DRVA2018-00074 Qu
--GEM ofJeDESERT---
DRIVEWAY APPROACH
PUBLIC WORKS CONSTRUCTION
See
ITYOFLAQUINTA LL 920'8 I I
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: 4/19/2018
LOCATION OF CONSTRUCTION(Street address or Description): 52425 AVENIDA JUAREZ
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH .
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
TIME WHEN WORK WILL BEGIN: 4/19/2018. TIME OF COMPLETION: 4/25/2018
MATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
nanent 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 a regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
S gnature of Applicant or Agent
JOSEPH BIRDSELL P 0 BOX 630 LA QUINTA, CA 92247 (760)409-7070
Name of Applicant (please print) Business Address Telephone No.
JOSEPH BIRDSELL P 0 BOX 630 LA QUINTA, CA 92247 . (760)409-7070
Name of Contractor and Job Foreman Business Address .
Telephone No
811293 Li C-0005036
Contractor's License No. City Business License No.
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL . $156.00
TECHNOLOGY ENHANCEMENT FEE $5.00
TOTAL: $0.00
PERMIT NO: DRVA2018 0007
DATE ISSUED: _
EXPIRATION DATE: ____
BYE?
_ 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.
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-GE.Mof:kDESERT -
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information: T
Applicant/Owner (please pthit name here): seA\ -
Applicant Address: 4 a& A' i- - CP gaaisn
Number Street City State Zip -Co-de—
Address or Parcel No. of work Location, if different from applicant's address above:
Number Street City State Zip Code
Date: £i'i.J" Apptic,o%3yhone No: (7b() 409 -7070
Applicant's Signature: '1J7
Approximate Start Date: _jJji.th,proximate Completion Date:
Contractor Information:
Address: SC) ps4 e&c& iu¼Z&, CA CI5
State Zip Code Number Street City
CAMrLL0Jtk D i 4 Q4Y
Phone Number: (uL) 49 7O71 Contractors License Number: _______________
City Business License Number: (tc. rc1
General Liability Insurance Company: C4AjCnid Co 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 Barn and 4pm
Permit Fee $156 + $5 Technology Enhancement Fee = $161 Total Fee
Permit No. Expiration Date ..........J_/_
Permit Issued by: Date Issued I /
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: _I..........J
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La