The URL can be used to link to this page

DRVA2017-00291 42tdn1a -GEM qk ME" -- DEC 132017 DRIVEWAY APPROACH U . OF LA QUINTA PUBLIC WORKS CONSTRUCTION CITY DESIGN AND DEVELOPMENT DEPARTMENT 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: 12/13/2017 LOCATION OF CONSTRUCTION(Street address or Description): 53780 AVENIDA'CORTEZ PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH DESCRIPTION OF CONSTRUCTION: STEMMER /_DRIVEWAY APPROACH DIMENSION OF INSTALLATION OR REMQVAL: ROXIMATE TIME WHEN WORK WILL BEGIN: 12/14/2017 TIME OF COMPLETION: 12/20/2017 TED CONSTRUCTION COST: $750.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and permanent resurfacing *and/or replacing improvements) 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. çSige of Applicant or Agij BRIAN K STEMMER CONSTRUCTION 74478 HWY 111 # 322 PALM DESERT, CA 92260 (760)819-5476 Name of Applicant (please print) Business Address Telephone No. BRIAN K STEMMER CONSTRUCTION 74478 HWY 111 # 322 .PALM DESERT, CA 92260 (760)819-5476 Name of Contractor and Job Foreman Business Address S. Telephone No. 649172 LIC-0108888 Contractor's License No. City Business License No. Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION DRIVEWAY RESIDENTIAL • $156.00 TECHNOLOGY ENHANCEMENT FEE • $5.00 TOTAL: $161.00 Policy Number PERMIT NO DRV2017-0029 DATE ISSUED: ____ EXPIRAN DATE: ____ WORK 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. .. - .(A& DESERT 0 DRIVEWAY APPROACH PERMIT APPLICATION Applicant Information: Applicant/Owner (please rjLLt name.here): SJC41YV1k_ Applicant Address: c 3 )r kL(Q.;,I t .* 1o/-7?, LA c2Ji ç Number Street City State Zip Code Address or Parcel No. of work location, if different from applicant's address above: t~D ktiict- ceik'z 6 u Number -Street C1t9 Date: _/_/ Applicant's Phone No: 7O ) Applicant's Signature: 1fjt1v 'Approximate Start Date: JT I.JJ.1. Approximate Completion Date: 'CA ciS) State 'Zip Code Contractor Information: . . . . Address: 11-14-7t . (I . P D 2'2. olD Number ' .Street . City. State Zip Code Phone Number: ('1 ) Contractors License Number: e41' ii 2 City Business License Number: General Liability Insurance Company: . Policy No. 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. The Hub Counter (760) 777-7125: Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm Permit Fee $156 + $5 Technology Enhancement Fee = $161 Total Fee Permit No. Expiration Date __/_......J Permit Issued by: . Date Issued __/.__/ Signature of Administrative Authority Work Inspected by: Permit Completion Date: ../J Inspector's Signature 0 Comments: Note- Drivwnv nnnrnnch must he constructed ner City of'La Ouinta Standard #221 ACUPROF CERTIFICATE OF LIABILITY INSURANCE DATE(MM!DDIYYYY) 1 1211212017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. This CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate doss not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Statewide Commercial Ins Brokers 2406 N Lake Avenue Altadena, CA 91001 Phone (877) 2077900 FaX (626)340-4807 MNOTeCT Customer Service PHONE (877) 207-7900 I jAk No): (626) 340-4807 mall@st8wide.com INSURER(S) AFFORDING COVERAGE NAJC S INSURER A: United Specialty Insurance Company, Inc. INSURED Brian K Stemmer Construction 74478 Hwy 111 #322 Palm Desert CA 92260- INSURERS: INSURER C: INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE *001 UBE POLICY NUMBER POLICY EFF (MMMDIYYYYI POLICY EXP IMMIDD!YYYY UMITS______________ A _DOTHER J COMMERCIAl. GENERAL LIABILITY 0 CLAIMS-MADE OCCUR El GENt. AGGREGATE LIMIT APPLIES PER: II POLICY 0 0 LOC Y -- S110504121212173 06/17/2017 06/17/2018 EACH OCCURRENCE $ 1,000,000 DA PREMAGE TO RENTED MISES (Ea occurrence) $ 50,000 MED EXP (Any one poison) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS. COMP/OP AGG $ 1,000,000 It - AUTOMOBILE LIABILITY ANY AUTO SCHEDULED OWNED L.J AUTOS ONLY AUTOS HIRED 0 NON-OWNED AUTOS ONLY AUTOS LIMIT SO MS $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident)8. PROPERTY DAMAGE (Per accident) $ $ - 0 UMBRELLA LIAR 0 OCCUR EXCESS LIAB CLAIMS-MADE - 0 DED 0 RETENTiONS EACH OCCURRENCE 8 AGGREGATE $ - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIRIPARTNERIEXEC OFFICERIMEMBER EXCLUDED? UTIVEj (Mandatory In NH) If yes, describe under NIA DESCRIPTION OF OPERATIONS below ' —I STAT PER UTE E ' U ' ON R- ' E.L. EACH ACCIDENT $ E.L DISEASE. EA EMPLOYE $ E.L DISEASE - POLICY UNIT $ DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional Rernadis Schedule, If moos space Is required) City of La Quinta is named as additional insured. CERTIFICATE HOLDER CANCELLATION City of La Quinta 78-495 Celle Tampico La Quinta, CA 92253 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2816f03) OF The ACORD name and logo are registered marks of ACORD