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BRES2017-0016ej 78-495 CALLE TAMPICO VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/17/2017 Application Number: BRES2017-0016 Owner: Property Address: 53149 VIA DONA 48D VIA DONA, LLC APN: 777380016 -/ Application Description: HIDEAWAY / BOZICK / SINGLE FAMILY DWELLING LA QUINTA, CA 0 Property Zoning: , 7 0 I=v �J Application Valuation: $856,596.10 o Applicant: Contractor: z m OCHOA DESIGNE ASSOCIATES_ MICHAEL JEHA CONSTIRUC'FIONr 73626 HIGHWAY 111 53408 VIA PISA PALM DESERT, CA 92260 1 LA QUINTA, CA 92253 znc, tv a o O (925)250-4038 n a --------------------------------------------------------------------------------------------- Llc. No.: 410408 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.: 4104�08 Dat/ ' Contractor: OWNER -BUILDER DEC ON 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).: (1 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 Na Lender's Add 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 3700 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 performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier„ Pl T Policy Number: _ 1 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 agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 7 "�7� �i Applicant WARNING: FAILURE TO SECURE WORKERS' CQA4tV%SAi1o`ffCOVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRrIWNAL 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 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 actor 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 property for inspection purposes. Date:- Signature (Applicant or Agee Date: 7/17/2017 Application Number: BRES2017-0016 Owner: Property Address: 53149 VIA DONA 48D VIA DONA, LLC APN: 777380016 Application Description: HIDEAWAY/ BOZICK /SINGLE FAMILY DWELLING LA QUINTA, CA 0 Property Zoning: " Application Valuation: $856,596.10 Applicant:. Contractor: OCHOA DESIGNE ASSOCIATES MICHAELJEHA CONSTRUCTION 73626 HIGHWAY 111 53408 VIA PISA PALM DESERT, CA 92260 LA QUINTA, CA 92253 (925)250-4038 ------------------------------------------------------- Llc. No.: 410408 ----------------------------------- Detail: NEW 9155 SQ. FT. SFD. THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH, FIRE PIT, BBQ,WATER FEATURES OR HOME GENERATOR AND AUTOMATIC TRANFER SWITCH. HOME IS FIRE SPRINKLED PER 2016 CRC CODES. j f .• f. FINANCIAL DESCRIPTION ACCOUNT QTY AMOUNT ART IN PUBLIC PLACES- RESIDENTIAL 270-0000-43201 0 $1,641.49 Total Paid for ART IN PUBLIC PLACES - AIPP: $1,641.49 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES ADMINISTRATIVE STAFF 101-0000-42600 0.25 $10.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER 101-0000-42600 0.5 $47.50 Total Paid for BLDG CITY STAFF - PER HOUR: $57.50 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $35.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $35.00 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 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 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE PC 101-000042600. 0 $17.73 Total Paid for ELECTRICAL: $43.06 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $142.12 DESCRIPTION ACCOUNT . QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $58.52 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $152.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $50.16 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $402.80 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 $190.00 Total Paid for GRADING: $228.00 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $228.00 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $151.98 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD 101-0000-42402 0 $25.34 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD PC 101-0000-42600 0 $10.14 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE 10170000-42402 0 $228.00 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $151.98 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $101.36 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $40.56 Total Paid for MECHANICAL: $937.36. DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PERMIT 101-0000-42400 0 $997.15 Total Paid for NEW CONSTRUCTION PERMIT: $997.15 DESCRIPTION ACCOUNTQTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,200.00 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $978.95 Total Paid for NEW CONSTRUCTION PLAN CHECK: $2,178.95 DESCRIPTION ACCOUNT QTY 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 i DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $380.10 'DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $380.10 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN 101-0000-42401 0 $177.38 DESCRIPTION. ACCOUNT QTY AMOUNT ROOF DRAIN PC 101-0000-42600 0 $177.38 DESCRIPTION ACCOUNT QTY AMOUNT -WATER HEATER/VENT 101-0000-42401 0. $38.01 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $22.80 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: $1,325.24 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $111.36 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $111.36 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 Building 3 Address Owner Address a ht 4 P.O. BOX 1504 76-495 CALLE TAMPICO /9 Af A LA OUINTA, CALIFORNIA 92253 City Zip Tel. Contractor cry © .J J d /1f Address 51731 V1r9 7J7ALLr:h`'J�1 City Zip Tel. L,� �1NT 41 3 o2S0 6 State Lic. City & Classif. Lic. # Arch., Engr., Designer f Address Tel. 76.0 City Zip State .004 • , -n r. 'J- - 0 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under proviatgns of Chapter 9 (commencing with Secllon 70D0) of Division 3 of the Business and Prolossinns Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: fSao. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance also requres fho a0plrcenl far such permit to fde a signed staloment that he is lklensed pursuant to tha provisions of rho Canlravor's License Law, Chapter 9 (cormgencintf with Seclon 7000) of Didnion 3 of the BusinDn and Prelesakx+s Code, or that ho is exempt Iherofrom, Rnd fha 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 (S500). [J I, as owner of the property, or my employaes with wages as their sole compensation, will do the work, and the structure is not intended or of for sale. (Sec. 7044, Bulsness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves therabn and who does such work himself or through his own empruyees, provided that such improvements are not intended or olleted for sale. If, however, the banding or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale ) I 1 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code-- The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law ) 1! 1 am exempt under Sec. B. & P.C, for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec 3800, Labor Code ) Policy No. Company (7 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 thg 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, Date Owner NOTICE TO APPLICANT. ft. offer making this Certificate of Exemption you should become subject to the Workers' Compcnsafion provisions of Me Labor Code, you must forthwith comply with such provisions or tN) permit shall be do emed rasbked. 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 it work thereunder is suspended for 180 days. I certify than I have read this application and state that the above information is correct. I agree to comply with all city and counly ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above - mentioned properly for Inspeclion purposes, Signature of applicant _ Date Mailing Address City, State, Zip APPLICATION ONLY BUILDING: TYPE'CONST. /J OCC.GRP.�� 3 A.P. Number 7 +% 7 — — 0l,lo Legal Description L.O 7— f] f /4 :? f Project Description Sq. Ft. p No. No. Dw. , Size / % Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. - �^ Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Building Permit Number: Project Description: SFR Exempt: ❑ (Materiels may contain hazardous washes and are not subJect to recycling provisions) Construction Debris Management Plan Plan Submittal Job Site Owners Noma Number, Street, or PO Boa City, Stab, Postal Code Owners Phone Number Ownsrs E-Mall Address Pr*mA Manager's Name Pmrject Managers Phone Number Project Manager's E-mail Address Builder / Contri Number, Street or PO City, stab, Postal c 7/13/2017 84149 Via Dona (Lot #48) Nick Bozick c% 84149 Vie Dona La Quinta, CA. 92253 Mike John 7MG26-250-4038 -Whocons _ctl�, asolm John Construction 53408 Via Pisa La Quints, CA. 92253 Project Square Footage[ Approx. 9,000 square feet City Approval 13y Renado Gouldiook->]EC1BUrnrtec Waste Date of City Approval n To Be Discarded: Product Tons Trash 37.00 Not recyclable Product Toms Asphalt 0.00 Recyclable Masonry (broken)R3' 0.00 BrIck/Block 0.00 Recyclable Plaster0.50 Cardboard 0.00 Recyclable Scrap Metal0.00 Commingled 0.00 Recyclable Tile (floo*1.0p Concrete 41.50 Recyclable Tile (roof)125 Drywall 4.50 Recyclable Wood.75 Donated / Reuse* 0.00 Recyclable Landscape Debris 1 0.00 *Describe Items Totalts: Recycle Trash Projected Diversion: 72.511 37.0 6BI.29 °I° I undsratand R Is the property owner's responsiblitty to submit copies of weight tickets or receipts to lire Dlstrtc# Environmental Coordinator as these hauls occur. i hereby certify, that complatigh Implementation or receipts and adherence of the Debris Management Plan (DMP) for the shove named project shall guarantee that at lesat 65% of the Jobslte waste is dlveried from Iandfliling. The remaining mstedaI will be recycled Or reused. I will divert, for recycling or re -use, rem$InIng 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 owners) and sha11 remain their property throughout the construction andlor demolition pmjea A contra utor serving as agent of the owner may obtain a DMP for the owner. Hnwevar, tha DMP is stlif issued In the name of the property ownsr(s) and the owner retain lags responalbll€fy for ensuring that the provisions of the DMP are adhered to. The property owners) and general contra ctor she I I be kept Informed of the dive rslon progress through bi-monthly reports. If self -hauling, all refuse material from this project site must be taken to an approved racyclar MCEIVED Owner/ Developer 1 Project Manager 1 Superintendent Dale JUL 14 2017 CITY OF LA BUINTA DI AKIA11h 1/- m-- - 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: _�__/gkd�Developer: M 1C,W -a Tract No.:t'l leAW4Iract Name: )^5 —� Lot No.(s): �S Address(s): L49 0, '9- �1.,na Phone Number: () �i) T 6 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 BUILDINGS/OTHER: 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 inf ill 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-quinta.org/PlanCheck/m 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 staff. �1 Recommended by: Date: ` / �? / 1-7 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: TAChecklists - Forms & ApplicationslForms & ApplicationslGREEN SHEET cover & PM10 less than 1 Acre Revised 10-02-12.doc City of La Quinta - PM 10 Fugitive Dust Control Project Information Construction Phase PM10 Agreement (< 1 acre/lot or Inf ill Project) Information Contractor: M to "poll apA (Orl511 Project Phase Project Name: L{Gr i (check one) Project Tract/Lot Numbers: DKConstruction Demolition Project Street Address: 5,6 `C4 Ln Total Acres in Active Construction (< 1 acre per Lot): Anticipated Start Date: 7 / 1b /a Anticipated Completion Date: 7 / IJ / PM10 Contact Information f Please note: Dust control is required 24 hours a day, 7 days a week, regardless of f construction status. Person listed below is responsible for dust control during I business and non -business hours. A Name: IUVUL Title: Comoanv Name: Mailing Address: 1�� �� State, ZIP Code: Primary Phone #: "I SS- Fax #: 24 Hour Emergency Phone#: Cell Phone #: Email Address: ,Z�;-O --qa 3� 0 4eli -�, �A P_10"LOC&?_Vt' PM10 Certificate #: CV 14 � " C)LJ -I `(p "'T�j�YIyJy✓ G�� ThP_ ah_ n_ ve stater) nrn_ nerty nwner (nr at ithnrized representative): 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 Ian or any I my initiated abatement'activities- Water Quality Manaaement Plan (WQMP) Exemption Form - Whitewater River Rp-ninn 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? L 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? 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 t Company Phone 2 R> Email cl\� Project Information Project Name Type (SFH, Multi -Family, Commercial, Etc.) Location or Street Address 57_2, Nearest Cross Streets V, A.- � Municipality/County/Zip Code La Quinta Tract Number(s) and/or Assessor Parcel Number(s) -17n 7 ,qq_ H E . f - , j 5 Other Location Information Watershed Whitewater River Source Control BMP Information Size of Project Area (nearest 0.1 acre) 411g y Z 5 F Project Area managed with Site Design or Low Impact Development (LID) BMPs (nearest 0.1 acre) �J E- a SoZiGk. 1 (% f p, On A. 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 Street or Mailing Address172 City ``� �.A, 62vtAet-VA Zip Code q ZZis 3 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) 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 Structural BMP (See Appendix H, Section 4.5.2.2) Storm Drain Inlet Stenciling and Signage V 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 projer_.t-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) BMP 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 Ocdinaricallo. 457;.the Californi@ Regional Water Quality Control Board _ Colorado River Basin Region Board Order No. 137-2008-00G1 and the State Water Resources -Control Board's Order No.'99=(--DWQ..' Signature'Q�_, _ Print Name. Title: Date:11 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. Q I certify under the penalty of the laws of the Stai California that I am the property owner of the pr( is the subject matter of this application and I am and hereby do consent to the filling of this applic acknowledge that the final approval by the City c if any, may result in restriction, limitations and co obligations being imposed on this real property. Signature: Print Name: I 'AWOWWA.L/J!MIX--1 Title: r� Date: !A! Phone: so YOUNG ENGINEERING Letter of Transmittal To: City of La Quinta Today's Date: 4-24-17 78-495 Calle Tampico City Due Date: 4-24-17 La Quinta, CA 92253 Project Address: 53149 Via Dona Attn: MARY Plan Check #: BRES2017-0016 Submittal: 0 15t ❑ 4th ❑ 2nd ❑ 55th 0 3'd ❑ Other: We are forwarding: 0 By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup Includes: Descriptions: Includes: # Of Descriptions: Copies: ❑ Structural Plans ❑ Revised Struct. Plans ❑ Structural Calculations ❑ Revised Struct. Calcs ❑ Truss Calcs ❑ Revised Truss Calcs ❑ Soils Report - Update ❑ Revised Soils Report 0 Structural P/C Responses 0 Approved Structural Plans / Comments 0 i Redlined Structural Plans 0 Approved Structural Calcs ❑ Redlined Structural Calcs ❑ Approved Truss Calcs ❑ Redlined Truss Calcs ❑ Approved Soils Report ❑ Redlined Soils Reports ❑ Other: Comments: Structural content is approvable with conditions: Engineer of Record shall review truss calculations and stamp them reviewed or provide city a letter of review and acceptance. Transit Per Diem= Admin Time = 0.25 hrs. Structural Engineer/Principal Review Time = 0.0 hrs. Plan Review Engineer Time = 0.5 hrs. This Material Sent for: ❑ Your Files 0 Per Your Request ❑ Your Review ❑ Approval ❑ Checking ❑ At the request of: Other: ❑ By: Joe Venuti Office: El (760) 772-5107 Other: El LOPC(&VALUENGR.COM Design and Development Department - guldlog Division 78-495 Celle Tcmplco, Lo Quinto, CA 92253 Pik: (760) 777-7125 Fax: (76R) 777-7MI Webnite: www.W-quintmorg DEFERRED TRUSS SUBMITTAL FORM Date: -- 1 Application Number. —op 1 Project Street Addre : 49 01 Pi-�-flj 1+ FCEIVED MAR 2 9 201 CITY OF LA QUINTA COMMUNITY DEVELOPMENT Applicant: ❑ Architect or $, Contractor of Project (Please check appropriate box) Policy Conditions: 1. Limited to Custom residential pre -fabricated wood trussed roof projects on o case by case basis; 2. This form wilt be completed and submitted to the Building Division for approval prior to the Second submittal, '* The approved form will be submitted as part of lbe second submittal package; 1 Deferred Truss SubrrAtat Witt consist of two sets wet stomped Truss Calculations, Roof Layout rind EngWtr of Record's Acceptance stomp or letter; 4. Review timeframe is 14 working days; S. 5ervxe Fee of plan review and processing based on actual hourly cast of plans examiner, structurol consuttont, permit technician (payment required at the time of pickup of approved truss calculations; 5. The deferred truss submittal review and approvat witl be required prior to a foundation f footing inspection (no exceptions). 7. The approved "JOB" Copy of Truss Calculations is required to be onsite at the time of inspection. Print tiame: H t cViise1 J ..__....-- Signature:.By singing this fo , the applicant acknowledges and agrees to all conditions and requirernent Approved By: Title; "`Note to Permit Technician: Do fiat Ampnt guhrnittn 78-495 Cage Tamplro I La Ckttinta I California %2253 1 760.777.7000 1 www.La-QulntaAS YOUNG ENGINEERLNG 77-682 Country Club Dr. Ste. B Palm Dosert, CA-9.2211 Letter of Transmittal To: City of La Quinta Today's Date: 8-25-17 78-495 Calle Tampico City Due Date: 8-25-17 La Quinta, CA 92253 Project Address: 53149 VIA DONA Attn: MARY Plan Check #: BRES2017-0016 Submittal: 0 15t ❑ 4th ❑ 2nd ❑ 5th ❑ 31d ❑ Other: We are forwarding: By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup Includes: Descriptions: Includes: # Of Descriptions: Copies: ❑ Structural Plans ❑ Revised Struct. Plans ❑ Structural Calculations ❑ Revised Struct. Calcs ❑ Truss Calcs !] Revised Truss Calcs ❑ Soils Report - Update ❑ Revised Soils Report ❑ Structural P/C Responses 0 Approved Structural Plans / Comments ❑ Redlined Structural Plans ❑ Approved Structural Calcs ❑ Redlined Structural Calcs Approved Truss Calcs ❑ Redlined Truss Calcs ❑ Approved Soils Report ❑ Redlined Soils Reports ❑ Other: Comments: Structural content is approvable. TRUSS CALCS ONLY Transit Per Diem= Admin Time = 0.25 hrs. _ Structural Engineer/Principal Review Time = 0.0 hrs. Plan Review Engineer Time = 1.0 hrs. This Material Sent for: ❑ Your Files 0 Per Your Request ❑ Your Review ❑ Approval ❑ Checking ❑ At the request of: Other: ❑ By: 0.0 Office : 0 (760) 772-5107 Other: El LQPC@VALUENGR.COM 5 CITY OF LA QUINTA SUB -CONTRACTOR. LIST on JOB ADDRESS 13 ✓Itf I do PERMIT NUMBER 151Z-Fs_2-"l_1—001POWNEBUILDER work This form shall be osted on the '06 with the Buildin Ins ection Card at all times in__a conspicuous place. Only persons appearing on this list or their employees of work and/orori thedvoidance „,+ _i + ho nnnrmiari by the Ruildina Division prior to commencement of work. Failure to comply will result in a stoppage