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BRES2016-0319Building Address Owner Mailing Q� Address [0 - G1 City (,A 0U1,J1 p3l4 RO. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 E LL C BUILDING: TYPE CONST �i _! �— OCC. GFIR SEP' t1 t� 52- A.P. Number (y6 7 . ro o • D Zo Tel. Legal Description tz r 66 . 1 lr�-r ,3 30 T 6. 2 , ZZ53 18,56-175. Io3Z 800k, 313, FA"3" 6/- so Project Description --.rp r i A � . —_ — A. A . l ., I G TY cr Address I So - 955 A-t��JvE 52 LA Qw JrA 19ZZs3 1760• 3g3.5ZbG State Lic. City & Classif. S - g157 336ILic. # 1 oq 5o `{ Arch., Engr., Designer &k. "YW- /4AYE-r- Arc. 04rMCTc*R S MAP—Ae: Vie—W. ' L M4g- I c zor,4 Iut:#O/56o2 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter g (commencing with Section 70D0) of Division 3 of the Business and Professions Codeand my license is in If 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. (Sec. 70315, Business and Professions Code: Any city orcounty which requires a permit to construct, after, improve, demolish, or repairany structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contras lor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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). 01, 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 does such work himself or through his own employees, provided that such improvements are not intended or offered for sale It, however, the building 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). G 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply loan owner of property who builds or improves (hereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law) 01 am exempt under Sec B & PC for this reason Date Owner WORKER'S COMPENSATION DECLARATION I hereby aff4n that 1 have a certificate of consent to sell -Insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800f.Labor Code.) Policy No. Company 7'FAL,I e—C �s )(Co is filed with the city. OCertified copy is hereby furnished JuzztzD' T-tf3 CERTI I A OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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 employ any person in any manner so as to become subject to Workers' Compensation Laws of California Date Owner N/Ii NOTICE TO APPLICANT. It, 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 property filled out, signed and validatedand is subject to expiration if work thereunder is suspended for 180 days. I certify that 1 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 the above mentioned property for inspection purposes Signature of applicant N/iA Date Mailing Address City, State, Zip S6 S.F. Sq. Ft. _' _ No. No. Dw. S l T6 !-"k, 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 ( n n r CONTACT INFORMATION NOV NAME: PHONE: ZONE: BY: ELOPMENT 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 = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE f January 31, 2017 Mr. Mark McClure 52647 Via Savona La Quinta, CA 92253 RE: Lot 68B at 53605 Humboldt Blvd. Construction Document Submittal #1 Dear Mr. McClure: RECEIVED FEB 0 2 2017 CITY OF LA QUINT4 COMM N TY DEVELOPMENT This correspondence shall serve as notification from The Madison Club Design Review Committee (DRC) that your final working drawing submittal was reviewed at the January 26, 2017 meeting. The project was approved to start construction subject to the comments listed below being revised and resubmitted no later than February 16, 2017 for review at the February 23`d meeting. 1. A Variance Request was received with regard to extending the pool into the Natural Area. Included with the Variance was a signed agreement from the neighbor (6713) with regard to the design. It was also noted that Mr. McClure owns Lot 69B and therefore is in agreement with the design as proposed. The DRC is recommending approval of the Variance assuming the Golf Club is not impacted by the design. 2. The gas meter location was noted on all plans except the landscape plan. 3. The trash area must be accessible through an unlocked gate or wall system even when the motor court gate is closed. The design, as proposed, is not acceptable as the trash location will not be favorable to an owner. Please revise to accommodate this community requirement. 