DRVA2019-0023I' (I
F
owf ce
R
ve ue de:
DEC 112019
PUBLIC WORKS CONSTRUCTION CEIVOFLAQUINTA
DESIGN & DEVELOPMENT DEPARTMENT
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and other like public work
improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 12/11/2019
LOCATION OF CONSTRUCTION(Street address or Description): 54660 AVENIDA JUAREZ
PURPOSE OF CONSTRUCTION: INSTALLAION OF NEW DRIVEWAY APPROACH FOR NEW SF DWELLING CONSTRUCTION PROJECT.
DESCRIPTION OF CONSTRUCTION: PALOMA HOMES /_BRES2O18-0414 /_DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL: DRIVEWAY APPROCH
ROXIMATE TIME WHEN WORK WILL BEGIN: 12/11/2019 TIME OF COMPLETION: 12/18/2019
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 and regulations of the City of La
Quinta and to pay for any additional replacement necessary as the result of this work. -
HEY DUDE CONSTRUCTION INC P 0 BOX 1018 THOUSAND PALMS, CA 92276 (760)343-5272
Name of Applicant (please print) Business Address Telephone No.
HEY DUDE CONSTRUCTION INC P 0 BOX 1018 THOUSAND PALMS, CA 92276 (760)343-5272
Name of Contractor and Job Foreman Business Address Telephone No.
845115 LIC-0100746
Contractor's License No. City Business License No.
ta Qai K r
- CEM9fthDESERT - -
DRIVEWAY APPROACH
Applicant's Insurance Company
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $175.00
TECHNOLOGY ENHANCEMENT FEE $5.00
TOTAL: $180.00
Policy Number
PERMIT NO: DRVA2019-0023
DATE ISSUED:I/'/ hiT
EXPIRATION DATE:IIAó
BY-44
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.
- cc23
acev Qw~&(v
GEM if ibe DESEKT -
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information:
Applicant/Owner (p/ease pLt name here): R j Dtick C\rck r \r c_
Applicant Address: è 1'r Pcrr CA cfl2J1 CO-
Jumber Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
Xe -L
Number Street City State Zip Code
Date: Lii°( Applicjpone No: (1 coo )34"52TZ....
Applicant s Signature:
Approximate Start Date: (I-_/ /_a Approximate Completion Date: (7_/fl/j
Contractor Information:
Address: ?° Cf 21 CQ.
Number Street City State Zip Code
Phone Number: (1c) 343— S2 Q.. Contractors License Number: ,Lk5 \ 5
City Business License Number:
General Liability Insurance CompanY:(zr)+re-C-tbrS_fr çeC,PoIicy No.
(see back for required insurance documents)
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 _0Zpition Date
Permit Issued by:
Signaturministrative Authority
Work Inspected by:
Inspector's Signature
Comments:
Date Issued
Permit Completion Date:
Note: Driveway approach must be constructed per City of La Quinta Standard #221
REV: 8/19/2019
RE: Driveway! Encroachment Permits - Compliance with Insurance Requirements
Per Engineering Bulletin #97-04 please provide proof of the insurance items and endorsement
certificates below:
J General Liability - $1M per occurrence I $2M general aggregate
J General Liability - Additional Insured Endorsement (for ongoing and completed.
operations)
IJ General Liability - Primary! Non-contributory Endorsement
0 Automobile Liability - $1M combined single limit
0 Workers' Compensation - Statutory Limits I Employer's Liability $1M per accident or disease
0 Workers' Compensation -Waiver of Subrogation Endorsement