DRVA2020-0012ta Qa ll 9 r
See below for Finance Revenue Codes
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DRIVEWAY APPROACH
PUBLIC WORKS CONSTRUCTION
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: 9/10/2020
LOCATION OF CONSTRUCTION (Street address or Description): 54080 AVENIDA OBREGON
PURPOSE OF CONSTRUCTION:
DESCRIPTION OF CONSTRUCTION: SMITH /_DRIVEWAY APPROACH
DIMENSION OF INSTALLATION OR REMOVAL:
APPROXIMATE TIME WHEN WORK WILL BEGIN: TIME OF COMPLETION:
ESTIMATED CONSTRUCTION COST:S1.500.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS: EXTENDING EXISTING DRIVWAY
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 occurringas 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 4)
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.
Signature of Applicant or Agent
SIPOVAC CONSTRUCTION INC 72651 THEODORA LANE PALM DESERT, CA 92260
Name of Applicant (please print) Business Address
SIPOVAC CONSTRUCTION INC 72651 THEODORA LANE PALM DESERT, CA 92260
Name of Contractor and Job Foreman Business Address
581636
(760)567-2347
Telephone No.
(760)567-2347
Telephone No.
Contractor's License No. City Business License No.
DESERT INSURANCE SOLUTION NN85227
Applicant's Insurance Company Policy Number
Finance Revenue Code
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL $175.00
TECHNOLOGY ENHANCEMENT FEE
TOTAL: $0.00
PERMIT NO: DRVA2020-0012
DATE ISSUED: 5/18/2020
EXPIRATION DATE: 12/5/2020
BY: EDWARD HERNANDEZ
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.