DRVA2019-0009*
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-
GEMqthoESER'r -
DRIVEWAY APPROACH APR
PUBLIC WORKS CONSTRUCTION CITY oiQUINTA
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: 4/8/2019
LOCATION OF CONSTRUCTION(Street address or Description): 52580 AVENIDA OBREGON
PURPOSE OF CONSTRUCTION:
DESCRIPTION OF CONSTRUCTION: BROOKS / DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: TIME OF COMPLETION:
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 an4*e'guJIons of the City of and to
pay for any additional replacement necessary as the result of this work. J I I I
Applicant or Agent
DJ's CONCRETE 52-585 AVENIDA OBREGON LA QUINTA, CA 92253 (760)578-1879
Name of Applicant (please print) Business Address Telephone No.
DJ's CONCRETE 52-585 AVENIDA OBREGON LA QUINTA, CA 92253 (760)578-1879
Name of Contractor and lob Foreman Business Address
875760
Contractor's License No.
OHIO SECURITY INSURANCE COMPANY
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $160.00
TECHNOLOGY ENHANCEMENT FEE $5.00
TOTAL: $0.00
Telephone No.
LlC-0104114
City Business License No.
BIS(18)56939755
Policy Number
PERMIT NO: DRVA2019-0009
DATE ISSUED: 4/8/2019
EXPIRATION DATE: 10/5/2019
BY: STEPHANIE SWANSTROM
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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- - GENt efhr DESERT
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information: -
Applicant/Owner (p/ease print name here,k
Applicant Address:
A.e,n4ckObrvi LA Ouinlak, Cfs, 1ZZ53
Number Street V 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: 4.ji_i2it Applicant's Phone No: (95) ) 505 O'
Applicant's Signature:
Approximate Completion Date: /f Approximate Start Date: C1)1_
Contractor Information:
Address 2-S-5 4Vi(P oS-FôiOiJ c4&Q iOT- C- 72z53
Number Street City State Zip Code
Phone Number: (0) I 47Contractors License Number: -7 S 7(.
City Business License Number: Lc__(OL{ ii '_l
General Liability Insurance Company: L.b+4' (}lu4cI4L Policy NoiLS L350 (61
Request for Inspection - Please call (760) 777-7097 before 1:30pm to request an inspection at /east 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 I I
Signature of Administrative Authority
Work Inspected by: Permit Completion Date: /..J
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #221
REV: 11/27/2018
AWIL7'
- THIS CERTIFICATE
CERTIFICATE DOE
BELOW. THIS CE
REPRESENTATIVE
IMPORTANT: If ft
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this certificate does
PRODUCER
Cumbre Insurance Sol
44-751 Village Court
Suite 200
Palm Desert, CA 9225
INSURED
DJ's Con
52585 A
La Quint
COVERAGES
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 CI.AIMS
- INSURANCE
-
aiii IñI POLICY EFf IIM&VYYYYT POLICY UP ItWaW(YY UNITS
A X [COIIMERCIAI.GENERALUABILITY
CLAPIS44ADE [] OCCUR
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BLS58135051 711012018 711012019
EACH OCCURRENCE 1,000,000
$ 500,000 DAMAGE 71D RENTED
MED EXP (Am one pemon) $ 15,000
PERSONAL & ADV INJURY $ 1,000,000
GENT. AGGREGATE LIMIT APPLIES PEft
POLICY [2] [II] LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS -COMPIOPAGG $ 2,000,000
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TOMOB1LEUABITY
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OWNED SCHEDULED
- AUTOS ONLY AUTOS
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COMBINED SINGLE LIMIT
(EaIdetl $
BODILY INJURY (Per L $__________
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UMBRELLA LIAB
EXCESS LIAB
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DED I I RETENTION S
EACH OCCURRENCE S
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WOIUCERS COMPENSATION
ANY PROPRIETORIPARTNERIEXECUTIVE
QFFICERIMEMBER EXCLUDED? El (IldMCy In NM)
If yes desaibe under
DESRIPTION Of OPERATIONS belies
N/A
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AND EMPLOYERS' UADUJTY YIN
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E.L. DISEASE- EA EMPLOYEE S
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DESCRIPTION OFOPERADONSILOCAflONS/VE)TICLES (ACORO 101, AddItional Remts SCIt.dl* ,nay beMMcbed If more apes. Is .equlrsd)
City of La Gulnta Is named as an additional Insured In respects to general IIabIIfty per the attached endorsement.
City of La Quints
78-495n CaNe Tampico
La Quints, 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,
ACORD 25 (2013) 'E 1985-2915 ACUHU CORPORATION. All fl95tS reservea.
The ACORD name and logo are registered marks of ACORD