DRVA2016-0011.4u1ft1ãi See below for Finance Revenue Codes
ENCROACHMENT PERMIT
OF1
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: 8/26/2016
LOCATION OF CONSTRUCTiON(Street address or Description): 54705 AVENIDA RAMIREZ
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: CABRITA /54705 AVE RAMIREZ
DIMENSION OF INSTALLATION OR REMOVAL:•
APPROXIMATE TIME WHEN WORK WILL BEGIN: 8/29/2016 TIME OF COMPLETION: 9/7/2016
FAUG 2 6 Z0116
cIIY0rLAILPNTA
cOwvaDthRDENT
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 rul d regultions of th i of aç
to pay for any additional replacement necessary as the result of this work.
/ \%tatüre of applicant oi A(ent
HUITRON CONSTRUCTION 50427 RIGO COURT COACHELLA, CA 92236 / (760)457-9960
Name of Applicant (please print) Business Address Telephone No.
HUITRON CONSTRUCTION 50427 RIGO COURT COACHELLA, CA 92236 ' (760)457-9960
Name of Contractor and Job Foreman Business Address Telephone No.
926190 lic-106213
Contractor's License No. City Business License No.
AMTRUST INTERNATIONAL UWS DSI 1256669500 -
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $145.00
TOTAL: $145.00
PERMIT NO: DRVA2O16-OO11
DATE ISSUED: 8/26/2016
EXPIRATION DATE: 8/26/2017
BY: RAMSES SEVILLA
WORK INSPECTED BY:
PERMIT COMPLETION DATES:
51f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request finalacceptance of improvements from the
City Council.
tJiPiI
OF DRIVEWAY APPROACH PERMIT APPLICATION
Finance Revenue Code PD
Applicant Information:
Applicant/Owner (please p!jfLt name here):
Applicant Address: 54- 7O A J_
Number Street
of wpijk location, if diff,
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ALJVO
A CA ¶
City . State Zip Code
licant's address above: ..I flA C
Number Street City
No ( Date:
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41;rl qc~ (:;D
51 Applicants Signature:
Approximate Start Date:4 Approximate Completion Date: ____I___/•
State Zip Code
Contractor Information:
Address: SO4t7 CCb0ke-N\Q-L Ci' 9
Number •treet City State• Zip Code
Phone Number: f0) 4E1 0Contractors License Number: 2_J V
City Business License Number: Ic9 tI4 f
r
i
General Liability Insurance Company: Policy No -,P51 105104y cm 00
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
Permit Issued by: Date Issued —/—/
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: II
Inspector's Signature
Comments:
Note: Driveway approach must be àonstructed per City of La Quinta Standard #221