DRVA2015-00094 F, See below for Finance Revenue Codes
-,v
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: 7/13/2015
LOCATION OF CONSTRUCTION(Street address or Description): 54640 AVENIDA CARRANZA
PURPOSEOF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN:7/14/2015 TIME OF COMPLETION: 7/14/2015
ESTIMATED CONSTRUCTION COST:S2.000.00 (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 s and regulations of the City nd
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 Telephone No.
813261 4537
Contractor's License No. City Business License No.
ASSOCIATED INDUSTRIES INS. AES1022833
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
PERMIT NO: DRVA2015-0
PF
DATE ISSUED:1/13 A P 0
EXPIRATION DATE:3//
JUL 132015
WORK INSPECTED BY*:
CI1Y OF LA QUINTA
PERMIT COMPLETION DATES: OMM WPMEDEPARTM ENT
51f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please Drint name here): FCrc c 1
Applicant Address:
r- 1IC\1I \ I
Number Street City State Zip Code
Address or Parcel No. of wojk location, if different from applicant's address above:
JcLL4) 1I. IFr—AI I)I
Number Street City State Zip Code
Date: Ei/,Ua S ]PPl\cant's Phone K1— d7w i) hi c—
Applicant's Signature: C_ 1/
Approximate Start Date: I ? !i S JApproximate Completion Date: LJl Y?!I30
Contractor Information:
Address:
ii JS SCA C, IJCAJI LJ
Number Street City State Zip Code
Phone Number: - ). Contractors License Numbed 26\ 3.- L I I
City Business License Number: L3
General Liability Insurance Company: c.o T\rrc I, Policy No. I!c ..S ? \ 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
Inspection Fee $20 + Permit Fee $10 = $OTuLdI-Fee
Permit No. Expiration Date
Permit Issued by: Date Issued 11i1!iII J
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: E1iE1i[ J
Inspector's Signature
Note: Driveway approach must be constructed per City of La Quinta Standard #221
2-CUD L\aoI - DO