DRVA2016-0002S.,
See below for Finance Revenue Codes
ENCROACHMENT PERMIT OFTt°
PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers,
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
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DATE: 2/18/2016
LOCATION OF CONSTRUCTION(Street address or Description): 54310 AVENIDA OBREGON
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: RW REAL ESTATE RESIDENCE / DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL: N/A
APPROXIMATE TIME WHEN WORK WILL BEGIN: 2/18/2016 TIME OF COMPLETION: 3/31/2016
ESTIMATED CONSTRUCTION COST: S300.00 (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 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 ity of and
to pay for any additional replacement necessary as the result of this work.
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Signature of Applicant or Agent
Name of Applicant (please print) Business Address I Telephone No.
J - Z CONCRETE CONSTRUCTION INC 42760 MADIO STREET INDlO, CA 92201 (760)775-5550
Name of Contractor and Job Foreman Business Address Telephone No.
813261 LIC-0003629
Contractor's License No. City Business License No.
ASSOCIATED INDUSTRIES INS. AE51022833
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
PERMIT NO: DRVA2016-0002
DATE ISSUED: L!J11
DIV
l
EXPIRATION DATE:!'
BY: MV
WORK 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.
DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (p/ease print name here): R W Real Estate
Applicant Address: 42760 Madio St Indio, CA.92201
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
54310 Ave Obregon La Quinta CA. 92253
Number Street City State Zip Code
Date: 02/17/16 A lic nt's Phone Nf(760 ) 7751234
Applicant's Signature:
Approximate Start Date: 02 /18 /16 Approximate Completion Date: 04 /18 /16
Contractor Information:
Address: 42760 Madio St. Indio, CA. 92201
Number Street City' State Zip Code
Phone Number: (760 ) 775-1234
City Business License Number: 3629
Contractors License Number: 813261
General Liability Insurance Company: Associated Industries Policy No. AES1022833
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 = $145 Total Fee
Permit Date Ito
Permit Permit Issued by: 4N'J.ØVW M b Date Issued
SignaturJf 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
heck A License: License Detail - Contractors* State License Board Page 1 of
Contractor's License Detail for License # 813261
)ISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this
nformation, you should be aware of the following limitations.
CSLB complaint disclosure is restricted by law (B&P 7124.6) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the
link or button to obtain complaint and/or legal action information.
Per B&P 7071.17 , only construction related civil judgments reported to the CSLB are disdosed.
Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration.
Due to workload, there may be relevant Information that has not yet been entered onto the Board's license database.
Business Information
J - Z CONCRETE CONSTRUCTION INC
42760 MADIO STREET
INDIO, CA 92201
Business Phone Number:(760) 775-5550
Entity Corporation
Issue Date 10/02/2002
Reissue Date 03/16/2005
Expire Date 03/3112017
License Status
This license is current and active.
MI information below should be reviewed.
Classifications
-8-CONCRETE I
Bonding Information
Contractor's Bond
This license filed a Contractor's Bond with BUSINESS ALLIANCE INSURANCE COMPANY.
Bond Number: G60115966615
Bond Amount: $15,000
Effective Date: 02/01/2016
Contractor's Bond History
Bond of *Qualifying Individual
The Responsible Managing Officer (RMO) CORONEL ESEQUIEL MACHADO certified that he/she owns 10 percent or more of the
doting stock/equity of the corporation. A bond of qualifying individual is not required.
Effective Date: 03/16/2005
Workers' Compensation
This license has workers compensation insurance with the BENCHMARK INSURANCE COMPANY
Policy Number:CST5007478
Effective Date: 12/31/2015
Expire Date: 12/31/2016
Workers' Compensation History
Miscellaneous Information
ips://www2.cslb.ca.gov/OnlineServices/CheckLicensellfLicenseDetail.aspx?LicNum=8 13261 2/18/201
heck A License - License Detail - Contractors State License Board 2 of
I U1/21!2UUb - LI(ENSh HEISSUEL) 10 ANO I HER EN III Y
Other
Personnel listed on this license (current or disassociated) are listed on other licenses.
tps://www2.cslb.ca.gov/OnlineServices/CheckLicensellfLicenseDetail.aspx?LicNum=8 13261 2/18/201