DRVA2019-0001PD ta Q tf
See below for Finance Revenue Codes
JAN 072019 D -iA GEM .fDE5EKr--
Clii OF LAQUINTA DRIVEWAY APPROACH
DESIGN & DEVELOPMENT DEPARTMENT 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: 1/7/2019
LOCATION OF CONSTRUCTION (Street address or Description): 55075 MONROE
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: MORROW /_DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: 1/7/2019 TIME OF COMPLETION: 3/7/2019
ESTIMATED CONSTRUCTION COST: (Including removal of all obstruction, materials, and debris, backfilling, compaction and placing
permanent resurfacing and/or replacing improvements)
COMMENTS: TEMPORARY DRIVEWAY APPROACH FOR HORSE TRAILER ACCESS. -
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 rulesand re uptimsoftheCityof and to
pay for any additional replacement necessary as the result of this work.
Si ure ~icant or Agent
SCOTT MORROW 55075 MONROE LA QUINTA, CA 92253 (949)533-5050
Name of Applicant (please print) Business Address
OWNER BUILDER
Name of Contractor and Job Foreman Business Address
Ot.4.'& I5U1LpI&
Contractor's License No.
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL
TECHNOLOGY ENHANCEMENT FEE
TOTAL:
Telephone No.
Telephone No.
City Business License No.
Policy Number
PERMIT NO: DRVA2019-0001
DATE ISSUED: ib (zoI
EXPN DATE: 42/2..OW
WORK I PECTED BY:
1f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
44i
GEM of rbe DESERT
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information:
Applicant/Owner (p/ease print name here,k 5C 6-77- ,/71O/Z1ZOL4,7
ApplicantAe
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01
Numr Street City State Zip Code
Address or Pael No of work location, if different from applicant's address a bove:
Ø'tr7Zie. z_oz
Number Street City State Zip Code
Date: i7iJ' Applicant's Phone No 50'51)
Applicant's Signature:
Date: Approximate Start Date: _LZ pproximate Completion
Contractor Information: I
Address:
Number Street City State Zip Code
Phone Number: (_____ S Contraátors License Number:
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 $160 + $5 Technology Enhancement Fee = $165 Total Fee
Permit No. Expiration Date ../....j.
Permit Issued by: Date Issued /.J
Signature of Administrative Authority
Work Inspected by: Permit Completion Dates /.......I.
Inspectors Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #221
REV: 11/27/2018