DRVA2015-0021See 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: 11/16/2015
LOCATION OF CONSTRUCTION (Street address or Description): 78680 AVENIDA NUESTRA
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRVIEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 11/18/2015 TIME OF COMPLETION: 11/23/2015
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS: DRIVEWAY APPROACH MUST BE CONSTRUCTED PER CITY OF LA QUINTA STANDAR221..,
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 leat 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.
Slgrture of Applicant or Agent
RICK MORRIS P0 BOX 366 LA QUINTA, CAO
Name of Applicant (please print) Business Address Telephone No.
WILLIAM MORRIS DEVELOPMENT 703 LA QUINTA, CA 92247 (760)668-2608
Name of Contractor and Job Foreman Business Address
Telephone No.
945496
Contractor's License No.
IN'L INS CO OF HANOVER LTD
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
100420
City Business License No.
IG01100252201
Policy Number
PERMIT NO: DRVA2015-0021
DATE ISSUED: JJ//&Jis-
EXPIRATION DATE:i(L(e//(t'2
WORK INSPECTED INSPECTED BY*:
PERMIT COMPLETION DATES:
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
lo sI
OF DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (p/ease pjt name here): (Zt14" (4 Sii ,ttt1 Koipft
Applicant Address: Ztize'Z- 11$ 'L''fl 'A-
Number Street City State Zip Code
Address or Parcel
ic&,t2 I
Number
o. of work location, if different from apgjiáant's address above:
j
Street City State Zip Code
Date: U/jkj Applica 's Phone No: ( 9
Applicant's Signature:
Approximate Start Date: I//f1d5Approximate Completion Date:
Contractor Information:
Address: D )C L.fr k A t2Z
Number Street City State Zip Code
Phone Number: (14 le 06 -12.9 Contractors License Number: t Iq I
City Business License Number: t I D'I2-D
General Liability Insurance Cornpani1. Policy No. i&otOO2-5?O
Request for Inspection - Please call (760) 777-7097 before 1:30pm to request an inspection at /east 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
lnecee-4O + Permit Fee $145
Permit No. Expiration Date II
Permit Issued by: Date Issued
Signature of Administrative Authority
Work Inspected by: Permit Completion Date:
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #221