BRES2017-024178-495 CALLE TAMP ICO VOICE (760) 777-7125 � D
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/26/2017
Permit Type/Subtype: BUILDING RESIDENTIAL/DWELLING - SINGLE FAMILY DETACHED Owner: -
Application Number: BRES2017-0241 PEPE BUILDS LLC.
Property Address: 52480 AVENIDA.CARRANZA��.� 52480 AVENIDA CARRANZA
APN: 773291001 j� Q LA QUINTA, CA 5'2253
'Application Description: PEPE BUILDS LLC / 2,820SF Wr'FiLhIIJG/RES 3/LASS ,F 13D
Property Zoning:
Application Valuation: $136,298.80 U;_ ✓✓ 7 2017
Applicant:U�17Cm'OFt j QUINTA Contractor:
GABRIEL RIOS yQ�, ENTDEPARTfdENT CORONEL ENTEF.PRISES INC
49901 CINNABAR 42760 MADIO S—REET
COACHELLA; CA 92236 INDIO, CA 92207
I 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 Professions Code,
and my License is in full force and effect.
License Class: B License No.: 7
Date: 1 a -a77- k� Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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
Contractor's 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).:
(_) 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 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.).
(_) 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.). .
(_) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
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
Lender's
(760)775-1234
Llc. No.: 727199
WORKER'S 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 37CO 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 perfo-mance of the work for which this permit
is Issued. My workers' compensation insuran.e carrier and policy number are:
Carrier: BENCHMARK INSURANCE COMPANY Policy Number: CST5009346
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner.sc as to become subject to the workers'
compensation laws of California, and agree ti -at, if I should become subject to the
workers' compensation provisions of Sec ' n .t70 of the or Cod I hall forthwith
comply with those provisions.
Date: Va —a 1 — \—I 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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to Me Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this apphcation 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 oRssuance of such permit, or cessation of
work for 180 days will subject permit to cance:lation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and'county ordinances and state laws relating to building
construction, and hereby authorize representztives of •s city to enter upon the
above-mentioned property for inspection purposes.
Date: �a- a 7•l t Signature (Applicant orAgent
r
Date: 12/26/2017
Application Number:
BRES2017-0241
Owner:
Property Address:
52480 AVENIDA CARRANZA
PEPE BUILDS LLC
APN:
773291001
52480 AVENIDA CARRANZA
Application Description:
PEPE BUILDS LLC / 2,820SF DWELLING/VB/RES-3/CLASS A-FR/13D
LA QUINTA, CA 92253'
Property Zoning:
Application Valuation:
$136,298.80
Applicant.
Contractor:
GABRIEL RIOS
CORONEL ENTERPRISES INC.
49901 CINNABAR
42760 MADIO STREET
COACHELLA, CA 92236
INDIO, CA 92201
(760)775-1234 .
----------------------------------------------------
----------------------------------------
Llc. No.: 727199
Detail: 2,112SF SINGLE FAMILY
DWELLING [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLCCK WALLS OR DRIVEWAY
APPROACH. RECONSTRUCTION OF FIRE DAMAGED DWELLING, DIF AND MSHCP EXEMPT, TUMF DEADLINE
PASSED AND 15 REQUIRED. 2016 CALIFORNIA
BUILDING CODES.
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $6.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: . $6:00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE
.101-0000-42403 .
.0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE PC
101-0000-42600
0
$17.73
Total Paid for ELECTRICAL: $43.06
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$26.52
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA.ADDITION 1,000SF, PC
101-0000-42600
0
$10.92
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$156.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$51.49
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $244.97
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT <=7KSF
101-0000-42408
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT <=7KSF PC
101-0000-42600
0
$38.00
Total Paid for GRADING: $76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$38.00
I
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD
101-0000-42402
0
$12.67.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD PC
101-0000-42600
0
$5.07
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE
101-0000-42402
0
$38.00.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN
101-0000-42402
0
$63.35
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN PC
101-0000-42600
0
$25.35
Total Paid for MECHANICAL: $233.10
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PERMIT
101-0000-42400
0
$555.36
Total Paid for NEW CONSTRUCTION PERMIT: $555.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$750.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$363.84
Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,113.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
.BUILDING SEWER
101-0000-42401
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$17.73
.DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$152.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$152.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$13.00
DESCRIPTION .
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT
101-0000-42401
.0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT,
WATER SYSTEM.INST/ALT/REP PC
101-0000-42600
0
.$12.67
` Total Paid for PLUMBIN 3 FEES: $431.76
DESCRIPTION
ACCOUNT
QTY
AMOUNT
'SMI - RESIDENTIAL
101-0000-20308
0
$17.72
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $17.72
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SINGLE FAMILY DETACHED
224-0000-20320
0
$1;837.44
Total Paid for TUMF - RESIDENTIAL: $1,837.44
Bin#
City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permity
Project Address:
O —
Owner's Name:
+
!
A.P. Number
`J
Address: �}
L�
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
lQ
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lie. #:
City Lic #:
Arch, Engr. esigner
.Address:
(1
City, ST, Zip:
C 6 ._.
'Telephone:
Construction Type:
Occupancy:
;State Lie. #:
Proj. Type
ew
Add'n
Alter Repair
Demo
Name of Contact:
SgFt:
#Stories
, # Units:
'Telephone of Contact: �l }� `l i
EstimatediVaIiie of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections
Plan Check Deposit:
Truss Calcs
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Piked Up
Construction:
Flood Plain Plan
Plans Resubmitted
Mechanical:
Grading Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
.3rd Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit Fees
Date:12/27/2017
No.: 17-00826-1
Owner: Pepe Builds LLC
Address:
City:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760)771-8515
Type: Single Family Residential
Lot # Street No. Street Name
52480
Comments:
Avenida Carranza
Email: ish@coronelent.com
Jurisdiction: La Quinta
Tract #:
Sq. Feet APN
474 773-291-001
Fire destroyed 1,638 sf home. Rebuilding total is 2,112 sf
i6►F 1 Ep
� Sr
H OE RMIJ 5r p1J N'cS
(iANCF4p Aiffu .F .l7
F- �NGNH YIELL5 p'q
¢' P4C 4t aF SFf7T y
iF :1U1NTA '\
a INi71V �
Permit No.
RECEIVED
DEC 2 7 2017
CITY OF LA -01 ; V it
COMMUNITY DEVELOPMENT
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions
under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or replacement
mobile homes. It has been determined that the above -named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fess imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $3.48 X 474 S.F. or $1,649.52 have been paid for the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued.
Fees Paid By: CURabobank_-ish CoronelCheck No.: 7013937
Bank Name/Recipient of Certificate Telephone:
Funding: Residential
By Scott L. Bailey
Superintendent
Fee Collected/ Exempted by: /Aaron M
Certificate Fees Due: $1,649.52
Original Paymentl;s) Rec'd: $0.00
New Payment Rec,'d: $1,649.52
Over/Under: $0.00
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you tWhe 90-day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL.
13Ie'F-52o (?-o 2 `4 f
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 9/25/2009
Green Sheet approvals are forwarded to the Building. & Sa€eiy Department directly by Pubiic Works. Please DO NOT
submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department until ALL requirements listed
below are complete. Incomplete applications or applications which cannot be processed will be returned to applicant.
Date:1al/ (DDeveloper. ,,_, .
Sa.**vi. Va(e
Tract No.: Tract Name:
2 QViha-v►
Lot No.(s): _
Address(s): y , U �� 2� _ Phone Number: (%bU ) -775-��-3y
The following are the requirements for Public Works Clearance to authorize issuance of a building permit from the
Building & Safety Department:
❖ CUSTOM HOMES: PROVIDE ITEMS #2, #3, #4. #5 & #7 BELOW
❖ TRACT HOMES: PROVIDE ITEMS #1, #2, #3 & #5 BELOW
❖ COMMERCIAL BUILDINGSIOTHER: PROVIDE ITEMS #1, #2, #3, #5 S #7 BELOW
❖ WALLS, SIGNS, OTHER: PROVIDE ITEM #5 BELOW
1. Attach Pad Elevation Certificates in compliance with the approved design elevation for building pad (maximum
allowable deviation of +/- 0.1 foot). Pad Elevation Certificates must be current (within 6 months of current date).
If a precise grading plan creates the pad for approval, please withhold green sheet submittal until a Pad Elevation
Certificate can be provided.
2. Attach geotechnical certification of grading plan compliance including compaction reports from a licensed Soils
Engineer. Recently rough graded residential developments which have a previously approved geotechnical
certification are exempt from this requirement.
3. Attach recorded final map or title information/grant deed showing proposed building locations are legal lots.
4. Complete the attached <1 acre per lot or infill project Fugitive Dust Control project information form, PM10 plan &
agreement or provide alternative & valid City approved PM10 plan set reference number or hard copy plan.
PM10 plans for commercial & residential developments (beyond 1 lot) are submitted separately with grading plans
& are subject to additional requirements. A current PM10 certification number is required.
5. Attach a copy of the rough or precise grading plan to the Public Works Department showing building location(s)
for pad elevation verification. AO flood zone developments will require an approved flood plain development plan.
6. Attach supporting documentation for wall plan, monument sign, grease trap or special facility installations.
7. Complete and sign the attached water quality management plan (WQMP) exemption form, if applicable. PW
approved building construction projects require either a WQMP or a completed WQMP exemption form.
Approved maps/plans maybe viewed at the following link: http;//www.la-quinta.orglPiarsChecklm_search.aspx
I have reviewed and confirmed the requirements listed above as presented and find the improvements to be sufficiently
complete for construction of the proposed buildings/structures/walls/signs on the subject lot(s). Pursuant to my findings,
the above project may be released for building permit issuance.
This section completed by City sta .
Recommended by: Date: l 3yl 17 F�e PM �1 v
Public Works Distribution: ( Green Sheet to Building & Safety 0 N �Y
( ) Green Sheet to Planning Department
Declined for approval for reason(s) as follow(s), please correct and resubmit:
TAChecklists - Forms & ApplicationsWorms & ApplicationslGREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc
IS
Water Quality Management Plan (WQMP) Exemption Form - Whitewater River Region
Documentation of Project Not Requiring a WOMP but Requiring Site Design BMPs and Source Control BMPs by
Entitlement Conditions of Approval or Permit Conditions — WQMP Required for the Listed Change of Land Uses
or for Changes of Pollutant Stream (All Questions Below Must be Answered "No" To Exempt Project)
Entitlement or construction of new single-family hillside residence(s) that create 10,000 square
feet, or more, of impervious area where the pre -development natural slope is 251/6 or greater?
Yes
No
7`
Entitlement or construction of new single-family hillside residence(s) that create 10,000 square
feet, or more, of impervious area where the pre -development natural slope is 10% or greater
�(
where erosive soil conditions are known?
Entitlement or construction of new commercial and industrial development(s) of 100,000 square
feet or more?
�(
(�
Entitlement -or construction of new automotive repair shop(s)_including body, upholstery, paint,
exhaust, tire, transmission, engine or other automotive specialty repair. [Standard Industrial
�(
(�
Classification (SIC) codes 5013, 7532, 7533, 7534, 7537, 7538, and 75391?
X
Entitlement or construction of new retail gasoline outlet(s) disturbing greater than 5,000 square
feet?
Entitlement or construction of new restaurant(s) (or potential restaurant shell space) disturbing
greater than 5,000 square feet?
�(
Entitlement or construction of new home subdivision(s) with 10 or more housing units?
Entitlement or construction of new parking lot(s) of 5,000 square feet or more, or with 25 or
more parking spaces, and potentially exposed to Urban Runoff?
�I
`
Applicant Information
Name and Title t . ' E"
Company
Phone -7t(D --7-7S _ \a te{
Email 2c� e L La c
Project Information
Project Name
Type (SFH, Multi -Family, Commercial, Etc.)
Location or Street Address
Nearest Cross Streets
Municipality/County/Zip Code
La Quinta
Tract Number(s) and/or Assessor Parcel Number(s)
Other Location Information
Watershed
I Whitewater River
Source Control BMP Information
Size of Project Area (nearest 0.1 acre)
Project Area managed with Site Design or Low
Impact Development (LID) BMPs (nearest 0.1 acre) ;
Is the project subject to onsite retention by City
ordinance or policy?
