DRVA2016-0007.4,
iaz, See belowfor Finance Revenue Codes
.0 Twit .4
% ENCROACHMENT PERMIT
OF
PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains andother like public
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 7/11/2016
LOCATION OF CONSTRUCTION(Street address or Description): 52085 AVENIDA HERRERA
PURPOSE OF CONSTRUCTION:
DESCRIPTION OF CONSTRUCTION: STEMMER /_DRIVEWAY APPROACH
DIMENSION OFINSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 7/12/2016 TIME OF COMPLETION: 7/15/2016
ESTIMATED CONSTRUCTION COST: S1.000.00 (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 HotIin at (760) 777-7097 prior to 1:30 P.M. at1twenty-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 City of and
to pay for any additional replacement necessary as the result of this work.
of
JOE W STEMMER JR. 42335 WASHINGTON ST #355 PALM DESERT, CA 92211 (760)880-3525
Name of Applicant (please print) Business Address Telephone No.
JOE W STEMMER JR 42335 WASHINGTON ST #355 PALM DESERT, CA 92211 (760)880-3525
Name of Contractor and Job Foreman Business Address Telephone No.
605857 . LIC-763387
Contractor's License No. CiM
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siness License No.
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Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
PERMIT NO: DRVA2016-0007
DATE ISSUED: 4111 iça
EXPN DATE:T2JftI I 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.
OoO7
PUBLIC • WORKS DEPARTMENT.
APPLICATION FOR PERMIT
'arn.
rract No: ProjectName:
I Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.
I Descrirtion of Construction (i.e.: See Plan Set No. 01
Dimension of Installation _orRemoval:
- Approximate Construction Start Date:
..
Approximate Construction Completiçn Date: r --- --• --
______
Estimated Construction Cost $k - jajji Z1 IT
_____
:
Estimated Construction Cost shall include the removal 617 all obstructions, materials, and debris, back-filling, compaction and
placing permanent-resurfacing and or replacing improvements
ContactName: 91Phone N umber i
Name of Applicant/Owner:
Applicant Address
Applicant Telephone Number_
Applicant E-mail Address M__
Name of Contractor:___________________________________
Contractor Address
Contractor Telephone Number
Contractor State License Number
Contractor City Business License Number -::9
Contractor E-mail Address:Jj :
10-A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4
Apnlicant or Contractor General Liability Insurance Company:
Anlicánt or Contrâctor.General Liability Insurance Policy Number:
Offiée Use Only:
!nspection Fee:
Permit Fee:
As-Built
Deposit:
Dust Control
Deposit:
Credit
Amount:
TOTAL FEE DUE:
Unvei(flecKlists - Forms & PppllCatlol
Office Use Only:
Assigned Permit Number.
Approval Date: .
Expiration
Date:
Issue
Date:
Mministrative Authority: