DRVA2015-00044 R412'a, See below for Finance Revenue Codes
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
"4
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: 419/2015
LOCATION OF CONSTRUCTION(Street address or Description): 52194 EISENHOWER DR
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:SEE CITY STANDARD 221
APPROXIMATE TIME WHEN WORK WILL BEGIN: 419/2015 TIME OF COMPLETION: 4/9/2016
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 rul and regylefi of the City of and
to pay for any additional replacement necessary as the result of this work. 7.
of Applicant or
CALl BUILT CONSTRUCTION 50855 WASHINGTON ST. STE#C-114 LA QUINTA,, CA 92253
Name of Applicant (please print) Business Address No.
CALl BUILT CONSTRUCTION 50855 WASHINGTON ST. STE#C-114 LA QUI.NTPCA 92253 (760)902-4308
Name of Contractor and Job Foreman Business Address Telephone No.
923574
Contractor's License No.
INT'L INS. CO. OF HANNOVER
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
105440
City Business License No.
1G01100252201
Policy Number
PERMIT NO: DRVA2015-0004
DATE lSSUED:ij../ 1-5-
EXPIRAT DATE
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. .
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ODRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please Drint name here): ICALI BUILT CONSTRUCTION I
ApphcaAddress:
F56 -55 I IWASHINGTON ST. STE. #C-114 lILA QUINTA IICA 1192253
Number Street City State Zip Code
Address or Parcel No. of work location, f different from applicant's address above:
[194 1 IEISENHOWER DR. I[LAQUINTA IlCA 1192253
Number Street - City State Zip Code
Date: E 1/!!/l215 ] Aplicfi"1Yqre No: (1760 1) 1902-4308 I
Applicant's Signature:
Approximate Start Date: [1/01•pprOximate Completion Date: P41,14 2015]
Contractor Information:
Address:
150-855 I WASHINGTON ST. STE.#C-1 14 JL.A QUINTA ((CA 1192253
Number Street City State Zip Code
Phone Number: (1760 ) 1902-4308 Contractors License Number: (923574 1
City Business License Number: J1050
General Liability Insurance Company: INTL INS. CO. OF HANNOVER Policy No. 11G01100252201
Request for Inspection — Please call (760) 777-7097 before 1:30pm to request an inspection at least 24
hours prior to your requested inspection date. Public Works Counter (760) 777-7075;
Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm
1 Lk
Permit No. Expiration Date
Permit Issued by: Date Issued Eiillil i
Signature of
Work Inspected by: Permit Completion Date: 1i/7j____
Inspector's Signature
Note: Driveway approach must be constructed per City of La Quinta Standard #221