SD2015-0002.4 See below,for
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Finance Revenue Codes
ENCROACHMENT PERMIT S
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: 4/1/2015
LOCATION OF CONSTRUCTION(Street address or Description):AVENIDA CARRANZA
PURPOSE OF CONSTRUCTION: DRAINAGE IMPROVEMENTS: HEADWALL ON EXISTING PIPES. CONCRETE CHANNEL. AND RIP RAP
DESCRIPTION OF CONSTRUCTION: CIP 2014-09 AVENIDA CARRANZA DRAINAGE
DIMENSION OF INSTALLATION OR REMOVAL:APPROX. 850 SF
ROXIMATE TIME WHEN WORK WILL BEGIN:4/1/2015 TIME OF COMPLETION: 4/15/2015
ESTIMATED CONSTRUCTION COST:$40.000.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS:'SEEPROJECTCONTRAC1iAND SPECIFICATIONS FOR CIP 2014-09 FOR PERMIT CONDITIONS
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
cubmit 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 and
to pay for any additional replacement necessary as the result of this work.
(
Signature of Applicant or Agent
DATELAND CONSTRUCTION-DENNIS C 83-801 AVE 43 INDlO, CA 92201 (760)342-2999
Name of Applicant (please print) Business Address Telephone No.
DATELAND CONSTRUCTION 83-801 AVE 43 lNDlO, CA 92201
Name of Contractor and Job Foreman Business Address
396698 31
Contractor's License No. - City Business License No.
COLONY INSURANCE COMPANY 103GL0008102-00
Applicant's Insurance Company Policy Number
(760)342-2999
Telephone No.
Finance Revenue Code
TOTAL $0.00
PERMIT NO: SD2015-0002
DATE ISSUED:
EXPIRATION DpE:1f/'
BY:/4f7.
W0A INSPECTED BY*:
PERMIT COMPLETION DATE*:
1f the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
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•
Purpose of Construction (i.e.: Rough Grading, Offsite Street, etc.)
-
Dimension of Installation or Removal:________________________________________
Approximate Construction Start Date:
Approximate Construction Completion Date
Estimated Construction Cost $r4OO 003 MM
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back-filling, compaction and
placing permanent resurfacing and or replacing improvements •
•
• • •
•
Contact Nam: I EPMMMIPhone Number:P4Z
Name of Applicant/Owner
Applicant Address 31 ALe 435Ir l!ZP1 f±•v .
Applicant Telephone Number 342Z999r2 ' P
Applicant E-mail Address
•
Name of Contractor ?uateIafluls flSjUCtiOflj
Contractor Address: -äbf'43I
Contractor Telephone Number
•••4•J• Contractor State License Number:
Contractor City Business License Number !
-•••_•-•s•-•• p, Contractor E-mail Address •••
A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED '
,plicant or Contractor General Liability Insurance Company:
che' r
p1icant or Contractor General Liability Insurance Policy Number:
Office Use Only:
•
Inspection Fee:
Permit Fee: •
• • • As-Built
• Deposit _•
Dust Control • •
• • Deposit:
Credit
Amount:
TOTAL FEE DUE: •
- i-orms PppilcaUOfl
Office Use Only:
Assigned Permit Number
Approval Date: •
Expiration •
Date: • •
Issue
•
•
• Date:
• :-
Administrative Authority: • •
• • •• ..
ion for l-'ermit postea -b-U : :...