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SFD (04-4072)55735 Medallist Dr 04-4072 BUILDING & SAFETY DEPARTMENT Cwt D .P.O. i x 154 (760).777-7012 t:pFf9 78-495 ALL FAX (760) 777-7011 LAjgL1ji 6, 2bALIF A 92253 INSPECTION REQUESTS (760) 777-7153 CITY ®6 LAQUINTA ILDING PERMIT FIN PNqr: IDEHT, Application Number CQA0`00:04Q-72 - "`Date 5/12/04 Property Address . . . . . _55735 MEDALLIST DR APN: 767-510-015- - - Application description DWELLING - SINGLE FAMILY DETACHED Property..Zoning . . . . . . . .LOW DENSITY RESIDENTIAL Application valuation . . . . 298162 Owner Contractor NORMAN ESTATES II EHLINE COMPANY C/O MEDALLIST GOLF DEVELOPMENT 55375 MEDALLIST DR 501 NORTH AlA LA QUINTA CA 92253 JUPITER FL 33477 (7.60) - 771-8130 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/LONG <=10 Flood Zone NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CRC # BEDROOMS 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 806.00 PATIO SQ FTG 514.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG '3410.00 ------------------------------------------------------------------------------- Permit BUILDING PERMIT Additional desc Permit Fee . . 1336.00 Plan Check Fee 217.10 Issue Date . . . Valuation 298162 Qty Unit Charge Per Extension BASE FEE 639.50 199.00 3.5000 THOU BLDG 100,0'01-500,000 696.50 .'Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee 150.47 Plan Check.Fee... 9.41 . 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 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: /I A10 7a Applicant: --Architect Applicant's Mailing Address: Architect ic. No.: Date: or, Engineer: 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 C e, and my Licengejs in full force and effect. t rte/ ��� c License Class j ----'license No. `^j Tj tia 'Date --'C; on ,actor ELt U C ,.> 0— co , 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 1, as owner of the property, or my employees with wages as their stile 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 1, 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. have and will maintain workers' compensation ' 'a rice, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ed. wo¢mu compensation ' nce carrier and p c number are: Cartier 1 d1y A-0 t-'�-� Policy Number 2.Z 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, a agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith compl- y withose provi w Date APP' licant 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 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. 1 certify that I have read this application and state that the above inf ation 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 t e ter upon a above-mentioned property for inspection purposes. date "'4D!!I!�Signature (Applicant or Agent): Page 2 Application Number . . . 04-00004072 Date 5/12/04 'Qty Unit Charge .Per Extension BASE FEE 15.00 3410'.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 119.35 806'.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL .16.12 ---------------------------------------------------------------------------- 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 9.000.0 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 . . . . 172.50 Plan Check Fee 10.78 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 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 8.00 7500 EA PLB GAS PIPE >=5 .6.00 1.00. 15.0000 EA. PLB-GAS METER. 15.00 Special Notes and Comments SFD - TR 2965.7, LOT -1.4. PLAN 2C. PERMIT- +►1. Page 3 Application Number 04-00004072 Date 5/12/04 Special Notes and. Comments DOES NOT INCLUDE BLOCK WALLS, POOL; SPA OR DRIVEWAY APPROACH. 75% PLAN CHECK FEE ' REDUCTION APPLIED FOR MULTIPLE' ISSUANCE .OF SAME PLAN TYPE. ------------------ Other Fees . . . . . . . ART IN PUBLIC PLACES -RES 245.40 DIF COMMUNITY CENTERS -RES 97..00 i DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 21.71 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 29.81 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ,. Charged Paid Credited Due Permit Fee Total 1801.47. .00 .00. 1801.47 Plan Check Total 2.45.26 .00 .00 245.26 Other Fee Total 2701.92 .00 .00 2701.92 Grand Total 4748.65 .00 .00 4748.65 Desert - - ENERGY AaE nces — PO. Box 62' S Rancho Miraq., l - vcc. v k' _J -u - Email: DESNRG OAOL.COM R 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 55-735 MEDALLIST DR. LA QUINTA CA. 92253 EHLINE CO. rolec ress; Builder Name GILBERT LEVZA 760-578-4301 PLAN 2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-2084 GROUP 4 HERS Rater Telephone Sample Group Number #CCNRK613292 03-29-05 LOT 14 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: ® 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. 4 ® 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 96 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) = 6 , Check Box for Pass or Fail (Pass=6% or less) ® El Pass Fail ® THERMOSTATIC EXPANSION VALVE (TXV) , ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is ® Elprovided for inspection Deseft- - - ENERGY '- r aEC Services PO. Box 62• Rancho Mirage, .., « . " k, _J c.w- ....rc a Email: DES NRG, D;ZL: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 55-735 MEDALLIST DR. LA QUINTA CA. 92253 EHLINE CO. Project, Address 760-578-4301 - Builder Name GILBERT LEVZA - PLAN 2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-2084 GROUP 4 HERS Rater Telephone Sample Group Number #CCNRK613292 03-29-05 LOT 14 2 OF 3 ' Certifying Signature Date Sample Lot Number ' t 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: N 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 forma ® 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 + M Test Leakage Flow in CFM 57 If fan flow is calculated as 400cfm/ton x number of tons enter calculated ' value here 1400 ` If fan flow is measured enter measured value here . Leakage Percentage (100 x Test Leakage/Fan Flow) = 4.0714 Check Box for Pass or Fail (Pass=6%o or less) • ® ❑ t, Pass Fail ®THERMOSTATIC EXPANSION VALVE (TXV) - ' ® Yes El No Thermostatic Expansion Valve is installed and Access is , provided for inspection t. ® ❑ Dewrt - - ENERGY CAD EC Services — 06. Box 62' Rancho Mirayw, k, wJ LJV- I VJL 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 55-735 MEDALLIST DR. LA QUINTA CA. 92253 EHLINE CO. Project Address Builder Name GILBERT LEVZA 760-578-4301 PLAN 2 3 UNITS Builder Contact Telephone Plan Number RICHARD KROWN 760-250-2084 GROUP 4 HERS Rater Telephone Sample Group Number #CCNRK613292 03-29-05 LOT 14 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) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM 45, 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) = 5.625 Check Box for Pass or Fail (Pass=6% or less) 9 El Pass _ Fail ® THERMOSTATIC EXPANSION VALVE (TXV) ® Yes ❑ No Thermostatic Expansion Valve is installed and Access is provided for inspection ® ❑