4. The wall heights at the driveway are noted on the response letter as being reduced to 6' maximum; however, the plans submitted do not reflect this condition and motor court walls (per the guidelines) are restricted to 5' high maximum. The committee suggests redesigning the front, left wall design by pulling the wall back so the majority is within the building envelope and can therefore be taller. This area can be reconfigured to include a trash area as well. There may be a need for a Variance for a slight overage at the corner which the DRC would support (see the first photo attached as an example layout that might work). 5. The mailbox design and location must be indicated on all of the plans including the landscape plans. 6. The drainage swale at the street still appears to be problematic. The drain to the inlet will be blocked by the boulders. 7. There appears to be a 4' high wall in the south view corridor which exceeds the 3' maximum height allowed and a wall return is needed at the southwest property line wall. All wall heights and designs must be coordinated to be consistent on all plan sheets for final review (grading/landscape/site). 8. Trees and shrubs that will exceed 3' in height may not be utilized in the rear yard view corridors unless a written approval is provided by the adjacent lot owner(s). The material over 3' where adjacent to Lot 69B is acceptable as Mr. McClure owns the lot. However, a written agreement is required for the material over 3' which is adjacent to 67B. The email provided which approved the pool did not address the planting. 9. Please clarify if the wall extension at the rear of the property between Lot 68B and 67B is an existing or proposed wall. If proposed then written confirmation from both neighbors is required. 10. The large boulders at the rear of the property must be further defined and should not exceed 3' in height unless the adjacent neighbor(s) agree to the height (adjacent to 67B should be acceptable). This comment does not appear to have been addressed. Please coordinate all plan sheets. 11. There are 36 uplights proposed which would require a Variance Request. In addition, there are four wall washers proposed which are not allowed. All down lights should be located in interior spaces or close to the home and catalog cut sheets with wattage information is required for all lighting. There was no variance submitted and the wall washer lights were not removed as noted in the response letter (see the second photo attached). Please coordinate the plans and the response letter to address these comments with your next submission. 12. Courtesy comment: The DRC suggests that CVWD be contacted as recent changes in their policies are requiring the review of landscape plans/water usage under some circumstances. This may impact your landscape design and the availability to secure a Permit. Please contact Brook Marshall at 760-219-8057 or by email at DRCFacilitator@gmail.com with any questions regarding this submittal or to schedule your Pre -Construction Meeting once a Building Permit has been obtained. No work should begin at the lot prior to the receipt of a Building Permit from the City of La Quinta. Sincerely, MADISON CLUB DESIGN REVIEW COMMITTEE Title: cc: Hayer HSA Eric Puls Discovery DRC File Date: Pursuant to Cal. Civil Code, any rejection by the DRC may be appealed to the Board of Directors for the Association. /f you wh t iso pursue an appeal, please contact the Association's property manager -so that you rruty be put on the nest meeting agenda. .F � . .rE r � cam{„ �.o+ •�� '�•+—•��j���'S.� v Coachella Valley Unified School District 83-733 Avenue 55, Thermal, CA 92274 (760) 398-5909 — Fax (760) 398-1224 Project Name: Owner's Name: The Madison Club McClure Homes, LLC This Box For District Use Only DEVELOPER FEES PAID AREA: AMOUNT LEVEL ONE AMOUNT : LEVEL TWO AMOUNT: MITIGATION AMOUNT I COMM/IND. AMOUNT: DATE: RECEIPT: CHECK #: INITIALS CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Address: 53-605 Humboldt, LaQuinta Project Description: SFD APN: 767-700-020 Tract #: Type of Development: Residential xx Total Square Feet of Building Area: Commercial 9956 Date: March 8, 2017 Phone No. 858-775-1032 Lot #'s: Industrial Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sigp on behalf of the owner/developer. Dated: March 8, 2017 Signature: SCHOOL DISTRICT'S REQUIREMENTS FOR TH ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED *1 ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code 17620 Number of Sq.Ft. Amount per Sq.Ft. Amount Collected Gov. Code Project Agreement Existing Not Subject to Fee 65995 Approval Prior to 1/1/87 Requirement Note: 9956 Pursuant to AB 181 any room additions or enclosures of 500 $3.48 sq. ft. or less are exempt from developer fees. Any mobile homes being relocated within the same school district's $34646.88 jurisdiction are exempt from developer fees. Building Permit Application Completed: Yes/No By: Elsa F. Esqueda, Director of Facilities and Maintenance Certificate issued by: Laurie Howard, Secretary Signature: "A r /.g{,L 4&J 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. 11/2010 A Taf 4 4aubrw COMMUNITY DEVELOPMENT DEPARTMENT 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 (760) 777-7012 FAX (760) 777-7011 CERTIFICATION OF BUILDING AREA STREET ADDRESS OF JOB: 53-605 HUMBOLDT APN: 767-700-020 DESCRIPTION OF WORK: NEW SFD SQUARE FOOTAGE: 9956 SQ. FT. OWNER'S NAME: EAST OF MADISON For questions regarding this letter, please call: City of La Quinta Permit Center (760) 777-7012 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 f CfT1' OF L,q QU1 I BUILD/NVG & S Nlq APPR®V DEPZ OR CONSrR ED crloN DATE zl � 61' Please note: This letter verifies conditioned square footage. Please can your School District to verify school fees, requirement for cashier's check or money order and hours of operation. 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 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 N Project Manager's Phone Nun Project Manager's E-mall Add Buckler / Contn Number, Street or PO City, State, Postal C Project Square 11/2/2016 53-605 Humbolt Blvd. La Quinta, CA 92253 McClure Homes, LLC (c/o Discovery Builders) 53-965 Humbolt Blvd. La Quinta, CA 92253 760-393-5271 morkmc5OAamail.com Zachary D. Hanan 760-393-5271 zhananAdiscoverybulldersllc.com Discovery Builders California, Inc. 53-965 Humbolt Blvd. La Quinta, CA 92253 11,722 square feet City Approval B Date of City Approval I (/OZ/ / (o RFC:�-fu�F�� NOV 0 3 201r CIT s' OF LA QUINTA COMMUNITY DEVELOPMENT Materials To Be Discarded: Product Tons Trash 48.00 Not recyclable Product Tons Asphalt 0.00 Recyclable Masonry (broken) 0.00 Recyclable Brick/Block 0.00 Recyclable Plaster 13.00 Recyclable Cardboard 0.00 Recyclable Scrap Metal 0.00 Recyclable Commingled 0.00 Recyclable The (floor) 1.00 Recyclable Concrete 40.00 Recyclable Tile (roof) 1.25 Recyclable Drywall 5.50 Recyclable Wood 15.25 Recyclable Donated /Reuse' 0.00 Recyclable Landscape Debris 0.00 Recyclable *Describe Items Totals: Recycle Trash rojected Diversion: 76.0 48.0 r 61.29% i understand R 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 50% of the jobsite waste is diverted from landfilling. The remaining material will be recycled or reused. I will dhreM 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 mayyatain a DMP for the owner. However, the DMP is still Issued in the name of the property owner(s) and the owner to al responsibility for ensuring that the provisions of the DMP are adhe to. a property owner(s) ge erai" n r shall be kept informed of the diversion progress through bl- brr> rrthly rip self -ha i(ng, furnll iproject efts must betaken to an approved recycler or transfer Owns v j / ag rt DateT— Design and Development Department - Building Division 78-495 Calle Tampico, La Quints, CA 92253 PH: (760) 777-7125 Fax: (760) 777-7011 Website: www.lo-quinto.org DEFERRED TRUSS SUBMITTAL FORM Date: 11161 /Zd14 Application Number:5 Project Street Address: 5-3 - G° 5 14V-4 go rrT F3L. Applicant: ElArchitect or ❑ Contractor of Project (Please check appropriate box) Policy Conditions: 1. Limited to Custom residential pre -fabricated wood trussed roof projects on a case by case basis; 2. This form will be completed and submitted to the Building Division for approval prior to the Second submittal,'* The approved form will be submitted as part of the second submittal package; 3. Deferred Truss Submittal will consist of two sets wet stamped Truss Calculations, Roof Layout and Engineer of Record's Acceptance stamp or letter; 4. Review timeframe is 10 working days; 5. Service Fee of plan review and processing based on actual hourly cost of plans examiner, structural consultant, permit technician (payment required at the time of pickup of approved truss calculations; 6. The deferred truss submittal review and approval will be required prior to a foundation / footing inspection (no exceptions). 7. The approved "JOB" Copy of Truss Calculations is required to be onsite at the time of inspection. Print name: WILLIAM HAYER Signature: By singing this form, the applicant acknowledges and agrees to all conditions and requirements. Approved By Title: Date: 78-495 Calle Tampico I La Quinta I California 92253 1 760.777.7000 1 www.La-Quinta.org PRINT b to 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: �(6,/ Z' / �Developer: -i �co��-'�/ L v. k Tract No.:33016-ZTract Name: IV(#A.) an CUJ Lot No.(s): r00 Address(s): 1-3-(n0!S7- -ARI v& Phone Number: C760 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 1-1 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 numbelr or hara 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-guinta.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. Recommended by: Date: Public Works Distribution: ( ) Green Sheet to Building & Safety RECEIVED ( ) Green Sheet to Planning Department Declined for approval for reason(s) as follow(s), please correct and resubmit: NOV O 3 2016 CITY OF LA QUINTA T:1Checklists - Forms & ApplicationslForms &Applications\GREEN SHEET cover & PM10 less than 1 Acre Revised 10-02-12.d❑c COMMUNITY DEVELOPMENT" 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) Construction ❑ Demolition Project Name: A,c,C101e, (gT� Project Tract/Lot Numbers: /�.�a� C A 06 /(n Project Street Address: S3 - (00� {-�✓ r+,�a `� � �C Total Acres in Active Construction (< 1 acre per Lot): . ,a ( Anticipated Start Date: // �JJ%Anticipated Completion Date:L2 / (S /ZOtI+ 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 2��.��• Title: r �- �-� "L C, r Company Name: c Dvt • ... �C�rS �- . •�rs,\►%,. nC , Mailing Address: (' vo V City, State, ZIP Code: Oro - Primary Phone #: -7 G0 - - SrZ.8 to Fax #: 24 Hour Emergency Phone#: 7400 Cell Phone #: 719 0 Email Address: �•-�. 7Cp✓'L, �C`�S �.0 PM10 Certificate #: C V t 602 p - 3 l b The above stated nronerty owner (or authorized renresentatyvel: 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 pla or any City/County initiated abatement activities. Sign re of operty Owner or Authorized Representative Date City of La Quinta - PM 10 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 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 00) days of ceasing activity. • 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. Wood 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. Water Qualitv Management Plan (WQMP) Exemation 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? 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 tt1v� y,^ cjr- Company `_'_ C n Phone "760- 31 -SZbf6 Email n c.o�a.'� 5 " «� ( ( -0— Project Information Project Name Type (SFH, Multi -Family, Commercial, Etc.) 0441- ' `'L 1 SF Location or Street Address $3 . GoS- .+...in� �.►� Nearest Cross Streets 54 * Municipality/County/Zip Code La Quinta Tract Number(s) and/or Assessor Parcel Number(s) () 7 (Z OZ.A Other Location Information Watershed Whitewater River Source Control BMP Information Size of Project Area (nearest 0.1 acre) Project Area managed with Site Design or Low Impact Development (LID) BMPs (nearest 0.1 acre) . Is the project subject to onsite retention by City ordinance or policy? Name of the Entity that will implement, operate, and maintain the Source Control BMPs , ` �' J �" �.� �C� Contact Name �( Street or Mailing Address S3 �i (� ✓vw���aT t City Zip Code Phone 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 Board Order No. 137-2008-0001 and the State Water Resources Control Board's Order No. 99-08-DWQ. Signature: Print Name: /2ewL�-__r Title: r', l.C� L✓� •"�2-� Date: L l /1- 46 Phone: ( t O) 31 5' 5 4C • r 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 —� ` ' t during the processing of the form, it is determined the Print Name: !mow- information contains errors or omissions, clarification and/or supplemental information may be required and the Title: PC,' preparation of such information may be considered, in the Community Development Director's judgment, an Date:/'L-! (✓ unreasonable delay and will result in a suspension of processing time limits in accordance with the California Code phone: (76) of Regulations, Title 14, Section 15109. 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 Signature: is the subject matter of this application and I am authorizing and hereby do consent to the filling of this application and Print Name: 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. Title: / •, trc. �S' �� Date: Phone: ( o )'S-t3 37n