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DRVA2020-0002
tev Qu I ~A& - GEM .fsheDES ERT - - DRIVEWAY APPROACH PUBLIC WORKS CONSTRUCTION / See below for Finance Revenue Code For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains and oth er likeuc work improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.ul I I DATE: 1/27/2020 II LOCATION OF CONSTRUCTION (Street address or Description): 52015 AVENIDA JUAREZ PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH FOR NEW CONSTRUCTION BRES2019-0015 06 FO ___ DESCRIPTION OF CONSTRUCTION: SEGAL / DRIVEWAY APPROACH / BRES2019-0015 CM DIMENSION OF INSTALLATION OR REMOVAL: APPROXIMATE TIME WHEN WORK WILL BEGIN: 1/27/2020 TIME OF COMPLETION: 2/15/2020 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 r ltions oici lf La Quinta and to pay for any additional replacement necessary as the result of this work. // 4 /7 of ADilicait or ROBERT SEGAL 79-865 INDEPENDENCE WAY LA QUINTA, CA 92253 (760)774-2194 Name of Applicant (please print) Business Address Telephone No. ROBERT SEGAL - OWNER BUILDER 79-865 INDEPENDENCE WAY LA QUINTA, CA 92253 (760)774-2194 Name of Contractor and Job Foreman Business Address Telephone No. 710171 Contractor's License No. City Business License No. Applicant's Insurance Company Finance Revenue Code PERMIT INSPECTION DRIVEWAY RESIDENTIAL $175.00 TECHNOLOGY ENHANCEMENT FEE $5.00 TOTAL: $0.00 Policy Number PERMIT NO: DRVA2020-0002 DATE ISSUED: I EXyN DATE: 42f1/2-02.0 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. tev ozi4tra - GEM of dye DESEKI - DRIVEWAY APPROACH PERMIT APPLICATION Applicant Information: Applicant/Owner (please pjt name here): D(3~0 -r Applicant Address: 32 \( VZ522_L C 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: M Applicant's Signature: Af Approximate Start Date: 2_/\ /252pproximate Completion Date: Z/!r_I2._c2_3 Contractor Information: Address: C -70 Number Street . City State Zip Code Phone Number: (260) 77((-294 Contractors License Number: 7 ( 0 City Business License Number: General Liability Insurance Company: Oje- buubev. Policy No. (see back for required insurance documents) Request for Inspection - Please call (760) 7777 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 NoØJAln2D—oLEiration Date 1.j2cI2OZO Permit Issued by: Date Issued SpQ'1f Administrative Authority -41 /21~ 2.0 2D Work Inspected by: Permit Completion Date: /1 Inspector's Signature Comments: Note: Driveway approach must be constructed per City of La Quinta Standard #ZZ1 REV: 8/19/2019 RE: Driveway I 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 / $2M general aggregate IJ General Liability - Additional Insured Endorsement (for ongoing and completed operations) 11 General Liability - Primary I Non-contributory Endorsement Automobile Liability - $1M combined single limit J Workers' Compensation - Statutory Limits / Employer's Liability $1M per accident or disease Workers' Compensation - Waiver of Subrogation Endorsement ...-. ..s. .. c-. tev 0"fra --GEM DESEKT - PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner-Builders Applying for Driveway Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a driveway permit for work within the public right-of-way has been submitted in your name listing yourself as the builder of the driveway improvements specified at 52.-otc P' i11 QeL.. LL- -' ' 3 We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a driveway permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATiON OF INFORMATION DIR)ECTIONS: Read and initial each statement below to signify you understand or verify this inrmation, 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting Y2. Owner-Builder and am aware of the limits of my insurance coverage for injuries to rs on my property. I understand driveway permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to 93. me this responsibility. - I understand as an "Owner-Builder" I am the responsible party of record on the per it. I understand that I may protect myself from potential financial risk by hiring a lic nsed Contractor and having the permit flied in his or her name instead of my own. 4 I understand Contractors are required by law to be licensed and bonded in California an to list their license numbers on permits and contracts. - 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. - 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to 7financial risk. 7.understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent that result from any latent construction defects in the workmanship or materials. 8. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Deportment of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State f Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information censed contractors. am aware of and consent to an Owner-Builder driveway permit applied for in my name, and understand that I am the party legally and financially responsible for proposed constjuction activity at the following address: / S 2— O N jPcj (LQL G-;;) .? L.J 10. I agree that, as the party legally and financially responsible for this proposed 9e nuction activity, I will abide by all applicable laws and requirements that govern tier-Builders as we[.[ as employers. D21 ii. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be .in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a driveway permit can be issued, the property owner and returned to the Note: A copy of property owner's driver's 9 acceptable to the agency is required to the property owner's signature. this form must be completed and signed by agency responsible for issuing the permit. er3e, form notariçation, or other verification pfented i.yienfne permit is issued to verify Signature of property owner: Date: t-21-cilO 78-495 Calle Tampico La Quinta, CA 92253 760.777.7000 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work): (@Qcfc.(ç Project Location or Address: 52_-Oc (\\. c5T'c'J C2LZ 1A.) 0k L1-,2 Name of Authorized Agent: Tel No. Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address Listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: /_2 ?— 02 78-495 Calle Tampico La Quinto, CA 92253 760.777.7000 RIGHT-OF-WAY Q ioo a- ---% a.— a.- SECTION B -B I A WEAKENED PLANE JOINTS LOT LINE - I @5FT.lNTERvAJ . i RIGHT-OF-WAY 2'Mflt FROM - - ' '. • Lu LOT LINE CO U(I ale .>, /•. a.. ___________ -'I . .' , a , • j , .:i •' - 4''I '' • L. ' I ,.' • i • 6' SIDEWALK rt rL I f . •4 • i ._. a . • - "L..,U .1. ' . MAYBE REDUCED TO 30 FT. MIN. WITH APPROVAL OF A '— CITY ENGINEER RESIDENTIAL 12' MIN. - 30' MAX. COMMERCIAL: UP 108% COMMERCIAL 35' MIN. -40' MAX.* RESIDENTIAL: UP 109% PLAN VIEW STREET GRADE STREET GRADE PREFERRED PREFERRED 4' T SECTION A A DETAIL NOTES: ALL CONCRETE SHALL USE TYPE V CEMENT AND PER CITY STANDARD 200. 20 FEET OF FULL-HEIGHT CURB REQUIRED - BETWEEN DRIVEWAYS WITHIN ANY ONE " PROPERTY FRONTAGE. 00000 USE 6 MIL PLASTIC SHEETING WHEN ABUTTING SOIL HAS A HIGH SULFATE CONTENT. CONSTRUCT THE PROFILE GRADE OF THE PRIVATE ON.SITE DRIVEWAY SO THAT IT PROVIDES SMOOTH VEHICLE ACCESS OVER THE DRIVE APPROACH. CHANGE IN GRADES SHALL NOT EXCEED 8%, UNLESS THE LENGTH IS LESS THAN 2 FEET THEN GRADE SHALL NOT EXCEED 15%. ** COMMERCIAL : UP TO 8% RESIDENTIAL: UP TO 9% ISOMETRIC VIEW NOT TO SCALE REVISIONS — DEPARTMENT OF PUBUC WORKS STANDARD — ENGINEERING DIVISION PLAN No. °t 4h1*pr e No. DATE DRIVEWAY 221 JAN-Il APPROVED BY: R.S DTE WITH SIDEWALK SHEET — — 00L sb/u ADJACENT TO CURB R.C.E. No. d56 V Ei. 12/31/f2 I A WEAKENED PLANE JOINTS LOT LINE © 5 FT. IN ,.r — RIGHT-OF-WAY 2 MIN, FROM ' 5 LOT LINE SIDEWALK J 4' APRON WHEN uI STREET GRADE EXCEEDS 4% <I > 'I 3' RESIDENTIAL 12' MIN. - 30 MAX MIN. COMMERCIAL 35 MIN. - 40 'MAX. PLAN VIEW 5' SIDEWALK RIGHT-OF-WAY ioo 6 THICK CONCRETE SECTION A - A DETAIL NOTES: q_ 3' MIN. * MAYBE REDUCED TO 30 FT. MIN. WITH APPROVAL OF CITY ENGINEER ** COMMERCIAL UP TO 8% RESIDENTIAL UP TO 9°/D 1 ALL CONCRETE SHALL USE TYPE V CEMENT AND PER CITY STANDARD 200. 20 FEET OF FULL-HEIGHT CURB REQUIRED BETWEEN DRIVEWAYS WITHIN ANY ONE PROPERTY FRONTAGE. 10 USE 6 MIL PLASTIC SHEETING WHEN ABUTTING SOIL HAS A HIGH SULFATE CONTENT. 4, CONSTRUCT THE PROFILE GRADE OF THE PRIVATE ON-SITE DRIVEWAY SO THAT IT PROVIDES SMOOTH VEHICLE ACCESS OVER THE DRIVE APPROACH 5. CHANGE IN GRADES SHALL NOT EXCEED 8%, UNLESS THE LENGTH IS LESS THAN 2 FEET THEN GRADE SHALL NOT EXCEED 15%. 040 el~ .00 ISOMETRIC VIEW NOT TO SCALE COMMERCIAL UP TO 8% RESIDENTIAL UP TO 15% REVISIONS DEPARTMENT OF PUBLIC WORKS" &r 4 #4 A STANDARD — T ENGINEERING DIVISION i1tt# Of. PLAN No. A JAN-1 I APPROVED BY: DRIVEWAY 221 F:dl //WITH SIDEWALK :IHEIET lic W04ks ,rec /Cly Enqreer ROE. No 4543 Exp 12/31/12 ISOMETRIC VIEW NOT TO SCALE Taf 4 4L DRIVEWAY WITH i SIDEWALK ADJACENT - TO WEDGE CURB STANDARD PLAN No. 221 SHEET 3 OF 3 LOT LINE 2 MIN. FROM LOT LINE A WEAKENED PLANE JOINTS A[r INTERVALS RIGHT-OF-WAY 4 5' TRANSITION 6' VERTICAL CURB L 4 SIDEWALK 5'TRANSITION 4 17 I 6" VERTICAL ITL CURB A WEDGE CURB SEE STD. 211 .- RESIDENTIAL 12 MIN. - 30 MAX. SIDEWALK — RIGHT-OF-WAY --1 0100 2% TRIES MAX. I - [THICK I CONCRETE SECTION A - A DETAIL NOTES: ALL CONCRETE SHALL USE TYPE V WEDGE CURB CEMENT AND PER CITY STANDARD 200. SEE STD. 211 20 FEET OF FULL-HEIGHT CURB REQUIRED BETWEEN DRIVEWAYS WITHIN ANY ONE PROPERTY FRONTAGE. USE 6 MIL PLASTIC SHEETING WHEN ABUTTING SOIL HAS A HIGH SULFATE CONTENT. CONSTRUCT THE PROFILE GRADE OF THE PRIVATE ON-SITE DRIVEWAY SO THAT IT PROVIDES SMOOTH VEHICLE ACCESS OVER THE DRIVE APPROACH. WEDGE CURB DRIVEWAYS SHALL BE USED ONLY WHEN POSTED SPEED IS IS 25 MPH OR LESS. WEDGE CURB DRIVEWAYS SHALL BE APPROVED BY THE CITY ENGINEER. CHANGE IN GRADES SHALL NOT EXCEED 8%, UNLESS THE LENGTH IS LESS THAN 2 FEET THEN GRADE SHALL NOT EXCEED 15%. REVISIONS DEPARTMENT OF PUBLIC WORKS ENGINEERING DIVISION APPROVED BY: J AN - Public Works c /CiryErgirieef RCE No 45843 Exp 12/31/12