DRVA2015-0007- t
4 See below for Finance Revenue Codes
01
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: 5/26/2015
LOCATION OF CONSTRUCTION(Street address or Description): 46840 CAMEO PALMS DR
PURPOSE OF CONSTRUCTION: DRIVEWAY PERMIT
DESCRIPTION OF CONSTRUCTION: DRIVEWAY PERMIT
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 5/27/2015 TIME OF COMPLETION: 5/27/2015
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS: DRIVEWAY PERMIT
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 of the City of and
to pay for any additional replacement necessary as the result of this work.
of Applicant or Agent
KENNETH SIESS
Name of Applicant (please print)
CALl BUILT CONSTRUCTION
Name of Contractor and Job Foreman
923574
Contractor's License No.
INT'L INS. CO. OF HAN NOVER
Applicant's Insurance Company
46840 CAMEO PALMS LA QUINTA, CA 92253
Business Address Telephone No.
52945 AVENIDA VELASCO LA QUINTA, CA 92253 (760)250-8474
Business Address Telephone No.
105440
City Business License No.
1G01100252201
Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL
TOTAL:
PERMIT NO: DRVA2015-0007
DATE ISSUED: 5/26/2015
EXPIRATION DATE: 11/22/2015
BY:TOMMI SANCHEZ
WORK INSPECTED BY*:
PERMIT COMPLETION DATES:
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
De V A 2- -000r7
DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please pjjf3j name here): bALLBUILtCONSTRUCIIONJNC :
Applicant Address:
6840 I bAMEO PALMS ILAQUINTA I CA -71 2253____J
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
Number Street City State Zip Code
Date: jjji/o15J Applicant's Phone No: (6O_i)2504994—
Applicant's Signature:
Approximate Start Date:S--1/2=7 /Oi5JApproximate Completion Date:
Contractor Information:
Address: ___ _____
ö5__JI1NASHINGTONST.STEC114 ILAQUINTA IbA I b2253
Number Street City State Zip Code
Phone Number: (76p I) O243O8 IContractors License Number: b2357_4 -
City Business License Number: ______________
General Liability Insurance Corn 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
n Fee $20 + Permit Fee $10 = $30 Total Fee
Permit No. I Expiration Date
Permit Issued by: Date Issued r,r/[1
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: F7/ F++1 /1 I
Inspector's Signature
Note: Driveway approach must be constructed per City of La Quinta Standard #221