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DRVA2019-0007ci Qa !A& be Fina U e R yen e Codes - GEM DESERT - - DRIVEWAY. APPROACH APR 052019 PUBLIC WORKS CONSTRUCTION CITY OF I.AQUINTA DESIGN & DEVELOPMENT DEPARTMENT For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains an otner like puoiic works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS. DATE: 4/5/2019 LOCATION OF CONSTRUCTION(Street address or Description): 51285 CALLE KALIMA PURPOSE OF CONSTRUCTION: INSTALLATION OF DRIVEWAY APPROACH DESCRIPTION OF CONSTRUCTION: HERRERA / DRIVEWAY APPROACH DIMENSION OF INSTALLATION OR REMOVAL: PROXIMATE TIME WHEN WORK WILL BEGIN: 4/8/2019 TIME OF COMPLETION: 4/19/2019 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, 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 d regulati s of the City of and to pay for any additional replacement necessary as the result of this work. Signat re of A plicant or Agent B & A CONSTRUCTION & RENOVATIONS LLC Name of Applicant (please print) B & A CONSTRUCTION & RENOVATIONS LLC P 0 BOX 732 CATHEDRAL CITY, CA 92235 (760)774-6376 Business Address Telephone No. P 0 BOX 732 CATHEDRAL CITY, CA 92235 (760)774-6376 Telephone No. Name of Contractor and Job Foreman Business Address 1031272 766645 Contractor's License No. City Business License No. Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION DRIVEWAY RESIDENTIAL $160.00 TECHNOLOGY ENHANCEMENT FEE $5.00 TOTAL: $165.00 Policy Number PERMIT NO: DRVA2019-0007 DATE ISSUED: .±I; ( q EXP DATE: 41c (e WORK INSPECTED BY: PERMIT COMPLETION DATE*: If the work is covered by a Subdivision Improvenent Agreement, Subdivider shall request final acceptance of improvements from the City Council. 7Dy2.JP20( i - 0001 ta Qa ~ 9 - GEM of,ke DUE -. DRIVEWAY APPROACH PERMIT APPLICATION Applicant Information: Applicant/Owner (please Qth2t name here): klaffl, Applicant Address: I 5 VY1iAmA. GtM 2.9 *. cv 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: _/_/ Applicant's Phone No: (1taO) ii-t-- 031 t.o Applicant's Signature: Approximate Start Date: _/_/__ Approximate Completion Date: _/__/ Contractor Information: Address: '• 0' * 1 ?- Mj1cL i-j (k g z Number Street City State Zip Code Phone Number: fl(pC)'1'141O'bl11Contractors License Number: ___________________ City Business License Number:LJI i(dOIJI4S' General Liability Insurance Com 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 / 'I Signature of Administrative Authority Work Inspected by: Permit Completion Date: Inspector's Signature Comments: Note: Driveway approach must be constructed per City of La Qu Letter of Authorazation Please be advised that Cai¼i V (Carlos Peraza/B & A Construction & Renovations) authorizes1'A N uau-I(B & A Construction & Renovations) to act as an agent on my (our) behalf in all matters relted to obtain/pull permits. I (we) futher understand and agree that I (we) shall remain remain reponsible for all permit conditions, permit provisions,fees,de posits, add itional charges amd collections resulting from permit application process, permit issuance and inspection of work. Company NameJ hdAorl QL-O Contractor's Name: Q(A n Contractor's Lic. No: ignatu re..office nsed Contractor Date ACRD L CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) I 4/4/2019 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 pollcy(Ies) 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 does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Insurance General Agency 1330 Orange Ave Suite 321 Coronado CA 92118 NAME: Pipeline ACT Jose Arellano Eat): I. No): 8662199967 MAJL ADDRESS: jose.pipelineinsurance®gmail.com INSURER(S) AFFORDING COVERAGE NAIC I INSURER A: PREFERRED CONTRACTORS INS CO RRG LLC 12497 INSURED B&a Construction & P0 Box 732 Cathedral City CA 92235 INSURER B: BERKSHIRE HATHAWAY HOMESTATE ENS CO 20044 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. uNSR LTR TYPE OF INSURANCE 0DI INSD UB1 wvo POLICY NUMBER Pui.uui en (MMIDD/YYYY) Lxi' MMIDD1YYYY) LIMITS A X COMMERCIAL GENERAL LIABIUTY CLAIMS-MADE X OCCUR ______ Y PC272995 06/04/2018 06/04/2019 EACH OCCURRENCE $ 1,000,000 JxMxUt (UPILNItU PREMISES (Es occurrence) $ 50,00 MED EXP (My one person) $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRO- POLICY Fj JECT bC ROTHER: GENERAl. AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 $ - B AUTOMOBILE LIABILITY ANY AUTO OWNED X AUTOS AUTOS [] SCHEDULED . HIRED NON-OWNED - AUTOS ONLY AUTOS ONLY - Y - BAAU935 124 06/04/2018 06/04/2019 UMMNLUSINLLL LIMIT (Ea accident) $ 500,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ KUPLK IT UAMAcjL (Per accident) $ - UMBRELLA UAB EXCESS UAB CLAIMS-MADE - OCCUR ___________________________ __________ __________ EACH OCCURRENCE $________________ - [] AGGREGATE $_______________ DED I I RETENTION S _____________________ $ - - IORKERS COMPENSATION P40 EMPLOYERS' LIABILITY Y I N NY PROPRIETOR/PARTNER/EXECUTIVE FFICER/MEMBER EXCLUDED? Mandatory In NH) I vac. descilbe under ESCRIPTION OF OPERATIONS below - N /A - - - pill- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more apace Is required) 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 DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jo$ Ar€U.4 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD