DRVA2017-0014c tti' o.j' .4z, tcL,tt&,
See below for Finance Revenue Codes
ENCROACHMENT PERMIT
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: 6/23/2017
LOCATION OF CONSTRUCTION(Street address or Description): 53255 EISENHOWER DR
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: D'ANNA/ DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN:q7rlME OF COMPLETION: :4347
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 againstany 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 aFpdTqgula ions of the City of
and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
CRYSTAL BLUE POOLS AND PATIOS
Name of Applicant (please print)
CRYSTAL BLUE POOLS AND PATIOS
846843
Contractor's License No.
WESCO INSURANCE COMPANY
31166 ORANGE AVENUE NUEVO, CA 92567 (951)906-2761
Business Address Telephone No.
31166 ORANGE AVENUE NUEVO, CA 92567 (951)906-2761
Telephone No.
/_/C -o//2 0a1
City Business License No.
04WB048149
Name of Contractor and Job Foreman Business Address
Applicant's Insurance Company Policy Number
Finance Revenue Code
IPERMIT INSPECTION
DRIVEWAY RESIDENTIAL
TOTAL:
PERMIT NO: DRVA2017-0014
DATE ISSUED: _____
EXP DATE: 7( /2J1
.
;F
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.
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information:
Applicant/Owner (please print name here): ?) 4(ro-
Applicant Address:
LQ CA .CVL ç 3
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
-fSe,.n A LO Of
Number Street City State Zip Code
Date: _I_/ APPlicant'sne
,
4x (77 ) OS/o3 C.
Applicant's Signature: S ...,
Approximate Start Date: / -/A p-proximate Completion pate:
P7/ 3 / ('7
Contractor Information:
Address:
rig I 1-t 6 L, &Sz VL j .R '
/ (
Number Street City State Zip Code•
Phone Number: 7'G91V (pOt, ' Contràctbrs License Number: '/
City Business License Number
General Liability Insurance Company: - øiiJTJ 31 Poliôy No.
Request for Inspection - Please call (760) 777-7097 before 1:30pm to .requestan inspection at least 24
hours prior to your requested inspection date. The Hub Counter (760) 777-7125.
Please Note: Inspections are normally performed Monday through Friday between Barn and 4pm
Permit Fee $152 + $5 Technology Enhancement Fee = $157 Total Fee
Permit No. Expiration Date /
Permit Issued by: Date Issued I /
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: I. /
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard#221