SFD (04-4068)55615 Medallist Dr
04-4068
o BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
k 92253 INSPECTION REQUESTS (760) 777-7153
LDING PERMIT
(4_-0000.4.0.68 .Date 5/12/04
Property Address . .55,615 MEDALLIST DR
APN: _ 767-510-012 - -
Application description.. DWELLING —SINGLE FAMILY DETACHED
Property Zoning . LOW DENSITY RESIDENTIAL
Application valuation 274539
1
Owner Contractor.
NORMAN ESTATES II EHLINE COMPANY -
C/O MEDALLIST GOLF DEVELOPMENT 5537.5 MEDALLIST DR
501 NORTH A1A LA QUINTA CA 92253
JUPITER FL 33477 (760). 77.1-8130
WCC: STATE FUND
WC: 2290006783 01/01/05
CSLB: 482086 11'/30/05
CCC: B
--------------------------- Structure Information =------------------------
Construction Type TYPE V'-- NON RATED
Occupancy Type . . . DWELLG/LODGING/CONG <=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 3.5000 THOU BLDG 100,001-500,000 612.50 .
Permit . . . . . . ELEC-NEW RESIDENTIAL
Additional desc
Permit Fee . . . . .137.11 Plan Check Fee 7.65
Issue Date Valuation . . . . 0.
Qty Unit Charge Per Extension
P.O. Box 1504 • �� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 444INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: — 0 (p Date:
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 LicenRs in full force and effect.
.1 ---License Class ' ( License No.
1_�' Date 0 _ C9ptractorF—��-i
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
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
d. M orkgom sation�ae4rance Carrie nd p licy�nu(arg:
,25rrier 1_ � % F—C) /Policy Number t 2-Iq /�-�✓ (n�
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' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provi o
nt
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
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 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 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 cancell ion.
I certify that I have read this application and state that the above info ion is 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 en r up he.above-mentioned property for inspection purposes.
Signature (Applicant or Agent):
• n r,xE' f µr n V e r3ti 't . .
zr
g!
Page'
2
Application
Number
. . . 04-00004068 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 ..Flan 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
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 WATERAEATER/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
----------------------------------------------------------------------------
15.0000
EA PLB GAS METER V
15.00
Special Notes
and Comments
SFD - TR 29657,
LOT.. 11.
PLAN 1C. PERMIT
-
C Page
3
Application Number
04-00004068, 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
366.0.0
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
Desert
ENERGY - CADEC
- PO. Box 62' Services
Rancho Miraq., r+ 4—
Em ail:
—Email: DESNRG OAOL.COM
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF.4R
GREG NORMAN ESTATES PH -2 PARTIAL DATE TESTED 03-30-05
Project Title Date'
EHLINE_CO.
55-615 y _'IM D LLIST DR. `LA QUINTA'CA. 92253
Project Address -578-4301 Builder Name
760
GILBERT LEVZA PLAN 1, 3 UNITS
Builder Contact Telephone Plan Number
RICHARD KROWN 760-250-2084 GROUP 4
HERS R7 - Telephone Sample Group Number
LOT 11 1 OF 3
#CCNRK613292 , 03-29-05
Certifying Signature Date • Sample tot 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 partof 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% DuctLeakage). t
Measured
Duct Pressurization Test Results (CFM @.25 Pa) values k t +
Test Leakage Flow in CFM 67 .
If fan flow is calculated as 400cfm/ton x number of tons enter calculated
4 value here 1600
If fan flow is measured'enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 4.1875
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 i'
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03/07/2005 20:50 17603401819 PAGE 02/18
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INSULATION CERTIFICATE
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regulation, ornia Administrative Code, Title 24, State of California, in the building located at,
INSLJLwATI®itI CERTIFICATE
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This is to certify that insulation has been installed in conformance with the current energy
TYPE: BATTS MAU CTURER: Certainteed 61 S. R-38
regulation, California Administrative Code, Title 24, State of California, in the building at
ss -615 MEDALLIST DRIVE, LOT 11, PRASE 2, LA QUINTA CA
WALLS:
CEILINGS:
TYPE: BATTS NFACTURER: Ce teed THICKNESS: R-19
TYPE: BATTS MAUNFACTURER; Certainteed THICKNESS: R-38
GENERA NTRACTOR: EHLINE CO BUILDERS LICENSE #
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WALLS:
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BY: TITLE:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS:. R-19
PARAGON SCHMID BUILDING PRODUCTS A MASCO CompanyL NSE # 221517
GENERAL CONTRACTOR: EHLINE CO BUILDERS LICENSE #
BY: TITLE:
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
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PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
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INSULATION CERTIFICATE
This is ertify that insulation has been installed in conformance with the current energy
a
regulation, ornia Administrative Code, Title 24, State of California, in the building located at,
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CEILINGS- - -
TYPE: BATTS MAU CTURER: Certainteed 61 S. R-38
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WALLS:
TYPE: BATTS NFACTURER: Ce teed THICKNESS: R-19
GENERA NTRACTOR: EHLINE CO BUILDERS LICENSE #
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BY: TITLE:
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PARAGON SCHMID BUILDING PRODUCTS A MASCO CompanyL NSE # 221517
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BY: TITLE: ACCOUNT REPRESENTIVE DATE:
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