DRVA2017-0025tev Qa b ( &
DRIVEWAY APPROACH
PUBLIC WORKS CONSTRUCTION
See below for Finance Revenue Cod(
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public wor
improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 11/2/203.7
LOCATION OF CONSTRUcTION(Street address or Description): 53825 AVENIDA RAMIREZ
PURPOSE OF CONSTRUCTION:
DESCRIPTION OF CONSTRUCTION: SIPOVAC / DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
MATE TIME WHEN WORK WILL BEGIN: TIME OF COMPLETION: -
ESTIMATED CONSTRUCTION COST: - (Including removal of all obstruction, materials, and debFls, backfilllng, 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 of the City of and
to pay for any additional replacement necessary as the result of this work.
.
L( .
Signature of Applicant or Agent
ANDREW SIPOVAC 53825 AVENIDA RAMIREZ LA QUINTA, CA 92253 (760)567-2364
Name of Applicant (please print) Business Address Telephone No.
ANDREW SIPOVAC 53825 AVENIDA RAMIREZ LA QUINTA, CA 92253 . -, S (760)567-2364
Name of Contractor and Job Foreman Business Address - Telephone No.
-7-
Contractor's License No. City Business License No.
.Applicant's Insurance Company . Policy Number
Finance Revenue Code
Credit Card Fee $2.90.
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $156.00
TECHNOLOGY ENHANCEMENT FEE $5.00
TOTAL: $0.00
RMIT NO: DRVA2017-0025.
TE ISSUED: 1,4oL,/ 7
IJN DATE:
WORK INSPECTED Bye:
PERMIT COMPLETION
If the work Is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of Improvements from the
City Council.