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DRVA2019-0015P 1 ,(. See below for Finance Revenue Codes - GEM .fDESERT' - DRIVEWAY APPROACH AUG 07 2019 L.J PUBLIC WORKS CONSTRUCTION For the constr urbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public works impr9o"Aw". IMPROVEMENTS and APPROVED SUBDIVISIONS. DATE: 8/7/2019 LOCATION OF CO NSTRUCTION (Street address or Description): 51715 AVENIDA MONTEZUMA PURPOSE OF CONSTRUCTION: NEW APPROACH S DESCRIPTION OF CONSTRUCTION: DAHLQUIST/ DRIVEWAY APPROACH DIMENSION OF INSTALLATION OR REMOVAL: N/A APPROXIMATE TIME WHEN WORK WILL BEGIN: 8/8/2019 TIME OF COMPLETION: 8/16/2019 ESTIMATED CONSTRUCTION COST: $600.00 (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 and regulations of the City of and to pay for any additional replacement necessary as the result of this work. 147 4 - Signature of MODERN TOUCH CONSTRUCTION Name of Applicant (please print) MODERN TOUCH CONSTRUCTION 67685 BROKEN ARROW LANE DESERT HOT SPRINGS, CA 92234 Business Address 67685 BROKEN ARROW LANE DESERT HOT SPRINGS, CA 92234 (760)835-2777 Telephone No. (760)835-2777 Telephone No. Name of Contractor and Job Foreman Business Address 1004355 Contractor's License N Applicant's InsuranceCompany LIC-766210 City Business License No. 4Eqcnh27à) Policy Number Finance Revenue Code PERMIT INSPECTION DRIVEWAY RESIDENTIAL $160.00 TECHNOLOGY ENHANCEMENT FEE $5.00 TOTAL: $165.00 PERMIT NO: DRVA2019-0015. DATE ISSUED: f4 77 EXP , N DATE: iL?/1c BY. WORK INSPECTED BY*: PERMIT COMPLETION DATES: 1f the work is covered by a Subdivision Improvement Agreement, Subdivider shall request final acceptance of improvements from the City COuncil. S., - GEM 4rAr DESERT DRIVEWAY APPROACH PERMIT APPLICATION Applicant Information: Applicant/Owner (p/ease Dr/nt name hereJ -'--54Z.- v2- Applicant Address: 5-1-71c 4Z..t A 'P/9 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: 2-1-V-ILI Applicant's Phone No: (74 )e.3c-3 72 7 Applicant's Signatur Approximate Start Date: $Tjj Approximate Completion Date: _L7_/ Contractor Information: Address: 76S I-A) / Z1/9S Number Street City State Zip Code Phone Number: 050-)Z35--Z777 Contractors License Number: ZOO &7/ 3.gç- City Business License Number: (c(?SS General Liability Insurance Company: Policy No. S.GS(OS I12 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. piration Date F Q_i_2 Permit Issued by: Signature of Administrative Authority Work Inspected by: Inspectors Signature Comments: Date Issued Permit Completion Date: IL iIii Note: Driveway approach must be constructed per City of La Quinta Standard #221 REV: 11/27/2018 S MODETOU-01 OCARDWELI DAWDDIYYYY) 1 713012019 ACRL CERTIFICATE OF LIABILITY INSURANCE 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 policy(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 License # 0E63493 NCRWCT Orr& Associates Insurance Services 28780 Single Oak Dr Ste 255 Eat): (951) 506-5859 I(Fffl , No): (800) 474-3003 SS: service@orrandassociates.com Temecula, CA 92590 INSURER(S) AFFORDING COVERAGE NAIC INSURER A Associated Industries Insurance Co. 23140 INSURED INSURERS: INSURER C: Modem Touch Construction INSURER D: 67685 Broken Arrow Lane Desert Hot Springs, CA 92241 INSURER E:_________________________________________ I INSURER F: CVERAFS CFRTIFIATF PJtIMRFR RFUISIfl!J IJIIMRFR' 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. INSR TYPE OF INSURANCE ADOL ..- POLICY NUMBER POI.ICY EFF mornw POLICY EXP 1 MMIODIYYYY UMITS______________ A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE [] OCCUR ______ X X . AES105312701 512312019 512312020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED occurrenceL_ PREMISES-lEa $ 100,000 MEDEXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENL AGGREGATE UNIT APPLIES PER: POLICY [] spof [] LOC GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED 11 SCHEDULED AUTOS ONLY L_J AUTOS ONLY H - - . (Pet accid I ent) COMBINED SINGLE UNIT lEa accldentt S BOOILY INJURY (Pet person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE S - - UMBRELLA LIAB EXCESS UAB CLAIMS-MADE H OCCUR - ________ EACH OCCURRENCE S AGGREGATE S = DED I I RETENTIONS __________________ - AND EMPLOYERS' LIABILITY ABILITY ANY PROPRIETORIPARTNERIEXECU11VE OFF10ER/MMBER EXCLUDED? [I] (Mandatory in NH) If yes describe under rICS6RIPTION OF OPERATIONS below NIA - WORKERS COMPENSATION I PER I I 0TH- i STATUTE I I E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remark, Schedule, may be attached It mom apace is required) Certificate Holder is named as Additional Insured as per attached endorsement forms. 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 eO1A Sc119t,-PL& ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD