DRVA2016-0008swornce Heunu
ENCROACHMENT PERMIT U EAUG0 3 20161PUBLIC WORKS CONSTRUCTION ________
CI1YOFLAQUINTA
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, w
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 8/3/2016
LOCATION OF CONSTRUCTION(Street address or Description): 53240 AVENIDA NAVARRO
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH PER CITY STANDARD 221
DIMENSION OF INSTALLATION OR REMOVAL: PER CITY STANDARD 221
APPROXIMATE TIME WHEN WORK WILL BEGIN: 8/3/2016 TIME OF COMPLETION: 9/2/2016
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris,backfilling, compaction and placing
permanent resurfacing and/or replacing improvements) S
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. it—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 applica
to pay for any additional replacement necessary as the result of this work. i
es a?d regulations of the City of a
g atur Ilcant or Agent
(760)775-1234
Telephone No.
Telephone No.
Qi j:•
CORONEL ENTERPRISES INC 42760 MADIO STREET INDlO, CA 92201
Name of Applicant (please print) Business Address
OWNER! BUILDER
Name of Contractor and Job Foreman Business Address
City Business License No.
Policy Number
PERMIT NO: DRVA2016-0008
DATE ISSUED: iRS1 5 ZO(
EXP DATE: ....i4as* 31 ZI7
WORK INS CTED 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.
Contractor's License No.
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL
TOTAL:
DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please pjft name here): Coronel Enterprises Inc.
Applicant Address: 42760 Madio Street Indio Ca 92201
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
53-240 Avenida Navarro La Quinta Ca
Number Street City State Zip Code
Date: 08//03/16 Applicant's Phone No: (760 ) 775-1234
Applicant's Signature:
Approximate Start Date: 06//03/2016 Approximate Completion Date: 09 /0 3 /201 6
Contractor Information:
Address: 42-760 Madio Street Indio Ca 92201
Number Street City State Zip Code
Phone Number: (760 ) 775-1234 Contractors License Number:
City Business License Number: 3629
General Liability Insurance Company: Benchmark Insurance Company Policy No. C5T5007478
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 No. Expiration Date _I_I
Permit Issued by: Date Issued
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: _I_I
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #221