04-4069 (SFD)55825 Medallist Dr
04-4069
BUILDING & SAFETY DEPARTMENT
ti (760).777-7012
FAX (760) 777-7011
2253 INSPECTION REQUESTS (760) 777-715,3
ING PERMIT
Application Number .
. . . . 04=0-0=00;4-069' Date
:5/12/04
Property Address . .
. . . .. 55825—MEDALLIST DR
APN:
76.7-500-002- - -
Application description
. . . DWELLING - SINGLE FAMILY DETACHED
Property Zoning
LOW DENSITY RESIDENTIAL
Application valuation
. . . 274539
Owner
Contractor
NORMAN ESTATES,II
EHLINE COMPANY
C/O MEDALLIST GOLF DEVELOPMENT
55375 MEDALLIST DR
501 NORTH AlA
LA'QUINTA '
CA 92253
JUPITER
FL 3.3477 (760) 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
733.`00
PATIO SQ FTG
911.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG
3070.00
---------------------------------------------------
Permit . . . .
--------=.-------------`--
BUILDING PERMIT
r_.
Additional desc
Permit Fee
1252.00 Plan Check Fee
203.45
Issue Date . . . .
Valuation
274.539
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 N.
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:
Applicant:
Applicant's Mailing. Address:
Architect
Architect
Lic. 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
Code, and Lice is It
is in full force and effect.
'/� „ n �., -ZG �r
License Classss �S icense No.� b
/ Date '-C�4ractor
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' compen��Sation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
sued. My wp*ers compens 'ertinsurance carrier an oli tuber re:
/e—Carrier (�--L) .� Policy Number �% 19W ME
_ 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 a ree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
i- PP forthwith comply with those provisi s.
Date "tO / Applicant
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 N 0C
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.
I certify that I have read this application and state that the above info ati n i 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 me up the above-mentioned property for inspection purposes.
ate—Z -Ao "s'T S' re (Applicant or Agent) -
Y..'
4
t.
Page
2
Application
Number .
. .
. . 04-00004069 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
-.;----------------------------1----------------------------------------------
BASE FEE'
15.00
Permit .
. . ... . MECHANICAL
Additional
desc
.Permit Fee
. . .
127.50
Plan Check Pee
7.97.
Issue Date
. . .
Valuation
0
Qty
Unit.Charge
Per,
Extension
BASE FEE
15.00
3.00
9.0000
EA
MECH FURNACE <=100K
27.0.0
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 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
15.0000
EA
PLB GAS METER
15.00
Special Notes
and Comments
SFD - TR 29657,
LOT 16.
PLAN 1C. PERMIT
Page
3
Application Number
. . . . .
04-00004069' .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 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 CAaEC L
-
Pb. Box 62' services
Rancho Mir- qG, V -ALL/ V VGII. ,/W LJV IUJG
Email: DESNRG (IAOL.COM
CERTIFICATE OF FIELD -VERIFICATION AND DIAGNOSTIC TESTING (Page I of 7) CF -4R
GREG NORMAN ESTATES PH -2 DATE TESTED 3-21-05
Project Title Date
55:i2_5 I MEDALLIST DRIVi LA QUNTA CA. 92253 EHLINE CO.
Project . ress '760-578-4301 Builder Name
GILBERT LEVZA PLAN 1 3 UNITS
Builder Contact Telephone Plan Number
RICHARD KROWN 760-250-1852 GROUP 3
HERS Rater/ Telephone Sample Group Number
#CCNRK613292 03-21-05 LOT 16 1 OF 1
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) V
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) ❑ ❑
Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
❑ Yes ❑ No Thermostatic Expansion Valve is installed and Access is ❑ ❑
provided for inspection
03/07/2005 20:50 17603401819 PAGE 06/18
INSULATION CERT FICAT `
This is to certify that insulation has been installed in conformance with the current energy i
regulation, Califomia Administrative Code, Title 24. State of California, in the building at +
55-825 MEDALLIST DRIVE, LOT 16, PHASE 2, LA QUINTA CA
EIL DS THICKNESS: R-38
TYPE: BATTS MAUNFACTURER: Certainteed
WALL THICKNESS: R-19
TYPE: BATTS MANUFACTURER: Certainteed
GENERAL CONTRACTOR: EHLINE CO BUILDERS LICENSE #- '
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
t"&.BY -
TITLE: ACCOUNT REPRESENTIVE DATE:
IN TI®N CERTIFICATE
This' to certify that insulation has been Installed in conformance with the current energy
regulat California Administrative Code, Title 24, State of Califomia, in,the building located at
CEILINGS:
TYPE: BATTS MA CTURER: Certainteed THICKNES
TYPE BATTS MAUNFACT : Certa ed THICKNESS: R-19
GENERAL CONTRA : EHLINE CO BUILDERS ICENSE #
BY: TITLE -
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE 1517
BY: TITLE: ACCOUNT REPRESENTIVE DATE:
F