DRVA2016-0004See below for Finance Revenue Codes
c&at 4
ENCROACHMENT PERMIT
OF
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 / DRIVEWAY APPROACH- RHONDO
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 andarising 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.
DJ's CONCRETE
Name of Applicant (please print)
Sign re of Applicant or Agent
52-585 AVENIDA OBREGON LAQUINTA, CA 92253 V (760)578-1879
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: DRVA2016-0004
DATE ISSUED: 3/15/2016
EXPIRATION DATE: 9/11/2016
BY: STEPHANIE KHATAMI
WORK INSPECTED BY:
IPERMIT COMPLETION DATE:
*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 pjt name here):
Applicant Address:% 4S Uvl A& R uayKL Lk 4t17L 6L, q5-
Number Street U City State Zip Code
I Address or Parcel No. of work location, if different from applicant's address above:
I Number Street City State Zip Code
Date: _/_/_ Applicant's Phone No:
I Applicant's Signature:
I Approximate Start Date: _/__/ Approximate Completion Date: —/ I
Contractor Information:
Address: 6' 6 It)t1tIiL Urei'yrii k Cit. '/w'?
Number Street LI City State Zip Code
Phone Number: (706 )51t'/k'74 Contractors License Number: 975740
City Business License Number: p j pi4 )//
General Liability Insurance Company: Policy 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 14) = $145 Total Fee
Permit No. Expiration Date _/__/
Permit Issued by: Date Issued I I
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: __I__J
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standarø FZZ I
I