BRES2017-032278-495:CAU1.T"PIG0 C 'i � � VOICE (760) 777-7125
LA QUITV'fA,'CAt1FDRNlA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/21/2018
Permit Type/Subtype: BUILDING RESIDENTIAL/DWELLING - SINGLE FAMILY DETACHED Owner:
Application Number: BRES2017-0322 SCOTT & SHANNON MCLENDON
Property Address: 79195 TOM FAZIO LANE NORTH. 79195 TOM FAZIO NORTH
APN: 766032027 LA QUINTA, CA 92253
Application Description: MCLENDON / 5,938SF DWELLING/VB/RES-3/CLASS A-FR/13D
Property Zoning:
Application Valuation: $534,187.60
Applicant: Contractor:
ANDREW PIERCE CORPORATION ANDREW PIERCE CORPORATION
44835 DEEP CANYON DR 44835 DEEP CANYON DR
PALM DESERT, CA 92260 PALM DESERT, CA 92260
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 QLicense! No.: 671203
r Date: v Contracto
OWNER -BUILDER D IARATION
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.).
(� 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.).
(� 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:
(760)346-3228
Llc. No.: 671203
WORKER'S COMPENSATION DECLARATION
1 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
ofth r which this permit is issued.
ve 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
issued.. My workers' compensation insurance carrier and polity number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9134034
- 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 Cal ifomia, 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 hose rovisions. .
Date: A p p I i c aal� 4,Fw,��
WARNING: FAILURE TO SECURE WORKERS' CO/AL
SATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMtNALTIES 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 the Building 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 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 information 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 city to enter upon the above-
mentioned .r�olper for inspection purposes. _ `��/��`�
Date: (�� �� Signature (Applicant or Went
Date: 2/21/2018
Application Number...__. BRES2017-0322
Owner:.
�ropeirtq'�ddress`'' ` .4§`it3iVl�AZlOIANE NORTH """
SCOTT & SHANNON MCLENDON
APN:. 766032027
79195 TOM FAZIO NORTH
Application Description: MCLENDON / 5,938SF DWELLING/VB/RES-3/CLASS A-FR/13D
LA QUINTA, CA 92253
Property Zoning:,
Application Valuation: $534,187.60
Applicant:
Contractor:
ANDREW PIERCE CORPORATION
..ANDREW PIERCE CORPORATION .
44835 DEEP CANYON DR
44835 DEEP CANYON DR
PALM DESERT; CA 92260
PALM DESERT, CA 92260
(760)346-3228
Llc. No.: 671203
Detail: 51938SF SINGLE FAMILY DWELLING [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE POOL AND SPA, WATER FEATURES, BBQ OR SITE
WALLS. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL •• •
., ::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
253-0000-43200
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
QTY
AMOUNT
TEMP POWER SERVICE
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TEMP POWER SERVICE PC
101-0000-42600
0
$18.20
Total Paid for ELECTRICAL: $44.21
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$106.08
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
RESIDENTIAL, EA ADDITION 1,OOOSF, PC
101-0000-42600
0
$43.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$156.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,OOOSF, PC •
101-0000-42600
0
$51.49
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $357.29
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF
101-0000-42408
0
$39.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT>7KSF PC
101-0000-42600
0
$195.05
Total Paid for GRADING: $234.06
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$195.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$130.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
s•.,; .:z,;.FJ(HAUST HOOD
101-0000-42402
0
$13.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD PC
101-0000-42600
0
$5.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE
101-0000-42402
0
$195.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE PC
101-0000-42600
0
$130.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN
101-0000-42402
0
$91.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN PC
101-0000-42600
0
$36.40
Total Paid for MECHANICAL: $795.80
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
$807.17
Total Paid for NEW CONSTRUCTION PERMIT: $807.17
DESCRIPTION.
ACCOUNT
QTY
AMOUNT.
101-0000-42600
($1,200.00)
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$1,200.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PLAN CHECK
101-0000-42600
0
$544.25
Total Paid for NEW CONSTRUCTION PLAN CHECK: $544.25
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PLAN CHECK DEPOSIT- RESIDENTIAL
101-0000-42600
1
$1,200.00
Total Paid for PLAN CHECK DEPOSIT- RESIDENTIAL: $1,200.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BACKFLOW DEVICE
101-0000-42401
0
$13.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BACKFLOW DEVICE PC
101-0000-42600
0
$5:20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$18.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$221.00.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC ,
101-0000-42600
0
$221.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM; 5+ OUTLETS
101-0000-42401
0
$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
$52.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ROOF DRAIN PC
101-0000-42600
0
$52.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0
$26.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$15.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$13.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$13.00
Total Paid for PLUMBING FEES: $741.03
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE - MAJOR
101-0000-42416
0
$20.00
Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $20.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI -.RESIDENTIAL
101-0000-20308
0
$69.44
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $69.44
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
79715/79775/79785/dlft/79 5/7935/79845 HIGHWAY 111
P.O. BOX 1504
78-495 CALLE TAMPICO
Building ` LA QUINTA, CALIFORNIA 92253
Komar Investments, LLC
Address 23 Corporate Plaza, Suite 247
City Zip Tel.
Newport Beach, CA 92660 1(949) 718-4844
P
& Classif. Lic. #
Arch., Engr.,
Designer SGPA Architecture and PlanninI4
1545 Hotel Circle South Stu. 200
Clt:Y P Zi State
San Diego, CA 1 92108 1 Lic. # C-1716
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm 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,
sraNkTua& HATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exampt from the Contractor's l.lrunsa Law for the following
reason: (Sec. 1031.5, Business and Prelesslons Code: Any city or county whrch requfres a
permit to construct, alter: improva. domclish, or repair any slruc[uro, prior 10 fl:. i�:,ruamCo also
r�(l0iras tho applfCan[ far such parm
if ro n7rr a sipprred state
that he fs licensed pursuan! [e
the Provisions pf the Can[rtrclor's LTG
ense Law, Chaplet 9 (commencing with Section 700tl) of
Aivslon 3 dl the sus fnass arad A ofessloras Code, pr that he is
exam pt therefroirt, and
the
basis
for the alleged exemption. Any vfofatfon of $ectlpn 703T.5by arty applicant tore permit subjects
the applicant fo a civil penally of not more than live 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 Profes-
sions Code: The Contractor's License Law does not apply to an owner of property who builds
or improves thereon and who [foes such work hirnswlf or through his awn emplpyaeS, provided
:hat such 1111provamerrts arc not intended Or offered for sale. It. however, the building or frn-
.provernent 1s ',Old within one ytrar pf completion, the aurnar-bufidar Will have tha burden of
proving that he did nor build or improve to, the purpose of sale),
❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct
the project. (Sac. 7044, Business and Professions Cade: The Contraclor's Licence Law does
nor apply "Ian owner or properly n who builds w improves thereon, and who contracts for such
pro%9cls W1th a Cent.-Io ro l�=sed P=uanr [0 he
Contractor's LJcense Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
WORKER'S COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compersatror Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less).
I certify that in the performance of the work for which this permit is issued, I shall not
empoy any person in any manner so as to become subject to Workers' Compensation Laws of
California.
Date Owner
NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work
for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
certify that I have read this application and state that the above information is correct.
I agree to comply with all city and courty ordinances and stafa laws relating td building
construction, and hereby authorize representatives of this city to errter the above -mentioned
property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
W, "014 mv._.
OFFMI
APPLICATION ONLY
sr
BUILDING: TYPE CONST. OCC. GRP.
A.P. Nu
Legal Description
Project Description
-701 S Z5_ ' `
1,
SI 606
o -1 - &AO
79 83 /r
L 7V20
o7- $ZI
79gys fr
J (,5)0
0-7 - SZZ
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
71 ] g.S le
jy 9'_W
0 7-$ Z 3
7g-775'f
F 4 73S
o ? - 8 a4
79-71Y ''
tr 14
0 -7 - S a 5'
x 33 ,
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Pep.
Q -
60
Plan Chk. Bal.
Z
(p -50
Const.
0-7. $ Z Z.
(p 5 0
Mech.
- 7- ,
oo
Electrical
0 7 • S a,4
(p Q
Plumbing
0 -1
4100
S.M.I.
Grading
Driveway Enc.
Infrastructure
,
TOTAL
cl
REMARKSII`d�
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by:_
Validated b.,
Date Permit
WHITE = BUILDING DEPARTMENT
1 Validation:
YELLOW = APPLICANT PINK = FINANCE
CO ichelia Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name: _
Owner's Name:
Project Address:
The Quarry
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
IMTIALS
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Scott A McLendon & Shannon P. McLendon
79-195 Tom Fazio Lane North, LQ
Project Description: SFD
APN: 766-032-027
Tract #:
Type of Development: Residential xx
Total Square Feet of Building Area:
Date: February 7, 2018
Phone No.
Lot #Is:
Commercial M Gu%ill:
ft.
FEB 2 1 2018
Certification of Applicant/Owners: The person signing certifies that the above information is co �i�tAMWT der
penalty of perjury and further represents that he/she is authorized to sign on behalf of tl owner/de �. �I�ITY DEVELOPMENT
Dated: January 7, 2016 _ Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code
17620
Number of Sq.Ft.
Amount per Sq.Ft.
Amount Collected
Gov. Code
65995
5938
$3.48
$20664.24
Project Agreement Existing Not Subject to Fee
Approval Prior to 1/1/87 Requirement
Building Permit Application Completed: Yes/No
By: William A. Aguirre, Director Facilities Dev. & Planning
Note:
Pursuant to AB 181 any room additions or enclosures of 500
sq. ft. or less are exempt from developer fees. Any mobile
homes being relocated within the same school district's
jurisdiction are exempt from developer fees.
Certificate issued by: Lauri, Howard, Secretary Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90-day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90-day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted.
MV ofconipli,wcc form updated 3-2007 11/2010
.( ,, PLAN LOCATION
Project Address: 37,p� Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #: 76!,�- oa 77
AA - s si
Applicant Name:
Address:
City, ST, Zip: 416As� d
Telephone:
Email:
Valuation of Project S
Contractor Name: 1901 ]
Q`-"Y"
i1
L
News SFD Construction:
Address:
Conditioned Space
SF
City, St, Zip
Garage
SF
Telephone:
Patio/Porch
SF
Email:
Fire Sprinklers
-SF
State Lic: , City Bus Lic:
Arch/I ng Name: a GN
Construction Type: Occupancy:
Address: 35 r iZ.
Grading:
�ity, St, Zip
Telephone: y �/ `
Bedrooms:
Stories:
# Units:
mail: kC J R[[
;tale Lic: City Bus Lic:
rr/L/
'roperty Owner's Name: �� - d
New Commercial / Tenant Improvements:
address:
Total Building SF
:ity, ST, Zip
Construction Type: Occupancy:
elephone:
mail:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000 -
�KESZo�7-o3ZZ
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 & Safety Department directly by Public 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: Developer: Developer: �Gc� tA G
Tract No.: 1 Tract Name: V' Y Lot No.(s).
Address(s): ��_ ���j 'rfC[`sL !)..A%�}-r Phone Number: (71-ZO AJ40 41
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/.gr_ant 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 may be viewed at the following link: http://www.la-cluinta.ocq/PianCheck/m search.asox
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. o'
Recommended by Date: / 7-3 / D
Public Works Distribution: ( ) 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 & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc
City .of La Quinta - PM10 Fugitive Dust Control Project Information
'Construction Phase PM10 A reement <1 acre/lot or Infill Project
Project Information
Project Contractor:
Project Phase
(check one)
RfConstruction
Demolition
Project Name: G W- , ` t>07 4 RO�
Project Tract/Lot Numbers:
Project Street Address: Tbm F*'40 ktA±f C■�
Total Acres in Active
Construction (<1 acre per
Lot):
Anticipated Start Date: �/ l�%Ahticipated Completion Date: I� �/ Jib
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:
V 6p
Company Name:
rL GO1�PU tGa'
Mailing Address:
tGP G�Nr a!^� P'B4'.D
City, State, ZIP Code:
L*C �+ ZZlat7
Prima Phone M
(vQ V,74b
Fax M
Zbfl ZJ�b 6240
24 Hour Emergency
Phone#:
Cell Phone #:
Email Address:
PM10 Certificate #:
IV/ 1d
The above stated property 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 harmless the City/County and its representatives from liability for any actions related to this dust control
plan or any City/Cou inty, initiated abatement activities.
nature op'roperty Owner or Authorized Representative Date
TAChecklists -Forms & Appkationswarms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc
Water Quality Management Plan (WQMP) Exemption Form - Whitewater River Region
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)
Yes
No
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% orgreater?
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?
/
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?
e
Entitlement or construction of new home subdivision(s) with 10 or more housing units?
/
r
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?
j
Applicant Information
Name and Title
PP4&e7l DV+4--r
Company
A4t>i��f rpi
Phone
7 pj
Email
Project Information
Project Name
Type (SFH, Multi -Family, Commercial, Etc.)
lsa�
Location or Street Address
779 14145P TOW F%-L O L �
Nearest Cross Streets
Municipality/County/Zip Code
La Quinta
Tract Number(s) and/or Assessor Parcel Number(s)
vV 1 -&t7 463
Other Location Information
Watershed
I Whitewater River
Source Control BMP Information
Size of Project Area (nearest 0.1 acre)
0 CjLj
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, andFr��O
maintain the Source Control BMPs
Contact Name
&A4Lr
Street or Mailing Address
GJ p",Z:P 4&0yC7t -+
City
Zip Code
r M
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)
i
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
Check Item
Source Control BMP Requirements — Small Sloped Lots, Small Commercial, < 10 Unit
To be
Subdivisions, < 5,000 Square Ft. Parking Lots, Etc.
Provided
Structural BMP (See Appendix H, Section 4.5.2.2)
l—
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,(Desigo & Maintenance)Jncluding PCC Surface, Canopy & Spill Prevention
Air/Water Supply Area Drainage.(Design & Maintenance) Including Spill Area Containment
Trash Storage Areas (Design & Mai'ntenance) Including Attached Lids, Storm Water Controls
Loi riding Dock's (Design &'Maintenance) Including Storm Water Controls, Dry & Frequent Cleaning
`
Procedures
Maintenance Bays (Design & Maintenance) Including Indoor Location & Storm Water
Containment
Vehicle%nd-Eouiprnent V1/ash'Areas (Design & Maintenance) Including Canopy & Containment
Outdoor Material Storage Areas:'(Desigri & Maintenance) Including Canopy & Containment
Outdoor Work Areas or Processing Areas (Design & Maintenance) Including Canopy &
Containment h
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)
F_ BMP Acknowledgement
The applicant shall comply with listed BMPs and applicable
provisions of the City's NPDES stgrmwater.discharge permit,
LQMC Sections 8.70.010 e't 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 Ofderil No. 13722068=0001 anti fhe State Water
Resources'Corittol Boiard's Ordbt No.'99-6&-DWO-:
Print Name: AAA-Y, 4-4*p4"
Title: V Ltd Pal Pr4U '-
Date:/L-/ -0
f
Applicant Certification
I certify that I have -read this form in its entirety and
understand the City's submittal and review process and the
Signature:
requirements for this form. I understand and agree that if
during the processing of the form, it is determined the
Print Name:
information contains errors or omissions, clarification and/or
_
supplemental information may be required and the
Title:
preparation of such information may be considered, in the
Community Development Director's judgment, an
Date: /1o/
unreasonable delay and -will result in a suspension of
processing time limits in accordance with the California Code
,
phone: -Teo 1 *b 2
of Regulations, Title 14, Section 15109.
1
Owner Certifica
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 1 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.
tion
Signature:
Print Name: G✓G� %7JfGiI�I�a
Title: ow)X�
Date: t / l & / It
Phone: (�&o 1710 - S
PrDfiessionally Mon�ajed by THE QUARRY AT LA QUINTA
SONALI` ED HOMEOWNERS ASSOCIATION 68950 Adelina Road
PROPERTY Cathedral City, CA 92234
MANAGEMENT Phone: (760) 325-9500
Fax: (760) 325-9300
The Como helhi lWhn''s Comunmi(i
11,111opleme w comlym I
January 12, 2018
Scott & Shannon McClendon
79195 Tom Fazio North
La Quinta, CA 92253
Re: 79195 New Construction
Dear Mr. & Mrs. McClendon:
The Board of Directors and Architectural/Landscape Committee appreciate your recent submission of
plans for new construction. We thank you for your patience during the review process to ensure the
HOKs Architectural Guidelines are being followed.
The Architectural Committee and Board of Directors have approved the plans as submitted. With
receipt of this letter you may move forward with your project with approval, which should also assist
in guaranteeing your compliance with all City of La Quinta building statutes. P
Thanking you in advance for your assistance in this matter and all the best to you in your exciting
endeavor.
Sincerely,
Caren Oliva
Caren Carnine Oliva
Community Manager, The Quarry at La Quinta HOA I��
Personalized Property Management RE
cc: Board of Directors, File.
JAN 17 2018
cTTY OF LA QUINTP'
CC)MMUNM DEVELOPMENT
Building Permit Number:
Project Description: � SFR
Exempt: ❑
(Materials may contain hazardous wastes and
are not subject to recycling provisions)
Construction Debris Management Plan
Plan Submittal Date 12/27/2017
Job Site Address, 79195 Tom Fazio Ln north
Owners Named
Number, Street, or PO Box
City, State, Postal Code
Owner's Phone Number
Owner's E-Mail Address
Project Manager's Name'
Project Managers Phone Number
Project Manager's E-mail Address
Builder / Contractor
Number, Street or PO Box
City, State, Postal Code
Scott & Shannon McLendon
79195 Tom Fazio Ln north
La Quinta, CA. 92253
Gary Lohman
760-880-3228
gary.1ohnaan andre lerceCorp.corn
Andrew Pierce Corp
P.O. Box 3420
Palm Desert, CA. 92261
Project Square Footage) Approx. 5,940 square feet
City Approval By Renado Gouldlock-DEC/Burrtee Wa
Date of City Approval
Materials To Be Discarded
Product
Trash
Asphalt
Brick/Block
Cardboard
Commingled
Concrete
Drywall
Donated / Reuse*
*Describe Items
Tons
25.00 Not recyclable
0.00 Recyclable
0.00 Recyclable
0.00 Recyclable
0.00 Recyclable
27.00 Recyclable
3.00 Recyclable
0.00 1 Recyclable
RECEIVED
JAN 17 2018
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
Product
Masonry (broken)
Plaster
Scrap Metal
Tile (floor)
Tile (roof)
Wood
Landscape Debris
Tons
0.00 Recyclable
7.00 Recyclable
0.00 Recyclable
0.65 Recyclable
0.80 Recyclable
9.25 Recyclable
Totals: Rec cie Trash Projected Diversion:
47.7 25.0 65.61 % 1
I understand it is the property owners 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 65% of the jobsite waste is
diverted from landfilling 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 still
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-monthly reports. If self -hauling, all refuse material from this project site must be taken to an approved recycler or transfer
Owner / Developer / Project Manager / Superintendant Date
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La Quinta BRES2017-0322
1/24/18
VMEsGi
A S.AFEbUIR Company
DATE: 1/24/ 18
JURISDICTION: La Quinta
PLAN CHECK #.: BRES2017-0322
PROJECT ADDRESS: 79195 Tom Fazio N.
SET: II
❑ APPLICANT
❑AURIS.
PROJECT NAME: Structural -Only Plan Check for McClendon SFR
u The plans transmitted herewith have been corrected where necessary and
substantially comply with the jurisdiction's codes.
® The plans transmitted herewith will substantially comply with the structural portions
of the jurisdiction's building 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.
i] The check list transmitted herewith is for your information. The plans are being
held at EsGil until corrected plans are submitted for recheck.
L 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 staff did not advise the applicant that the plan check has been completed.
❑ EsGil staff did advise the applicant that the plan check has been completed.
Person contacts Telephone #:
Date contacted: *1nerson
Email:
Mail Telephone Fax
® REMARKS: Plans should show drainage away from the building as required by
Section R401.3. 6" in 10' is required (5%) for pervious areas. 2% is required for
impervious areas. Note #13 on the precise grading plan does not comply and 1 %
is shown at the patio at the south side of the house towards the pool. Thank you!
By: Tamara Fischer (Enclosures:
EsGil
1/18/18
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