DRVA2017-0026 (DRIVEWAY APPROACH)s
4F �° DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
-pplican Owner (please print name here):
L�
Applicant Address: '- -7 U C A -1 as 0 �
Number Street City State Zip Code
Address or Parcel No. of work location, if d
Number Street
from applicant's address above:
a... Cs -ll- q_J--�,.S 3
City
Date: Applicant's Phone v: 4 760 t -7 31L -7
Applicant's Signature:
Approximate Start Date: `i _I�1�`jApproximate Completion Date: a /'�:k /-�2
State Zip Code
Contractor Information:
Address: 41-703 -700 Nk, U `t� \ , .\<< ,U 'JL0
Number Street City State Zip Code
Phone Number: f 760 f -7-7!S- `t Contractors License Number:�3a
City Business License Number:
General Liability Insurance Company: - z • 1 Policy No. - ']_ 23 3 Q
Request for Inspection - Please call (760) 777-7097 before 7:30pm to request an inspection at least 24
hours prior to your requested inspection date. Public Works Counter (760) 777-7075.
Please (Vote: Inspections are normally performed Monday through Friday between Sam and 4pm
Permit Fee $44.6-44-4,5-T..aI44-sa
Permit No. Expiration Date 1 1
Permit Issued by: Date Issued 1 1
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: 1 1
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quints Standard #227
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DRIVEWAY APPROACH
PUBLIC WORKS CONSTRUCTION
See below for Finance Revenue Cod(
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public wor
improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 11j9/2017
LOCATION OF CO NSTRUCTION(Street address or Description): 52230 AVE NIDA MADERO
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: PEPE BUILDS 1 COVE 1 DRIVEWAY APPROACH
DJMENSION OF INSTALLATION 0,11 REMOVAL:
ROXI MATE TIME WHEN WORK WILL BEGIN: 11/9/2017 TIME OF COMPLETION: 11/23/2017
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS:
In consideration of the granting of this permit, the applicant hereby agrees to:
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from 'and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started at (760) 777-7097. To
submit an inspection request, leave a message on the Inspection Request Hotline at (760) 777-7097 prior to 1:30 P.M. at least twenty-four
(24) hours prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of ity of and
to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
CORONEL ENTERPRISES INC 42760 MADIO STREET INDIO, CA 92201
Name of Applicant (please print) Business Address
J - Z CONCRETE CONSTRUCTION INC 42760 MADIO STREET INDIO, CA 92201
(760)775-1234
Telephone No.
(760)775-5550
Name of Contractor and Job Foreman Business Address Telephone No.
813261 LIC -0003629
Contractor's License No. City Business License No.
ASSOCIATED INDUSTRIES INS, AES1022833
Applicant's insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $156.00
TECHNOLOGY ENHANCEMENT FEE $5.00
TOTAL: $161.00
(PERMIT NO: DRVA2017-0026
DATE ISSUED:
EXPIRATION DATE:
BY:
WORK INSPECTED BY*:
PERMIT COMPLETION DATE*;
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
11-13-2017 10:39:49 AM GPS X= 33.568655 Y= -116.317508