DRVA2015-0006o1' 14z utt See below for Finance Revenue Codes
o ENCROACHMENT PERMIT
OF
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: 4/21/2015
LOCATION OF CONSTRUCTION(Street address or Déscription):52337 AVENIDA NAVARRO
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:N/A
MATE TIME WHEN WORK WILL BEGIN:4/22/2015 TIME OF COMPLETION: 4/27/2015
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
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.
x
Sigpture of Applicant or Agent
DARCY DEEKS 92253
Name of Applicant (please print) Business Address Telephone No.
MARVIN JORDAN CONSTRUCTION P0 BOX 228 LA QUlNTP CA 92253 (769)485-0991
Name of Contractor and Job Foreman Business Address Telephone No.
343335 2051
Contractor's License No. City Business License No.
AMTRUST INTL XN104763500
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
PERMIT NO: DRVA2015-0006
DATE ISSUED:4(f 15
EXIONDATE
BY-
/IcD
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.
DRIVEWAY APPROACH PERMIT APPLICATION
bayvt 'b&2k~
19nance Keven U em
Applicant Information:
Applicant/Owner (please Drint name here):
Number Street City State Zip Code
Number Street City State Zip Code
Date: Phone No: 1
Applicant's Signature:
Approximate Start Date: P{ i i i21Zproximate Completion Date:
I Contractor Information:
j') .5IIó( W!iOM.M 1(f1 ujnj 7. -77J.
Murdber Street City State Zip Code
Phone Number: _____ riContractors License Number:1 3i\~ •
City Business License Number: L 2O
General Liability Insurance Company: Policy No.
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
Inspection Fee $2mtt FeeTO=$OTht$Eeg..Iq
Permit No. I' - ] Expiration Date I .
Permit Issued by: Date Issued liilTlil• J
Signature of Administrative Authority
Work Inspected by: __ Permit Completion Date: 11CiiE ]
Inspector's Signature
Note: Driveway approach must be constructed per City of La Quinta Standard #221