DRVA2015-0020See below for Finance Revenue Codes
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: 10/22/2015
LOCATION OF CONSTRUCTION(Street addres or Description): 53-325 AVENIDA HERRERA
PURPOSE OF CONSTRUCTION: .]2( fpr.
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH FOR 53-325 AVENIDA HERRERA
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN:10 TIME OF COMPLETION: flL.2.
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS: BUILDER/OWNER
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 ( .z) 727-7097. 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 Applica,ror Agent
ELEUTERIO ACOSTA JR. 53-325 AVENIDA HERRERA DRIVE. LA QUINTA, CA 92253 (760)564-1836
Name of Applicant (please print) Business Address Telephone No.
ELEUTER10 ACOSTA JR. 53-325 AVENIDA HERRERA DRIVE. LA QUINTA, CA 92253 (760)564-1836
Name of Contractor and Job Foreman Business Address Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company . Policy Number.
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
- - - IQTAL: $145.00
OCT 222015
CRY OF LA QUINTA
PERMIT NO: DRVA2015-0020
DATE ISSUED: 10/22/2015
EXPIRATION DATE: 10/22/2016
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.
4u4dii
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date:
Tract No: Project Name:
Vicinity:
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)_________________
Description of Construction (i.e.: See Plan Set No. 01234)
Dimension of Installation or Removal:
Approximate Construction Start Date: //) - 22--
Approximate Construction Completion Date: I,— 5.. IS-
Estimated Construction Cost: $ t7)p -
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-fulling, compaction and
placing permanent resurfacing and or replacing improvements
.Contact Name: (u.4eaOj4wsv4& .1. Phone Nurnber6O )V-/3
Name of Applicant/Owner: s-,sqe qsA 4i,&'-e--
Applicant Address: js'-zc 4j,d4- L1L 1)1W47 £— 92-2.sj
Applicant Telephone Number: (7,6e.) 5$ V-i36
Applicant E-mail Address:
Name of Contractor: 6/e.i.,4eio 1e-e.'.s4 .z.
Contractor Address:
Contractor Telephone Number:
Contractor State License Number: 41- LA.) ,ve1e
Contractor City Business License Number:
Contractor E-mail Address:
PA COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVlDED4
Applicant or Contractor General Liability Insurance Company:
Applicant or Contractor General Liability Insurance Policy Number:
Office Use Only: Office Use Only:
Inspection Fee: I I Assigned Permit Number:
Permit Fee:
As-Built
Deposit:
Dust Control
Deposit:
Credit
Amount:
TOTAL FEE DUE:
- t-orms & PpplicationsAppIiCatiOfl fo
Approval bate:
Expiration
Date:
Issue
Date:
Administrative Authority:
C-,
-