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BRES2021-0390DESIGN & DEVELOPMENT DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type: Permit Number: Property Address: APN: Legal Description Property Zoning: Valuation: Building Residential BRES2021-0390 56065 VILLAGE DR 764030010 $312,793.40 Declaration / Acknowledgement BUILDING PERMIT Ottigta CALIFORNIA PHONE (760) 777-7125 WWW.LAQUINTACA.GOV APPLIED DATE: 07/15/2021 ISSUED DATE: 06/13/2022 Owner: Barbara Wynn P.O. Box 2756, Chino Hills, CA 91709 Applicant: A & D BUILDERS 125 E LINDEN AVE, BURBANK, CA 91502 Contractor: A & D BUILDERS / 861394 125 E LINDEN AVE, BURBANK, CA 91502 PRIOR TO THE ISSUANCE OF THIS PERMIT FOR CONSTRUCTION, ALTERATION, IMPROVEMENT, DEMOLITION, OR REPAIR THE OWNER, APPLICANT AND/OR CONTRACTOR UNDER PENALTY OF PERJURY HAVE AFFIRMED WHEN APPLICABLE, THROUGH THE SUBMITTAL OF FORMS OR BY OTHER ELECTRONIC MEANS, THE FOLLOWING: LICENSED CONTRACTOR OR OWNER -BUILDER DECLARATION (1 or 2) 1) They are licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and the referenced License is in full force and effect, or; 2) That they are exempt from the Contractors' State License Law for the reason(s) indicated by either (2)(a) and/or (2)(b), or (2)(c) where he or she is exempt from licensure by a valid exemption. [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code] 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).) a) As owner of the property, or my employees with wages as their sole compensation, will do all of or portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, 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 it was not built or improved for the purpose of sale.). b) As owner of the property, will be exclusively contracting with licensed c) Are exempt from licensure under the Contractors' State License Law. As an Owner -Builder, they acknowledge that, except for their personal residence in which they must have resided in for at least one year prior to completion of the improvements covered by this permit, they cannot legally sell a structure built as an owner -builder if it has not been constructed in its entirety by licensed contractors. It is understood that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application was submitted at the following Web site: http://www.leginfo.ca.gov/calaw.html. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY (If applicable) A construction lender will be used for completion of the improvements covered by this permit and the name and information of which is on file for public inspection during the regular business hours of the public entity. Failure of the applicant to indicate the construction lender on the application does not relieve that person of the requirement to give the construction lender preliminary notice from that duty. WORKERS' COMPENSATION DECLARATION (1, 2 or 3) WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 1) Has and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2) Has 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. 3) Certifies that, in the performance of the work for which this permit is issued, shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, shall forthwith comply with those provisions. NOTICE TO APPLICANT (1, 2 and 3) 1) Each person upon whose behalf this application was made, each person at whose request and for whose benefit work is being 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 360 days from date of issuance of such permit, or if cessation of work for 180 days will subject permit to cancellation. On or after January 1, 2019, every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 12 months after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 12 months after the time the work is commenced. 3) Certified that they read the application and state that the information provided is correct. 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. IMPORTANT: An Application for Permit was made to the Building Official, subject to the conditions and restrictions set forth at the time of application, which is now hereby an Issued Permit. If any part of the information being supplied on this permit is inaccurate or untrue, please contact the City of La Quinta at (760) 777-7125 immediately for correction. Printed: 1/31/25 12:30 pm Page 1 of 6 BUILDING PERMIT Permit Type: Permit Number: Property Address: Building Residential BRES2021-0390 56065 VILLAGE DR Use of Permit WYNN / 3,515SF DWELLING/VB/RES-3/CLASS A-FR/13D *" 3,515SF SINGLE FAMILY DWELLING - [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE PV SYSTEM, POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH OR OTHER SIMILAR EXTERIOR STRUCTURES [DE GUZMAN ENGINEERING]. 2019 CALIFORNIA BUILDING CODES. Construction Details Residential Work Type Dwelling - Single Family Detached Patio Square Footage 725 Code Edition 2019 Number of Units 1 Dwelling Units per 3.33 Acre (CVMSHCP) Electrical Service? Yes Number of Forced Air 3 Furnace(s) Number of Exhaust 1 Hood(s) Number of Roof Drains 4 Sewer Connection? Yes Conditioned Square Footage Fire Sprinkler Square Footage Number of Floors Building/Unit Occupancy Classification(s) Number of Flag or Light Pole(s)? Temporary Power Service? Number of Condenser(s) Miscellaneous Mechanical Water System Install or Alteration? 3515 4133 1 R-3: 1 &amp; 2 Family Dwellings, U: Utility/Misc Structures 0 Yes 3 1 Yes Garage Square Footage Construction Type 618 V-B Number of Bedrooms 3 Grading Required? Yes, New Dwelling New Electrical Square Footage Miscellaneous Electrical Number of Ventilation Fan(s) Number of Plumbing Fixtures/Traps Number of Gas Outlet(s) 4733 1 6 17 8 Valuation Details Sq Ft Value Printed: 1 /31 /25 12:30 pm Page 2 of 6 BUILDING PERMIT Permit Type: Permit Number: Property Address: Building Residential BRES2021-0390 56065 VILLAGE DR Financial Information Invoice No. INV-00001191 PERMIT-BRES2021-039 0 Fee Re -Inspection Fee Total for Invoice INV-00001191 OTHER ELECTRICAL EQUIPMENT GAS SYSTEM, 5+ OUTLETS PC RESIDENTIAL - CUSTOM HOME >7KSF SERVICES PC ROOF DRAIN BSAS SB1473 FEE MULTI -SPECIES RESIDENTIAL 0-8 UNITS - 2021 UPDATE OTHER ELECTRICAL EQUIPMENT PC BUILDING SEWER PC PLAN CHECK/PERMIT EXTENSION PROCESSING FIRE NEW RESIDENITIAL PC TUMF 2021 - SINGLE FAMILY DWELLING ART IN PUBLIC PLACES - RESIDENTIAL DIF - CIVIC CENTER FIXTURE/TRAP PC FURNACE DIF - MAINTENANCE FACILITIES VENT FAN PC RESIDENTIAL, EA ADDITIONAL 1,000SF PC OTHER MECHANICAL EQUIPMENT PC DIF - TRANSPORTATION BUILDING SEWER WATER SYSTEM INST/ALT/REP EXHAUST HOOD PC DIF - PARK IMPROVEMENTS RESIDENTIAL - CUSTOM HOME >7KSF PC TEMP POWER SERVICE PC OTHER MECHANICAL EQUIPMENT VENT FAN TEMP POWER SERVICE RESIDENTIAL, EA ADDITIONAL 1,000SF RECORDS MANAGEMENT FEE - MAJOR GAS SYSTEM, 5+ OUTLETS DIF - LIBRARY WATER SYSTEM INST/ALT/REP PC RESIDENTIAL, FIRST 1,000SF PC EXHAUST HOOD DIF - COMMUNITY CULTURAL SMI - RESIDENTIAL DIF - FIRE PROTECTION FIXTURE/TRAP CONDENSER/COMPRESSOR RESIDENTIAL, FIRST 1,000SF CONDENSER/COMPRESSOR PC Fee Amount Amount Paid $87.53 $87.53 $87.53 $87.53 $27.79 $27.79 $27.78 $27.78 $41.68 $41.68 $13.89 $13.89 $55.56 $55.56 $13.00 $13.00 $1,400.00 $1,400.00 $27.79 $27.79 $19.45 $19.45 $111.71 $111.71 $242.00 $242.00 $2,358.00 $2,358.00 $281.98 $281.98 $1,230.00 $1,230.00 $236.13 $236.13 $125.04 $125.04 $313.00 $313.00 $33.36 $33.36 $23.36 $23.36 $41.68 $41.68 $4,009.00 $4,009.00 $27.79 $27.79 $13.89 $13.89 $5.56 $5.56 $2,106.00 $2,106.00 $208.41 $208.41 $19.45 $19.45 $41.68 $41.68 $83.34 $83.34 $27.79 $27.79 $56.68 $56.68 $21.00 $21.00 $41.68 $41.68 $397.00 $397.00 $13.89 $13.89 $55.02 $55.02 $13.89 $13.89 $956.00 $956.00 $40.66 $40.66 $369.00 $369.00 $236.13 $236.13 $125.04 $125.04 $166.73 $166.73 $83.37 $83.37 Printed: 1/31/25 12:30 pm Page 3 of 6 BUILDING PERMIT Permit Type: Permit Number: Property Address: Building Residential BRES2021-0390 56065 VILLAGE DR NEW CONSTRUTION - SINGLE FAMILY RESIDENTIAL NEW CONSTRUCTION PLAN CHECK 2021 NEW CONSTRUCTION PERMIT 2021 FIRE NEW RESIDENTIAL TECHNOLOGY ENHANCEMENT FEE FURNACE PC SERVICES ROOF DRAIN PC Total for Invoice PERMIT-BRES2021-0390 $161.00 $1,697.46 $2,568.92 $161.00 $5.00 $83.37 $27.79 $55.56 $161.00 $1,697.46 $2,568.92 $161.00 $5.00 $83.37 $27.79 $55.56 $20,502.30 $20,502.30 Grand Total for Permit $20,589.83 $20,589.83 Workflow / Inspections Workflow Step / Action Name Inspections v.1 FINAL INSPECTION v.2 FINAL INSPECTION v.1 TEMP USE OF PERM PWR v.2 TEMP USE OF PERM PWR v.1 SEWER CONNECTION v.2 ............................................................................................................................. SHOWER PAN v.3 ............................................................................................................................. GAS LINE/TEST v.3 ............................................................................................................................. SHOWER PAN v.2 ............................................................................................................................. GAS LINE/TEST v.2 ............................................................................................................................. SHOWER PAN v.1 ............................................................................................................................. DRYWALL NAIL v.1 LATH v.1 INSULATION v.4 INSULATION v.3 INSULATION v.2 INSULATION v.1 ROUGH ELEC v.1 ROUGH PLBG v.1 ROUGH MECH v.1 FRAMING v.1 OKAY TO WRAP v.1 OVERHEAD ROUGH PIPING v.1 GAS LINE/TEST v.1 ROOF NAIL v.1 SLAB v.1 FOOTINGS v.1 SEWER CONNECTION v.1 UNDERGROUND PLBG v.1 TEMPORARY POWER v.2 ............................................................................................................................. TEMPORARY POWER v.1 Action Type Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Start Date End Date 07/15/2021 0:00 Application Completeness Check v.1 Printed: 1/31/25 12:30 pm Page 4 of 6 BUILDING PERMIT Permit Type: Permit Number: Property Address: Building Residential BRES2021-0390 56065 VILLAGE DR Confirm Fees Paic Submittal Document Verification v.1 Generic Action Generic Action Plan Check v.1 Building Major Review v.1 Receive Submittal Permit Issuance v.1 Contractor / Owner -Builder Information v.1 ................................................................................................................................................................ Verify & Invoice Fees v.1 ................................................................................................................................................................ Ready to Issue v.1 Verify Fee Payment & Issue Permit v.1 Print, Attach, and Email Building Permit v.1 Inspections - Do Not Pour Concrete Until Approved v.1 ...................................................................................................................................................................................................... Setbacks v.1 ...................................................................................................................................................................................................... Underground Plumbing v.1 ...................................................................................................................................................................................................... Water Line v.1 Footing v.1 Slab v.1 Inspections - Cover No Work Until Approved v.1 Roof Nail v.1 Okay to Wrap v.1 Framing v.1 ........................................................................................................................................................................... Rough Electrical v.1 ........................................................................................................................................................................... Rough Mechanical v.1 ........................................................................................................................................................................... Rough Plumbing v.1 ........................................................................................................................................................................... Rough Fire Clearance v.1 ........................................................................................................................................................................... Shower Pan v.1 ........................................................................................................................................................................... Insulation v.1 ........................................................................................................................................................................... Drywall Nail v.1 ........................................................................................................................................................................... Exterior Lath v.1 ........................................................................................................................................................................... Gas Test v.1 ........................................................................................................................................................................... Sewer Connection v.1 Generic Action ...................................................... Generic Action ...................................................... Generic Action Generic Action Create Report ...................................................... Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection Inspection ..................__________________ Inspection Inspection Generic Action ........________ ...................._____ Inspection ......__________________............ Inspection ...................................................... Inspection ...................................................... Inspection ...................................................... Inspection ...................................................... Inspection Inspections - Masonry v.1 Inspections - Electrical for Meter Release v.1 Temporary Power v.1 Temp Use of Permanent Power v.1 Inspection Inspection Inspections - Final v.1 Final Fire v.1 Final Building v.1 Final Building v.2 Final Building v.3 Inspection Inspection Inspection Inspection 09/21/2023 8:00 09/21/2023 8:00 09/22/2023 15:06 10/02/2023 0:00 10/04/2023 13:31 10/05/2023 0:00 10/09/2023 11:45 Certificate of Occupancy v.1 Certificate of Occupancy v.1 Create Report 10/10/2023 8:23 10/10/2023 8:25 10/10/2023 8:23 10/10/2023 8:25 Printed: 1/31/25 12:30 pm Page 5 of 6 BUILDING PERMIT Permit Type: Permit Number: Property Address: Building Residential BRES2021-0390 56065 VILLAGE DR Inspections Construction or work for which a permit is required shall be subject to inspection by the building official and such construction or work shall remain visible and able to be accessed for inspection purposes until approved. Approval as a result of an inspection shall not be construed to be an approval of a violation of the provisions of the applicable code and other ordinances of the jurisdiction. Inspections presuming to give authority to violate or cancel the provisions of the applicable code and other ordinances of the jurisdiction shall not be valid. It shall be the duty of the owner or the owner's authorized agent to cause the work to remain visible and able to be accessed for inspection purposes. Neither the building official nor the jurisdiction shall be liable for expense entailed in the removal or replacement of any material required to allow inspection. It shall be the duty of the holder of the building permit or their duly authorized agent to notify the building official when work is ready for inspection. It shall be the duty of the permit holder to provide access to and means for inspections of such work that are required by this code. Certificate of Occupancy A building or structure shall not be used or occupied in whole or in part, and a change of occupancy of a building or structure or portion thereof shall not be made, until the building official has issued a certificate of occupancy therefor as provided herein. Issuance of a certificate of occupancy shall not be construed as an approval of a violation of the provisions of the applicable code and other ordinances of the jurisdiction. Certificates presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid. Service Utilities A person shall not make connections from a utility, a source of energy, fuel, or power, or a water system or sewer system to any building or system that is regulated by the applicable code and other ordinances of the jurisdiction for which a permit is required, until approved by the building official. Printed: 1/31/25 12:30 pm Page 6 of 6 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: 5 / 25 / 20a Developer: Modern Development LLC Tract No.: 28983 Tract Name: Lot No.(s):30 Address(s): 56065 Village Dr La Quinta Ca Phone Number: (818 ) 535-2682 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 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-quinta.orq/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. Recommended by: Date: / / 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 Agreement (<1 acre/lot or Infill Project Project Information Project Contractor: Project Phase (check one) Project Name: New Custom Home Project Tract/Lot Numbers: 28983 / 30 Construction Project Street Address: 56065 Village Dr La Quinta Ca Demolition Total Acres in Active Construction (<1 acre per Lot): 5 25 20 5 252022 Anticipated Start Date: / / Anticipated Completion Date: / / 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: � Henrik Artonian 4 / / /� n a ha e pe c c © jfet1cti, Title: Supervisor Company Name: A & D Builders Mailing Address: 129 E. Linden Ave City, State, ZIP Code: Burbank Ca 91502 Primary Phone #: Q 818-535-2682 vANAr t ?6©' 60 i — 67 I Fax #: 818-955-5100 24 Hour Emergency Phone#: 818-535-2682 Cell Phone #: 818-535-2682 Email Address: henrik1300@gmail.com henrik1300� PM10 Certificate #: f@ C v p) 6/' ©� I C ( ') O J 49— 1 l 0/ The above stated property owner (or authorized 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 aro ncccccary; • 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/Coup itiated abatement activities. Signature of Property Owner or Authorized Representative Date T:\Checklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc M A 09 co City of La Quinta - PM10 Fugitive Dust Control Plan (<1 acre per Lot or Infill Project) This Fugitive Dust Control Plan shall take into account applicable SCAQMD Regulations Rule 403, 403.1, 401, 402, 201, 203 and Portable Equipment Registration Program (PERP). • WATERING: Continuous watering is required to prevent dust and must occur a minimum of four (4) times daily. Water shall be applied from an adequate sized metered water source to dry soils to prevent: • Visible dust emissions >20% opacity • Visible dust emissions that travel >100 feet from the source (within site) • Visible dust emissions that cross any property line o� EDUCATION: The responsible dust control Individual and key personnel shall attend SCAQMD PM10 class and obtain PM10 certificate number prior to construction activity (training information may be obtained by contacting SCAQMD at (909) 396-2183). • CONSTRUCTION & DEMOLITION ACTIVITIES: A copy of this approved Fugitive Dust Plan must be kept on site. At least one short-term stabilization method must be used during off hours. At least one long-term stabilization measure must be used within ten (10) days of ceasing activity. S• WEATHER MONITORING: Wind predictions shall be monitored. • SIGNAGE: Approved signs shall be installed at a highly visible location. Please refer to the Coachella Valley Fugitive Dust Control Plan Handbook for Construction Signage Guidelines. • TRAFFIC: Construction traffic shall not be allowed on the pad, unless absolutely necessary. If vehicles operate on pad, pad shall be kept firm and moist through hose watering and sprinklers; and a maximum traffic speed of 15mph will be enforced. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on pad. .• PARKING: Parking is not allowed on pad. All vehicles must park on street at designated areas only. • TRACK OUT: Provide 24 hour street cleaning and track out system as approved by City Public Works inspectors. No dirt on public or private roads. Track out shall be cleaned up within one (1) hour of incident and at the conclusion of each workday. • DIRT PILES: Dirt piles shall be limited to 50 cubic yards and built per California Building Code grading requirements. Piles shall be kept moist or covered with tarp material. Larger dirt piles will require stockpile or grading permit. .• FENCING: Provide PM10 fencing at perimeter of public roads and where applicable. VVood slat fencing can be installed at rear of property and return 20 feet on either side if HOA restrictions apply. Block walls can replace PM10 fencing during the construction phase. • EQUIPMENT: Extra hoses and sprinklers shall be maintained on site. ❖ EXCAVATION MEASURES: All areas to be excavated or graded shall be pre -watered. Water shall also be applied during excavation or grading operations. ❖ DUMP TRUCKS: Open top dump trucks shall be wet down, moist and covered with a tarp prior to leaving site. • INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required. • RECORD KEEPING: Fugitive Dust Control Plan records (i.e. self inspection records, records of use of chemical suppressants, etc.) shall be maintained for 3 years by the Property Owner (or Authorized Representative). Property Owner shall notify the City and SCAQMD within 10 days of completion of project. T:\Checklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc Water Quality ManaOement 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% 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? 1 1 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 Henrik Artonian Company Modern Development LLC Phone 818-535-2682 Email henrik1300@gmail.com Project Information Project Name Type (SFH, Multi -Family, Commercial, Etc.) New Custom Home Location or Street Address 56065 Village Dr La Quinta Ca Nearest Cross Streets Palms Golf Club / Airport Blvd Municipality/County/Zip Code La Quinta Tract Number(s) and/or Assessor Parcel Number(s) APN 764-030-010 Other Location Information Watershed Whitewater River Source Control BMP Information Size of Project Area (nearest 0.1 acre) ee 0. ?G A c^< t_,. jJ` Project Area managed with Site Design or Low Impact Development (LID) BMPs (nearest 0.1 acre) n/ n Q 1 ► . 7 k 06 ei / Cti 1'k0� V"t C-'a Is the project subject to onsite retention by City ordinance or policy? Nv Name of the Entity that will implement, operate, and maintain the. Sourc�a Cnntml HMPQ Q n / r. Ile NA I Hi n��N. 1 q et L /Cu, t(�Ph - Contact Name [,j' Pnp i h f) p --p F CIA. Street or Mailing Address rt` 5,4\ (Z- L 1 wi., PN p vi City Bv`1`\11w tA- Zip Code ej(5 oa, Phone 818-535-2682 T:\Checklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 Tess than 1 Acre Revised 9-25-09. doc Check Item To be Performed Source Control BMP Requirements - All Projects Require Non -Structural BMP Source Control 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 Check Item To be Provided Source Control BMP Requirements — Small Sloped Lots, Small Commercial, <10 Unit Subdivisions, <5,000 Square Ft. Parking Lots, Etc. Structural BMP (See Appendix H, Section 4.5.2.2) 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) 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 Ordinance No. 457; the California Regional Water Quality Control Board — Colorado River Basin Region Bc,a rd Order No. R7-2OO8-0001 and the State Water Recot.tr Control Board's Order No. 99-08-DWQ. Signature: Print Name: Henrik Artonian Title: Supervisor Date: 5 / 25 / 2022 Phone: (818 ) 535-2682 T:\Checklists - Forms & Applications\Forms & Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 9-25-09.doc 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. Print Name: Henrik Artonian Supervisor Title: Date: v / I / �a Phone: ( ) S 35-- Owner Certification I certify under the penalty of the laws of the State of California that I am the property owner of the property that is the subject matter of this application and I am authorizing and hereby do consent to the filling of this application and acknowledge that the final approval by the City of La Quinta, if any, may result in restriction, limitations and construction obligations being imposed on this real property. Signature: /( Print Name: P/�/y /9/ti' A 4, Title: O w� Date: 4/_L/__19 69 Phone: ( VI) se-3 pa cettit •efiQtildad DESIGN & DEVELOPMENT DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 (760) 777-7125 FAX (760) 777-7011 CERTIFICATION OF BUILDING AREA STREET ADDRESS OF JOB: 56065 VILLAGE DRIVE APN: 764-030-010 DESCRIPTION OF WORK: NEW SINGLE-FAMILY DWELLING SQUARE FOOTAGE: 3,515 OWNER'S NAME: BARBARA WYNN P.O. BOX 2756 CHINO HILLS, CA 91709 For questions regarding this letter, please contact: City of La Quinta Permit Center (760) 777-7125 Coachella Valley Unified School District 83-733 Avenue 55 P O Box 847 Thermal, CA 92274 (760) 398-5909 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 DATE CITY OF LA QUINTA BUILDING DIVISION REVIEWED FOR CODE COMPLIANCE 09/20/2021 BY I C Please note: This letter verifies conditioned square footage. Please call your School District to verify school fees, requirement for cashier's check or money order and hours of operation. Building Permit Number: Project Description: BRES2021-0309 SFR Exempt: ❑ (Materials may contain hazardous wastes and are not subject to recycling provisions) Construction Debris Management Plan Plan Submittal Date Job Site Address Owner's Name Number, Street, or PO Box City, State, Postal Code Owner's Phone Number Owner's E-Mail Address Project Manager's Name Project Manager's Phone Number Project Manager's E-mail Address Builder / Contractor Number, Street or PO Box City, State, Postal Code Proiect Sauare Footaae Approval By Burrtec Date of City Approval 8/20/2021 56065 VILLAGE DR. LA QUINTA, CA BARBARA WYNN P.O. BOX 2756 CHINO HILLS, CA 91709 ( RAMON J CORONADO (760) 408-0972 aracoronadoeaol.com EXCLUSIVE CONSTRUCTION 3777 PLACENTIA LN. RIVERSIDE, CA 925001 4,858 Materials To Be Discarded: Product Trash Asphalt Brick/Block Cardboard Commingled Concrete Drywall Donated / Reuse* *Describe Items Tons Not recyclable Recyclable Recyclable Recyclable Recyclable Recyclable Recyclable Recyclable 18.00 0.00 0.00 1.25 0.00 24.25 2.50 0.00 Product Masonry (broken) Plaster Scrap Metal Tile (floor) Tile (roof) Wood Landscape Debris Tons 0.00 6.00 0.00 0.50 0.70 9.25 0.00 Recyclable Recyclable Recyclable Recyclable Recyclable Recyclable Recyclable Projected Diversion: 71.18% I understand it is the property owner's responsibility to submit copies of weight tickets or receipts to the District Environmental Coordinator as these hauls occur. I hereby certify that completion, implementation and adherence of the Debris Management Plan (DMP) for the above named project shall guarantee that at least 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 Ramon J Coronado 8/20/2021 Owner / Developer / Project Manager / Superintendant Date Construction Debris Management Plan Summary of Requirements As of January 1, 2017, The Green Building Standards Code (CALGreen) requires that the construction of most new structures in the State of California comply with sections 4.408 and 5.408 of the code in accordance with Assembly Bill 939 requiring that no more than 35% ofjobsite waste be disposed of as trash at local land fill sites and transfer stations. Exceptions may be made for certain projects under certain conditions. The City of La Quinta is committed to the highest level of environmental respect, to conserving our precious natural resources and setting an example to provide for a better world for generations to come. Recycling helps keep reusable resources out of landfills and will also reduce disposal costs. IMPORTANT: Burrtec Waste & Recycling Services is the City's franchise hauler. If you choose to self -haul any recyclables or trash, you must provide copies of all weight tickets and/or receipts from the transfer station, landfill, or recycler as the job progresses. Clean-up companies and other haulers are not permitted to haul waste or recyclables from the City of La Quinta. Self -haul weight tickets should be submitted to: Mike Veto, District Environmental Coordinator - mveto@burrtecdesert.com, or faxed to (760) 340-0417, or mailed to: 41575 Eclectic Street, Palm Desert, CA. 92260. OSABUOGBE C. IGBINEDION, PE Civil Engineering Consultant July 27, 2022 City of La Quinta Public Works Department 78495 Calle Tampico P. O. Box 1504 La Quinta, CA 92247-1504 Subject: Pad and Finish Floor Elevation Certification for Development Located at 56-065 Village Dr., Tract Map No. TR 28983, Lot 30: APN: 764-030-010 This letter is to verify that the locations and elevations of the building pad and finished floor for Lot 30 of Tract Map No. 28983 were field checked by my Associate, Jesus Castro and found to be in substantial conformance with the approved Precise Grading Plan. The results are as follows: Location Elevation or Setback on Approved Grading Plan Observed Elevation or setback During field Inspection Pad Elevation 466.50 feet (NAVD88) 466.49 feet (NAVD88) Finished Floor Elevation 467.00 feet (NAVD88) 467.00 feet (NAVD88) Front Setback 20.0 feet 20.0 feet Right side setback 5.0 feet 5.0 feet Left side setback 5.0 feet 5.0 feet Rear setback 28.0 feet 28.0 feet If you have any questions regarding this matter, please contact me at (760) 880-8095. Sincerely, Osabuogbe Chris Igbinedion, P.E. Consultant. IVo,C566 9 m� xp06/30/23 �� lV\ w�OF 44500 San Pasqual Avenue, Palm Desert, California, 92260. (760) 880-8095 ENGINEER OF RECORD INSPECTION THRU VIDEOS To whom it may concern, October 10, 2022 Location: 56065 Village Drive La-Quinta CA 92253 Type of project: New Single -Family Residence Structure's condition at provided Videos: All framing including roof diaphragm is already constructed. Foundation and slab were already constructed and covered. Observation: All shear walls, framing and, joist that can be shown on the videos appear's to be present and consistent with the approved structural plans. Some beams and headers that was shown on the videos appears to be consistent with the design but no size verification. Only visual inspections were done and only on items that can be seen on the provided videos are covered on this letter. Conclusion: Overall, the structure's framing elements that can be seen and inspected thru provided video comply with the intended structural design. N colo Klaus De Guzman P.E. C76675 Engineer Disclaimer: The engineer of record responsibility is for the structural design aspect only. It does not include construction procedures, alteration and etc. that affect structural design. This letter does not make FOR responsible for checking the structure to be in full compliance per approved design plans. f CAL FIRE - RIVERSIDE UNIT RIVERSIDE COUNTY FIRE DEPARTMENT OFFICE OF THE FIRE MARSHAL — LA QUINTA 78495 Calle Tampico, La Quinta, CA 92253 • Phone (760) 777-7074 • www.rvcfire.org July 29, 2021 Barbara Wynn PO Box 2756 Chino Hills, CA 91709 Re: Residential Fire Access & Water Plan Review — WYNN RESIDENCE BRES2021-0390 / 56065 VILLAGE DRIVE, LA QUINTA, CA 92253 CALIFORNIA The plans you submitted for the above referenced project have been reviewed by Riverside County Fire Department - Office of the Fire Marshal personnel and are approved with the following conditions. 1) Property/Unit Addressing shall be provided. Minimum 4-inch tall numbers of contrasting color to their background shall be displayed on the structure and viewable from the roadway or posted at the driveway entrance and maintained visible. 2) The proposed structure requires a fire flow of 1,000 gallons per minute from a single hydrant located within 600-feet of all exterior portions of the structure. (CFC 507.5.1 & APPENDIX B) 3) Public/Private fire hydrants located in front of the property shall be provided with a minimum 3-feet radius around the hydrant of clearance of any obstructions, including vegetation. 4) A Residential Fire Sprinkler system shall be installed in compliance with CRC R313. CA Licensed Contractor (C-16) shall submit plans and details for review and approval prior to system installation and Rough Inspections. The Fire Depaitiuent approved plans and conditions letter must be at the job site. Applicant shall be responsible to contact the Fire Department to schedule inspections. Requests for inspections are to be made at least 48 hours in advance and may be arranged by calling (760)777-7131. All questions regarding the meaning of these conditions should be referred to the Office of the Fire Marshal staff at (760)777-7074. Kohl Hetrick - Fire Safety Specialist 78495 CALLE TAMPICO, LA QUINTA, CA 92253 / 760-777-7000 / INSPECTION HOTLINE: 760-777-7131 Exclusive Construction Services 3777 Placentia Lane Riverside, Ca 92501 951-682-2003 City of La Quinta 78495 Calle Tampico, La Quinta, CA 92253 Re: 56065 Village Drive, La Quinta, Ca June 1, 2022 Exclusive Construction has withdrawn from the project on 56065 Village drive. Please release permit BRE52031-0390 to A & D Builders, 129 E Linden Ave, Burbank, Ca 91502 Exclusive Construction 6/1/22, 11:47 AM Personnel List - CSLB Home I Online Services I License Detail I Personnel List �Contractor's License Detail (Personnel List) Contractor License # 865005 Contractor Name EXCLUSIVE CONSTRUCTION Click on the person's name to see a more detailed page of information on that person lc:Rinses Currently Associated With Name RICHARD WAYNE KLEIN Title QUALIFY PARTNER Association Date 09/28/2005 Classification B Additional There are additional classifications that can be viewed by selecting this link. Classification Name GERALD WAYNE KOHUTEK Title GENERAL PARTNER Association Date 09/28/2005 Licenses No Longer Associated With Back to Top Conditions of Use Privacy Policy Accessibility Accessibility Certification Copyright © 2022 State of California https://www.cslb.ca.gov/OnlineServices/CheckLicensell/PersonnelList.aspx?LicNum=865005&LicName=EXCLUSIVE+CONSTRUCTION 1/1 ir Associa® Desert Resort Management The Village at the 'aims July 8, 2021 Barbara Wynn PO Box 2756 Chino Hills, CA 91709 RE: Architectural Request - New Home Construction 56-065 Village Drive Dear Barbara Wynn: Your architectural request has been approved as per the application and drawing/plans submitted for the following: New Home Construction We trust that only licensed, insured contractors will be performing the work. Please be reminded that any damage to the common area due to construction should be repaired in a timely manner. Thank you for your cooperation in filing for architectural approval. Please return the enclosed Notice of Completion form to our office when this project has been completed so a final inspection of the project can be performed. If you have any questions or concerns, please do not hesitate to contact our office at (760) 346- 1161. Sincerely, Catherine Baker, CMCA® AMS® On behalf of the Architectural Review Committee of The Village at the Palms 42-635 Melanie Place, Suite 103 Palm Desert, CA 92211 760-346-1161 760-346-9918 www.drminternet.com Associa` The leader in community association management www.associaonline.com AQMD South Coast Air Quality Management District acknowledges by this Manuel De Jesus Contreras succes fully completed Rule 403.1. Coachella Valley Fugitive Dust Control Training pale hued: Led +: Certification is valid for 2 dears from the due of issuance 07/15/2021 CV2107-011052-11072 me4t eAussu 1Yainn, O[tirer f omphan e and f injat ement RTIFICATE OF OCCUPANCY DESIGN AND DEVELOPMENT DEPARTMENT This Certificate is issued pursuant to the requirements of Chapter 1 Section R110 of the California Residential Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 56065 VILLAGE DR Use Classification: Building Residential Occupancy Group: U: Utility/Misc Type of Construction: V-B Structures/ R-3: 1 & 2 Family Dwellings Code Edition: 2019 Sprinkler Installed: YES By: Mark Hunt Date: 10/9/2023 12:00: OOAM Building Official: AJ ORTEGA taiOttlitra — GEM of the DESERT — Permit No.: BRES2021-0390 Land Use Zone: Sprinkler Required: YES Owner of Building: Barbara Wynn Address: P.O. Box 2756 City, ST, ZIP: Chino Hills, CA 91709 POST IN A CONSPICUOUS PLACE