DRVA2016-00014 ,
See below for Finance Revenue Codes
5 -1 wi- 4.
A.
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: 1/7/2016
LOCATION OF CONSTRUCTION(Street address or Description): 54380 AVENIDA MARTINEZ
'PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: COVE / MORRIS
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 1/8/2016 TIME OF COMPLETION: 118/2016
ESTIMATED CONSTRUCTION COST: $300.00 (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 twen ty-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 the City of and
to pay for any additional replacement necessary as the result of this work.
of iØI'icant or Agent
ROPER PROPERTIES LIC 54380 AVENIDA MARTINEZ LA QUINTA, CA 92253 (760)272-9292
Name of Applicant (please print) Business Address Telephone No.
CALl BUILT CONSTRUCTION 52945 AVENIDA VELASCO LA QUINTA, CA 92253 (760)250-8474
Name of Contractor and Job Foreman Business Address Telephone No.
923574
Contractor's License No.
INT'L INS. CO. OF HANNOVER
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
105440
City Business License No.
IG01200224600
Policy Number
PERMIT NO: DRVA2016-0001
DATE ISSUED: J12
(
I(o
EXPIRATION 1-7
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. .
__ 9,
VA 4OUO1U100,
PUBLIC WORKS.DEPARTMENT
APPLICATION FOR PERMIT
Date:
r a c t No: Project a*me" IJ 027i
Purposeof Construction (i.e.: Rough Grading, Offsite__Street, _____
INdILIV UI UULIdLUI.
Contractor Address
Contractor Telephone Number f3 7)
Contractor State License Number øi?1
Contractor City Business License umber:
Contractor E-mail A y-E"M 241I ___
A.- COPY OF THECURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4 :
Applicant.or Co i/actor General Liability Insurance_Compan.:
Ap1icant or Contr 'tor Gener, iabi ity,Jnspra e Poll Numj
Office Use Only:* . I Office Use Only:
Inspection Fee: . . Assigned Permit Number:
Permit Fee: Approval pate:
.
. As-Built
. . . Expiration
Dcposit: - . . Date: . .
Dust Control Issue
Deposit: . Date:
Credil
Amount: ... . . . Administrative Authority:
TOTAL FEE DUE:
.
I Urive/UflecKlists i-orms & Applications Application for t-'ermit posted o-b-U9