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BRES2017-020178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: WILLIAM MORRIS 52520 AVENIDA NAVARRO LA QUINTA, CA 92253 4 VOICE (760) 777-7125 4 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT . Date: 11/7/2017 BUILDING RESIDENTIAL/DWELLING - SINGLE FAMILY DETACHED Owner: BRES2017-0201 RICK MORRIS 78605 AVENIDA LA 1ARITA 51525 AVENIDA JJAREZ 770145001 LA QUINTA, CA 0 MORRIS / 2,824SF DWELLING/VB/RES-3/CLASS A-FR/SPRINKLED $187,001.70 NOV 612011 CITY OFLAQUINT- A CAMMUNIT/OEVELOPMENTDEPARTMENT Contractor: WILLIAM MORRIS DEVELOPMENT INC DBA W M B 52-520 AVENIDA NAVARRO LA QUINTA, CA 92253. (760)688-2608 Uc. No.: 945496 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjuryone ofthe following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700,of the Labor Code, for the performance License Class: B License No.: 945496 of the work for which this permit is issued. -7 �_ - I have and will maintain workers' co npensation insurance, as required by Date: (I 1 f Contractor:—AAI. t c Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: 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 Name: Lender's Address: Carrier: EXEMPT Policy Number: I certify that in the performance of ne 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 3;00 of the Labor Code, I shall forthwith comply with hose provisions. r Date: i 1 -7111-7 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 ($100,0001I. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to thelBuilding Official 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 Cty 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 applica:iion becomes null and void if work is not commenced within 180 days from date of is: uance 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building . construction, and hereby authorize representati-es of this city t enter upon the above-mentioned property for inspection purposes. � Date: t ( 17 Signature (Applicant or Agent): i Date: 11/7/2017 Application Number: BRES2017-0201 Owner: Property Address: 78605 AVENIDA LA JARITA RICK MORRIS APN: 770145001 51525 AVENIDA1UAREZ Application Description: MORRIS / 2,824SF DWELLING/VB/RES-3/CLASS A-FR/SPRINKLED LA QUINTA, CA 0 Property Zoning: Application Valuation: $187,001.70 Applicant: Contractor: WILLIAM MORRIS WILLIAM MORRIS DEVELOPMENT INC DBA W M B 52520 AVENIDA NAVARRO 52-520 AVENIDA :NAVARRO LA QUINTA, CA 92253 LA QUINTA, CA 9:.253 (760)688-2608 --------------------------------------------------------------------------------------------- Llc. No.: 9.45496 Detail: 2,824SF SINGLE. FAMILY DWELLING [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2016 CALIFORNIA BUILDING CODES. i p DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $8.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $8.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - CIVIC CENTER 252-0000-43200 0 $942.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF -FIRE PROTECTION 257-0000-43200 0 $433.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - LIBRARIES 25370000-43200 0 $344.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARK MAINTENANCE 256-0000-43200. 0 $40.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARKS/REC 251-0000-43200 0 $2,048.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 DESCRIPTION . ACCOUNT IQTY AMOUNT TEMP POWER SERVICE 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE PC 101-0000-426000 101-0000-42600 $17.73 Total Paid for ELECTP.ICAL: $43.06 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF .101-0000-42403 0 $39.78 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $16.38 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 CONSTRUC-ION: $263.69 DESCRIPTION ACCOUNT. •D.TY 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 $190.00 . Total Paid for GRADING: $228.00 DESCRIPTION ACCOUNT I QTY AMOUNT AIR HANDLER 101-0000-42402 0 $76.00 DESCRIPTION ACCOUNT QTY AMOUNT AIR HANDLER PC 101-0000-42600 0 $25.34 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $76.00 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $50.66 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 VENT FAN 1:01-0000-42402 0 $63.35 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $25.35 Total Paid for MECHAMICAL: $334.44 DESCRIPTION ACCOUNT QTY AMOUNT MULTI SPECIES RESIDENTIAL 0-8 UNITS - 2017 UPDATE 101-0000-20310 0 $1,245.00 Total Paid for MULTI -SPECIES RESIDENTIAL: $1,245.00 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PERMIT 101-0000-42400 0 $599.22 Total Paid for NEW CONSTRUCTION PERMIT: $599.22 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 $507.66 Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,257.66 DESCRIPTION ACCOUNT IDTY AMOUNT BACKFLOW DEVICE 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT BACKFLOW DEVICE PC 101-0000-42600 0 $5.07 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 $164.71 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $164.71 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS 101-0000-42401 O $39.01 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $26.01 . DESCRIPTION ACCOUNT QTY AMOUNT - ROOF DRAIN 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN PC 101-0000-42600 0 $12.67 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 PLUMBING FEES: $526.19 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $24.31 Total Paid for STRONG MOTION INSTRUMENTATIOM SMI: $24.31 DESCRIPTION ACCOUNT 1QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMEN'r FEE: $5.00 DESCRIPTION ACCOUNT QTY . AMOUNT SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 Total Paid for TUMF - RESIDEMTIAL: $1,837.44 EsGil Corporation In Partnership with Government for Building Safety DATE: 10/26/2017 ❑ APPLICANT JURIS. JURISDICTION: LA QUINTA ❑ PLAN REVIEWER ❑ FILE PLAN CHECK NO.: BRES2017-0201 SET: II PROJECT ADDRESS: 78-605 AVENIDA LA JARITA PROJECT NAME: SFD STRUCTURAL ONLY FOR MORRIS ® The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. ❑ The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. ❑ The check list transmitted herewith is for your information. The plans are being held at EsGil Corporation until corrected plans are submitted for recheck. ❑ The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. ❑ The applicant's copy of the check list has been sent to: ® EsGil Corporation staff did not advise the applicant that the plan check has been completed. ❑ EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: 9 Telephone #: Date contacted: (by,.--W) Email: Mail Telephone Fax In Person ❑ REMARKS: By: Bert Domingo Enclosures: EsGil Corporation ❑ GA ❑ EJ ❑ MB ❑ PC 10/20/2017 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 $isi# 4* {; City of La Quinta I Building & Safety Division 78-495 Calle Tampico 1 La Quinta, CA 92253 - (760) 777-7012 Y Building Permit Application and Tracking Sheet Permit# / "J Projecl Address: —76 1 ] (,, l•� Owner's Name: 4 A.P. Number '716— O� l Address: Legal Description: i i� � a b� L i'+1 City. ST, Zip: C.•&, 3 Contractor: l Telephone: � /'f - Address: 4 3 Project Description: y [' City, ST, Zip: & . 12,5 Telephoned State Lic. #: City Lic #: Arch, Engr., Designer: l C' �) -� Address: u h City, ST, Zip: ) jl ' YaTelephone: 2_�zb Construction Type: Occupancy: State Lic. #: Proj. Type ew Add'n Alter Repair Demo ?dame of Contact: � SgFt: 2$Z #Stories l 1 # Units: Telephone of Contact: _ .,� 3 T:stimated Value of Project: APPLICAN : DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING :PERMIT FEES Plan Sets Plan Check Submitted I Item Amount Structural Cales Reviewed, ready for corrections Plan Check Deposit: Truss Calcs Called Contact Person :Plan Check Balance: Title 24 Cales Plans Picked 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: 11/3/2017 No.: 17-00785-1 Owner: William Morris Address: City: Type: Single Family Residential Lot # Street No. 78605 Comments: CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760)771-8515 Email: Jurisdiction: La Quinta Tract #: Street Name Sq. Feet APN Avenida La Jarita 2824 770-145-001 Permit No. �': VE NOV 06 2017 CITY OF LA QUINTA 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 2824 S.F. or $9,827.52 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: CC/Bank of Southern California Bank Name/Recipient of Certificate By Scott L. Bailey Superintendent Fee Collected/ Exempted by: /%haron Check No.: 209683 Telephone: 760-668-4260 Funding: Residential Certificate Fees Due: $9,827.52 Original Payment(s) Rec'd: $0.00 / New Payment Rec'd: $9,827.52 Over/Under: $0.00 NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify o that the 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 bull • g 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. 139VV 2,017-02.01 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 a royals are forwarded to the Buildin & Safet De artment direct) b Public Works. Please DO NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department until ALL requirements listed be low are complete. Incomplete applications or applications which cannot be processed will be returned to applicant. Date: /1/3/17 Developer: w L) � L'�i�/t� Tract No.: Tract Name:'R19f 6V'17/ -*-- L-�� Lot No.(s): '�� '_L_*1 Nyp f / Acidress(s): 77 to T/ V-eA194- JR-*- "A- Phone Number:% ZZ- (� � a_y 7"7 Y S 5 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 & #7 BELOW ❖ WALLS SIGNS OTHER: PROVIDE ITEM #6 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 WOMP or a completed WQMP exemption form. Approved maps/plans may be viewed at the following link: http://wvvw.la:guinta.org/Pl@nCher-k/m search.as x 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 staff. Recommended by: Date: It / 6 / 1-7FoYL �� I / 0Nr.Y Public Works Distribution: ( t/ j Green Sheet to Building & Safety ( ) Green Sheet to Planning Department Declined for approval for reason(s) as follow(s), please correct and resubmit: T:\Checklists - Forms & ApplicalionsWorms & Applications\C,REEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc Cif of La Quinta - PM10 Fugitive Dust Control Project Information 'Construction Phase PM10 Agreement <1 acre/lot or Infill Pro'errt� iect Information Project Phase (check one) Construction Demolition Proiect Contractor: w t M 15 Vt1-U-rA4 Project Name: ( I l P t T act/Lot Numbers: I - PW ro�ec r _ Project Street Address: g �� f Total Acres in Active Construction(<1 acre per Anticipated Start Date: 1 1 Anticipated Completion Date: _7_1j_z2_1_L2 Lot): PM10 Contact Information Please note: Dust control is required 24 hours a day. 7 days a week, regardless of construction status. Person listed below is responsible for dust control during business and non -business hours. — - Name• Title: �� 1 /_ 1, L. Ili--_ IA A" V - v ' 7 1�,,4` Company Name: Mailin Address: Cit , State ZIP Code: S 70 S � V I P-r A- Primary Phone #: Fax #: -7 7&0- 24 Hour Emergency Phone#: 7� -77W $7`7- - Cell Phone #:` Email Address: PM10 Certificate #: D The above stated ro ert owner or authorized re resentative Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to SCAQMD Rules 403, 403.1, 401, 402, 201, 203 and PERP; Shall constitute an Agreement to comply with all project conditions as identified in the approved dust control plan. Acknowledges that dust control is required twenty-four (24) hours a day, seven (7) days a week, throughout the period of project performance, regardless of project size or status; Shall ensure that each and every contractor, subcontractor and all other persons associated with the project shall be in continuous compliance with all requirements of the approved dust control plan; Shall take all necessary precautions to minimize dust, even if additional measures beyond those listed in the dust control plan are necessary; ❖ Shall authorize representatives of City/County to enter the property for inspection and/or abatement purposes; ❖ Shall hold harmles the City/County and its representatives from liability for any actions related to this dust control plan or any City/Ounty initiated abatement activities. Signature of roperty Owner or Authorized Representative T:\Checklists- Forms & Applications\Fors & Applicatiens\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09 doc Date Water Quality Manaqement Plan (WQMP) Exemption Form - Whitewater River Reaion Documentation of Project Not Requiring a WQMP 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 25% or greater? 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? ' Yes I No f f -� 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? 7� 41 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? Applicant Information Name and Title Company Phone 7-7-.;7 Email rw, B r fr! 5 4,4A ( s'Cwn p, ! V Project Information Project Name Type ISM, Multi -Family, Commercial, Etc.) WT Location or Street Address $ 6,5 h— Nearest Cross Streets L (,L 4*a n— Municipality/County/Zip Code La Quinta Tract Number(s) and/or Assessor Parcel Number(s) Other Location Information Watershed Whitewater River Source Control BMP Information Size of Project Area (nearest 0.1 acre) �� . /01 I d go ^ yd!R I 1 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? 7_260 4 4:1-1 0 ND Name of the Entity that will implement, operate, and maintain the Source Control BMPs Contact Name Street or Mailing Address Z City Zip Code ��.L Check Item Source Control BMP Requirements - All Projects Require Non -Structural BMP Source Control To be Performed Non -Structural BMP (See Appendix H, Section 4.5.2.1) Ongoing Irrigation System and Landscape Maintenance Ongoing Litter Control Ongoing Drainage System Inspection & Maintenance Education/Training for Property Owner, Operators, Occupants, or Employees Activity Restrictions — Prohibition of Debris Blowing/Sweeping/Washing into Street/Storm Drain, Closed Trash Lids, Restriction of Vehicle Washing Ongoing Street Sweeping at Private Streets and Private Parking Lots Source Control BMP Requirements — Small Sloped Lots, Small Commercial, < 10 Unit Check Item To be Subdivisions, < 5,000 Square Ft. Parking Lots, Etc. �......:.�...� Provided r�-"-:...._I neon /[�__ A..-_.-J7.. LJ c....a:...., n r- -3 '1► - .� iruc a gip/ GNU" (See Appen YIA ", Sec ion 't.:J. L. LI Storm Drain Inlet Stenciling and Signage Landscape and Irrigation System Design to Minimize Erosion & Nuisance Runoff Protection of Slopes and Channels to Minimize Erosion Multi -Family Project Use of Community Car Wash Racks Wash Water Controls for Food Preparation Areas to Use Sanitary Sewer Fueling Area (Design & Maintenance) Including PCC Surface, Canopy & Spill Prevention Air/Water Supply Area Drainage (Design& Maintenance) Including Spill Area Containment Trash Storage Areas (Design & Maintenance) Including Attached Lids, Storm Water Controls Loading Docks (Design & 'Maintenance) Including Storm Water Controls, Dry & Frequent Cleaning Procedures Maintenance Bays (Design & Maintenance) Including Indoor Location & Storm Water Containment *Vehicle and Equipment Wash Areas (Design & Maintenance) Including Canopy & Containment Outdoor Material Storage Areas (Design & Maintenance) Including Canopy & Containment Outdoor Work Areas or Processing Areas (Design & Maintenance) Including Canopy & Containment CC&R's, Maintenance Agreements or Other mechanisms will be used to ensure the ongoing operation, maintenance, funding, transfer and implementation of the project -specific WQMP requirements. Legal description and plat stamped by Registered Surveyor to be attached to the applicable CC&R or Maintenance Agreement for recordation at Riverside County. (Optional Requirement to be reviewed on a Project by Project basis) HMP Acknowledgement The applicant shall comply with listed BMPs and applicable provisions of the City's NPDES stormwater discharge permit, LQMC Sections 8.70.010 et seq. (Stormwater Management and Discharge Controls), and 13.24.170 (Clean Air/Clean Water); Riverside County Ordinance No. 457; the California Regional Water Quality Control Board — Colorado River Basin Region Board Order No. R7-2008-0001 and the State Water Resources -Control Board's Order No.`99=08LDWQ. Signature: Print Name: Title Date:/�/ Applicant Certification 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: -1-24kjV- noe Title:' Date: �I / Phone: (-74r O) _77�g7' _ 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. 1 Signature: Print Name: �� r Title: Date: LL Phone:(Ilec) 7Z-t S�ZJ