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SFD (04-4066)
55540 Medallist Dr 04-4066 Application Number . . . Property Address . . . APN: Application description Property Zoning . . . . . Application valuation . . Owner 92253 .DING PERMIT NORMAN ESTATES II C/O MEDALLIST GOLF DEVELOPMENT 501 NORTH 'AlA JUPITER FL 33477 I BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 • f t 04.,00004`0-66 Date.,' 5/12/04 55540 MEDALLIST DR 767-510-017- - - DWELLING.- SINGLE FAMILY DETACHED LOW DENSITY RESIDENTIAL 274539 Contractor ------------------------ EHLINE'COMPANY ,55375 MEDALLIST DR LA QUINTA CA 92253 (760) 771-8130 Qty Unit Charge Per, .Extension ' 1 r WCC: STATE FUND WC: 2290006783 01/01/05 CSLB: 482086 11/30/05 CCC: B -------------=------------ Structure Information --7 ---------------------- 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 r 1252.00• Plan Check Fee 203.45 Issue Date Valuation 274539 Qty Unit Charge Per Extension BASE FEE 639.50 175.00 3.5000 THOU BLDG 100,001-500,000 t"'.` 612.50 ---------------------------------------------------------------------=------ Permit . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 137.11 Plan Check Fee 7.65 Issue Date Valuation ' 0 Qty Unit Charge Per, .Extension ' 1 r P.O. Box 1504 • " VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4 4 a INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: d 4 IWO CO irp Date: l0 Applicant: Chitect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. 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 Licenin full force and effect. /License Class Pi icense No. `` � Z©T, Date - b n rectorI�—� iJ L r >.J C--- C<�, 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 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 Sassed. M work ompensation in ce carne an oti,cy number re er 1 "4- � olicy Number 19 `-i -) _ I certify that, in the performanc 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, aD4 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 provis"c is. , _ I-- 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 construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address 0 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, indemnity 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 appfication becomes null and void if work is not commenced within 160 days from date of issuance of such permit, or cessation of work for 160 days will subject permit to cancellation. 1 certify that I have read this application and state that the above info ion's correct, 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 n the above-mentioned property for inspection purposes. ature (Applicant or Agent): Page 2 Application. Number . . . . . 04-00004066 Date 5/12/04 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 Issue Date . . Valuation .0 Qty Unit' Charge Per Extension ---------------------------------------------------------------------------- BASE FEE 15.00 Permit . . . . . MECHANICAL Additional desc Permit Fee 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 <=100K 27.00 3.00 9'.0000 EA MECH B/C-<=3HP/100K BTU 27.00 8.00 i 6.5000 EA MECH VENT FAN-., 52.0.0 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 . 6.00.00 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 1.00. ------------------------------------------ 15.000.0 EA PLB GAS METER 15.00 Special Notes ---------------------------------- and Comments SFD - TR 29657, LOT 54. PLAN 1B: PERMIT Page 3 Application'Number . . . . . 04-00004066 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 MAINZ' 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 :001 2639.14 Grand Total 4573.90 .00 00 4573.90 De"FIt- ENERGY S ' CAOEC S ameeS — PO. Box 62' Rancho MiraWc, - zv ,v cu. k, _J LJV- I UJG Email: DESNRG OAOL.COM CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R GREG NORMAN ESTATES PH -2 Project Title 55-540 MEDALLIST DRIVE LA QUNTA CA. 92253 Project Address 760-578 1301 GILBERT LEVZA Builder Contact Telephone RICHARD KROWN 760-250-1852 HERS Rate Telephone #CCNRK613292 03-21-05 Certifying Signature Date DATE TESTED 3-21-05 Date EHLINE CO. Builder Name PLAN 1 3 UNITS. Plan Number GROUP 3 Sample Group'Number LOT 54 1 0F 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 comp_ly_,. 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) ❑ THERMOSTATIC EXPANSION VALVE (TXV) ❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ❑ ❑ Pass t " Fail ❑ ❑ •C, Certificate of Occupancy Qg&rC4V INC.MNAnTED . i - oF 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'..I r BUILDING ADDRESS: 55-540 MEDALLIST DR. Y ' s 5 Building Permit No.: 04-4066 Use classification: SFD 9._ f I x p Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: RL Owner of.Building:. MEDALLIST DEVELOPMENT- Address: 1070 E. INDIANTOWN RD. t City, ST, ZIP: JUPITER, FL 33477 By: STEVE TRAXEL s Date: 03-28-2005 I Building Official i V E d POST IN A CONSPICUOUS PLACE