DRVA2018-0009.•..'
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- GEM fsJe DESERT--
DRIVEWAY APPROACH
Sn Iow4 ce vefdes
MAY 152018 JUJ
PUBUC WORKS CONSTRUCTION - CITY OFLAQUINTA -
DESIGN & DEVELOPMENT DEPARTMENT
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: 5/15/2018
LOCATION OF CONSTRUCTION(Street address or Description): 51792 AVENIDA RAMIREZ
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: SANCHEZ / DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL: 5/18/2018
APPROXIMATE TIME WHEN WORK WILL BEGIN: 5/15/2018 TIME OF COMPLETION: 5/18/2018
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, offiters, 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 anftegulations of the City of and to
pay for any additional replacement necessary as the result of this work.
of Applicant qf Agent
CARDENAS CONSTRUCTION
COMPANY INC PC BOX 1537 INDIO, CA 92201
Name of Applicant (please print) Business Address
CARDENAS CONSTRUCTION
COMPANY INC P 0 BOX 1537 INDIO, CA 92201
Name of Contractor and Job Foreman Business Address
886924 LIC-0106770
Contractors License No. City Business License No.
(760)393-6617
Telephone No.
(760)393-6617
Telephone No.
Applicant's. Insurance Company Policy Number •
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL • $156.00
TECHNOLOGY ENHANCEMENT FEE • • $5.00
TOTAL: $161.00
1 l
PERMIT NO: DRVA2018-0009
DATE ISSUED:
EXPIRATION DATE: /J5/I q
BY48
WORK INSPECTED BY*:
IPERMIT COMPLETION DATE*:
*If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
- GI!1I 'f;'e DESERT -.
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information:
'
Applicant/Owner ('please print name.here): Cq dt ti, Co. ca.hj.., ' .1 ''r4 "-
Applicant Address: 5I g z Arthrd. •, La LJ '
QZZS
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
Number -Street • City State Zip Code
Date: i)/j5jjJ Applicant's Phone No:(DCQ'_J ___________
Applicant's Signature:
'Approximate Start Date: 5/I$/i(Approximate Completion Date: 7 —
Contractor Information:
Address: P. C. .5 Ox 1537 ' INPIp t,4 1ZZp?
Number Street S City. State Zip Code
Phone Number: (760) 57 - 7?O' Contractors License Number: c 9 Z'f
City,Business License Number:
General Liability Insurance Company: Policy No. C 1 S PTW5o Cl (ff3) 17
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 Sam and 4pm
Permit Fee $156 + $5 Technology Enhancement Fee = $161 Total Fee
Permit No. Expiration Date
Permit Issued by: ' Date Issued ,
-
Signature' of Administrative Authority '
Work Inspected by: S Permit Completion Date:
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City. of La Quinta Standard #221
Permit application submittal requirements:
1. Application completely filled out with the following items attached
a. Ensure there's a City Business License # on application
2. Current Certificate of Liability. Insurance
City of La Quinta as additional insured with endorsement if work is being done in the
public right of way S S S
3. Traffic Control Plan if there are lanes on public streets being closed
Traffic Control plan must be stamped by a Civil or Traffic Engineer or;
Applicable traffic control plan from 2012 WATCH Manual or 2012 California MUTCO.
4. Bonds or cash deposits maybe required for grading, off-site improvements, and/or dust control
A5RLf CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
05/14/2018
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: If the certificate holder Is an ADDITIONAL INSURED, the pollcyQes) must 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 does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
ACW GROUP, LLC dba: AKAMINE CHRISTMAN WALL INSURANCE
77-810 LAS MONTANAS SUITE 204
Ø,E• 7605370703 I ,:760-200-3434
j%: bhoskins@acwgroup.com
INSURER(S) AFFORDING COVERAGE NAIC# PALM DESERT, CA 92211
INSURER A: LLOYDS OD LONDON
INSURED INSURER B:
INSURER C: CARDENAS CONSTRUCTION COMPANY, INC
INSURER D:
P0 BOX 1537
INSURER E:
Indio CA 92202 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSUK(Na L9STEO BELWIIM1EE4 ISSUEb TO 1(E 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.
li4SR LTR - TYPE OF INSURANCE
ASSL SUOR
POLICY NUMBER
POLICY EFF
(MM/DWYYYYI
POUCY EXP
£MM/DWYYYY) LIMITS_________________
A )( [COMMERCIAL GENERAL LIABILITY CISDTWO04903 17 12/12/201 I2/12/201& EACH OCCURRENCE 1,000,000
7 CLAIMS-MADE OCCUR PREMISES Me occurrerm) $ 50,000
J MED EXP (My one person) 5 5,000
.
PERSONAL & AM INJURY S 1,000,000
G9l'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 :
X POLICY E LOG PRODUCTS. COMP/OP AGG $ 2,000,000
$ OTHER:
- AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT
ccident s
BODILY INJURY (Per person) $ ANY AUTO
BODILY INJURY (Per accident) S =ALL OWNED SCHEDULED
AUTOS ' AUTOS
NON.OW%IED
- HIRED AUTOS AUTOS :
: PROPERTY DAMAGE
(Per eccldentt
$
-
UMBRELLA LIAB U OCCUR EACH OCCURRENCE S
-
AGGREGATE S EXCESS UAB I cjts.,o€
OW I I RETENTION
- WORKERS COMPENSATION
AND EMPLOYERS UABILTY Y/N
ANY PROPRIETORIPARTNER/EXECU1IVE
-
- STATUTE I I ER
E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
N /A
- EL. DISEASE EA IPLOYE S
EL DISEASE - POLICY UNIT $ -
lives describe under
DESCRIPTION OF OPERATIONS below -
'
-
- -
•
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.-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddItional Remarks Schedule, may b. attacked It more epice is required)
RE: 51792 Avenida Ramirez La Quinta ca 92253
The City of La Quinla has been listed as an additional insured per the attached endorsement (CO 20 10 10 01) for work performed on behalf of named insured
for work performed under written contract.
Note: Additional Insured sttaus is subject to all terms, conditions & exclusions.
The City of La Quinta
78495 Calle Tampico
La Quinta Ca 92253
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORGED REPRESENTATIVE
CD 1299.014 ACORD CORPORATION. All rlahts reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
UMR: B6991SCO2016S01 I COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: cISDTwO04903 17 CG 20 10 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
Section II - Who Is An Insured is amended to
include as an insured the person or organization
shown in the Schedule, but only with respect to
liability arising out of your ongoing operations
performed for that insured.
With respect to the insurance afforded to these
additional insureds, the following exclusion is
added:
2. Exclusions
This insurance does not apply to "bodily in-
jury" or "property damage" occurring after:
All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
site of the covered operations has been
completed;
or
That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 10 01 Copyright ISO Properties, Inc., 2000 Page lofi 0