DRVA2015-0019of' 114z. tLd"
See below for Finance Revenue Codes
orf 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: 10/21/2015
LOCATION OF CONSTRUCTION(Street address or Description): 53285 AVENIDA RUBIO
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH FOR 53285 AVENIDA RUBIO
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE 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 DBA CALIFORNIA
CONSTRUCTIO 30520 RANCHO CALIF RD #107146 TEMECULA, CA 92591 (951)805-1036
Name of Applicant (please print)
BRAD PETERSON DBA CALIFORNIA
CONSTRUCTIO
Name of Contractor and Job Foreman
407474
Contractor's License No.
FARMERS INSURANCE EXCHANGE
Applicant's Insurance Company
Business Address Telephone No.
30520 RANCHO CALIF RD #107146 TEMECULA, CA 92591 (951)805-1036
Business Address Telephone No.
112395
City Business License No.
605074145
Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL
TOTAL:
PERMIT NO: DRVA2015-0019
DATE ISSUED: 10/21/2015
EXPIRATION DATE: 10/21/2016
BY: TOMMI SANCHEZ
WORK INSPECTED BYE:
PERMIT COMPLETION DATES:
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
I
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 locati
Number Street
if different from applicant's address above:
)Li 0 LAQUINTA
City
CA q22$-3
State Zip Code
Date: 10//'s Phone N O: 1951 1 805-1
Applicant's Signat
Approximate Start Date: 10 /25 /15 Approximate Completion Date: :!/.__/i__
Contractor Information:
Address: 30520 RANCHO CA. RD SUITE 107146 TEMCULA
Number Street City
Phone Number: (951 ) 805-1036 Contractors License Number: 407474
City Business License Number: ii 239'
General Liability Insurance Company: .1015ta..ac.Q No.
CA 172 S9 I
State Zip Code
(L'OSO7LI ,qS
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 $145L :1-
Permit No. -DI2 'J1\ 2.0 [!;Expiration Date Lb/'at II(
Wie( A
Permit Issued by: IL Date Issued lb 1-211(5
Signaturefministrative 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