DRVA2019-0024ta Qai4trev
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DRIVEWAY APPROACH
PUBLIC WORKS CONSTRUCTION
eIojn Re n ode
DEC 112019
CI1YOF LAQUINTA
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): 54680 AVENIDA JUAREZ
PURPOSE OF CONSTRUCTION: INSTALLAION OF NEW DRIVEWAY APPROACH FOR NEW SF DWELLING CONSTRUCTION PROJECT.
DESCRIPTION OF CONSTRUCTION: PALOMA HOMES /_BRES2O18-0412 / DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL: DRIVEWAY APPROCH
APPROXIMATE 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.
Applicant or Agent
HEY DUDE CONSTRUCTION INC P 0 BOX 1018 THOUSAND PALMS, CA 92276
Name of Applicant (please print) Business Address
HEY DUDE CONSTRUCTION INC P 0 BOX 1018 THOUSAND PALMS, CA 92276
Name of Contractor and Job Foreman Business Address
845115 LIC-0100746
Contractor's License No. City Business License No.
(760)343-5272
Telephone No.
(760)343-5272
Telephone No.
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: DRVA2019-0024
DATE ISSUED:bjll/71f,
EXPIRATION DATE:
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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DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information: - -
Applicant/Owner (please pjij name here):
Applicant Address: PO Z b b , C q22-T Ca
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above:
5LcQ L CP\ LL5[
Number Street City State Zip Code
Date: iija Applicant9e No: (7Go)
Applicant's Signature: /43'i'
Approximate Start Date: 7_/10 /jL Approximate Completion Date: (7_Ifl_/jj_
Contractor Information:
Address: P oqsnle IMb TLj'X)C Pc Qn CG CR1\CQ
Number Street City State Zip Code
Phone Number: (1c) L Contractors License Number: U 'S
City Business License Number: 0O144C
Co General Liability Insurance Company: C .c rr erS lvL)ror%c.L Policy No. P-D P6 cd-s52
(see back for required insurance documents)
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 No.ZiJA2O1 Date
Permit Issued by: xz.. ~_ -' Date Issued
Signat!'WInistrative Authority
Work Inspected by: Permit Completion Date:
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #ZZ1
REV: 8/19/2019
C
RE: Driveway! Encroachment Permits - Compliance with Insurance Requirements
Per Engineering Bulletin #97-04 please provide proof of the insurance items and endorsement
certificates below:
General Liability - $1M per occurrence I $2M general aggregate
General Liability - Additional Insured Endorsement (for ongoing and completed
operations)
General Liability - Primary! Non-contributory Endorsement
IJ Automobile Liability - $1M combined single limit
1 Workers' Compensation - Statutory Limits / Employer's Liability $1M per accident or disease
Workers' Compensation - Waiver of Subrogation Endorsement
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