DRVA2014-1001.. ' .. .
4 4z uia'a,
See below for Finance Revenue codes
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 6/30/2014
LOCATION OF CONSTRUCTION(Street address or Description): 77450 CALLE TACATE
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH PERMIT
DESCRIPTION OF CONSTRUCTION:
DIMENSION OF INSTALLATION OR REMOVAL:
PROXIMATE TIME WHEN WORK WILL BEGIN: 7/1/2014 TIME OF COMPLETION: 7/3/2014
ESTIMATED CONSTRUCTION COST:__ (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS: CALL 24 HRS PRIOR TO INSPECTION TO 760-777-7097. DRIVEWAY APPROACH SHALL BE CONSTRUCTED PER CITY STANDARD #221
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 the City of and
to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
EDWIN BURGOS 1603 2ND ST MANHATTAN BEACH, CA 92253 (310)658-0109
Name of Applicant (please print) Business Address Telephone No.
.1 - Z CONCRETE CONSTRUCTION IN 42760 MADIO STREET INDlO, CA 92201 (760)775-5550
Name of Contractor and Job Foreman Business Address Telephone No.
813261
Contractor's License No.
STATE COMP INSURANCE FUND
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $143.00
$143.00
4537
City Business License No.
1948756
Policy Number
PERMIT NO: DRVA2014-1001 L,
DATE ISSUED: 6/30/2014
EXPIRATION DATE:6/30/2015
BY:TOMMI SANCHEZ
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.
••••";.
FINANCE
R--2z 14 1 o i
Revenue Code___
OF
CITY OF LA QUINTA
DRIVEWAY APPROACH PERMIT APPLICATION
( Please print in ink )
DATE /,jh ________
ADDRESS OR PARCEL NO. - ks CA '_LE Tc-A—t'
APPROXIMATE START AND COMPLETION DATE Z u
Applicant/Owner Address Phone No.
03 /!c
/
Contractor & Foreman Address !hone No.
zr—z (—i) '5i33(1
Contractors License No. City Business License No.
/ 4-53
General Liability Insurance Co. Policy No.
TATt
REQUEST FOR INSPECTION - DATE TIME______
* Note - Requests for inspection must be received a minimum of 48 hrs in advance
Inspection Fee $_20 PERMIT NO. DW 2257
Permit Fee $_10
Total Fee $ 3 ((4
EXPIRATION DA
DATE ISSU,
I
COMMENTS:
* NOTE - DRIVEWAY APPROACH SHALL BE CONSTRUCTED PER RIVERSIDE
COUNTY-STANDARD 7 Ckj ski-i cLcu-d 22-1
Date Paid: Monday, June 30, 2014
Paid By: J-Z Concrete
Cashier: TSA
Pay Method: CHECK 967
Printed: Monday, June 30, 2014 10:42 AM 1 of 1