DRVA2017-0011T4&t 4 -4 Q"
ENCROACHMENT PERMIT
PUBLIC WORKS CONSTRUCTION
See below for Finance Revenue Codes
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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: 5/11/2017
LOCATION OF CONSTRUCTION(Street address or Description): 52810 AVENIDA NAVARRO
PURPOSE OF CONSTRUCTION: APPROACH PERMIT
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH /_PEPE BUILDS
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 5/11/2017 TIME OF COMPLETION: 6/11/2017
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 rules and regulations the City of
and to pay for any additional replacement necessary as the result of this work.
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Signature of Applicant or Agent
CORONEL ENTERPRISES 42760 MADIO STREET INDlO, CA 92201 . . (760)775-1234
Name of Applicant (please print) Business Address . Telephone No.
J - Z CONCRETE CONSTRUCTION INC 42760 MADIO STREET INDlO, CA 92201 . (760)775-5550
Name of Contractor and Job Foreman Business Address Telephone No.
813261
Contractor's License No.
ASSOCIATED INDUSTRIES INS.
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $152.00
TOTAL: $152.00
LIC-0003629
City Business License No.
AES1022833
Policy Number
PERMIT NO: DRVA2017-0011
DATE ISSUED: 5/11/17
EXPIRATION DATE: 5/11/2018
BY: ARMANDO MAGALLON
INSPECTED BY:
PERMIT COMPLETION DATES:
51f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council. .
Permit Fee:
Office Use Only:
Inspection Fee:
Office Use Only:
Assigned Permit Number: VA
Approval Date:
As-Built
Deposit:
Dust Control
Deposit:
Credit
Amount: Administrative Authority:
Expiration
Date:
Issue
Date: -
TOTAL FEE DUE:
T"df 4 6(4p -QU&M
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
Date:
Tract No: Project Name:
Vicinity: _Q 0 fivt ri& jjuar ('E
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.) cu c
Description of Construction (i.e.: See Plan Set No. 01234)
Dimension of Installation or Removal:
Approximate Construction Start Date: —\ -
Approximate Construction Completion Date: (,_\%, -
Estimated Construction Cost: $
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Mme:
Name of Applicant/Owner: (\
Applicant Address:
Applicant Telephone Number: -o —z is
Applicant E-mail Address:
Phone Number: 7 -31 7
Name of Contractor:
Contractor Address:
Contractor Telephone Number: -, -- s -
Contractor State License Number: (_, a. 6 I
Contractor City Business License Number: LC-- OQO !,bc(
Contractor E-mail Address:
10~A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED 4
Applicant or Contractor General Liability Insurance Company:
Applicant or Contractor General Liability Insurance Policy Number: