DRVA2016-00094 ol 4 ui4, r
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
See below for Finance Revenue Codes
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: 818/2016
LOCATION OF CONSTRUCTION (Street address or Description): 77975 CALLE COIl MA
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: STEMMER /_DRIVEWAY APPROACH
N OF INSTALLATION OR REMOVAL:
APPROXIMATETIME WHEN WORK WILL BEGIN: 8/12/2016 TIME OF COMPLETION 8/15/2016
ESTIMATED CONSTRUCTION COST: $500.00 (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 ndregulaLion~oftheCity of and
to pay for any additional replacement necessary as the result of this work. ,- I 1 'Z I
of Applicant or Agent
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. City Business License No.
PREFERRED CONTRACTORS INSURANCE CO PC105542
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
PERMIT NO: DRVA2016-0009
DATE ISSUED: t'I1I I.
EXPIRATION DATE: 9iII(1
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.
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date:
I A
Frallo Project Name
Vicinity
I Purpose of Construction (i.e.:.Rough Grading, Offsite Street,
wtion of ConstructiOn (i.e.: See Plan Set No. 01234
lrffi~ C_M-'M'iwK +' " Dimension of Installation or Removal L 111 ' 5cC'
Approximate construction Start Date: ___________________________________________
Approximate Construction Completion Date
Estimated Construction Cost ' J
Estimated Construction Cost shall include the removal of all obstructions, materials, and dcbns back-filling, compaction and
placing permanent resurfacing and or replacing improvements,
Contact-Name: •I hone Number 'k
:Name of Applicant/Owner: Vj
Applicant Address
Applicant Telephone Number. f..'._ •
A ____________
Name of Confractor:
Contractor Address
Contractor Telephone Number 0.4
Contractor State License Number QI
Contractor City Business License Number__
kr •?' Contractor E-mail Address _
A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVJDED4
A orContractor General Liability Insurance Company:__-
. Applicant or CataQtQr General Liability insurance Polity Number:
Offiée_Use Only:
• !nspection Fee:' •
Permit Fee: • •
•
As-Built
Deposit:
Dust Control • • • •
• :
Deposit:
Credit
Amount:
TOTAL FEE DUE:
.-----.•--- -.--- -
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OfficeUse Only:
ërmit umber •
Approval Date:
Expiration
Date:
Administrative Authority:'
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