DRVA2015-0008.4 See below for Finance Revenue Codes
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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: 6/17/2015
LOCATION OF CONSTRUCTION(Street address or Description): 51-885 AVEN IDA BERMUDAS
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
TE TIME WHEN WORK WILL BEGIN: TIME OF COMPLETION:
ESTIMATED CONSTRUCTION COST:S2.000.00 (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 ru s and regulations of th •ty of and
to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
CORONEL ENTERPRISES 42760 MADIO STREET INDlO, CA 92201 (760)775-1234
Name of Applicant (please print) Business Address Telephone No.
J - Z CONCRETE CONSTRUCTION IN 42760 MADIO STREET INDlO, CA 92201 (760)775-5550
Name of Contractor and Job Foreman Business Address
813261
Contractor's License No.
ASSOCIATED INDUSTRIES INS.
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
Telephone No.
4537
City Business License No.
AE51022833
Policy Number
PERMIT NO: DRVA2015-0008
DATE ISSUED: 6/17/2015
EXPIRATION DATE: 12/14/2015
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.
OEDRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please pLyLt name here): IIcmcc\ I
Applicant Address:
rL -7( iI:, I
Number Street City State Zip Code
Number Street City State Zip Code
Date: 1TJi9iI t5J licant's Phone No: I
Applicant's Signature: EI_i2
Approximate Start Date: I i... ki Vi !i \5]Approximate Completion Date: -71111 , 51
Contractor Information:
Address:
Yo \. IICAJI cLi
Number Street City State Zip Code
Phone Number: (7p 1-7-7S- 'I ]Contractors License Number: ['R\3 2L\
City Business License Number: I
General Liability Insurance Company:- Policy No. SI a93 I
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
Fee $20 + Permit Fee $10 = $30 Total Fee
Permit No. Expiration Date
Permit Issued by: Date Issued llilTil i
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: 11/J ]
Inspector's Signature
Note: Driveway approach must be constructed per City of La Quinta Standard #221
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