Name of the Entity that will implement, operate, and
maintain the Source Control BMPs
Contact Name-
Z
Street or Mailing Address '-A /t �oS
_ City
T CA -
Zip Code
ao \
Applicant Certification
I certify that I have read this form in its entirety and
understand the City's submittal and review process and the
requirements for this form. I understand and agree that if
during the processing of the form, it is determined the
information contains errors or omissions, clarification and/or
supplemental information may be required and the
preparation of such information may be considered, in the
Community Development Director's judgment, an
unreasonable delay and will result in a suspension of
processing time limits in accordance with the California Code
of Regulations, Title 14, Section 15109.
Signature:
Print Name: =5�
Title. t l VL
Date: �� / -XI �—I
Phone: ( 7t U ) -7 -Z 5 -
Owner Certification
I certify under the penalty of the laws of the State of
California that I am the property owner of the property that
is the subject matter of this application and I am authorizing
and hereby do consent to the filling of this application and
acknowledge that the final approval by the City of La Quinta,
if any, may result in restriction, limitations and construction
obligations being imposed on this real property.
Signature:
Print Name: VI, IA �5
Title: Y r
Date: \\ /a) I / `-�
Phone: ( —JLO ) 7 7S
Building Permit Number:
Project Description: [S;FR
Exempt: ❑
(Materials may contain hazardous wastes and
are not subject to recycling provisions)
Construction Debris Management Plan
Plan Submittal Date
12/14/2017
Job Site Address
52480 Carranza
RE c
Owner's Name
Pepe Builds
DEC,
Number, Street, or PO Box
P.O. Box 447
201?
te, Postal Code
Owner's
aPhone
Indio, CA. 01
Capp?U�
Number
Owner's
760-7 5--1 34
, Q�/
7
E-mail Address
,. y�V"VrA
Project Manager's Name
Ish Coronel
Project Manager's Phone Number
760-578-3367
Project Manager's E-mail Address
ishjDcoroneient com
Builder / Contractor
Coronel Enterprises Inc.
Number, Street or PO Box
42760 Madio St.
City, State, Postal Code
Indio, CA. 92201
Project Square Footage
Approx. 2112 square feet
City Approval By
Renado Gouldlock-DEC/Surrec
waste - 7
3 4
Date of City Approval
�Z�
Materials To Be Discarded:
Product
Tons
Trash
8.50 Not recyclable
Product Tons
Asphalt
Brick/Block
0.00 Recyclable
0.00 Recyclable
Masonry (broken) 0.00 Recyclable
Cardboard
Commingled
0.00 Recyclable
Plaster 2.00 Recyclable
Scrap Metal 0.00 Recyclable
Concrete
0.00 Recyclable
9.25 Recyclable
Tile (floor) 0.20 Recyclable
Drywall
1.00 Recyclable
Tile (roof) 0.30 Recyclable
Wood
Donated / Reuse'
0.00 Recyclable
3.25 Recyclable
Landscape Debris 0.00 Recyclable
"Describe Items
Totals: Rec cle Trash
16.3
8.5
Projected Diversion:
65.669
I understand it is the property owner's responsibility to submit copies of weight tickets or receipts to the District
Environmental Coordinator as these hauls occur. I hereby certify that completion, implementation and adherence of the
Debris Management Plan (DMP) for the above named project shall guarantee that at least 55% of the jobsite waste is
diverted from fandflling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining
materials generated from the first day of the project through the completion of the project in accordance with this plan. This
DMP is issued in the name of the property owner(s) and shall remain their property throughout the construction and/or
demolition project. A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is stiff
issued in the name of the property owner(s) and the owner retains legal responsibility For ensuring that the provisions of the
DMP are adhered to. The property owner(s) and general contractor shall be kept informed of the diversion progress through
bi-monlhly reports. If self hauling, all refuse material from this project site must be taken to an approved recycler or transfer
1 Developer 1 Project Manager / Superinlendant Date