DRVA2016-0003See below for Finnce Revenue Codes
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%. ENCROACHMENT PERMIT
4610F 1
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: 3/15/2016
LOCATION OF CONSTRUCTION(Street address or Description): 78745 AVENIDA NARANJA
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: GALLAVAN I DRIVEWAY APPROACH- NARANJA
DIMENSION OF INSTALLATION OR REMOVAL: N/A -
APPROXIMATE TIME WHEN WORK WILL BEGIN: 3/16/2016 TIME OF COMPLETION: 3/23/2016
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. A
Signature qAppIIcant or Agent
DJ'S CONCRETE 52-585 AVENIDA OBREGON LA QUINTA, CA 92253 (760)578-1879
Name of Applicant (please print) Business Address Telephone No.
Di's CONCRETE 52-585 AVENIDA OBREGON LA QUINTA, CA 92253 . (760)578-1879
Name of Contractor and Job Foreman Business Address Telephone No.
875760 : 0104114.
Contractor's License No. City Business License No.
OHIO SECURITY INSURANCE COMPANY . BIS(1B)56939755
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
PERMIT NO: DRVA2016-0003
DATE ISSUED: 3/15/2016
EXPIRATION DATE: 9/11/2016
BY: STEPHANIE KHATAMI
WORK INSPECTED B(:
PERMIT COMPLETION DATE:
*If the work is covered by aSubdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
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Applicant Information:
Applicant/Owner (please pj_t name here): Avui 611tta4'2.
Applicant Address: '714& Riiu'thi& [Ju4uOL, qç
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
Number Street City State Zip Code
Date: _I_/ Applicant's Phone No:
Applicant'.s Signature:
Approximate Start Date: II Approximate Completion Date: II
Contractor Information:
Address: 12'b U#i 1t 1AALt Q- 'zz62
Number Street LI City State Zip Code
Phone Number: (7b0 )7 11'74 Contractors License Number:
City Business License Number: I9I04 /J/
General Liability Insurance Company: O&4,O C61fO4tJPolicy No.
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 Total Fee
Permit No. Expiration Date II
Permit Issued by: Date Issued
Signature of Administrative Authority
Work Inspected by:
Inspector's Signature
Permit Completion Date:
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #221