DRVA2015-0018See below fdr Finance Revenue Codes
ENCROACHMENT PERMIT
OFfl
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: 10/21/2015
LOCATION OF CONSTRUCTION(Street address or Description): 51900 AVENIDA DIAZ
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH FOR 51900 AVENIDA DIAZ
DIMENSION OF INSTALLATION OR REMOVAL:
TIME WHEN WORK WILL BEGIN: 10/25/2015 TIME OF.COMPLETION: 10/28/2015
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 rules and regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
BRAD PETERSON - L.Q. ESTATES 30520 RANCHO CA. RD. SUITE 107146 TEMCULA, CA 92591 (951)805-1036
Name of Applicant (please print) Business Address Telephone No.
CALIFORNIA CONSTRUCTION CO. 30520 RANCHO CA. RD. TEMECULA, CA 92591 (951)805-1036
Name of Contractor and Job Foreman Business Address Telephone No.
407474 112395
Contractor's License No. City Business License No.
FARMERS INSURANCE EXCHANGE 605074145
Applicant's Insurance Company Policy Number
Finance Revenue Code PERMIT NO: DRVA2015-0018
PERMIT INSPECTION DATE ISSUED: 10/21/2015
DRIVEWAY RESIDENTIAL $145.00 EXPIRATION DATE: 10/21/2016
TOTAL: $145.00 BY: TOMMI SANCHEZ
WORK INSPECTED BY*:
PERMIT COMPLETION DATES:
51f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
Council.
I(L{\4
OF DRIVEWAY APPROACH. PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please print name here): BRAD PETERSON! L.Q. ESATES
Applicant Address: 30520 RANCHO CA. RD. SUITE 107146 TEMCULA CA 92591
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
51900AVENIDADJAZ LAQUINTA
Number Street City
Date: 1/_/_ AIicay*'s Phone No: (951 ) 805-1036
Applicant's Signature-
Approximate Start Date: 10 /25 /15 Approximate Completion Date: 10 /.2 I.1
CA ?240.
State Zip Code
Contractor Information:
- Qo.1i f:byA a_. 00
Address: 30520 RANCHO CA. RD SUITE 107146 TEMCULA CA
Number Street City State Zip Code
Phone Number: (951 ) 805-1036 Contractors License Number: 407474
City Business License Number: /1 Z 3 '
General Liability Insurance Company: F..rvrjy..s 1jh1. frIcy No.
c5(y7q q s
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
Permit Fee $145
Permit No.V?3ZO!S- Expiration Date !D / 21 /j.
oD(
Permit Issued by: Date Issued LP_/2!_/J_S
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: II
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #221