided for by Section 3700 of the Labor Code,' for 'the
rY J. Q performance of the work for which this permit is issued.
<< Q ( (bi /!l have and will maintain workers' compensation insurance, as required by
Se'iibn 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:
Z Carrier Policy No. •
J (This section need not be completed if the permit valuation is for $10000 or less):
O I certify that in the performance of the work for whlch.thls 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 Sec iion.3700yof the Labor
i 3 Code, I shall forthwith comply with tth. ° &e provlslons.
.Date: 1O:•:27 -12'K Applicant riP,
Warning: Failure to secure _Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1100,000,16
addition to the cost of compensation, damages as provided for In Section 3706
of the- Labor,Code, interest and attorney's fees. •
. IMPORTANT Application is hereby made to the Director 'ofBuilding and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to °
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance, of such
permit, or cessation of work for 180 days will subject permit to cancellation..
s I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
•'^' the above-mentioned property for inspection °purposes.
Signature (Owner/Agent) ,+ -._- Date
L j
BUILDING PERMIT PERMIT#
DATE+w VALUATION' ' LOT TRACT
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JOB SITE
AP N
ADDRESS -
OWNER
CONTRACTOR/DESIGNER/EN INEER ,
ITO 1, LIP
81-140MMORl^..LaDWM
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U; QUIMA CA. 9ni-.,3
Uv4UDr1A1 CA 99112W
USE OF PERMIT
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CONSTRUCTION i FBF lv`:1"h:'rt iar•11+ OC? i YC1, 1 :Oa
I'F,1.,AN CHRIO K 111,°? jar'!,000143V-3 t$ X1,1"ii,t?d'
T It'C.' ?Ar'i CAL FIRlOt:-.000» b 1R4i iiY X31 , i4
ZG&,'S`R1C1A.1. F ;' 01..- 60420.000 $2441.06
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.. i 01 X00 419-000 x:5.43 R0
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aE'ItC 1!•Sa YAL'7'1YI./In 16011,.1 . 5ua `{i1...Qiif1-2
OR111Jf2dS3:TSK 01.000," ,21400 i5,r iSi
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"I NNIDIX 11-190:
p Yd e P PAW FL
r OCT 2'71 (Y3 € IrUNS D ; INTO
0,18 W
CITY OF LA GUINTA `
FINANCE DEPT
RECEIPT
DA'TE / '
BY a
DATE FI LED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
,
Ducts
Slab Grade
Or,
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Y 1Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final Jr-
BLOCKWAL APPROVALS
POOLS - SPAS
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
,-S,
Encapsulation
Gas Piping
/G O
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:
Desen
ENERGY s -- CADEC
PO. Box 62'
Semces —
Rancho MirayC,.,. va iu , vCll. 1/W .GJV-IUJL
Email: DESNRG OAOL.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 qq Date
55W MEDALLIST DRIVE LA QUNTA CA. 92253 EHLINE CO.
Project Address Builder Name
GILBERT LEVZA 760-578-4301 PLAN 4 3 UNITS
Builder Contact ' Telephone Plan Number
ALAN WEAVER 760-880-5504 GROUP 2
HER ter Telephone Sample Group Number
kle- #CCNAW183266 12-17-04 LOT 8 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)
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
values
Test Leakage Flow in CFM 28
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) = 3.5
Check Box for Pass or Fail (Pass=6% or less)
Pass -
® THERMOSTATIC EXPANSION VALVE JXV)
® Yes ❑ No Thermostatic Expansion Valve is installed and Access is
provided for inspection
Fail
01
This is to certify that in latlon has been installed in conformance with th cu en®rgy
regulation; California Ad 'nistrativa Code, Title 24, State of California, in t wilding located a4
CEILINGS: '
TYPE: BATTS MAUN CTURER: Certainteed
TYPE: IATTS MAUNFACTU C®rtaintei
GENERAL CONTRACTOR: EH CO a ILDIERS
BY: TI E.
PARAGON SCHM BUILDING PRObUCTS A
BY, TITLE: ACCOUNT
60/L0 39Vd 90Z 0WHOS N09V6Vd
THICKNESS: R-363
THICKNESS: R-19
LICENSE #
Company LICENSE # 229517
RESENTIVE DATE.
080T0b609L 01?:£T 6002/0£/60
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....- ... INSULATInlUyq_ 10ypwr H ® E
r%
This is to certify that insulation has been installed in C3nformance with the current energy
regulation, California Administrative Code, Title 24, State of Calitomia
in the building at
f
55-495 MEDALLIST DRIVE LOT 8, WUI1 p7A CA
k
CEILINGS:
r
TYP E: BAITS , 'MAUNFACTURER: Jahn Manville THICKNESS: R-38
r.
.WALLS:
TYPE: eATTS MANUFACTURER: Certainteed THICKNESS: R-19
GENERAL CONTRACTOR: EHLINE CO BUILDERS UCENSE #
y
BY: TITLE:
PARAGON SCHMIQ BUILDING PRODUCTS A MASCO Company LICENSE
# 221517
r
_8Y: TITLE: ACCOUNT REPRESENTIVE OATE-4ZZS G
This is to certify that in latlon has been installed in conformance with th cu en®rgy
regulation; California Ad 'nistrativa Code, Title 24, State of California, in t wilding located a4
CEILINGS: '
TYPE: BATTS MAUN CTURER: Certainteed
TYPE: IATTS MAUNFACTU C®rtaintei
GENERAL CONTRACTOR: EH CO a ILDIERS
BY: TI E.
PARAGON SCHM BUILDING PRObUCTS A
BY, TITLE: ACCOUNT
60/L0 39Vd 90Z 0WHOS N09V6Vd
THICKNESS: R-363
THICKNESS: R-19
LICENSE #
Company LICENSE # 229517
RESENTIVE DATE.
080T0b609L 01?:£T 6002/0£/60
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Certifica to Of..Dccupanc s
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Fof 'B:uildi g ,, Safety Dep_ artment
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'.This Certificate" is issued pursuant- 6 -the requirements of Section 109, of the ,California: Building
Coale, -certifying, that, at* -.the .timeof-;=issuance, - this,'=structur`e" was,in, compliance with • the
provisions -of`the Building,--Code.-and the' varous ordinances+.of the'.Ci(Y regulating buildin 9
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construction and/or use =
y
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'BUILDING. ADDRESS: 55-495 MEDALLIST -DRIVE
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TEMPORARY:CERTIFICATE -'MODEL HOME' -'y
Use classification: SINGLE FAMILY DWELLING'- y -`Building Permit No.: 0309-202
Occupancy Group: R-3 - •; ,. ''~ - rType ofJConstruction VN° ' ' Land Use Zone: RL
1-7
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,r Owner of'Building -NORMAN ESTATES II LLC Address: 81-140 NATIONALDRIVE '
City; ST,.ZIP: LA QUINTA, CA. 92253
-13 y: GARY HARTMAN'.
+Date:
f 6-25=2004 -,
• Building Official
- POST IN A -CONSPICUOUS PLACE